HOW TO REFER A PATIENT
ENQUIRY

Gynaecology

Specialist Care for Women’s Reproductive Health

Gynaecology is the branch of medicine that focuses on the health of the female reproductive system, including the uterus, ovaries, fallopian tubes, cervix, vagina, and external genitalia. It encompasses a wide range of conditions and concerns related to women’s health, particularly those related to the reproductive and sexual systems. Gynaecology is often intertwined with obstetrics, which deals with pregnancy, childbirth, and the postpartum period, and the two specialties together are often referred to as OB-GYN. Gynaecology in the UK plays a crucial role in women’s health, offering a wide range of services from routine check-ups to specialized treatments for complex conditions.

Who can be referred

  • Women who are age 18 and above
  • Registered with a General Practitioner in UK

Common gynaecology conditions we treat

Gynaecology covers a broad spectrum of health issues, including, but not limited to:

Menstrual disorders refer to a range of conditions that affect a woman’s menstrual cycle, causing irregularities or discomfort. These disorders can involve changes in the frequency, duration, or severity of menstruation, as well as painful or abnormal bleeding. Menstrual disorders are common and can impact a woman’s quality of life, fertility, and overall well-being.

 

Types of Menstrual Disorders:

Amenorrhea:

  • Primary Amenorrhea: The absence of menstruation by age 16, in the absence of any other underlying health issues.
  • Secondary Amenorrhea: The cessation of menstruation for three or more months in a woman who previously had regular periods, often due to pregnancy, stress, or other underlying medical conditions.

Dysmenorrhea:

This refers to painful menstruation. It can be classified into:

  • Primary Dysmenorrhea: Painful periods without underlying pelvic pathology, often due to the release of prostaglandins (hormones that cause uterine contractions).
  • Secondary Dysmenorrhea: Pain caused by an underlying condition, such as endometriosis, fibroids, or adenomyosis.

Menorrhagia:

This is excessive or prolonged menstrual bleeding, defined as periods that last longer than 7 days or require frequent changes of sanitary products (more than one pad or tampon per hour).

Metrorrhagia:

Irregular bleeding between periods, which can occur for various reasons, such as hormonal imbalances or fibroids.

Oligomenorrhea:

Infrequent menstruation: Periods occurring more than 35 days apart but less than 6 months apart.

Polymenorrhea:

Frequent periods, or menstrual cycles that occur at intervals of less than 21 days.

Premenstrual Syndrome (PMS):

A set of physical and emotional symptoms that occur in the second half of the menstrual cycle, typically before menstruation. Symptoms may include irritability, bloating, fatigue, and mood swings.

Premenstrual Dysphoric Disorder (PMDD):

A more severe form of PMS, with symptoms like severe depression, irritability, anxiety, and mood swings that disrupt daily life.

 

Causes of Menstrual Disorders:

Menstrual disorders can arise from a variety of factors, including hormonal imbalances, structural issues in the reproductive organs, lifestyle factors, and underlying medical conditions. Here are some common causes:

1. Hormonal Imbalances:

  • Estrogen and progesterone: Imbalances in these hormones can affect ovulation and menstrual cycles. For example, anovulation (when ovulation does not occur) can result in irregular periods or absence of menstruation.
  • Conditions like polycystic ovary syndrome (PCOS) are characterized by hormonal imbalances, leading to irregular periods, heavy bleeding, or the absence of periods.

2. Polycystic Ovary Syndrome (PCOS):

  • A common endocrine disorder that causes hormonal imbalances, leading to irregular periods, anovulation (lack of ovulation), and sometimes excessive hair growth (hirsutism) and acne.
  • Women with PCOS may also experience infertility due to ovulatory dysfunction.

3. Thyroid Disorders:

  • An underactive thyroid (hypothyroidism) or overactive thyroid (hyperthyroidism) can disrupt the menstrual cycle, leading to irregular periods or absent periods.

4. Stress:

  • Physical or emotional stress can affect the hypothalamus (part of the brain that regulates hormones) and disrupt the normal release of hormones, which may result in delayed or missed periods.

5. Excessive Exercise or Low Body Weight:

  • Excessive exercise, especially in women with very low body fat, can disrupt hormonal balance and cause amenorrhea or irregular periods.
  • Low body weight or eating disorders (e.g., anorexia nervosa) can cause a disruption in menstrual cycles due to insufficient body fat to support regular hormonal cycles.

6. Obesity:

  • Obesity can lead to insulin resistance, which may increase androgen (male hormone) levels and disrupt the normal hormonal balance, causing irregular periods or PCOS.

7. Endometriosis:

  • A condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterus. It can cause painful periods, heavy bleeding, and infertility.

8. Fibroids:

  • Uterine fibroids (non-cancerous growths in the uterus) can cause heavy or prolonged menstrual bleeding, pain, and sometimes irregular periods.

9. Adenomyosis:

  • This condition occurs when the endometrial tissue (lining of the uterus) grows into the muscle wall of the uterus. It can cause painful periods, heavy bleeding, and an enlarged uterus.

10. Pelvic Inflammatory Disease (PID):

  • PID is an infection of the female reproductive organs, often caused by sexually transmitted infections (STIs). It can lead to irregular bleeding, painful periods, and in some cases, infertility.

11. Medications:

  • Certain medications, such as antipsychotics, anticoagulants, and birth control (e.g., hormonal contraceptives), can cause changes in menstrual cycles, including irregular bleeding or absent periods.

12. Perimenopause and Menopause:

  • As women approach menopause (usually between the ages of 45 and 55), hormonal changes can lead to irregular periods or changes in bleeding patterns. This transition period is called perimenopause.

13. Structural Issues:

  • Structural issues such as uterine polyps, fibroids, or cervical abnormalities (like a blocked cervix or a narrow cervical canal) can interfere with normal menstrual flow, causing heavy bleeding, pain, or irregular periods.

14. Genetic Factors:

  • Some menstrual disorders, such as primary amenorrhea or early onset of menopause, may have a genetic component.

15. Cancer:

  • Uterine cancer or cervical cancer can cause abnormal bleeding, including irregular periods or postmenopausal bleeding.

