Gynaecological

Services

 

 

 

 

 

 

 

 

 

 

 

 

Dr Samina has many years of experiences diagnosing and treating the full range of gynaecological problems. Dr Samina can look after women of all ages from adolescents to post-menopausal age groups. She can provide assessment and complete care for the following conditions:

* Pelvic pain
* Infertility
* Ovulation induction
* Endometriosis
* Ovarian cysts
* Heavy and/or long periods (‘Heavy menstrual bleeding’)
* Irregular periods
* Fibroids
* Abnormal pap smears (‘Cervical screening tests’) and colposcopy
* Prolapse symptoms
* Abnormal urine symptoms (going too often, leaking urine with standing or coughing, or pain with passing urine)
* Menopause symptoms
* Vulval and vaginal conditions (e.g., lumps, irritation, dryness, abnormal discharge)

Dr Samina provides a holistic approach to managing gynaecological conditions.  Care of women with some of these conditions often requires more than one treatment, and Dr Samina will use a multi- disciplinary team approach as needed.  If appropriate, Dr Samina will refer women to pelvic floor physiotherapists, dietitians, pain specialists and mental health specialists as required.

 

Ovulation Induction (OI)

 

OI is a potential treatment option for couples who have had trouble conceiving for around 12 months. Sometimes an imbalance in a woman’s reproductive hormones leads to irregular or absent menstrual cycles. This can make getting pregnant difficult. Women who meet the criteria for the Ovulation Induction Cycle are often prescribed medications to help address this imbalance. These medications stimulate the growth of an ovarian follicle (egg) and assists ovulation.

 

You will be monitored to assess your response to the medications. Monitoring may involve:

•       A series of vaginal ultrasounds to assess ovarian follicle growth and thickness of the lining of the uterus (endometrium)

•       Using urinary Luteinizing Hormone (LH) detection kits to predict when ovulation occurs.

•       Blood tests to check hormone levels. When you become fertile, i.e., when you are ovulating, it is essential to have regular intercourse with your partner.

 

If you have issues with having regular intercourse, please advise the fertility specialist as soon as possible. They will help you assess if ovulation induction is the best way for you to achieve a pregnancy.

 

The first day of your period (full flow of bleed) is called Day One. Dr Samina will help you plan your cycle, i.e., when to start taking your medication and the dose required.

Clomiphene

Clomiphene tablets are usually started early in your cycle (between day three and five) and are taken for five days. This medication stimulates the release of a naturally occurring hormone called FSH, which will cause ovarian follicles to grow.

 

Letrozole

Letrozole tablets are also started early in the cycle (between day three and five) and are taken for five days. Letrozole increases the production of FSH by suppressing the production of oestrogen. The

production of FSH will cause ovarian follicles to grow.

 

Vaginal Ultrasound

Vaginal ultrasounds measure the thickness of the lining of the uterus (the endometrium) as well as the size and number of follicles on both ovaries. Trigger injections are not always necessary, if you surge naturally, they are not required.

Trigger injection

Human Chorionic Gonadotrophin – Pregnyl® 5000IU Trigger injections cause ovulation to occur approximately 36 to 48 hours after administration. It is a one-off injection given in the same way as FSH injections. Some patients ‘surge’ spontaneously, (i.e., begin ovulating) so do not need this injection. Dr Samina will advise you on what date it should be administered. The trigger injection can be given in the clinic by a nurse or self-administered at home. The timing is not crucial so can be given at any time of the day. It is important to have regular intercourse once ovulation has been triggered.

Pregnancy test

If you do not have a period within 19 days of ovulation, you need to have a pregnancy blood test.

Timing of intercourse

The ideal time for intercourse is before and up to the time of ovulation. You may start having intercourse any time after the first scan unless multiple follicles are identified. Once a large follicle (>16mm) is identified you should have frequent intercourse (every day if possible).

