Are you troubled by heavy or erratic menstrual period?
You are not alone. Period-associated problems are very common and most women put up with these for quite some time hoping they would go away on their own. Whilst this may be possible for some, many endure countless days of heavy menstrual flow, erratic bleeding and/or associated pain, and more often than not, end up feeling exhausted, becoming anaemic or finding it hard to cope with daily living, study and/or work.
There are many factors that can contribute to abnormal vaginal bleeding. Some are related to hormonal changes which are usually seen in adolescents, perimenopausal women, women with ovulatory problems, or women taking hormonal medications; while others may be due to underlying diseases such as fibroids, adenomyosis, polyps, infections, pregnancy loss and cancers, to name a few.
At Yap Specialist, our gynaecologist will listen to your concerns and evaluate your history which may include treatments you have previously tried and what methods work best for you. A comprehensive assessment will then be performed to help determine the cause and the severity of your problem; this can include physical examination, blood tests, and/or ultrasound scan . A range of treatment options will then be discussed and our specialist will assist you in selecting not only the most effective but the most suitable treatment to meet your needs. Treatment options can range from non-hormonal tablets, hormonal pills / injection / implant, or surgery. Thereafter, we shall continue monitor your progress until your problem is resolved or at least managed up to your satisfaction.
Further reading: how can I reduce or stop the heavy bleeding?
Having a baby is one of our greatest milestones in life – it is a wonderful experience to be able to give birth to our children and raise a family. There are many books and reading materials out there on pregnancy, but our specialist will help you focus on what is important and relevant to you.
Here, we take a holistic approach to understand your needs, to demystify myths surrounding fertility, pregnancy and childbirth, and to manage problems which can affect your chances of having a healthy baby. Getting a pre-pregnancy counselling allows you to address all your concerns with our specialist who will listen to your queries, systematically assess your health and give you a comprehensive yet easy-to-follow roadmap. This process will start with a comprehensive history taking, an appropriate examination, and a set of blood tests and ultrasound scan. You will then receive counselling about your health status and ways you can do to enhance your health and your chances of having a spontaneous pregnancy. This would give you better preparation and greater confidence in going to the next stage of your journey to having a baby.
One pertinent point to note, don’t wait too long to start a family – get a fertility check-up which includes an assessment of your ovarian reserve to help you work out how much time left in your reproductive lifespan before it is too late. We can discuss the option of storing your valuable eggs or embryos if you wish to delay your childbearing plan.
Further reading on Pregnancy Planning
Having a baby is a very personal journey. Some find it easy and straight-forward, others have a tougher and more risky journey. Whichever journey you go through, it is a personal one, which makes it sweeter if you have someone supporting you through, and have a specialist guiding you all the way to experience the best moment of your life – the birth of your precious baby. You may have read or hear stories about the things that could go wrong in pregnancy and childbirth, and may be constantly worrying about labour pain and how on earth the baby can come out.
Yeap, those worries are legitimate because pregnancy and childbirth can be risky and potentially life-threatening to mother and/or baby, and these complications can happen even in young, healthy and supposedly low risk pregnant women. Looking back at history, it was not too long ago that our grandparents and the generations before them dreaded about the moment of not seeing their wife and baby survive through the childbirth process, and now these events are very uncommon, thanks to modern surveillance of pregnancy progress and childbirth in the labour ward with modern facilities like operating theatre, blood-bank, and nursery to provide emergency backup in case of any unexpected complications.
Our mission is to ensure you have a memorable pregnancy and childbirth experience; to support and guide you and your partner throughout this very personal journey; and above all, to make this process safe and comfortable.
In our clinic, you will see the same specialist throughout your pregnancy care, who is almost certain will be there delivering your baby. Your pregnancy care will include a comprehensive assessment and a personalised pregnancy care plan. With each subsequent antenatal visit, our specialist will monitor your health; the growth and well-being of your baby with an ultrasound scan to check your baby’s position, heartbeat, growth and fluid in the womb; and address any concerns along the way. You will be encouraged to attend antenatal classes organised by the private hospital you intend to have your confinement. The choice of delivery and pain management will be discussed to select the one you prefer, and although we would normally promote natural birth, how you wish to have a baby is entirely your choosing as long as it is deemed safe and reasonable. This would mean no homebirth or water-birth, and we would reason out with you why those choices pose a potential risk to you and the people looking after you.