Diagnosis of Menstrual Disorders:

To diagnose menstrual disorders, healthcare providers may:

  • Take a detailed medical history, including menstrual patterns, lifestyle factors, and family history.
  • Perform a physical exam to check for signs of underlying conditions.
  • Order blood tests to check hormone levels (e.g., thyroid hormones, prolactin, FSH, LH).
  • Perform an ultrasound or MRI to look for structural abnormalities like fibroids or ovarian cysts.
  • In some cases, a laparoscopy or hysteroscopy may be performed to directly observe the reproductive organs.

Pelvic Organ Prolapse (POP) is a condition where one or more of the pelvic organs, such as the bladder, uterus, rectum, or small intestine, droops or slips down from its normal position into the vagina due to weakened or damaged pelvic floor muscles and tissues. This can lead to discomfort, urinary problems, difficulty with bowel movements, and a feeling of heaviness or bulging in the pelvic region.

Types of Pelvic Organ Prolapse:

Pelvic organ prolapse can affect different organs, leading to various symptoms and conditions:

1. Cystocele (Bladder Prolapse):

  • This occurs when the bladder drops into the front wall of the vagina, causing urinary symptoms such as frequent urination, incontinence, or difficulty emptying the bladder fully.

2. Rectocele (Rectal Prolapse):

  • This occurs when the rectum bulges into the back wall of the vagina, leading to symptoms like difficulty passing stools, feeling of incomplete bowel evacuation, or constipation.

3. Uterine Prolapse:

  • This occurs when the uterus drops into the vaginal canal. It may result in a feeling of heaviness or pressure in the pelvis, as well as urinary and bowel symptoms. In more severe cases, the uterus may protrude from the vaginal opening.

4. Enterocele (Small Bowel Prolapse):

  • This is when the small intestine drops into the upper part of the vagina, causing pelvic discomfort, a feeling of fullness, and difficulty with bowel movements.

Causes of Pelvic Organ Prolapse:

Pelvic organ prolapse is typically caused by the weakening or stretching of the pelvic floor muscles and supportive tissues that hold the pelvic organs in place. Several factors can contribute to this weakening, including:

1. Pregnancy and Childbirth:

  • Vaginal delivery, especially multiple or difficult births, is one of the most common causes of pelvic organ prolapse. The stress and strain during childbirth can stretch and weaken the pelvic floor muscles, ligaments, and connective tissues.
  • Multiple pregnancies or large babies can increase the risk of developing prolapse, as the pelvic floor experiences repeated stretching and pressure.

2. Age:

  • As women age, especially after menopause, the pelvic floor muscles and tissues lose their elasticity and strength due to decreasing levels of estrogen, a hormone that helps maintain pelvic tissue integrity.
  • The natural process of aging causes a decrease in muscle tone and support, leading to an increased risk of prolapse.

3. Hormonal Changes:

  • After menopause, there is a decline in estrogen, which helps maintain the strength and tone of pelvic tissues. This can make the pelvic floor more prone to weakness and prolapse.

4. Chronic Increased Pressure on the Pelvic Floor:

  • Chronic constipation or straining during bowel movements can put excessive pressure on the pelvic floor muscles, contributing to prolapse.
  • Obesity also places extra weight on the pelvic floor muscles, which can lead to their weakening and increased risk of prolapse.

5. Heavy Lifting:

  • Repeatedly lifting heavy objects can strain the pelvic floor muscles and cause damage, leading to prolapse over time.

6. Genetic Predisposition:

  • Some women may be genetically predisposed to weaker connective tissues, which can make them more prone to pelvic organ prolapse. Family history of prolapse may increase risk.

7. Chronic Coughing:

  • Long-term coughing, such as from smoking or respiratory conditions like chronic obstructive pulmonary disease (COPD), can increase pressure on the pelvic floor and contribute to prolapse.

8. Connective Tissue Disorders:

  • Conditions such as Ehlers-Danlos syndrome (a genetic disorder affecting connective tissue) can increase the risk of prolapse because they make tissues more elastic and less supportive.

9. Previous Pelvic Surgery:

  • Past surgeries involving the pelvic region, such as hysterectomy (removal of the uterus), can affect the pelvic floor muscles and ligaments, potentially leading to prolapse.

10. Pelvic Inflammatory Disease (PID):

  • Chronic or severe pelvic infections, like PID, can cause scarring and weakening of the pelvic tissues, increasing the risk of prolapse.

11. Multiple or Prolonged Labors:

  • Prolonged labor during childbirth can weaken the pelvic floor muscles, increasing the risk of prolapse. Similarly, women who have had multiple vaginal births are at a higher risk.

Symptoms of Pelvic Organ Prolapse:

The symptoms of pelvic organ prolapse can vary depending on the type and severity of the prolapse, but common symptoms include:

  • Pelvic heaviness or pressure: A sensation of fullness or a heavy feeling in the pelvic area, especially when standing or walking.
  • Bulging or protrusion: The feeling or appearance of something "coming out" of the vagina, which can be most noticeable during physical activity or after standing for long periods.
  • Urinary issues: These may include urinary incontinence, frequent urination, urgency, or the inability to completely empty the bladder.
  • Bowel problems: Constipation, difficulty passing stools, or the feeling of incomplete bowel evacuation.
  • Painful intercourse: Discomfort or pain during sexual activity due to prolapse.
  • Fatigue: The feeling of tiredness or discomfort, especially after standing for prolonged periods.

Diagnosis of Pelvic Organ Prolapse:

To diagnose pelvic organ prolapse, a healthcare provider will typically:

  • Take a detailed medical history, including childbirth history, symptoms, and lifestyle factors.
  • Physical examination: This may involve a pelvic exam to assess the degree of prolapse and identify which organ(s) are affected.
  • In some cases, further imaging tests such as an ultrasound or MRI may be used to evaluate the severity of the prolapse.