Common medication side effects

Clomiphene tablets (Clomid and Serophene)

  • Headache
  • Depression
  • Hot flushes
  • Temporary visual disturbances like blurring and yellow discolouration
  • Multiple Pregnancy

Letrozole

  • Hot flushes
  • Joint pain
  • Fatigue
  • Nausea
  • Multiple Pregnancy

HCG (Pregnyl® 5000IU and 1500IU)

  • Nausea
  • Vomiting
  • Weight gain
  • Shortness of breath
  • Diarrhoea
  • Painful breasts
  • Bloating
  • Mild stomach pain

Heavy Menstrual Bleeding

 Heavy menstrual bleeding is defined as bleeding loss more than 80ml per period. This may be apparent if you are: 

  • Using more than 1 tampon per hour
  • Using more than 20 tampons or pads per cycle
  • Bleeding for more than 7 days
  • Passing clots larger than a 50c piece

Unfortunately many of (40%) women believe their cycles are normal and put up with a reduced quality of life. There are many causes of heavy bleeding including polyps, fibroids, hyperplasia, cancer or dysfunctional uterine bleeding and less common causes due to thyroid or bleeding disorders. If there has been a change in menstrual flow in a person over 35 years of age, the gold standard is to perform a hysteroscopy and curette to exclude serious pathology. Numerous medical and surgical options are available for the treatment of heavy menstrual bleeding including Mirena and NovaSure Endometrial ablation.

IUD & Mirena placement

Hormonal intrauterine devices (or IUDs) like Mirena offers effective, long-term contraception for premenopausal women, including teenagers. Its effects can last for up to 5 years and after removal you will return to your full baseline fertility prior to insertion. IUDs can also decrease menstrual problems and endometriosis, the risk of pelvic inflammatory disease (PID), STIs, and endometrial and cervical cancers. Dr Samina has performed many successful IUD and Mirena placements, so you get added peace of mind that your procedure will go smoothly and with minimal risk. Dr Samina also performs Nova Sure Endometrial Ablation.

What is NovaSure Endometrial Ablation?

QUICK — The actual procedure is done in just five minutes and a one time procedure.

SIMPLE — There’s no pre-treatment required. And you can have the procedure done any time during your cycle, even if you are bleeding.

SAFE AND EFFECTIVE — Approved by the Food and Drug Administration (USA) in 2001 with more than 15 years of clinical experience. (citation required).

This one-time five-minute procedure is designed to remove just the uterine lining—the endometrium—which is the part of your body that causes heavy bleeding. No incisions are required, leaving your uterus intact. For 9 out of 10 women, their heavy periods are dramatically reduced or stopped altogether.

How the NovaSure procedure works

Step 1: Your doctor opens your cervix (the opening to your uterus) slightly, inserts a slender wand and extends a triangular-shaped netted device into your uterus.

Step 2: The netting expands, fitting to the size and shape of your uterus.

Step 3: Precisely measured radiofrequency energy is delivered through the netting for about 90 seconds.

Step 4: The netted device is pulled back into the wand, and both are removed from your uterus.

This procedure requires Hysteroscopy Important Safety Information NovaSure endometrial ablation is for premenopausal women with heavy periods due to benign causes who are finished childbearing. Pregnancy following the NovaSure procedure can be dangerous. The NovaSure procedure is not for those who have or suspect uterine cancer; have an active genital, urinary or pelvic infection; or have an IUD. NovaSure endometrial ablation is not a sterilization procedure. Rare but serious risks include, but are not limited to, thermal injury, perforation and infection. Temporary side effects may include cramping, nausea, vomiting, discharge and spotting.

Hysteroscopy

If you’re experiencing severe cramping, abnormal bleeding, fibroids, polyps, infertility or your IUD device had been misplaced, a hysteroscopy lets your doctor see inside your uterus. A thin, lighted instrument with a camera called a hysteroscope, is inserted into your vagina and gently guided through your cervix and into the uterus. The camera is connected to a videoscreen to allow Dr Samina to examine the lining (endometrium) of your uterus. A treatment can be done at the same time.

Colposcopy for abnormal pap results

If you’ve had an abnormal pap smear test result, a colposcopy lets your Gynaecologist examine your cervix, vagina and vulva more closely. It usually takes around 20 minutes and can be performed in the surgery.

A special instrument called a colposcope is used to look closely at your vagina or cervix and a biopsy (a small sample of tissue) can be collected for further testing. It’s normal to feel a bit anxious about a colposcopy, but there’s no need for concern. Your cervix largely has little sensation so you’re unlikely to feel a biopsy in this area. If you’re having a cervical biopsy, you may feel a little discomfort, such as pressure or minor cramping. If you’re having a biopsy taken in the lower part of your vagina or vulva, Dr Ahmed will administer a local anaesthetic to numb the area first. After your colposcopy, you might experience some minor pain, light bleeding or dark discharge and you may need to avoid tampons or vaginal intercourse for around a week.