We also put a strong focus on good pain management as we understand that labour can be painful and women can have varying degree of pain tolerance. Good pain management ensures you have control over your birthing experience, and help you avoid traumatic childbirth.
Our overriding goal is to provide you and your partner a comprehensive first-class professional care throughout your pregnancy journey til you have your baby in your arms, and to not only ensure a safe outcome but also bring you a memorable and wonderful experience. We call this, having your baby in extraordinary style.
The following is an example of a pregnancy care schedule.
Family planning is basically a strategy to influence the number of children one wishes to have and when. Although it is often not a precise method, it allows people to choose and to manage their family size and structure, and this is often a very personal choice influenced by one’s background, faith and society. There are many different methods to choose from and basically can be categorised into 5 groups: natural methods, barrier methods, contraceptive pills, non-pill alternatives, and sterilisation.
There is no right decision, just one which suits your needs and is compatible with your belief and values. It is also something that can change over time, and as such, it is important to choose methods which give you the flexibility to change your plan as your circumstances evolve.
Hormonal Replacement Therapy or HRT is using medications that exert oestrogenic and/or progestogenic properties to relieve menopausal symptoms and improve women's well-being. As we know, when women are approaching menopause, the levels of female hormones (namely oestrogen and progesterone) are decreasing. This can result in distressing symptoms like hot flushes, night sweets, difficulty sleeping and dry vagina etc. For some people, the symptoms may overtime resolve naturally or through lifestyle modification, but for others, HRT may be the effective remedy for these symptoms.
There are some common myths or misunderstanding about HRT being circulated in the public forum. People may be scared about the potential risks like breast cancer, and may therefore choose to take natural remedies or nothing at all. But what do we know about HRT from the research studies? Click here to find out more.
What are the benefits and risks of HRT?
Oestrogen is the effective component to relieve hot flushes and night sweats while progesterone counteracts the oestrogen's effect on the womb and thereby help prevent cancer of the womb lining (or endometrium). Oestrogen can also help prevent the build-up of cholesterol plagues in your vessels and slow down bone calcium loss, thereby delaying the onset of osteoporosis.
Numerous studies have also demonstrated that HRT can significantly relieve women from hot flushes, night sweets, joint pain, dry vagina and other menopausal-related symptoms far more effective than non-HRT counterparts like black cohosh, red clover, anti-depressants etc. The largest international randomised trial (i.e. WHI trial) demonstrated that if HRT was commenced under the age of 60, there was significant reduction in bone fractures and diabetes mellitus while the risks of developing breast cancer, pulmonary embolism and stroke were very small (increased by <4 in 10,000 women years). For those who were taking the oestrogen-only HRT, the risk of developing breast cancer was reduced compared to the placebo control group.
How many types of HRT are there?
There are many different types of HRT available. Generally, it can be divided into three groups.
1. Combined HRT which contains both oestrogenic and progestogenic hormones.
2. Oestrogen only HRT.
3. Tibolone (e.g. Livial) which is a synthetic hormone that has oestrogenic and progestogenic properties.
HRT comes in various forms, like oral tablet, skin patch, implant, gel or cream. Talk to your doctor to find out which type suits you best.
Who should consider taking HRT and who not?
HRT is recommended for women with any of the following conditions:
1. Having significant hot flushes or other menopausal symptoms which are poorly controlled by lifestyle modification.
2. Reaching early menopause (i.e. age 40 to 45).
3. Being diagnosed with premature ovarian failure/insufficiency (i.e. age <40).
4. Having both ovaries removed surgically before the age of 45
Women with any of the following conditions should not commence on HRT:
1. Aged over 60 due to the increased risk of developing stroke.
2. Past / current history of breast cancer, blood clot tendency (e.g. DVT) and severe hypertension
3. Heavy smoking
What are the common side effects of HRT?