Urinary continence refers to the ability to control the release of urine from the bladder. It involves the coordinated function of the bladder, urethra, and surrounding muscles and nerves that regulate the storage and release of urine. In a person with urinary continence, there is no involuntary leakage or loss of urine.
Urinary incontinence, on the other hand, is the inability to control urination, leading to involuntary leakage of urine. It is a common condition that can vary in severity, ranging from occasional leaks to a complete loss of control over bladder function.

Types of Urinary Incontinence:
There are several different types of urinary incontinence, each with different causes and symptoms:

1. Stress Incontinence:

  • Description: This is the most common type, especially in women, and occurs when there is leakage of urine during activities that put pressure on the bladder, such as coughing, sneezing, laughing, lifting heavy objects, or exercising.
  • Cause: It usually results from weakened pelvic floor muscles or sphincter muscles, which support the bladder and control the release of urine.

2. Urge Incontinence (Overactive Bladder):

  • Description: This is characterized by a sudden, intense urge to urinate, followed by involuntary leakage before getting to the toilet. It is sometimes called overactive bladder (OAB).
  • Cause: It occurs due to involuntary contractions of the bladder muscle (detrusor muscle) or irritation of the bladder, which leads to a frequent need to urinate.

3. Overflow Incontinence:

  • Description: This occurs when the bladder does not empty completely, leading to overflow leakage. It often results in dribbling of urine because the bladder is too full.
  • Cause: This type can be caused by an obstruction in the urinary tract (e.g., an enlarged prostate in men) or nerve damage that affects the bladder’s ability to contract.

4. Functional Incontinence:

  • Description: This occurs when a person cannot reach the toilet in time due to physical or mental impairments, such as mobility issues, cognitive impairments, or severe arthritis.
  • Cause: The condition is not directly related to the urinary system but rather to physical or mental challenges that prevent the individual from reaching the bathroom in time.

5. Mixed Incontinence:

  • Description: This type of incontinence involves a combination of stress incontinence and urge incontinence.
  • Cause: It is typically seen in people who experience both pressure-related leaks and urgency-related leaks.

Causes of Urinary Incontinence:

Urinary incontinence can occur due to a variety of underlying causes, including physical conditions, medical issues, or lifestyle factors. These can include:

1. Weak Pelvic Floor Muscles:

  • Pregnancy and childbirth can weaken the pelvic floor muscles and lead to stress incontinence, particularly in women.
  • Age: As people age, the pelvic muscles may weaken, making urinary control more difficult.
  • Obesity: Excess weight can increase pressure on the bladder, weakening the pelvic muscles.

2. Neurological Disorders:

  • Nerve damage from conditions like diabetes, stroke, multiple sclerosis (MS), Parkinson's disease, or spinal cord injuries can interfere with the bladder’s ability to store and release urine properly.
  • Dementia and Alzheimer's disease can also lead to functional incontinence, where the person cannot remember to go to the bathroom or is physically unable to reach it in time.

3. Bladder Dysfunction:

  • Overactive bladder (OAB) occurs when the bladder muscle contracts uncontrollably, causing an urgent need to urinate and potential leakage.
  • Bladder infections (cystitis) or bladder stones can irritate the bladder and lead to incontinence.

4. Hormonal Changes:

  • Menopause: In women, the decrease in estrogen levels after menopause can cause the tissues of the urethra and vagina to weaken, leading to urinary incontinence, particularly stress incontinence.
  • Pregnancy and childbirth: Hormonal changes during pregnancy and the physical stress of childbirth can lead to weakened pelvic floor muscles and urinary incontinence.

5. Urinary Tract Infections (UTIs):

  • UTIs can cause irritation and inflammation of the bladder, leading to temporary urge incontinence, frequent urination, and discomfort.

6. Obstructions in the Urinary Tract:

  • In men, enlarged prostate or prostate cancer can block the normal flow of urine, causing overflow incontinence.
  • Bladder stones or tumors in the urinary tract can also cause urinary incontinence due to obstruction.

7. Medications:
Certain medications can contribute to urinary incontinence as a side effect. These may include:

  • Diuretics (used for high blood pressure)
  • Sedatives and muscle relaxants
  • Alpha blockers (used for prostate problems)
  • Antidepressants or antipsychotics

8. Caffeine, Alcohol, and Bladder Irritants:

  • Caffeine and alcohol are known bladder irritants that can worsen incontinence symptoms by increasing urine production and irritating the bladder.
  • Spicy foods, artificial sweeteners, and acidic foods may also irritate the bladder in some individuals.

9. Surgical Procedures:

  • Certain surgeries, particularly those involving the pelvic area such as hysterectomy or prostate surgery, can damage the muscles or nerves controlling the bladder, leading to incontinence.

10. Pelvic Organ Prolapse:

  • In women, a pelvic organ prolapse (e.g., bladder, uterus, or rectum dropping into the vagina) can lead to urinary incontinence due to a loss of support to the bladder or urethra.

Risk Factors for Urinary Incontinence:

  • Age: As people age, the bladder’s capacity decreases, and the muscles around the bladder weaken, increasing the risk of incontinence.
  • Gender: Women are at higher risk, especially due to pregnancy, childbirth, and menopause.
  • Obesity: Excess weight can increase pressure on the bladder, leading to incontinence.
  • Chronic conditions: Diabetes, high blood pressure, and neurological disorders can contribute to urinary incontinence.
  • Family history: There may be a genetic component, as incontinence tends to run in families.

Diagnosis of Urinary Incontinence:

A healthcare provider will typically diagnose urinary incontinence through:

  • Medical history and a detailed symptom review.
  • A physical exam, including a pelvic or rectal exam, to assess bladder function and pelvic floor strength.
  • Urinalysis to rule out urinary tract infections or other abnormalities.
  • Bladder diary to track urination patterns and symptoms.
  • Urodynamic testing to measure how well the bladder and urethra are storing and releasing urine.
  • Cystoscopy (in some cases) to look for bladder problems or obstructions.

Endometriosis is a chronic medical condition where tissue similar to the lining of the uterus (called the endometrium) grows outside the uterus, typically in areas like the ovaries, fallopian tubes, and the pelvic cavity. This tissue behaves like normal endometrial tissue: it thickens, breaks down, and sheds during the menstrual cycle. However, unlike the tissue inside the uterus, which exits the body during menstruation, the tissue outside the uterus has nowhere to go. This can cause inflammation, scarring, and adhesions (abnormal tissue bands that can cause organs to stick together).

