Abnormal Bleeding
Menstrual bleeding usually occurs each 28 days. Sometimes the cycle may be longer or shorter than 28 days. At times the cycle may be very irregular, or bleeding may become very heavy. This may just be due to a temporary hormonal imbalance, but it can be due to problems in the uterus or the ovaries.
Sometimes polyps can cause heavy menstrual bleeding, bleeding between periods or bleeding after sexual intercourse. Uterine polyps are benign growths of the lining of the uterus (the endometrium). They can also occur at the cervix. Occasionally, polyps can develop abnormalities, particularly in older women so it is generally advised to remove them before they come dangerous.
Fibroids can also cause irregular bleeding or heavy periods. Fibroids are a growth arising from the muscle of the uterus and can press on the lining of the uterus (endometrium) and cause bleeding. It is very rare for a fibroid to become cancerous.
The ovaries produce hormones which control the uterus. Some conditions can alter the hormonal production and stop the ovaries producing an egg (ovulation) each month. An example of this is polycystic ovarian syndrome.
Abdominal Pain
Pain can be caused by any organ in the abdomen such as bowel or kidneys. Ultrasound can help to try and establish an exact cause for pain.
It is not uncommon for the onset of a period to cause a lot of discomfort. Sometimes a problem like endometriosis can cause severe pain and cysts can be seen. Sometimes these cysts are often on or near the ovary.
Each month the ovaries produce a cyst and these usually resolve around the time of the next period. Occasionally these can be come large and tender and are a reason for abdominal pain.
Exclusion of Ovarian Cancer
Developing ovarian cancer is more likely if there is a history of ovarian cancer. It usually can occur after the menopause. Symptoms from ovarian cancer tend to occur quite late in the disease when it is difficult to treat. Ultrasound is able to detect early cancers while they are still small and have not caused any symptoms. A tumour requires formation of new blood vessels in order to grow. Colour Doppler ultrasound is used in the detection of the formation of new blood vessels.
Ovarian Cancer Screening
Regular screening is recommended if you are a woman who is over 50 or who has a family history of ovarian cancer. This examination helps identify if the ovaries are enlarged of if new blood vessels have appeared to supply a growing tumour.
Follicle Tracking
This involves tracking the development of egg-containing follicles within the ovary from an immature state to a mature state where there are leading or dominant follicles. The process is monitored with transvaginal ultrasound in combination with blood levels of the female hormones oestrogen and progesterone.
Most follicle tracking that takes place is done as part of IVF treatment. For most IVF treatments, the ovaries are artificially stimulated with follicle stimulating hormone (FSH) which produces multiple mature follicles which are eventually harvested. Follicle Tracking can take place on a daily basis for a period of time whilst the follicles are being closely monitored.
Polycystic Ovaries
Polycystic Ovaries (PC0) are ovaries that contain an excessive number of primordial follicles. Primordial follicles are tiny fluid filled sacs which contain the eggs. An ultrasound of the ovaries during the reproductive years usually shows on average 4-12 follicles in each ovary. When more than 15 follicles are present, the ovary is called polycystic.
Polycystic Ovaries should not be confused with polycystic ovarian syndrome (PCOS). PCOS is a condition that results from a disturbance of blood hormones and may present with weight gain, acne, irregular or infrequent periods and excess hair growth.
What is the cause of polycystic ovaries (PCO)?
In a normal menstrual cycle there are usually 5-10 follicles at the beginning of the cycle. Later in the cycle usually around day 14, one follicle gets bigger (leading follicle) and shortly thereafter ovulation takes place with release of the egg. The remaining follicles regress and disappear before the next cycle. These events are usually after every 4 weeks and result in the monthly menstrual bleed. In women with PCO, not all of the follicles regress each cycle and therefore there is an increase in number with successive cycles. Despite extensive research no single cause explains this variation from normal.
Fibroids
A fibroid is a benign growth of fibrous muscle tissue which develops in the wall of the uterus. Fibroids range in size from 5mm (the size of a pea) to 150mm (the size of a football). Our advanced gynecological equipment allows us to accurately measure fibroids in 3 dimensions. They are very common and are present in up to 30% of women. They generally do not cause any problems and many patients go through life with their fibroids unnoticed.
Some patients do however run into problems which may include:
- Infertility
- Heavy or irregular periods
- Pain
Infertility may occur as a result of blockage of the fallopian tubes. Such a blockage may prevent the sperm from meeting the egg just before conception or prevent the embryo’s passage toward the uterus. Fertility may also be reduced if the fibroids significantly disrupt the cavity of the uterus.
Irregular bleeding can result due to enlargement or distortion of the uterine cavity by fibroids. A fibroid extending into the cavity can also cause heavy and irregular bleeding.
If fibroids enlarge to such a size that they outgrow their blood supply degeneration of the muscle may occur and pain may result. Degeneration may also occur in pregnancy. Both of these complications are rare.
Problematic fibroids may be treated with a variety of hormones to decrease their size. It may however, take several months before a reduction in size is noted. Other fibroids may be dealt with by surgery. If the fibroid is small and positioned within the cavity it may be possible to introduce a narrow telescope into the uterine cavity and remove the fibroid. Larger fibroids are usually approached either through keyhole or open surgery.