Laparoscopic Surgery

Laparoscopy or keyhole surgery is an advanced surgery technique that’s less invasive, so it’s less traumatic for your body. Dr Ahmed is trained to perform laparoscopic surgery.

Why do I need Laparoscopic Surgery?

Laparoscopy is used for a wide range of conditions, including endometriosis, fibroids, ovarian cysts, chronic pelvic pain or a hysterectomy.

What happens during a Laparoscopy?

Instead of a large open incision along your bikini line, your laparoscopic surgeon will make just a few tiny (0.5-1cm) incisions to insert a narrow high-definition camera so your Doctor can see a magnified video of your pelvic area.

Ectopic Pregnancy

Ectopic pregnancy is a pregnancy that is not in the usual place within the uterus but develops outside the uterus (womb). The most common place that ectopic pregnancy occurs is in one of the fallopian tubes (tubes that carry eggs from the ovaries to the uterus). Rarely, an ectopic pregnancy takes place in the abdomen, ovary or neck of the uterus (cervix).

An ectopic pregnancy happens when a fertilized egg gets stuck on its way to the uterus. This may be caused when the fallopian tube has been scarred, damaged or the shape is changed.Factors that can increase your risk for an ectopic pregnancy include:

  • History of fallopian tube infection such as pelvic inflammatory disease (PID), chlamydia and gonorrhea
  • History of fallopian tube infection such as pelvic inflammatory disease (PID), chlamydia and gonorrhea
  • Previous surgery on the fallopian tubes or in the pelvic area
  • Taking fertility medications around the time of conception
  • Women who get pregnant while an intrauterine device (IUD) is in place

If you have an ectopic pregnancy you may experience abnormal vaginal bleeding, absence of menstrual periods (amenorrhea), breast pain, lower back pain, nausea, lower abdominal or pelvic pain and mild cramping on one side of the pelvis. If you have a ruptured ectopic pregnancy you may have fainting, shoulder pain, intense pressure in the rectum, severe lower abdominal pain and low blood pressure. To diagnose ectopic pregnancy your doctor will perform a pelvic examination. Your doctor may check your human chorionic gonadotropin (hCG) levels. An abnormal rise in blood hCG levels may indicate an ectopic pregnancy. If an ectopic pregnancy is suspected, you will probably also have ultrasounds of your pelvis to visualize the location of pregnancy. A more sensitive ultrasound test may be done using an intravaginal probe (special probe inside the vagina). A laparoscopy can also be performed to provide diagnosis and treatment. Treatment choice for an ectopic pregnancy depends on the size and location of the pregnancy.Treatment options include nonsurgical and surgical methods. If the ectopic pregnancy is in the fallopian tube and the embryo is still relatively small, you may be given medications to stop the growth of the embryo. These medications dissolve the fertilized egg without doing any harm to your fallopian tubes or other organs. As the medications begin to work you may have abdominal pain and vaginal bleeding especially within the first several days. Your doctor will monitor your hCG blood levels to make sure that the ectopic pregnancy has been completely removed and no further treatment is needed. If the pregnancy is continuing or if you have certain health conditions indicating that medications should not be used you will likely need surgery to remove the abnormal pregnancy. Surgical intervention may also be necessary if the tube has ruptured, damaged or if there is severe bleeding inside the abdomen. The ectopic pregnancy may be removed using laparoscopy, a less invasive surgical procedure. During this surgery a long thin tube attached with a camera, called laparoscope is passed into the abdomen through a small incision. This enables your surgeon to observe the ectopic pregnancy and remove it.

Women who have had one ectopic pregnancy are later able to have a successful pregnancy. If your fallopian tubes are not damaged after an ectopic pregnancy, then you have better chances of conceiving again, but you will be at higher risk of ectopic pregnancy. If one of the tubesruptured or was badly damaged or removed, you still have chances of conceiving again.When you do become pregnant again, see your doctor as soon as you can to check that your pregnancy is developing in the right place.

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