Key Characteristics of Endometriosis:

  • Pain: The most common symptom of endometriosis is pelvic pain, which can range from mild to severe. The pain often intensifies during menstruation but can occur at any time during the cycle.
  • Infertility: Many women with endometriosis may experience difficulty getting pregnant, as it can affect the fallopian tubes, ovaries, and the normal function of the reproductive organs.
  • Heavy Menstrual Bleeding: Women with endometriosis may experience excessive menstrual bleeding (menorrhagia) or spotting between periods.
  • Painful Intercourse: Pain during or after sex (dyspareunia) is common in women with endometriosis.
  • Painful Bowel Movements or Urination: Endometriosis can affect the bladder or bowel, causing pain during bowel movements or urination, particularly during menstruation.
  • Fatigue: Many women with endometriosis report feeling tired or fatigued frequently, which can be exacerbated by the pain and inflammation associated with the condition.

Causes of Endometriosis:

The exact cause of endometriosis remains unclear, but several theories attempt to explain its development. The potential causes include:

1. Retrograde Menstruation:

  • One of the most widely accepted theories is that during menstruation, some of the menstrual blood, containing endometrial cells, flows backward through the fallopian tubes into the pelvic cavity instead of leaving the body. These cells can then implant and grow on the organs inside the pelvis, leading to endometriosis.

2. Embryonic Cell Transformation:

  • This theory suggests that certain embryonic cells, which are present during fetal development, have the potential to transform into endometrial-like cells. These cells can later form endometriosis tissue.

3. Genetic Factors:

  • Genetics may play a role in the development of endometriosis, as the condition is more common in women with a family history of the disease. Women whose mothers or sisters have endometriosis are more likely to develop the condition themselves. Specific genes or genetic predispositions may increase the likelihood of developing endometriosis.

4. Immune System Dysfunction:

  • A compromised or weakened immune system might fail to recognize and destroy endometrial-like tissue that grows outside the uterus. Normally, the immune system would eliminate these abnormal tissue growths, but when it fails, endometriosis can develop.

5. Hormonal Imbalance:

  • Estrogen is a key hormone involved in the development of endometriosis. High levels of estrogen may encourage the growth of endometrial tissue outside the uterus, causing the characteristic symptoms of the condition. This may explain why endometriosis is more common during the reproductive years and often improves after menopause when estrogen levels drop.

6. Lymphatic or Blood Spread:

  • Another possible cause is the spread of endometrial cells through the bloodstream or lymphatic system. This theory suggests that endometrial-like cells can be transported to other parts of the body via the blood or lymph, where they may implant and grow, although this is less commonly accepted.

7. Environmental Factors:

  • Some researchers suggest that environmental toxins and chemicals, such as those found in industrial pollutants or endocrine-disrupting chemicals (e.g., dioxins), may increase the risk of developing endometriosis by interfering with hormonal regulation. However, this theory requires further research.

8. Developmental Factors:

  • There is a possibility that endometriosis may arise during the development of the reproductive organs, possibly related to abnormalities during fetal development that lead to the abnormal positioning of endometrial-like tissue.

Risk Factors for Endometriosis:

Several factors can increase the risk of developing endometriosis, including:

  • Age: Endometriosis is most common in women in their 30s and 40s, but it can also affect younger women, especially those who have never been pregnant.
  • Family History: Women with a mother, sister, or daughter who has endometriosis are more likely to develop the condition themselves.
  • Never Giving Birth: Women who have never been pregnant are at a higher risk, possibly due to changes in hormone levels or the pelvic environment.
  • Short Menstrual Cycles: Women with shorter menstrual cycles (less than 27 days) or heavy menstrual bleeding may have a higher risk of developing endometriosis.
  • Higher Estrogen Levels: Conditions that lead to higher levels of estrogen, such as obesity, can increase the risk of endometriosis. Estrogen may stimulate the growth of endometrial-like tissue.
  • Medical Conditions: Certain conditions, such as uterine abnormalities or outflow obstruction of menstrual blood, can increase the risk of developing endometriosis.

Diagnosis of Endometriosis:

Diagnosing endometriosis can be challenging, as its symptoms can overlap with other conditions like pelvic inflammatory disease, irritable bowel syndrome, or ovarian cysts. Common diagnostic methods include:

  • Pelvic Exam: A doctor may feel for cysts or scars behind the uterus, though endometriosis cannot always be diagnosed through a physical exam.
  • Ultrasound:An ultrasound, often using sound waves to create an image of the internal organs, may detect endometriomas (endometriosis-related cysts) on the ovaries.
  • MRI: Magnetic resonance imaging can help identify endometriosis, particularly if there is deep pelvic involvement.
  • Laparoscopy: This is the gold standard for diagnosing endometriosis. A surgeon inserts a small camera (laparoscope) through a small incision in the abdomen to visually inspect the pelvic organs for endometrial-like tissue. If necessary, a biopsy can be taken for further analysis.

Fibroids and cysts are two common types of growths that can occur in the body, especially in the reproductive organs, and can sometimes cause discomfort or complications. Though they may sound similar, they are different in terms of their structure, causes, and symptoms. Here’s an overview of each:

Fibroids (Uterine Fibroids)

Fibroids are non-cancerous (benign) tumors that develop in the muscle tissue of the uterus. They are made up of smooth muscle cells and fibrous tissue and can vary in size, from small, pea-sized lumps to large masses that can distort the shape of the uterus. They are also known as leiomyomas or myomas.

Types of Fibroids:

  • Intramural Fibroids: These are the most common type and develop in the wall of the uterus.
  • Subserosal Fibroids: These grow just under the inner lining of the uterus and can protrude into the uterine cavity.
  • Submucosal Fibroids: These grow just under the inner lining of the uterus and can protrude into the uterine cavity.
  • Pedunculated Fibroids: These grow on a stalk (peduncle) inside or outside the uterus.

