The endometrium is the name of the tissue that lines your uterus (womb). Endometriosis is a condition where tissue, like the endometrium, grows in other parts of the body. Usually these growths occur inside the pelvic cavity in places such as the ovaries, bowel, or a lining of the pelvic cavity and abdomen called the peritoneum. Each month, as the endometrial lining of the uterus builds up with blood that will be lost during your period, these other growths of endometrial tissue get bigger and can bleed and cause inflammation and adhesions (internal scarring). Some women with this condition do not have many symptoms, whereas others suffer severe pain and problems such as infertility and tiredness. The diagnosis can only be made by a laparoscopy, and if it is confirmed then treatment options include medication that will help to control the pain and inflammation, hormonal treatment to suppress the endometriosis or some women may need laparoscopic surgery to remove the tissue growths.

Fibroids are noncancerous growths or tumours on the muscular part of the uterus (womb); sometimes they are also called myomas. Fibroids may be very small (about 5mm) or can grow to be quite large (about 100mm). Many women with fibroids do not notice any symptoms and will not need treatment, whereas others may experience problems such as painful and heavy periods, or even swelling of their abdomen and pressure on their bladder or bowel. Treatment includes medication to shrink the fibroids or surgical removal. If the fibroid is growing inside the cavity of the uterus this can be removed with a fine instrument (Versapoint bipolar diathermy) passed through a small telescope that goes through the cervix into the uterus (hysteroscopy). Once this has been done then other treatments for heavy periods such as Balloon Endometrial Ablation or the Mirena Intrauterine System are more effective. Larger fibroids in women who have completed their family may require a hysterectomy.

An ovarian cyst is a fluid-filled sac or pouch in the ovary. In most cases, the cyst grows as a result of ovulation (when the egg is released from the ovary), and it will usually shrink over time. Sometimes, the ovarian cyst may cause pain. The best way to check for an ovarian cyst is by ultrasound examination, and the treatment will depend on how troublesome the symptoms are. Sometimes it is best to leave the cyst alone and just check it regularly with ultrasound. In other cases it may need to be removed by laparoscopic surgery.

Polycystic ovarian syndrome (PCOS) is a hormonal disorder that can cause you to have a variety of symptoms, including no periods or irregular periods, increased hair growth on the face and body, acne (pimples) and increased bodyweight. PCOS is also one of the main causes of infertility in women. The ovaries of women with PCOS often contain many small cysts (fluid-filled sacs), but this does not seem to be the cause of the condition. For women who have not reached menopause, the most common treatment is the birth control pill, which will regulate your periods. There are also other medicines that can help control the symptoms.

Menstruation is the medical name for your monthly period. This is when blood and tissue from the lining of the uterus (womb) is shed through the vagina and out of the body. Menstruation starts at puberty and it is stimulated by hormones that make a girl’s body able to become pregnant. This usually happens anytime between the ages of 9 and 16 years. Menstruation will recur about every 28 days (the menstrual cycle), unless interrupted by pregnancy, and will stop at menopause, which occurs at about 50 years of age. There are a number of problems that can occur with menstruation ranging from mild to severe. More than half of all women will have cramps (dysmenorrhoea) during the first day or two of their period. Other problems include very heavy or long periods (menorrhagia) or no periods (amenorrhoea). If you consult Dr. Rachel Moss regarding very heavy periods and are over the age of 40, then she may recommend pipelle endometrial sampling and a pelvic ultrasound scan to exclude any serious causes and the presence of fibroids before deciding on the best treatment options.

The endometrium is the lining of your uterus (womb). Endometrial ablation is the surgical removal or destruction of this lining. There are different methods of destroying the endometrium including electricity, balloon therapy, laser therapy, microwave or freezing. Dr. Rachel Moss does ablation using balloon therapy which is the safest of the procedures available. The operation is usually done under anaesthetic, although it is possible to be awake. It is done through the vagina, so there is no need for the abdomen to be cut open. The endometrium will heal leaving scarring, which usually reduces or stops menstrual periods. In women who have very heavy periods (menorrhagia), an endometrial ablation can be done instead of a hysterectomy as it is an easier procedure than a hysterectomy and recovery is quicker. Endometrial ablation is only performed in women who no longer wish to have children and who have permanent contraception.

