A hysteroscopy is used to see inside your womb to investigate gynaecological symptoms such as: heavy menstrual bleeding, unusual vaginal bleeding, postmenopausal bleeding, pelvic pain, difficulty conceiving and repeated miscarriages.
Your consultant will use a narrow telescope with a light and camera at the end, called a hysteroscope. The hysteroscope is passed through your vagina and cervix into your womb. It requires no incisions.
A hysteroscopy diagnoses fibroids and polyps. It can be used to treat and remove fibroids, polyps, out of place intrauterine devices (IUDs) and scar tissue that may be causing absent periods and reduced fertility.
Gynaecological laparoscopy is keyhole or minimally invasive surgery performed under general anaesthetic. It can be used to diagnose or treat a women’s health condition.
The inside of your abdomen and pelvis can be viewed using a laparoscope, a small tube with a camera and light source that sends images to a television monitor. Small skin incisions are made to allow the laparoscope to be inserted.
It’s used to: diagnose and treat endometriosis, treat fibroids, remove ovarian cysts, remove scar tissue, treat an ectopic pregnancy, perform female sterilisation, remove the womb or ovaries and investigate and treat cancer.
Laparoscopy has a number of advantages over open surgery including: shorter hospital stays, faster recovery times and, reduced pain, bleeding and scarring.
Anterior vaginal wall repair
A sinking vaginal wall, known as a prolapse, may cause a number of symptoms: inability to fully empty your bladder, full bladder feeling at all times, vaginal pressure, bulging at the opening of your vagina, pain when having sexual intercourse, leaking urine when you cough, sneeze, or lift something and bladder infections.
An anterior vaginal wall repair is used to restore a vaginal prolapse. It’s carried out under general or spinal anaesthetic and takes about half an hour. During the procedure your gynaecologist will move your vagina back to its correct position. They’ll also tighten your bladder support tissues and remove any bulge in your vagina.
Endometriosis is very common. It’s a chronic condition where endometrial tissue develops outside the womb often on organs in the abdomen and pelvis.
If you’ve endometriosis, you may suffer from: painful, heavy periods or bleeding between periods, lower abdomen, pelvis or lower back pain, pain when having sexual intercourse and difficulty conceiving.
A laparoscopy can confirm endometriosis. Your specialist may be able to see endometriosis tissue or a sample (biopsy) may be taken for laboratory testing. Endometriosis can also be treated using a laparoscopy by way of inserting surgical instruments to remove the endometriosis.
A hysterectomy surgically removes the womb. It’s performed to treat symptoms such as: heavy periods, chronic pelvic pain, fibroids (non-cancerous tumours), uterus prolapse or womb, ovary or cervix cancer. It’s only performed if other treatments haven’t been successful or if the woman is not of childbearing age as following a hysterectomy a woman cannot become pregnant.
The main types of hysterectomy are:
total hysterectomy - womb and cervix are removed - most often performed
subtotal hysterectomy - main part of the womb is removed; the cervix is left in place
radical hysterectomy - womb and surrounding tissues (fallopian tubes, part of the vagina, ovaries and lymph glands) are removed.
The ways to perform a hysterectomy are:
vaginal hysterectomy – womb is removed through an incision in the top of the vagina under general, spinal or local anaesthetic.
laparoscopic hysterectomy – womb is removed through small incisions in the abdomen under general anaesthetic. This is most commonly performed.
abdominal hysterectomy – womb is removed through a cut in the lower abdomen under general anaesthetic.
Your consultant gynaecologist will advise you on the best type of hysterectomy and way to perform it based on your individual need and health.
Ovarian cyst removal
Ovarian cysts are sacs filled with fluid that grow on a woman’s ovary. They’re common and often disappear without treatment. Some cysts require surgery to remove them. The cysts may be large or persistent, causing symptoms or cancerous or could become cancerous.
Most cysts are removed using laparoscopy.
If an ovarian cyst is particularly large, or if it could be cancerous, your gynaecologist may remove the cyst by laparotomy. Performed under general anaesthetic, a single larger cut is made in your stomach for greater access to the cyst. The whole cyst and ovary can be taken out and sent to a laboratory to check whether it’s cancerous. The incision is then stitched or stapled.
Removal of ovaries
The surgical removal of one or both of the ovaries is called an oophorectomy. Your ovaries are organs that are located above the uterus and hold your eggs. An oophorectomy is usually carried out if you have damaged ovaries or to treat conditions such as ovarian cancer or endometriosis.
Ovary removal is carried out under general anaesthetic either laparoscopically or using open surgery. It’s sometimes performed as part of a more complete hysterectomy surgery to remove the womb.
It can remove one or both ovaries. If one ovary is taken out, menstruation continues and the woman can go on to have children. If both ovaries are removed, menstruation will stop and a woman won’t be able to have children.
Laparoscopic sterilisation is a method of female contraception. The fallopian tubes are blocked or sealed to prevent eggs from reaching the sperm. The eggs continue to be released from the ovaries but they are then naturally absorbed into the woman’s body.
Laparoscopy is the usual method of female sterilisation. Clips, rings or tying and cutting the fallopian tubes can block them.
Hysteroscopic sterilisation is an alternative method of female sterilisation. It uses a hysteroscope to insert a piece of titanium metal into your fallopian tubes. The fallopian tubes then form scar tissue around the metal and block the tube over time.
Hormone replacement therapy (HRT) is used to relieve symptoms of the menopause (when a woman stops having periods. Her menstrual cycle stops and her ovaries permanently stop releasing eggs). Women go through the menopause usually between the ages of 40 and 58 years.
As a woman moves into the menopause she may experience symptoms including: hot flushes, night sweats, disturbed sleep, mood changes, vaginal dryness and a reduced sex drive.
These symptoms are brought about because of a drop in the blood level of the oestrogen hormone as a woman approaches the menopause. HRT replenishes the oestrogen hormones and the symptoms are reduced.
Treatment for miscarriage
A miscarriage is the unexpected loss of a pregnancy in the first 23 weeks. It’s a very distressing time as the loss of the baby is grieved. However, most women go on to have a successful pregnancy in the future after a miscarriage.
Most early miscarriages are the result of a problem with the baby’s genetic material (chromosomes) that causes the baby to not develop normally. The reason for later or recurrent miscarriages may not be known but may be linked to age and health including diabetes, thyroid problems, immune system issues, fibroids, blood clot conditions, reproductive system problems, infection and cancer treatment.
Often following a miscarriage there’s pregnancy tissue left in your womb and this is known as an incomplete miscarriage. You may choose to wait for it to pass naturally, take medication that opens your cervix and allows the tissue to pass or have it surgically taken away.
Stress incontinence treatment
Stress incontinence is when you leak urine due to an increase in pressure on the bladder. For example, when you cough, laugh, sneeze or exercise. It’s the most common type of incontinence and happens when the pelvic floor muscles that support the bladder are weakened.
It’s often caused by childbirth. Ageing and obesity are also linked to stress incontinence. It can occur in men who’ve had prostate cancer treatments.
The first-line treatment is the strengthening of the pelvic floor muscles with pelvic floor exercises. Medicines may help the muscles around the urethra to contract more strongly. If these aren’t successful surgery will be recommended.
There are various surgical options: tension-free vaginal tape (TVT) procedure (women only - tape is used to support the urethra and bladder neck), sling procedure (sling supports your bladder neck and urethra), colposuspension (women only – laparoscopic or open surgery lifts the tissues between your bladder and urethra) and artificial urinary sphincter (replacement urinary sphincter).