Causes of Fibroids:

The exact cause of uterine fibroids is not fully understood, but several factors may contribute to their development:

1. Hormonal Imbalance:

  • Estrogen and progesterone are the key hormones that regulate the menstrual cycle. Fibroids are believed to be influenced by these hormones, as they tend to grow during a woman's reproductive years (when hormone levels are high) and shrink after menopause (when hormone levels drop).

2. Genetics:

  • There may be a genetic component, as fibroids often run in families. Women with a family history of fibroids are at higher risk of developing them.

3. Age:

  • Fibroids are more common in women aged 30 to 40, though they can develop at any age. Their occurrence often decreases after menopause.

4. Obesity:

  • Overweight or obese women have higher levels of estrogen and are at greater risk of developing fibroids.

5. Ethnicity:

  • African-American women are more likely to develop fibroids at a younger age and may experience more severe symptoms compared to women of other ethnicities.

6. High Blood Pressure (Hypertension):

  • Some studies suggest that women with high blood pressure may be at a higher risk for developing fibroids

Symptoms of Fibroids:

Not all women with fibroids experience symptoms, but when they do, symptoms can include:

  • Heavy menstrual bleeding or prolonged periods.
  • Pelvic pain or pressure.
  • Frequent urination (if the fibroid presses on the bladder).
  • Constipation (if the fibroid presses on the rectum).
  • Painful intercourse.
  • Back pain.
  • Infertility or difficulty becoming pregnant (in severe cases).

Cysts

Cysts are closed sacs or pouches filled with fluid, air, or other substances that can form in various parts of the body. Ovarian cysts, which form on the ovaries, are the most common type, especially in women of reproductive age.

Types of Cysts:

1. Functional Cysts:

  • Follicular cysts: These develop when the follicle (a sac that holds an egg) doesn't release the egg during ovulation and continues to grow.
  • Corpus luteum cystsThese form after the egg is released from the follicle, but the sac doesn't dissolve as it should and fills with fluid.

2. Dermoid Cysts:

  • These are congenital cysts that can contain tissue like hair, skin, or teeth. They develop from cells present at birth.

3. Endometriomas:

  • These cysts form when endometrial tissue (tissue similar to the uterine lining) grows outside the uterus and attaches to the ovaries, forming a cyst.

4. Cystadenomas:

  • These cysts develop from the cells on the surface of the ovaries and can contain a watery or mucous fluid.

4. Polycystic Ovarian Syndrome (PCOS):

  • This is a condition where multiple small cysts form on the ovaries due to hormonal imbalances, particularly an excess of androgens (male hormones).

Causes of Cysts:

The causes of cysts depend on the type of cyst, but common factors include:

1. Hormonal Imbalance:

  • In conditions like PCOS, an imbalance in the hormones that regulate ovulation can lead to the formation of multiple cysts on the ovaries.

2. Ovarian Cycle Disruptions:

  • Functional cysts (follicular or corpus luteum cysts) occur when the normal process of ovulation is interrupted. For example, when a follicle doesn't release an egg or a cyst formed after ovulation doesn't dissolve as expected.

3. Endometriosis:

  • Endometrial tissue that grows outside the uterus can attach to the ovaries and form endometriomas, a type of cyst filled with old blood.

4. Pregnancy:

  • A cyst known as a corpus luteum cyst may form after ovulation, especially during early pregnancy.

5. Infection or Inflammation:

  • An infection in the reproductive organs can sometimes lead to the formation of cysts. For example, tubo-ovarian abscesses are cysts that develop due to infection in the fallopian tubes and ovaries.

6. Genetics:

  • Certain types of cysts, such as dermoid cysts, may be present from birth, due to developmental changes during fetal development.

7. Age:

  • As women age, cysts, particularly functional cysts, tend to decrease after menopause, but certain cysts like cystadenomas can develop later in life.

Symptoms of Cysts:

Many cysts, especially functional ovarian cysts, don’t cause any symptoms and may go unnoticed. When symptoms do occur, they can include:

  • Pelvic pain or discomfort, especially during menstruation or sexual activity.
  • Abdominal bloating or a feeling of fullness.
  • Irregular menstrual cycles or missed periods.
  • Painful urination or difficulty emptying the bladder (if the cysts press on the bladder).
  • Nausea or vomiting (if a cyst twists or ruptures).

In the case of PCOS, women may experience additional symptoms such as excessive hair growth, acne, and weight gain.

Diagnosis of Fibroids and Cysts:

  • Pelvic Exam: A doctor may feel for abnormal lumps or growths in the abdomen or pelvis.
  • Ultrasound: This imaging test uses sound waves to create an image of the ovaries, uterus, and any cysts or fibroids present. It is the most common method for diagnosing both fibroids and cysts.
  • MRI or CT Scan: These imaging tests may be used if more detailed images are required.
  • Laparoscopy:A surgical procedure used to visually inspect the organs and remove or biopsy the cysts or fibroids.
  • Blood Tests: To assess hormone levels or to rule out conditions like pregnancy or infections.

Hormonal disorders refer to conditions that arise when the endocrine system, which is responsible for producing and regulating hormones, malfunctions. Hormones are chemical messengers that help regulate various bodily functions, including metabolism, growth, mood, reproductive processes, and much more. When hormone levels become too high or too low, it can lead to a variety of health problems.

Causes of Hormonal Disorders

Hormonal disorders can be caused by several factors, including genetic conditions, environmental influences, lifestyle factors, and underlying diseases. Here are some of the common causes:

1. Glandular Dysfunction:

Endocrine glands (such as the thyroid, adrenal glands, pituitary gland, and ovaries/testes) may malfunction, leading to abnormal hormone production.

  • Hyperfunction: When a gland produces too much of a hormone.
  • Hypofunction: When a gland produces too little of a hormone.
  • Examples: Hypothyroidism (underactive thyroid), Hyperthyroidism (overactive thyroid), and Addison’s disease (underactive adrenal glands).

2. Autoimmune Conditions:

Autoimmune diseases occur when the immune system mistakenly attacks healthy cells in the body, including the cells that produce hormones. This can cause hormone imbalances.

