Gynaecology

Polycystic Ovary Syndrome (PCOS) is one of the most common hormonal disorders affecting people with ovaries, impacting around 8-13% of reproductive-aged women globally. It is characterised by irregular menstrual cycles, excessive androgen levels causing symptoms like acne and excess hair growth, and polycystic ovaries visible on ultrasound. It is important than other conditions are ruled out before a diagnosis can be made. PCOS is closely linked to metabolic conditions such as insulin resistance, obesity, and increased risk of type 2 diabetes and cardiovascular disease. 

Management focuses on lifestyle modification including weight management, exercise, and diet to improve insulin sensitivity. Medical treatments may include hormonal contraceptives to regulate periods and reduce androgen symptoms, Metformin to improve insulin resistance, and fertility treatments if pregnancy is desired. Addressing metabolic conditions early is important to reduce long-term health risks. 

Endometriosis is a chronic condition affecting approximately 10-15% of women of reproductive age, and up to 70% of those with chronic pelvic pain. It occurs when tissue similar to the lining of the uterus grows outside of the uterus, causing inflammation, pain, heavy periods, and can affect fertility. 

While there is no cure, pain and symptoms can be managed with medications such as NSAIDs and hormonal therapies including combined oral contraceptives, progestogens, GnRH agonists, or hormonal IUDs. Surgical options, especially laparoscopy, can remove endometrial lesions to relieve pain and improve fertility. Treatment is personalised balancing symptom control and fertility goals. Because endometriosis symptoms vary, early diagnosis and multidisciplinary management can improve quality of life.   

Contraception options are wide-ranging and include hormonal methods (pills, patches, implants, injections), barrier methods, and intrauterine devices (IUDs).  

The IUD, a small device inserted into the uterus, is a highly effective, long-acting reversible contraceptive. 

 IUD Insertion: This procedure can be performed in a clinic setting or in an operating theatre under anaesthesia. It involves placing the device through the cervix into the uterus. IUDs can be hormonal (releasing progestogen) or non-hormonal (copper) and provide contraception for 5-10 years depending on the type. IUDs may also help reduce heavy menstrual bleeding and pelvic pain.  

Recurrent pregnancy loss (RPL) is defined as the loss of two or more pregnancies and affects approximately 1-2% of couples trying to conceive. Causes are varied and can include genetic abnormalities, uterine anomalies, hormonal or metabolic issues, immune disorders, and blood clotting disorders. 

Management involves thorough investigations tailored to the individual's history, including genetic testing, imaging of the uterus, blood tests for hormone levels and some rare disorders. Interventions depend on the cause and may include surgical correction, hormonal therapies, anticoagulants, or lifestyle recommendations. Supportive care and counselling are also integral to addressing the emotional impact of RPL. Close early pregnancy monitoring is recommended and offered to all who have experienced recurrent pregnancy loss in their subsequent pregnancy.