Many women experience feelings of tension, anger, fatigue and depression just before and during the first days of their menstrual period. This is called premenstrual syndrome (PMS) and is probably caused by the change in hormone levels. In most women with PMS, symptoms will not be severe enough to require treatment, but some will need to discuss their symptoms with a doctor. Sometimes symptoms can be improved by avoiding some types of food, such as coffee and foods high in salt.

Cervical dysplasia is the growth of abnormal cells around the cervix (entrance to the uterus). Although this condition is not cancer there is a small risk that these cells could become cancerous. It is picked up by cervical smears and if picked up a colposcopy is done to decide if treatment is required. Sometimes no treatment is needed as the condition is mild and may improve by itself. For more severe dysplasia, treatment involves removing the abnormal cells with an electrical loop called Loop Excision. Whether you have treatment or not, you should have more frequent Pap smears in the future.

A Pap smear, which was to look for signs of precancer on your cervix (entrance to the uterus) has been replaced by an HPV test, as HPV is the cause of precancer on the cervix, in women who are having regular screening. Women who are being followed up for previously abnormalities or who have abnormal bleeding will have a smear (cytology) in addition to an HPV test. If an HPV test only is required then a self swab can be done with your GP. If a smear/cytology is required then a nurse or doctor will put an instrument called a speculum into the vagina to open it, and then gently wipe or brush a few cells from the cervix to send to the laboratory for testing. If the HPV test is positive, the smear/cytology test will be required to seen if cervical cells are going through any changes that happen before cancer grows. It will also show if cancer cells are present. Regular cervical screening make it possible to prevent cancer before it grows, or to pick up the cancer early so that it is more easily cured. A National Cervical Screening Programme aims to provide all New Zealand women with regular cervical screening and now recommends that an HPV test be done every 5 years between the ages of 25 and 70 year, starting from the time your smear was due according to the cervical screening program that was in place until September 2023. If an HPV test is positive you will be advised to have either a cytology sample taken if you have not had one, or a colposcopy examination depending on the type of HPV present and your age.

A colposcopy is a detailed examination of the cervix (entrance to the uterus) with a specially lit microscope (colposcope). As with a smear, an instrument called a speculum is inserted into the vagina, and then the colposcope is positioned outside the vagina with its light directed on the cervix. A specialist will perform a colposcopy if your HPV test is abnormal or a smear has shown abnormal or cancerous cells on the cervix or if you report abnormal bleeding such as bleeding after sex or bleeding between periods. During the colposcopy small samples of tissue (biopsies) may be removed and examined in the laboratory so the doctor can get a clearer idea of the extent of the abnormal cells.

The most common vaginal infections are yeast infections (also called candidiasis or thrush), trichomoniasis, or bacterial infections (also called bacterial vaginosis). Symptoms of an infection may include irritation, itching, discharge and odour. To make a diagnosis a doctor will usually do a vaginal swab, which involves wiping a type of cotton bud gently across the infected area. The swab is then sent to the laboratory for analysis. There are many medicines that can successfully treat these infections.

Menopause is also called the “change of life” and is the time when your periods will become irregular and stop. This is a natural process in all women and for most it will occur between the ages of 45 and 55 years. Menopause is brought on by decreasing levels of the hormone oestrogen and this can cause a variety of symptoms, including hot flushes, night sweats, mood swings, sleeping problems, memory problems, depression and vaginal dryness. Some women do not notice any symptoms or they are very mild, whereas others experience more severe problems and should go to their doctor for advice. There are many treatments available to reduce the symptoms associated with menopause and, in some cases, lifestyle changes can also help.

Hormone replacement therapy (HRT) is when female hormones (oestrogen by itself or with progesterone) are given to a woman during or after menopause when the production of oestrogen by the ovaries declines. The hormones can be taken as tablets, implants, skin patches or gels. There are now some natural forms of HRT approved for use. HRT became less popular after a large study in the USA in 2001 found that long-term use of HRT can increase the risk of some serious diseases in older women, such as breast cancer and blood clots. However, further analysis of this study since then has shown that, for some women, use of HRT around the time of menopause for up to 5 years can provide relief from symptoms caused by having less oestrogen in their bodies, such as hot flushes and loss of bone density, with far fewer risks than in the older age group. The usual oestrogen component of the modern HRT is plant-derived oestradiol. There is now a natural plant based progesterone available as a capsule that has been approved for use. The risks and benefits of HRT should be thoroughly discussed with a doctor before treatment begins.