  • Example: Hashimoto’s thyroiditis, an autoimmune disease that causes hypothyroidism, and Graves' disease, which causes hyperthyroidism.

3. Genetic Conditions:

Some genetic mutations can affect hormone production or regulation, leading to disorders.

  • Polycystic ovary syndrome (PCOS), a condition that often leads to hormonal imbalances affecting the ovaries, and Klinefelter syndrome, which can cause hormonal imbalances in males.

4. Tumors or Growths:

Tumors in the endocrine glands can cause them to produce excess hormones.

  • Example: Pituitary tumors can lead to the overproduction of growth hormone, leading to acromegaly or gigantism.
  • Adrenal tumors can lead to excessive production of cortisol, resulting in Cushing's syndrome.

5. Infections or Inflammation:

Certain infections or inflammation in endocrine glands can disrupt hormone production.

  • Example: Inflammation of the thyroid, known as thyroiditis, can cause hormone imbalances.

6. Medications:

Some medications can interfere with hormone levels, either by affecting hormone production or by altering the way hormones are used in the body.

  • Example: Corticosteroids can interfere with cortisol production, leading to Cushing's syndrome.
  • Birth control pills and hormone replacement therapies (HRT) can alter reproductive hormone levels, leading to temporary hormonal imbalances.

7. Lifestyle Factors:

Poor diet, chronic stress, and lack of sleep can affect hormone production and regulation.

  • Example: Stress can increase the levels of cortisol, the stress hormone, and chronic high levels of cortisol can lead to weight gain, high blood pressure, and a weakened immune system.

8. Obesity:

Excessive body fat, especially abdominal fat, can lead to hormonal imbalances by affecting the production of hormones like insulin, estrogen, and leptin.

  • Obesity is often associated with insulin resistance, which can lead to type 2 diabetes.
  • It can also affect estrogen levels, increasing the risk of hormone-related conditions like breast cancer.

9. Age:

Hormonal changes naturally occur with age, especially in women during menopause and men during andropause.

  • Menopause marks the end of a woman's menstrual cycle and a decline in the production of hormones like estrogen and progesterone, leading to symptoms like hot flashes and mood swings.
  • In men, testosterone levels gradually decline with age, leading to changes in libido, muscle mass, and mood.

10. Environmental Toxins:

Exposure to certain chemicals or toxins can disrupt the endocrine system. These chemicals are often referred to as endocrine disruptors.

  • Examples: Pesticides, plastics containing BPA (Bisphenol A), and certain industrial chemicals have been linked to hormonal disruptions.

Common Hormonal Disorders and Their Causes

1. Hypothyroidism (Underactive Thyroid):

  • The thyroid gland does not produce enough thyroid hormones (T3 and T4).
  • Causes: Autoimmune conditions (e.g., Hashimoto's thyroiditis), iodine deficiency, certain medications, and radiation therapy.

2. Hyperthyroidism (Overactive Thyroid):

  • The thyroid produces too much thyroid hormone, speeding up metabolism.
  • Causes: Autoimmune conditions (e.g., Graves' disease), thyroid nodules, or excessive iodine intake.

3. Polycystic Ovary Syndrome (PCOS):

  • A condition where women have hormonal imbalances, including high levels of testosterone , which can disrupt ovulation.
  • Causes: Genetics, insulin resistance, and inflammation.

4. Cushing’s Syndrome:

  • High levels of cortisol, often due to a tumor in the pituitary or adrenal glands.
  • Causes: Tumors, prolonged use of corticosteroid medications, or overproduction of cortisol by the adrenal glands.

5. Addison’s Disease:

  • Insufficient production of cortisol and sometimes aldosterone by the adrenal glands.
  • Causes: Autoimmune response, infections, or tumors affecting the adrenal glands.

6. Diabetes Mellitus:

  • Type 1 diabetes: The body cannot produce insulin due to autoimmune destruction of the pancreas.
  • Type 2 diabetes: The body becomes resistant to insulin, and the pancreas can't produce enough insulin to overcome the resistance.
  • Causes: Genetics, obesity, poor diet, lack of physical activity, and age.

7. Growth Hormone Deficiency (GHD):

  • Insufficient production of growth hormone by the pituitary gland, leading to stunted growth and other metabolic issues.
  • Causes: Pituitary tumors, genetic factors, or trauma to the pituitary gland.

8. Osteoporosis:

  • A condition where bones become weak and brittle due to low estrogen or testosterone levels.
  • Causes: Aging, menopause, or insufficient calcium and vitamin D intake. It can also be linked to low thyroid or adrenal hormone levels.

9. Infertility:

  • Hormonal imbalances can interfere with ovulation and sperm production.
  • Causes: PCOS, thyroid disorders, high levels of prolactin (a hormone produced by the pituitary), or low levels of estrogen or testosterone.

10. Amenorrhea (Absence of Menstrual Periods):

  • The absence of menstruation, which can be caused by hormonal imbalances.
  • Causes: Pregnancy, PCOS, stress, low body weight, and certain medications.

Symptoms of Hormonal Disorders

Hormonal disorders can manifest with a variety of symptoms, depending on which hormones are out of balance. Common symptoms include:

  • Fatigue or low energy
  • Unexplained weight gain or loss
  • Irregular menstrual cycles
  • Mood swings, anxiety, or depression
  • Hot flashes or night sweats
  • Hair loss or thinning hair
  • Acne or oily skin
  • Infertility or difficulty getting pregnant
  • Sleep disturbances or insomnia
  • Excessive thirst or urination
  • Changes in libido (low or high)

1. Vulvodynia:

  • Definition: Vulvodynia is a chronic pain condition affecting the vulva, often without any identifiable cause. It can present as burning, stinging, irritation, or sharp pain.
  • Causes: The exact cause is unknown, but potential factors include nerve injury, infections, muscle spasms, or hormonal imbalances. It may also be linked to vulvar infections, chronic inflammation, or genetic predisposition.

