Gynaecology

Dr Genia Rozen diagnoses and treats the full range of gynaecological conditions.

Cervical screening has changed in Australia. The Pap test has been replaced by a new ‘Cervical Screening Test’ every five years. Cervical cancer is one of the most preventable cancers. Regular cervical screening, by detecting and treating early cellular changes, is your best protection against cervical cancer.

The test is a simple procedure to check the health of your cervix. It feels the same as the Pap test, but tests for the ‘human papillomavirus’ (known as HPV). For most women aged 25 to 74 their first Cervical Screening Test is due two years after your last Pap test. After that, you will only need to have the test every five years if your result is normal.

A colposcopy is a minor procedure in which a special microscope is used to examine the surface of the cervix for abnormalities. During a colposcopy, a small amount of tissue (biopsy) might be removed and sent to a laboratory for testing.

If you are sexually active and not currently wishing to conceive, you may want to find reliable contraception. There are many options and it can be confusing trying to decide which method is right for you.

Commonly used methods include:

  • Hormonal options such as the pill, combined vaginal contraceptive ring, progesterone only pills/implants/IUD
  • Non-hormonal options such as: intrauterine device (IUD), diaphragm
  • Permanent options include: tubal ligation, vasectomy.

Please speak to Dr Rozen to choose a method that’s right for you.

Endometriosis is a condition in which there is presence of endometrial-like tissue in a location outside the uterus. The lesions in endometriosis are associated with inflammation, scarring,and can be found on pelvic organs such as the ovary, the peritoneum (which lines the pelvic cavity) and other places in the body. It reacts to the hormonal changes within the menstrual cycle. This often causes pelvic pain which is cyclical in nature, tending to be worse just prior to and during the period. It can cause a spectrum of other pain symptoms, such as during intercourse, bowel or bladder function. While some women have severe pain, others may not have any symptoms at all, or can present only with trouble conceiving.

Endometriosis can affect fertility in a number of ways. It can cause anatomical disruption to the pelvic organs or affect eggs and embryos via inflammation within the pelvic environment.

The best way to diagnose endometriosis is via a laparoscopy (key hole surgery) and this allows treatment at the same time. Medical treatment for endometriosis is possible, however does not improve fertility. When a laparoscopy to remove endometriosis is undertaken, it is important to normalise the anatomy and preserve ovarian tissue, which contains the immature eggs. The ultimate goal is to simultaneously improve symptoms and maximise your fertility.

Minimally invasive gynaecological surgery (including laparoscopy and hysteroscopy) is a viable option for women with a variety of conditions, with benefits over traditional surgery. There is a significantly reduced recovery period which helps women return to their normal activities as quickly as possible. Other benefits include:

  • Smaller incisions
  • Less pain
  • Less trauma to nerves, tissues and muscles
  • Lower risk of postoperative infection
  • Shorter hospital stay
  • Less scarring
  • Reduced blood loss
  • Better cosmetic results.

The goal is to manage each patient’s problems in a way that is unique to them and achieve an excellent outcome with minimal side effects. For some women, for example with very large fibroids, open surgery is still the most appropriate treatment.

Menopause occurs when you have not had a menstrual period for 12 months. Menopause is a natural part of life occurring at around age 51 years but can also happen for other reasons including medical treatment of cancer or surgery.
At menopause, you stop producing oestrogen (the main sex hormone in women) and this can lead to menopausal symptoms, such as hot flushes, sleep disturbance and mood changes. Oestrogen levels can vary in the time leading up to the final menstrual period (called the perimenopause).

Other common concerns that women may not feel comfortable discussing, include reduced libido and sexual satisfaction. Sometimes this is because they feel embarrassed or believe that nothing can be done. However, effective treatments are available and Dr Rozen can discuss these further with you. Premature menopause is when a woman enters menopause before the age of 40 and occurs in approximately 1% of women. This may be due to:

  • Primary ovarian insufficiency (POI) where the periods stop spontaneously
  • Chemotherapy treatment and radiotherapy for cancer
  • Surgically induced menopause when the ovaries are removed.

