What is it?
Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus, often on the pelvic lining, bladder, ovaries and fallopian tubes. In severe cases it can be found on the bowel, and sometimes as high as the diaphragm. This tissue responds to hormonal changes and can cause inflammation, pain, and scarring.

What are the symptoms?
Common symptoms include:

• Painful (and sometimes heavy) periods 

• Chronic pelvic pain

• Pain during or after sex

• Pain during urination

• Digestive issues like bloating, constipation, or nausea

• Mood symptoms (anxiety, depression)

• Difficulty conceiving

How is it diagnosed?
Diagnosis involves a combination of symptom review, imaging (such as ultrasound), and sometimes laparoscopic surgery for confirmation.

How do I treat it?
There is no known cure as such, but symptoms can be managed through:

• Hormonal treatments such as the pill, or an IUD

• Pain relief medications – e.g. paracetamol, ibuprofen

• Laparoscopic surgery to remove endometrial lesions

• Lifestyle support including physiotherapy, dietary changes, psychological support

• Treatment of associated symptoms e.g. constipation (with aperients)

Can endometriosis affect fertility?
Yes, sometimes it can. Endometriosis may interfere with ovulation, or cause scarring and inflammation. However, many women with endometriosis do conceive—with or without fertility support. If you are having troubles, we recommend seeking review. 

Resources:

1. Pelvic Pain Foundation:     https://www.pelvicpain.org.au

2. Dr Susan Evans E:Book:

What is cervical screening?
A cervical screening test (CST) is a test on the cervix, which helps detect the presence of a common virus called Human Pappiloma Virus (HPV), and also detects abnormal cells on the cervix, ideally before they become cancerous. In Australia, a CST is recommended from the age of 25yo, until an exit screen between 70-74yo. Generally it is recommended every 5 years if results are normal, or annually if HPV is detected. 

Do I have to see a doctor for a CST?

Yes, you do have to see a doctor. Recently however, in women without symptoms, an option of a self-collected CST is available. This involves a self-collected vaginal swab to detect the presence of HPV. If no HPV is found, then you are cleared for 5 years. If HPV is found however, you still need to see a doctor for a full CST. 

What is a colposcopy and why might I need one?
A colposcopy is a procedure where your doctor uses a magnifying device to closely examine your cervix after an abnormal screening result (such as high grade changes to the cells, or a high-risk HPV). A vinegar solution is applied to highlight abnormal cells, and a biopsy may be taken for further analysis. The biopsy helps determine if any treatment is required. 

Is a colposcopy painful?
Most people feel mild discomfort during a colposcopy, but everyone is different. We recommend taking some simple analgesia prior to your appointment. You may experience light cramping or bleeding for up to 72 hours afterwards. 

What happens after a colposcopy?
Results guide whether treatment is needed. Treatment, if required, is most commonly a small day procedure called a LLETZ. Your gynaecologist will discuss this with you if required. 

What is chronic pelvic pain?
Pelvic pain lasting more than 6 months can stem from reproductive, urinary, gastrointestinal, or musculoskeletal causes. Sometimes no clear cause is found.

What are common symptoms?
Pain may be constant or cyclical, and can occur during menstruation, sex, urination, or bowel movements.

How is it diagnosed?
Diagnosis includes a pelvic exam, imaging (ultrasound, MRI), and sometimes laparoscopy. You may be referred to specialists like gastroenterologists or urologists.

What treatments are available?
Options include:

• Pain medications (NSAIDs)

• Physical therapy

• Nutritional therapy (e.g., magnesium, vitamin B1)

• Surgery (e.g., nerve ablation)

• Psychological support and biofeedback 

Polycystic Ovarian Syndrome (PCOS)  is a hormonal disorder affecting ovulation, often causing irregular periods, acne, excess hair growth, and fertility issues.

What causes PCOS?
It’s linked to insulin resistance and elevated androgens. Genetics and lifestyle factors also play a role.

What are the risks associated with PCOS?
PCOS increases the risk of:

• Type 2 diabetes

• Gestational diabetes

• Cardiovascular disease (e.g. high cholesterol)

• Endometrial hyperplasia and cancer

• Infertility

How is it diagnosed?

Diagnosis is via a combination of symptom review, blood tests and ultrasound features. 

How is it treated?
Treatment is multifactorial, and may vary over time. Examples include:

• Hormonal treatment to regulate periods and reduce androgen levels (e.g. the pill, IUD)

• Metformin to improve insulin sensitivity.

• Weight loss to restore ovulation.

• Ovulation induction medications to improve conception rates (e.g. letrozole, clomiphene)

What are fibroids?
Fibroids are (typically)  non-cancerous growths in the uterus. They vary in size and location and may cause symptoms or be asymptomatic.

What symptoms can they cause?

• Heavy or prolonged periods

• Pelvic pain or pressure

• Frequent urination

• Constipation

• Infertility or miscarriage

How are they diagnosed?
Fibroids are typically diagnosed on ultrasound or MRI, in the investigation of pain or heavy bleeding. Sometimes they are found incidentally.  When large, they can be appreciated on pelvic examination also. 

What are treatment options?

Treatment is not always required. They are very rarely cancerous, and if not causing symptoms, can often be left alone. When treatment is required, options include:

• Medications (e.g., pill, IUD)

• Minimally invasive surgery (e.g., hysteroscopy or laparoscopic removal)

• Definitive surgery e.g. Hysterectomy

• Uterine artery embolization (to shrink fibroids) 

• In selected cases, hormone blocking (e.g. Zoladex). 

Your gynaecologist will review your fibroids, and discuss with you the recommended treatment. 

What is Heavy Menstrual Bleeding  (HMB)?

The medical term for this is menorrhagia. There is no strict definition of this, however typically it is bleeding that is heavy enough to interfere with a woman’s daily functioning. Often times a woman will pass large clots or soak through sanitary items.

What symptoms are associated with HMB?

HMB is often associated with pain. It can also cause anaemia due to low iron, and in severe cases, associated symptoms such as shortness of breath, dizziness and fatigue.

What investigations are required?

Some investigations are required to exclude treatable causes. You will typically require blood tests and an ultrasound. 

How is it treated?

Treatment options depend on risk factors, age, and desire for ongoing fertility. Options include:

• Non-hormonal medications e.g. Tranexamic Acid

• Hormonal medications e.g. the pill, IUD

• Minimally invasive surgery e.g. Endometrial ablation

• Definitive surgery e.g. Hysterectomy

• Symptomatic treatment e.g. iron supplements or infusion