A person with urinary incontinence is unable to control the release of urine from their bladder. This may be an occasional leakage or a complete inability to hold on to their urine. Women experience incontinence more often than men, and this may result from muscle damage during pregnancy and childbirth or the changes associated with menopause. The most common type of urinary incontinence in women is stress incontinence. This is when urine leaks out when movements, such as coughing, laughing or sneezing put pressure on the bladder. The treatment of urinary incontinence will depend on the cause of the problem, but may include exercises, medication or surgery.

Sling procedures are common surgical operations to stop stress incontinence. This is a condition where urine leaks out when movements, such as coughing, laughing or sneezing put pressure on the bladder. Stress incontinence occurs when the muscles supporting the urethra (tube that carries the urine out of the body) become weak and the urethra no longer works well as a valve to keep the urine in the bladder. Sometimes this results from the effects of childbirth. Sling procedures provide support to the weakened muscles by placing a stitch or strip of mesh under the urethra so that it won’t accidentally release urine when there is pressure on the bladder. Tension-Free Vaginal Tape (TVT) Procedure In tension-free vaginal tape (TVT) surgery, a mesh-like tape is placed under the urethra to give it support. The TVT procedure is done through small cuts in the vagina and in your pubic area or upper thighs. It can be performed under local anaesthetic (this means that you don’t have to go to sleep during the operation) or you can be asleep if you wish.

If the uterus (womb) or bladder slips out of position, this is referred to as a prolapse. It is caused when the supporting muscles become weak, allowing a part of the uterus or bladder to bulge into the vagina. The most common reason that these muscles become weak is childbirth, and a uterine prolapse or bladder prolapse (also called cystocoele) is more common in women who have had a lot of babies. Symptoms include pain, heaviness in the vaginal area and a frequent need to pass urine. In mild cases, exercises may help improve the symptoms, but women with more severe prolapses may need to have surgery. Women who do not wish surgery or wish to postpone surgery but still wish to be comfortable can have a ring pessary fitted in the vagina which are easily removed for cleaning and usually, once fitted, are not aware they are there other than that the prolapse feeling has gone.

A hysterectomy is an operation to remove your uterus (womb). Some types of hysterectomies include the removal of other organs as well, and this will depend on the reason for the operation. A hysterectomy is a treatment for many different diseases and conditions and it can be done through the vagina or through a cut in the abdomen, or sometimes through the vagina combined with laparoscopy. Modern methods use electrosurgical (safe burning) techniques that reduce the pain as well as the blood loss associated with the procedure and hence shorten hospital stay and speed recovery.

An oophorectomy is an operation to remove one or both ovaries. It is done for many reasons including ovarian cancer, ovarian cysts or to remove the source of the hormone oestrogen that is produced by the ovaries and can stimulate some cancers. If both ovaries are removed, your periods will stop and you will not be able to have children. Sometimes an oophorectomy is done together with a hysterectomy.

This is an operation where the cervix (entrance to the uterus) is dilated and a hysteroscope (small lighted mini telescope) is inserted into the uterus through the vagina and cervix so the specialist can see the inside of the uterus. It is done to find the cause of abnormal bleeding such as bleeding between periods or bleeding after the menopause. If no cancer is present, a small spoon-like instrument with a long handle, called a curette, is inserted and the lining of the uterus is scraped off and sent to the laboratory for examination. This procedure can be done under a general anaesthetic (you are asleep) in Kensington Hospital next door or without anaesthetic after taking painkillers. We know have all the equipment to allow to be able to do outpatient hysteroscopy if your situation is suitable.

Many gynaecological investigations are performed by laparoscopy. This is a procedure to view the inside of the abdomen (stomach) through a specially lit type of mini telescope (laparoscope) that is inserted through a small cut in the abdomen. The laparoscope also contains a small camera that sends pictures to a screen that the doctor can watch. Sometimes surgical procedures (keyhole surgery) can be performed at the same time. A laparoscopy is performed under a general anaesthetic (you are asleep).