HRT, having lower dose of hormones than the contraceptive pills, is generally well tolerated. Common reported side effects of HRT include nausea, headache, breast tenderness, fluid retention and occasional vaginal spotting.
For how long should HRT be taken?
As oestrogen is important to maintain healthy bones and female physique, women with insufficient oestrogen level before the age of 45 are recommended to take HRT at least until they have reached the average menopausal age of 50. Those who wish to control menopausal symptoms like hot flushes can take HRT for 2-5 years before gradually weaning it off. Those who wish to delay the onset of osteoporosis can take HRT for over 5 years, but the benefits and risks become less clear after 7 years of use as the research data is limited in this regard.
Following are estimated numbers regarding the risks of HRT usage over a five-year period:
Of 1000 women in their 50s
who DO NOT take HRT over five years:
who DO take HRT over five years:
11 may get breast cancer
15 may get breast cancer
84 may get abnormal mammogram screening result
139 may get abnormal mammogram screening result
4 women may have a stroke
6 women may have a stroke
3 women may develop serious blood clots
8 women may develop serious blood clots
For further reading:
Vaginal prolapse is very common in women, believed to be over 30% of the female population. Conservative treatment includes pelvic floor exercises, pessary support and vaginal oestrogen supplement (for postmenopausal women).
Surgical options can be divided into 2 main groups: 1) reconstructive, and 2) obliterative types. The former option is suitable for women who wish to retain vaginal sexual function.
For reconstructive surgery to be durable in preventing recurrent vaginal prolapse, the supportive fascia would have to be strengthened and reinforced, and this can be achieved by a combination of physiotherapy, oestrogen supplement, and native tissue repair using dissolvable sutures. Unfortunately, this approach still accounts for a recurrent rate of 10% to 70%.
To improve on our long term clinical outcome, several approaches have been introduced. Mesh was popularised in the 2000s and not long after, had been introduced worldwide as the panacea for vaginal prolapse.
In recent years, there have been quite a lot of bad publicity against the use of artificial meshes as more and more women reported unacceptable complications like dyspareunia and mesh erosion. Mesh erosion rate was reported as high as 25%.
Cochrane review recently reported a significantly higher rate of needing repeat surgery in women who had transvaginal mesh surgery compared to those who had native tissue repairs.
These complications resulted in some high profile lawsuit in the United States and review by the FDA.
Facing the threat of expensive lawsuits, many manufacturers of mesh began to withdraw their products from the market, e.g. Ethicon, AMS and Bard. AMS which became Astora in 2015 decided to settle more than 20,000 of its own cases for reportedly more than $2.4 billion.
Now, the only manufacturers left to provide transvaginal mesh in Australia is Boston Scientific and Restorelle. Studies on their mesh products are too limited to draw a conclusion on benefits & safety.
Our View & Approach:
We have always been sceptical of the use of transvaginal mesh because of the unique anatomy & function of vagina as opposed to abdominal hernias. So far, all our patients who needed vaginal prolapse repair did not end up having mesh put in.
Our approach to women needing prolapse repair is to have:
1) Good patient selection
2) Proper preoperative preparation
3) Careful anatomical repair
4) Long-term postoperative care
With patient selection, we offer vaginal reconstructive surgery in those whom we think have reasonable healthy native tissue. Those who have very weak tissue / fascia and are not sexually active are given the option for obliterative surgery, also called colpocleisis, which have a very low rate for recurrence and complications.
For those who wanted vaginal reconstructive surgery, every effort is made to strengthen their native tissue and maintain this long term. Our recurrence rate is comparatively low, with only two known cases in the last 5 years! As expected, there have been no reported failure rate for vaginal obliterative surgery in our cohort of patients.
Monday-Friday 9am till 5pm
After hour by request only
Phone: 08 8297 4338
Mobile: 0422 014 044