2. Vulvar Lichen Sclerosus:

  • Definition: This is a skin disorder that causes thin, white patches on the vulva, leading to itching, irritation, and sometimes scarring.
  • Causes: The exact cause is not fully understood, but it is thought to involve an autoimmune reaction, where the body attacks its own skin cells. It may also be triggered by hormonal changes (e.g., during menopause) or genetics.

3. Vulvar Cysts (Bartholin’s Cyst):

  • Definition: A Bartholin’s cyst occurs when the Bartholin glands, which are located on either side of the vaginal opening and secrete lubrication, become blocked and fluid-filled.
  • Causes: The blockage can be caused by infections (such as bacterial infections), trauma, or hormonal changes that affect the functioning of the glands.

4. Vulvar Infections:

  • Definition: Various infections can affect the vulva, including bacterial, fungal, and viral infections. Common infections include yeast infections (candidiasis), bacterial vaginosis, and sexually transmitted infections (STIs) such as herpes, human papillomavirus (HPV), and trichomoniasis.
  • Causes:
  • Yeast infections are caused by an overgrowth of Candida fungus.
  • Bacterial vaginosis results from an imbalance of the bacteria that naturally reside in the vagina.
  • STIs are transmitted through sexual contact and are caused by bacteria, viruses, or parasites.

5. Vulvar Dermatitis:

  • Definition: Vulvar dermatitis is an inflammation of the skin of the vulva, often characterized by redness, itching, and irritation.
  • Causes: It can be caused by allergic reactions, irritants such as soaps, fragrances, or synthetic clothing, or underlying skin conditions like eczema or psoriasis.

Vaginal Disorders

1. Vaginitis

  • Definition: Vaginitis is an inflammation or infection of the vagina that can cause itching, abnormal discharge, burning, and odor.
  • Causes:
  • Bacterial vaginosis: An overgrowth of harmful bacteria, often due to sexual activity, antibiotics, or douching.
  • Yeast infections (candidiasis): Caused by an overgrowth of Candida fungi.
  • Trichomoniasis: A parasitic infection caused by the Trichomonas vaginalis parasite.
  • Allergic reactions: To medications, hygiene products, or spermicide.

2. Vaginal Atrophy (Atrophic Vaginitis):

  • Definition: Vaginal atrophy refers to the thinning and inflammation of the vaginal walls, often leading to dryness and discomfort during intercourse.
  • Causes: The primary cause is low estrogen levels, often due to menopause, breastfeeding, or the use of medications that suppress estrogen (e.g., chemotherapy, birth control pills).

3. Pelvic Inflammatory Disease (PID):

  • Definition: PID is an infection of the female reproductive organs (uterus, fallopian tubes, ovaries) that can cause pain in the lower abdomen and may lead to long-term complications like infertility.
  • Causes: PID is usually caused by sexually transmitted infections (STIs) like chlamydia or gonorrhea, but can also result from non-STI-related infections.

4. Vaginal Prolapse (Pelvic Organ Prolapse):

  • Definition: Vaginal prolapse occurs when the pelvic organs (e.g., uterus, bladder, or rectum) descend into the vaginal canal due to weakened pelvic muscles and ligaments.
  • Causes: Childbirth, aging, menopause, and chronic constipation are common causes, as they put pressure on the pelvic floor and weaken the muscles and tissues that support the organs.

5. Vaginal Dryness:

  • Definition: Vaginal dryness refers to insufficient lubrication of the vaginal tissues, leading to irritation, itching, or discomfort, especially during sexual activity.
  • Causes: Hormonal changes (especially during menopause), certain medications (such as antihistamines or chemotherapy), low estrogen levels, and stress can all contribute to vaginal dryness.

6. Endometriosis:

  • Definition: Endometriosis occurs when tissue similar to the lining of the uterus (endometrium) grows outside the uterus, often causing pain, especially during menstruation.
  • Causes: The exact cause is unknown, but it may be linked to retrograde menstruation, genetics, or immune system disorders.

7. Vaginal Cancer:

  • Definition: Vaginal cancer is a rare form of cancer that develops in the tissues of the vagina.
  • Causes: HPV infection is a major risk factor, as it can cause changes in the vaginal cells that lead to cancer. Smoking and weakened immune systems are also risk factors.

Symptoms of Vulvar and Vaginal Disorders

Vulvar and vaginal disorders can present with a wide variety of symptoms, including:

  • Itching, burning, or stinging sensations in the vaginal or vulvar area.
  • Pain or discomfort during sexual intercourse (dyspareunia).
  • Abnormal discharge (color, consistency, odor).
  • Vaginal dryness or a feeling of tightness.
  • Pain during urination or bowel movements.
  • Swelling, redness, or rash on the vulva.
  • Pelvic pain or discomfort.
  • Bleeding or spotting between periods.
  • Changes in menstrual patterns, such as irregular periods or heavy bleeding.

Diagnosis of Vulvar and Vaginal Disorders

Diagnosis of vulvar and vaginal disorders typically involves a combination of the following:

  • Physical Examination: A healthcare provider will visually inspect the vulva and vagina for signs of infection, irritation, or abnormalities.
  • Pelvic Exam: A pelvic exam may be performed to evaluate the vagina, cervix, and other reproductive organs.
  • Lab Tests: Swabs may be taken from the vagina or vulva to check for infections, such as yeast, bacterial vaginosis, or STIs.
  • Blood Tests: To evaluate hormone levels (e.g., for conditions like vaginal atrophy) or to rule out autoimmune diseases.
  • Imaging: In certain cases, imaging tests such as ultrasound or MRI may be needed, particularly if there is suspected pelvic organ prolapse or vaginal cancer.
  • Biopsy: In rare cases, a biopsy of the vaginal or vulvar tissue may be taken to rule out cancer or precancerous changes.

Gynaeology FAQs

You can access our gynaecology service through a referral from your GP.

Yes. For many NHS services, you have the right to choose where you are treated. You can discuss this with your GP when being referred.

Our clinic offers assessment, diagnosis, and treatment for a wide range of common women’s health concerns including All common conditions seen – Menopause/Perimenopause, fibroids, endometriosis, menorrhagia, vaginal discharge, vaginal pain, IUS, Ring pessary, PCOS, irregular menstruation.

