Hysteroscopy is performed if your gynaecologist needs to look inside your womb to investigate symptoms including: heavy periods, unusual vaginal bleeding, pelvic pain, repeated miscarriages, difficulty conceiving and postmenopausal bleeding.
A narrow telescope with a light and camera at the end, called a hysteroscope, is used. It’s passed through your vagina and cervix into your womb negating the need for any incisions. The procedure is performed on an outpatient or day case basis.
A hysteroscopy can diagnose fibroids, polyps, endometrial cancer or an abnormally-shaped womb.
Treatment can also be provided once diagnosis has been made and includes the removal of fibroids, polyps, displaced intrauterine devices (IUDs) and scar tissue that causes absent periods and reduced fertility.
Gynaecological laparoscopy, also known as keyhole or minimally invasive surgery, allows your gynaecologist to see and access the inside of your abdomen and pelvis. It can be used to diagnose or treat women’s health conditions.
The procedure is usually performed under general anaesthetic and involves making small incisions to your skin and inserting a laparoscope. This is a narrow tube with a camera and light at one end that sends images to a television monitor for your gynaecologist to see.
Laparoscopy is used to: diagnose and treat endometriosis, treat fibroids and ectopic pregnancies, remove ovarian cysts, scar tissue, womb or ovaries, perform female sterilisation and, investigate and treat cancer.
It has some advantages over open surgery such as a faster recovery and shorter hospital stay and, less pain, bleeding and scarring after the operation.
Anterior vaginal wall repair
Anterior vaginal wall repair is used to restore a sinking vaginal wall, also known as a vaginal wall prolapse.
Symptoms of a sinking vaginal wall include: bladder problems (unable to fully empty, full feeling all of the time, leaking urine when you cough, sneeze or are active), bladder infections, pressure in your vagina, bulging at the opening of your vagina and painful sex.
During an anterior vaginal wall repair your gynaecologist will move your vagina back into its correct position, tightening your bladder support tissues and remove any bulge in your vagina. It’s carried out under general or spinal anaesthetic and normally takes about half an hour.
Endometriosis is a common, chronic and debilitating condition. It can affect all women and girls of child bearing age. It happens when endometrial tissue that’s normally found inside your womb develops outside the womb often on organs in the abdomen and pelvis.
Symptoms of endometriosis include: painful or heavy periods, bleeding between periods, fatigue, pain in the lower abdomen, pelvis or lower back, pain during and after sex and, an inability to conceive.
If endometriosis is suspected your gynaecologist will perform a diagnostic laparoscopy to enable them to see any endometriosis tissue. A biopsy can be taken and sent for laboratory testing. Laparoscopy can treat the endometriosis and this can be performed in the same procedure once diagnosis has been made. Surgical instruments will be inserted and used to remove the endometriosis.
A hysterectomy surgically removes your womb. This means that following the operation you won’t be able to get pregnant. Your gynaecologist will only recommend a hysterectomy if other treatment options are unsuccessful.
A hysterectomy is used to treat: heavy periods, chronic pelvic pain, fibroids, prolapse of the uterus or cancer of the womb, ovaries or cervix.
There are a number of types of hysterectomy. The decision is made based on your condition and how much of your womb and reproductive system can be left in place.
The main hysterectomies are: total hysterectomy (most frequently performed – involves the removal of your womb and cervix), subtotal hysterectomy (the removal of the main part of your womb leaving the cervix in place) and radical hysterectomy (the removal of your womb and surrounding tissues including: fallopian tubes, part of your vagina, ovaries and lymph glands).
A hysterectomy can be performed in three ways:
- laparoscopic hysterectomy – keyhole surgery to remove the womb, often the preferred choice.
- vaginal hysterectomy – a cut in the top of the vagina is made to remove the womb.
- abdominal hysterectomy – a cut in the lower abdomen is made to remove the womb.
Your consultant gynaecologist will advise you on the best type of hysterectomy based on your individual needs.
Ovarian cyst removal
Ovarian cysts are fluid-filled sacs on a woman’s ovary. They’re very common and often disappear on their own after a few months. Large or persistent cysts, symptom causing cysts and cancerous cysts or potentially cancerous cysts can be surgically removed.
Most ovarian cysts are removed using laparoscopic surgery. If a cyst is particularly large, or it could be cancerous your gynaecologist will recommend a laparotomy for better access to the cyst. A laparotomy involves making a single larger cut in your stomach and removing the whole cyst and often the ovary too to send to the laboratory to examine for cancer.
Removal of ovaries
The surgical removal of ovaries is called an oophorectomy. It’s performed if you’ve damaged ovaries or to treat conditions such as ovarian cancer or endometriosis.
One or both ovaries can be removed. If you have one ovary removed, you may continue to menstruate and have children. If you have both ovaries removed menstruation stops and you’ll no longer be able to have children.
Ovary removal is a simple procedure, performed under general anaesthetic either laparoscopically or using open surgery. Ovaries are often removed as part of a hysterectomy.
Laparoscopic sterilisation is a female contraception. During the procedure your fallopian tubes are blocked or sealed to stop the eggs from reaching the sperm and being fertilised. After the procedure eggs are still released from the ovaries but are absorbed naturally into the woman's body.
Sterilisation is often carried out by laparoscopy and the fallopian tubes are blocked using clips, rings or tying and cutting the tubes.
Sterilisation can also be performed using a hysteroscope, called hysteroscopic sterilisation. A tiny piece of titanium metal is inserted into your fallopian tubes which form scar tissue and block the tube over time.
As a woman moves into the menopause she stops having periods as her menstrual cycle stops and her ovaries permanently stop releasing eggs. This results in a drop in her blood level of the oestrogen hormone and often causes a variety of symptoms including: hot flushes, night sweats, mood swings, vaginal dryness and a reduced sex drive.
Hormone replacement therapy (HRT) can relieve these symptoms. It replenishes the oestrogen hormones and the symptoms are reduced.
Treatment for miscarriage
A miscarriage is defined as the unexpected loss of a pregnancy in the first 23 weeks. Most miscarriages are thought to be caused by the baby having abnormal chromosomes which mean they won't develop properly. Most women go on to have a healthy pregnancy following a miscarriage.
Pregnancy tissue may be left in the womb after a miscarriage. It will pass naturally after a period of time, medication can be provided to cause the tissue to pass or, the tissue can be surgically removed.
We understand the distress of a miscarriage, as the loss of the baby is grieved, and we will care for our patients compassionately and discuss the best options based on individual preference and wellbeing.
Stress incontinence treatment
If you leak urine due to an increase in pressure on your bladder it’s termed as stress incontinence. Leakage may happen when you cough, laugh, sneeze, lift or exercise. It’s the most common type of incontinence and is due to weakened pelvic floor muscles that support your bladder.
After childbirth women may find they’ve stress incontinence. It’s also linked to ageing and obesity and may occur in men who’ve had prostate cancer treatments.
Initially pelvic floor exercises will be recommended to strengthen your pelvic floor. Medicines can encourage your muscles around the urethra to contract more strongly.
Surgery will be recommended if these aren’t successful. There are various surgical options:
- tension-free vaginal tape (TVT) procedure (tape supports the urethra and bladder neck -women only)
- sling procedure (a sling supports your bladder neck and urethra)
- colposuspension (surgery lifts the tissues between your bladder and urethra - women only)
- artificial urinary sphincter (replacement of the urinary sphincter).