Gynaecology

Chronic pelvic pain

In women, chronic pelvic pain is distinct from pain associated with painful or difficult menstruation in that it is non-cyclical and symptoms persist for a minimum of three months. Conventional treatments include hysterectomy, analgesics and ovarian cycle suppressants. Ask your doctor which treatments are best at alleviating the symptoms or tackling the underlying cause.

As the condition can last for years, many patients seek alternatives to drugs and surgery. Ask your doctor if any complementary therapies can help.

Treatments include counselling or psychotherapy, hormone therapy and hysterectomy with or without removal of the ovaries. Ask your doctor about the success rates and side effects of all available options.

In men, chronic pelvic pain occurs in the lower pelvic region, at the base of the penis and around the anus. The source of the problem is thought to be the prostate gland. Ask your doctor to carry out tests to ensure your symptoms are not those of prostate cancer.

Initially, painkillers and or antibiotics may be prescribed to ease the pain and ensure that no infection is present. Ask your doctor whether you can take a course of antibiotics even if a urine test for infection is negative. Urine tests are not 100% effective.

Other treatments may include alpha-blockers, which are used to treat prostate enlargement. They relax the muscle tissue and the outlet of the bladder. Ask your doctor if you would be suitable for this course of treatment and find out about any side effects.

Stress management and other pain relieving techniques are sometimes used to offer long-term pain management. Ask your doctor for a referral to a pain clinic or specialist in stress management if this is required.

Menorrhagia

(Heavy bleeding at menstruation)

If there are no signs of an underlying abnormality, treatment is not absolutely necessary but most women prefer to have something to help them cope more easily each month. Ask your doctor for pros and cons on the options available.

If the problems are severe, bleeding may be regulated by tablet treatment. These may be hormonal or non-hormonal. Hormonal treatments include the contraceptive pill. Ask your doctor about potential side effects.

Alternative approaches include the use of a hormone containing a contraceptive coil. Ask your doctor if this is suitable in your case.

Surgical alternatives include destroying the lining of the womb with a laser or applying heat treatment to the lining of the womb with hot water in a balloon. Ask your doctor about the success rates of this type of surgery at your local hospital.

Hysterectomy - the removal of the uterus - is often the last resort for menorrhagia sufferers. Ask your doctor about the effectiveness of alternative treatments.

Where hysterectomy is performed, it is an effective cure. Ask your doctor how about the potential surgical complications and length of recovery period.

If fibroids or polyps are found to be the cause of heavy periods, these will be removed via a hysteroscopy. Ask your doctor about the chances of recurrence and further surgery.

Fibroids

Fibroids are benign overgrowths of muscle in the womb. If they are small and your main problem is one of heavy periods, medical therapy with drugs is usually recommended. There are various treatments. Ask your doctor which treatment is right for you depending on your age, family situation and general well-being.

Myomectomy is a surgical procedure which involves removing the fibroids but leaving behind the uterus.

Hysterectomy is a cure for fibroids and removes all the fibroids along with the uterus. Following surgery, you will not have any more periods, and you cannot become pregnant. Ask your doctor to clearly explain the risks involved and the chances of being cured by the procedure recommended for you.

Ask your doctor when the symptoms of menopause are likely to begin and whether hormone replacement therapy could help.

If you have a hysterectomy, there is also the choice of total or subtotal hysterectomy. Ask your doctor which is more appropriate in your case.

A surgical treatment that involves cutting off the blood supply to the fibroids can be carried out under local anaesthesia and light sedation. Without a blood supply the fibroids degenerate and become smaller, thus reducing the uncomfortable symptoms associated with them. Ask your doctor when you can expect to see an improvement and be able to recover fully.

Endometrial cancer

Most cancers of the womb are discovered at an early stage and are cured by a hysterectomy (surgical removal of the womb). Ask your doctor for a second medical opinion if you are not satisfied with the recommended course of treatment.

A hysterectomy is a major operation with a significant convalescence period. Ask your doctor what exercises you can to do aid recovery and when it will be safe to resume normal levels of activity such as driving and mild exercise.

There is no reason why you cannot resume a normal sex life following a hysterectomy. Ask your doctor when it is safe to have intercourse again.

Radiotherapy may be given after the operation if your doctor feels there is any risk of the cancer coming back. Radiotherapy may be used instead of surgery if the cancer cannot be removed surgically, or if the woman is not fit enough to have an operation. Ask your doctor about the side effects of treatment and how best you can offset them.

If the cancer has spread to other parts of the body, treatment with a female hormone, called progesterone, may be able to shrink the cancer and control symptoms. Ask your doctor how your age, health and type of tumour can affect the chances of success.

After your treatment has been completed your doctor will want you to have regular check-ups and possibly x-rays. These will often continue for several years. Ask your doctor what symptoms of recurrence you should look out for during this time.

Cervical cancer

Surgery is usually the first treatment for cancer of the cervix in its early stages. Radiotherapy is as effective as surgery but the side effects are greater. Ask what the success rates for surgery performed at this stage of cervical cancer are at your local hospital.

If it is thought that some cancer cells may still be left after the surgery, you may be advised to have radiotherapy afterwards to reduce the chance of the cancer coming back. Ask what sort of ongoing monitoring will be required and when you will be in the all clear.

Radiotherapy is used if there is a high risk that the cancer may come back. It is often used to treat cervical cancer in conjunction with chemotherapy. Ask how long you will need to undergo this treatment and about the possible long-term effects of both treatments on your well-being.

New treatments are being developed by scientists all the time. Ask your doctor about new developments and how you might be able to get involved in clinical trials.

Cervical cancer may return so regular smear tests are essential. Ask your doctor what aspects of your lifestyle can be changed to minimise the risks of recurrence.

Ovarian cancer

Surgery is the initial treatment for almost all women with ovarian cancer. Depending on the extent of the cancer, the ovaries, the fallopian tubes and the womb may all be removed. But often this won't be known until the operation itself. Ask your doctor about all the possible scenarios before surgery.

Depending on how extensive your surgery is your recovery time may vary. Ask your doctor how long it will be before you can return to work and resume normal activity.

Surgery is rarely used in isolation and a full treatment plan will be created for you. Ask if you can speak to both a surgeon and a cancer specialist before your treatment plan is finalised.

Chemotherapy can be used to treat ovarian cancer. In most cases it is given after surgery. Doctors may recommend a combination of chemotherapy drugs. Ask your doctor about your individual chance of recurrence, what are the chances of a cure without the chemotherapy and how much the chemotherapy is likely to help.

Doctors rarely use radiotherapy in the treatment of early ovarian cancer. Sometimes, they use radiotherapy to help with symptoms that arise as a result of advanced cancers. Ask your doctor how long your period of radiotherapy is likely to last and what side effects you can expect.

After your treatment is finished, you will have regular check-ups and possible scans or x-rays. These will probably continue for several years. Ask your doctor how long it will be before you can say you are cured.

---

« Back to main menu