If you start experiencing problems with your reproductive system, it?s vital that you visit your doctor right away. Not only are there possible implications for your health, but your chances of having children could be affected, too
Obstetrics and gynaecology covers the health of women?s reproductive organs and the care of women during pregnancy and childbirth. This very broad spectrum includes routine screening for diseases such as gynaecological cancers; non-surgical treatment for common complaints such as period problems and fibroids; and complex surgical procedures such as hysterectomies.
Monthly period problems
A normal menstrual cycle is usually 21-35 days long, with bleeding for around five days and 25-80ml of blood loss. Period problems fall into three areas: absent periods (amenorrhea ? classed as primary, when periods don?t start by the age of 16; and secondary, when periods stop for three months or more); painful periods (dysmenorrhoea, when the pain limits activities or needs medication); and heavy periods (menorrhagia, when more than 80ml of blood is lost or periods last longer than a week).
What causes it?
Primary amenorrhea can be caused by developmental problems or failure of the ovary to receive or maintain eggs. Secondary amenorrhea can be due to hormonal disturbances, premature menopause, intra-uterine scarring formation, excessive exercise, anorexia, severe stress, thyroid dysfunction or as a side effect of certain drugs. Dysmenorrhoea is common and is caused by contractions of the uterus as it squeezes the uterine lining (blood) out through the vagina. Menorrhagia has no underlying cause in 40-60% of cases, but can sometimes be a side effect of cervical polyps, fibroids, pelvic inflammatory disease or hormonal imbalance.
Treatment
For amenorrhea, treatment may be deemed unnecessary, unless the patient is trying to conceive. For menorrhagia, treatment may involve drug or hormone therapy to reduce menstrual blood flow.
Fibroids
These are non-cancerous growths in the uterus. It?s thought that 30-40% of women in the UK will have fibroids during their lifetime. They are most common in women in their 30s and 40s, particularly in overweight and Afro-Caribbean women. Fibroids are made up of muscle and fibrous tissue range from the size of a pea to a melon, although they often go undetected.
What causes them?
Fibroids swell when oestrogen levels are high ? for example, during pregnancy ? and shrink when oestrogen levels are low, such as after the menopause. However, the exact cause of fibroids is unknown. Many sufferers have no symptoms, but they can cause heavy periods and lead to anaemia. If fibroids grow large, they can press against the bladder, leading to an increased need to urinate.
Treatment
Most fibroids do not require treatment and will simply be monitored by ultrasound. If necessary, they can be surgically removed. Small ones can be removed by keyhole surgery or through the vagina. Larger fibroids require open surgery and, in severe cases, hysterectomy. There are also new surgical techniques that can help. Uterine artery embolisation involves injecting a chemical into the artery feeding the fibroid to block blood flow, reducing the size of the fibroid by up to 60%. Magnetic resonance imaging (MRI) technology can also be used to locate and treat fibroids.
Endometriosis
This affects two million women in the UK and occurs when the lining of the uterus grows into other parts of the body. Blood can?t be expelled during a period, causing pain, inflammation and scar tissue, which can lead to infertility. It commonly occurs on the ovaries, fallopian tubes and outer womb. Symptoms include painful, heavy or irregular periods, pain during
or after sex, bowel problems and fatigue.
What causes it?
The exact cause of this condition is not fully known, although theories relate it to genetic disposition, environmental toxins and cell mutations.
Treatment
As there?s no cure, the aim is to reduce the severity of symptoms and improve quality of life. Medication can relieve pain, slow cell growth and preserve fertility.
Pcos
Around one in 10 women have polycystic ovary syndrome (PCOS). It is characterised by tiny cysts on the ovaries; the ovaries producing higher levels of male hormones (leading to excessive body hair, thinning of scalp hair and acne); and not ovulating each month (causing irregular or absent periods and fertility issues).
What causes it?
The causes are unclear but it?s widely believed that increased insulin production is a main contributing factor. This condition is also associated with obesity.
Treatment
As the cause is not understood, the focus is on managing symptoms and preventing complications such as high blood pressure and diabetes. Losing weight helps to lower insulin levels and improve fertility, while medication or topical treatments can help to control acne and excessive hair growth.
Pelvic inflammatory disease
This is a bacterial infection of the womb, fallopian tubes and/or ovaries. Symptoms include pain in the pelvis and lower abdomen, discharge, fever and heavy, painful periods ? but often there are no symptoms at all.
What causes it?
PID is caused by an infection that travels up from the vagina ? most commonly chlamydia and gonorrhoea.
Treatment
If diagnosed early, a two-week course of combined antibiotics usually clears the infection. Sexual partners should also be treated in order to stop reinfection.
Pre-eclampsia
This condition usually occurs during the second half of pregnancy (from around 20 weeks) or immediately following birth. Women develop high blood pressure, fluid retention and protein in the urine. Symptoms include sudden swelling of the face, hands, feet and ankles, rapid weight gain, blurred vision or seeing flashing lights, abdominal pain and severe headaches.
What causes it?
Current theories suggest that insufficient blood flow to the uterus, causing the placenta to not develop properly, and hormonal imbalance are to blame. It is more common in first-time pregnancies; in those with high blood pressure, diabetes or polycystic ovary syndrome; and in women either under the age of 18 or over 40.
Treatment
In mild cases, women are advised to take bed rest and have regular check-ups. If the condition worsens and the mother and/or baby is at risk, the baby must be delivered.
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Gynaecological cancers
We take a look at three types of female cancer: cervical, endometrial and ovarian. Increased?awareness of their symptoms can mean an earlier diagnosis and treatment
The disease
Cervical cancer is one of the most common cancers that affect a woman?s reproductive organs. Strains of the human papillomavirus (HPV), a sexually transmitted infection, play a role in causing most cases. HPV is a commonly occuring virus and because most women with HPV never develop cervical cancer, other risk factors, such as your genetics, environment and lifestyle choices, also determine whether or not you will develop the disease.
Endometrial cancer (cancer of the uterus) is often found during its earliest, most treatable stage because it frequently causes vaginal bleeding between menstrual periods or after the menopause. It is caused when cancerous cells start to develop in the lining of a woman?s uterus (the endometrium). There are three types of ovarian tumours, named according to where they form in the ovary. Epithelial tumours develop in the thin layer of tissue covering the ovaries. Germ cell tumours occur in the egg-producing cells. And stromal tumours develop within the oestrogen- and progesterone-producing tissue that holds the ovary together.
Treatment
Early cervical cancers can be treated with surgery. If the tumour is microscopic, it may be removed with a biopsy. Larger tumours of up to 4cm and confined to the cervix will usually be treated with a radical hysterectomy ? an operation to remove the uterus and the tissue to the side of it (parametrium). Larger tumours are treated with a mixture of chemotherapy and radiotherapy.
Figuring out female health
The facts and stats of conditions and diseases affecting today?s women the world over
- Around 2,800 new cases of cervical cancer are diagnosed in the UK each year ? that?s 55 new women a week facing the condition.
- Only one in three women with fibroids will show symptoms. Often the benign growths are only found by chance during a routine check-up.
- 15 out of every 100 premenopausal women suffers from endometriosis, with the condition typically affecting women aged between 25 and 49.
- One in 60 sexually active women under 45 visit their GP with pelvic inflammatory disease each year. One in five will become infertile.
Picture credit: Shutterstock
The above feature was
published in
Dr Hilary Jones'
Healthcare Guide
Sept 2012.
Click here for more
Dr Hilary Jones.
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Source: http://www.athomemagazine.co.uk/hilary-jones/6188-obstetrics-and-gynaecology-problems-below-the-belt
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