Please bring:

  • A list of current medications
  • Details of any medical conditions or previous surgeries
  • Relevant scan or test results if available
  • Your menstrual history if applicable

Yes. Patients are welcome to bring a partner, family member, friend, or carer for support during appointments.

Yes. If you need to rearrange your appointment, please contact the appointments team as soon as possible. We require at least 24 hours’ notice for appointment changes or cancellations wherever possible. Failure to attend appointments, or repeated late cancellations with less than 24 hours’ notice, may result in you being discharged back to your GP.

Yes. All consultations and medical records are confidential and handled in accordance with healthcare privacy regulations.

The doctor or specialist nurse will first discuss your symptoms and medical history. If an examination is needed, they will explain everything beforehand and ask for your consent. You may also request a chaperone at any time.

Depending on your symptoms, tests may include:

  • Blood tests
  • Cervical screening
  • Swabs
  • Ultrasound scans
  • Urine testing
  • Endometrial biopsy

Most appointments last between 15-20 minutes depending on the reason for your visit.

We understand this is important for many patients. Please let our admin team know your preference when booking and we will do our best to accommodate this.

Menopause occurs when periods stop permanently due to lower hormone levels. It is diagnosed after 12 months without a menstrual period.

The average age is around 51, but symptoms can begin several years earlier during perimenopause.

Perimenopause is the transitional stage before menopause when hormone levels fluctuate and symptoms begin, even if periods are still occurring.

Symptoms can include:

  • Hot flushes
  • Night sweats
  • Poor sleep
  • Mood changes
  • Anxiety
  • Brain fog
  • Vaginal dryness
  • Joint aches
  • Reduced libido
  • Irregular periods

In many women over 45, menopause can be diagnosed based on symptoms alone. Blood tests are not always needed.

Hormone Replacement Therapy (HRT) replaces hormones that decline during menopause and can help relieve symptoms.

For most women, HRT is safe and effective. The benefits and risks vary depending on age, medical history, and the type of HRT used. Your clinician will discuss the best options for you.

HRT can be given as:

  • Tablets
  • Patches
  • Gels
  • Sprays
  • Vaginal preparations


Some women require both oestrogen and progesterone.

Yes. HRT can be prescribed during perimenopause if symptoms are affecting your quality of life.

Yes. Alternatives may include:

  • Lifestyle changes
  • Cognitive behavioural therapy (CBT)
  • Non-hormonal medications
  • Vaginal moisturisers and lubricants

Helpful measures include:

  • Regular exercise
  • Good sleep habits
  • Reducing alcohol and caffeine
  • Stopping smoking
  • Maintaining a balanced diet
  • Stress management

Yes. Hormonal changes can affect mood, anxiety levels, concentration, and sleep. Support and treatment options are available.

Symptoms vary widely. Some women experience symptoms for a few years, while others may have symptoms for longer.

You should seek advice if symptoms are affecting your daily life, sleep, work, relationships, or emotional wellbeing.

Our Team

Parijat Bhattacharjee Consultant Gynaecologist

Parijat Bhattacharjee

Consultant Gynaecologist

I am a Consultant Gynaecologist with a special interest in Minimal Access Surgery and Fertility with more than 20 years of experience. I believe in giving personalized care to women with complex gynecological problems.

Farah Ahmed DRCOG DFSRH specialise in Menopause Management

Farah Ahmed

DRCOG DFSRH specialise in Menopause Management

Dr Farah Ahmed is an experienced NHS GP with over 15 years of practice and a special interest in Women’s Health and Menopause. She is a diplomate of the Royal College of Obstetricians & Gynaecologists and the Faculty of Sexual & Reproductive Healthcare, and holds a British Menopause Society Certificate in the Management of Menopause. Farah is dedicated to providing evidence-based, patient-centred care, empowering women to take charge of their health at every life stage. She is also a member of the National Association for Premenstrual Syndrome and co-author of Coping with PMS, a practical guide to managing premenstrual syndrome.

hina afgan General Practitioner at harrow health

Hina Afgan

General Practitioner

I am a General Practitioner with a special interest in women’s health, supported by extensive experience in gynaecology. I’m committed to delivering patient-centered care, with a focus on managing common gynecological conditions, hormonal concerns, and menopause, including HRT management.

Dr Sara Mills

Dr Sara Mills

General Practitioner

Dr Sara Mills is a specialist GP in menopause, holding the British Menopause Society (BMS) Menopause Specialist Certificate and the Certificate of Post-Reproductive Health from the BMS and the Royal College of Obstetricians and Gynaecologists (RCOG). She works across Harrow and Hillingdon with a wider interest in women’s health. Her clinical focus includes menopause, perimenopause, hormone replacement therapy (HRT), and general gynaecology, particularly the management of menstrual disorders. She is especially passionate about supporting women through the perimenopausal and menopausal transition, offering both medical and holistic management options tailored to each individual’s needs.

Dr Mills is a dedicated advocate for women in the healthcare setting. She strives to ensure her patients feel heard, supported, and empowered to make informed decisions about their health. Her approach is rooted in creating a safe, open, and compassionate space where women can speak freely and receive personalised, evidence-based care.

Dr Hetal Doshi

Dr Hetal Doshi

General Practitioner

Dr Hetal Doshi is a highly experienced General Practitioner with over 10 years of clinical practice, with a special interest in general gynaecology, fertility and menopause. She holds a Master’s degree in Gynaecology from India and is a Diplomate of the Royal College of Obstetricians and Gynaecologists (DRCOG). Dr Doshi also holds the Diploma of the Faculty of Sexual and Reproductive Healthcare (DFSRH) and is fully trained in the fitting of intrauterine devices (coils) and contraceptive implants. She is passionate about delivering holistic, patient-centred, and evidence-based care, ensuring that her patients feel heard, supported and empowered throughout their healthcare journey.

Related Services

Menopause

Dedicated support for women experiencing menopausal symptoms, offering personalised treatment plans and holistic care.
Find out more

Diagnostic Scans

Non-invasive imaging to support accurate diagnosis and ongoing monitoring of a wide range of health conditions.
Find out more