The impact on physical health, including increased risks of earlier onset of osteoporosis and cardiovascular disease, emotions, mood, body image and relationships can be significant. But there are treatment options and ways to manage premature and early menopause.

Testing for possible causes and associated conditions may be necessary, after which a management plan tailored to your symptom and hormonal needs, is developed. Many women with ovarian insufficiency are unable to conceive a baby naturally. However, it is still possible to have a healthy pregnancy using a donor egg or embryo to conceive. If a woman has already frozen her own eggs, these can be used with her partner’s (or donor) sperm.

Some women get through their monthly periods easily with few or no concerns. Their periods come like clockwork, starting and stopping at nearly the same time every month, causing little more than a minor inconvenience.

However, other women experience a host of physical and/or emotional symptoms just before and during menstruation. From heavy bleeding and missed periods to unmanageable mood swings, these symptoms may disrupt a woman’s life in major ways.

Most menstrual cycle problems have straightforward explanations, and a range of treatment options exist to relieve your symptoms. If your periods feel overwhelming, discuss your symptoms with Dr Rozen. Once your symptoms are accurately diagnosed, a tailor-made treatment for you can be developed.

The spontaneous loss of a woman’s pregnancy before the 20th week that can be both physically and emotionally painful. A miscarriage generally occurs for reasons outside your control and nothing can be done to prevent or stop it from happening. Most women who have had a miscarriage will go on to have a healthy pregnancy in the future. Up to 1 in 4 confirmed pregnancies end in miscarriage before 20 weeks, but many other women miscarry without having realised they are pregnant. For most couples, having a miscarriage is not associated with any underlying reproductive disorder. Often, it is caused by a random genetic “mistake” in early fetal development. However, three or more miscarriages in a row may indicate an underlying problem and require further investigation.

There are various ways of dealing with a miscarriage, largely based on your preference. A D&C (or ‘curette’) is a minor operation. The full name is dilatation and curettage. It is done in an operating theatre, usually under general anaesthetic. There is no cutting involved because the surgery happens through the vagina. The cervix (neck of the uterus) is gently opened and the remaining pregnancy tissue is removed so that the uterus is empty. Usually the doctor is not able to see a recognisable embryo. The actual procedure usually only takes five to ten minutes, but you will usually need to be in the hospital for around four to five hours. Most of this time will be spent waiting and recovering.

You may have to wait a day or two to have a curette and sometimes, while you are waiting, the pregnancy tissue will pass on its own. If this happens and all of the tissue is passed you may not need to have a curette.

If you have Rhesus factor “negative” blood group you will usually be offered Anti-D injection following a miscarriage.

Pelvic pain is pain that occurs in the lower abdomen and pelvis. Pelvic area mainly consists of reproductive, urinary and digestive systems such as uterus, bladder and intestines. Pelvic pain can be acute or chronic. Acute pelvic pain occurs suddenly and stays only for a short period of time. Chronic pelvic pain lasts for more than six months and does not show any improvement with treatment.

Non- gynaecological causes of pain are common and include:

  1. Gastrointestinal causes, such as: Irritable bowel syndrome, coeliac disease, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), constipation, diverticular disease
  2. Urinary tract causes: interstitial cystitis, urinary tract infections, bladder tumours
  3. Musculoskeletal and neurological causes: weak pelvic floor muscles and posture, fibromyalgia, nerve entrapment or damage following previous surgery, spinal disc bulge.

All of these can have similar symptoms, which can make it hard to figure out the source of the pain. Understanding your symptoms can help you and your doctor begin to pinpoint the cause or causes of your chronic pelvic pain.

PCOS is the most common endocrine (hormonal) abnormality in women of reproductive age, affecting 15% of women.

While there is no universally agreed definition, the most would diagnose PCOS when a woman has a two or more features of irregular ovulation, clinical and/or hormonal changes associated with increased androgen activity, and polycystic appearing ovaries.

The name originates from the multiple follicles observed on ultrasound. However, these are not cysts, and by themselves are not diagnostic of the condition (some women may have PCOS and not have the characteristic ultrasound appearance).

