Gynaecological Procedures
Hysterectomy
Hysterectomy is an operation performed to remove the womb. This may be
accompanied by the removal of the tubes and ovaries depending on the
the reason the operation is being performed. The reasons it may be
required include cancer (and pre-cancer), fibroids (benign tumours of
the muscle of the womb), endometriosis and heavy periods. There are
now a number of alternatives to hysterectomy for many of these
conditions.
If a hysterectomy is needed, recent advances
have resulted in the operation being much less invasive. Laparoscopic
hysterectomy and/or vaginal hysterectomy can often result in discharge
from hospital the next day, and return to normal activity in 2-3
weeks. Most hysterectomies (even for cancer) can be performed with
this approach.
A useful resource for information regarding
hysterectomy can be found
here
Alternatives to Hysterectomy
There are a number of alternatives to hysterectomy,
particularly for heavy periods (the commonest reason the operation is
performed) and fibroids. A pretty comprehensive list can be found
here, or on the hysterectomy association website
here (or see links).
In general, the threshold for performing a
hysterectomy for benign (non-cancer) conditions should be driven by
you. It is worth going through the lists of alternative treatments
with your doctor or gynaecologist so that you understand what is
available to you, and why a particular treatment is (or isn't)
suitable.
Colposcopy
Colposcopy is simply a better look at the cervix, designed
to look for the type of abnormalities which might be picked up by a
smear. Smears aim to identify abnormalities of the cervix many years
before cancer develops, so that they can be treated. Therefore the
first thing to say about receiving an abnormal smear result is - don't
worry!
The colposcopy examination itself is very similar to a smear test.
Dye is used to highlight abnormalities on the cervix, which may be
biopsied or removed. The whole procedure should be painless, is
performed by a specially trained nurse or doctor, and lasts between 5
and 20 minutes depending on whether a simple biopsy (sample) is taken
or an area of abnormality removed (a “loop” performed with local
anaesthetic). Again depending on what is done, you may bleed slightly
for 1-2 days or up to 2 weeks. A letter should then follow in 3-4
weeks outlining the results and any follow-up needed.
The most common outcome from a colposcopy visit is to be reassured
that your cervix is normal, or to have any abnormality removed with a
very low chance of needing any further treatment.
For more information regarding abnormal smears
and colposcopy, the
British Society
for Colposcopy is an excellent resource.
For answers to common questions, particularly in
relation to colposcopy in Leeds, please click
here. A patient
information leaflet giving advice following treatment of cervical
abnormality in Leeds is also available
here.
Please click below for
the excellent NHS cervical screening programme leaflets regarding:
Contraception
There are now a myriad of contraceptive choices currently available.
By far the safest long-acting contraceptive available is the Implanon®
implant, as it does not contain oestrogen (like the combined pill) or
require a general anaesthetic. It has the lowest failure rate of all
known female contraceptives (even lower than sterilisation).
The most comprehensive information leaflets
available outlining the different contraceptive choices is available
here. Individual leaflets are
available to read on the on the family planning association website (http://www.fpa.org.uk),
with links posted below:
Ovarian
Reserve Tests
These have been recently developed to look at a woman's "ovarian
reserve". As a woman is born with all the eggs she will ever have,
these decline during a natural reproductive lifespan. Once all the
eggs have been released the menopause will ensue. Just prior to that
time, it can become increasingly difficult to fall pregnant. It has
previously been impossible to predict when this will happen, however,
there is now a "test" (actually a set of 3 blood tests) available
which can help predict a woman's "ovarian age". The tests combine FSH
(follicle-stimulating hormone), AMH (anti-mullerian hormone) and
Inhibin B. Additional ultrasound tests may also be helpful by counting
the number of antral follicles on the ovaries, although these are
generally reserved for those planning or undergoing IVF treatment.
A brochure on the ovarian reserve test can be
downloaded from here, and
more information can be obtained from the
PlanAhead website