Problems which may be experienced include:

  • Irregular or only occasional periods which may be very heavy when they occur
  • Difficulty in getting pregnant because of irregular ovulation or no ovulation
  • Problems with weight management and a high upper body fat distribution
  • Excessive hair growth or occasionally hair loss
  • Acne.

 

Two or three consecutive miscarriages may be accompanied by feelings of grief and failure. While most often the investigations for a cause lead to the finding of ‘unexplained’ pregnancy loss, occasionally it will reveal a treatable issue.

Have Questions?

A laparoscopy is an operation used to look inside your abdomen. A thin instrument called a laparoscope (similar to a telescope) is inserted through a tiny cut in your belly button to help us examine and operate (if needed) in your abdomen without making large cuts. Laparoscopy is often performed as a day procedure. Why is a laparoscopy performed?

To diagnose certain problems it is necessary to look directly into the abdomen at the reproductive organs. Common reasons for undergoing a laparoscopy include the assessment of painful or heavy periods, pelvic pain (as may occur with endometriosis or adhesions), pelvic masses (such as ovarian cysts) or as assessment of fertility. Endometriosis, pelvic adhesions, pelvic inflammatory disease, ovarian cysts, non-functioning fallopian tubes and some fibroids can be diagnosed and appropriately treated.

What are the alternatives?

Similar procedures may be performed by open surgery (laparotomy). This is a much more invasive procedure, involving a higher risk of complications, longer time in hospital and longer recovery after discharge. However, in certain situations a laparotomy may be the most appropriate procedure.

How is laparoscopy performed?

Laparoscopy is normally performed under a general anaesthetic in the operating theatre. Instruments may be inserted into the vagina or rectum to assist in the procedure. A small cut is made in your belly button. The abdomen is inflated with gas and a laparoscope is inserted to look at the internal organs. A further 1-3 small cuts are made in your abdomen, depending on what needs to be treated. After the procedure, the instruments are removed, the gas released and the cuts are then closed with dissolving stitches. The procedure itself takes approximately forty five minutes or more, but you can expect to be in theatre and recovery for a number of hours.

Hysteroscopy is a way to look inside the uterus. A hysteroscope is a thin, telescope-like device that is inserted into the uterus through the vagina and cervix. It may help us to diagnose or treat a uterine problem. It is often combined with a curettage, which samples the lining of the uterus. Why is a hysteroscopy performed?

To diagnose certain problems, we need to look directly into the inside of the uterus. Common reasons for undergoing a hysteroscopy include the assessment of heavy periods, abnormal vaginal bleeding, fibroids, polyps, or as part of the assessment of fertility.

What are the alternatives?

This depends on the nature of your problem. An ultrasound scan can provide some helpful information. A small sample of the lining of the uterus may be able to be taken in the outpatient clinic to help rule out some problems, however, a hysteroscopy may be the only way to diagnose certain conditions.

How is a hysteroscopy performed?

Hysteroscopy is minor surgery that may be done in a clinic or an operating room. It is performed under local or general anesthesia. The cervix is widened (dilated) and a telescope is passed to look at the inside of the uterus. A sample of the lining is often taken to be examined more closely. It is also possible to remove a polyp or a fibroid with a hysteroscope. This procedure does not involve any cuts or stitches to the abdomen. It takes approximately ten minutes but you can expect to be in theatre and recovery for a number of hours.

You can make an appoint in two ways:

  1. Request an Appointment via this website, by clicking here
  2. Call us on (03) 8376 6230.
  • A referral letter from your GP (couples trying to conceive may use a joint referral: this must name both partners)
  • Copies of any blood tests your GP has recently arranged for you
  • Copies of imaging reports and ideally the images themselves of any investigations you have recently undertaken
  • Copies of your medical records/operation reports from any gynaecological surgery you have had in the past
  • A completed new patient registration form
  • A signed consent form for a transvaginal ultrasound (if required).

Sometimes it can be helpful to take a family member or friend with you when you meet with a specialist. You may feel more confident if someone else is with you, a relative or friend can help remind you about things you planned to share with or ask the doctor, and he/she also can help you remember what the doctor says.