Your gynaecologist may request that you have a hysteroscopy so that they can see inside your womb. It involves inserting a narrow telescope with a light and camera at the end, called a hysteroscope, into your womb. It’s passed through your vagina and cervix so you won’t need any incisions.
A hysteroscopy investigates many symptoms such as: pelvic pain, heavy periods, unusual vaginal bleeding, postmenopausal bleeding, repeated miscarriages or a difficulty getting pregnant.
Conditions including fibroids and polyps can be diagnosed. Treatment can be provided by way of removing fibroids, polyps, displaced intrauterine devices (IUDs) and scar tissue that’s causing absent periods and reduced fertility.
Laparoscopy is keyhole or minimally invasive surgery. It involves making small incisions to your skin to allow a laparoscope to be inserted. A laparoscope is a small tube with a camera and light source that sends images to a television monitor and allows your gynaecologist to see the inside of your abdomen and pelvis. It’s usually performed under general anaesthetic.
These days laparoscopy is used whenever possible as opposed to open surgery as it has some advantages including: a faster recovery time, less pain and bleeding, a shorter hospital stay and reduced scarring.
Anterior vaginal wall repair
Anterior vaginal wall repair is a surgical procedure that restores a sinking vaginal wall, called a prolapse.
Symptoms of a vaginal wall prolapse include: inability to fully empty your bladder, your bladder feeling full all the time, bladder infections, pressure in your vagina, bulging at your vaginal opening, pain when having sex and, urine leaking when you cough, sneeze, or lift something.
Before an anterior vaginal wall repair you’ll be given a general or spinal anaesthetic. The procedure takes approximately half an hour and involves repositioning your vagina back into its correct place, tightening your bladder support tissues and removing any bulge in your vagina.
Endometriosis is a common, chronic condition for women of childbearing age through to the menopause. If you’ve endometriosis, then the endometrial tissue that normally lines your womb is found elsewhere in your body such as your ovaries, fallopian tubes, vagina, bladder and bowel. The tissue thickens and breaks down with your menstrual cycle but remains in your body and causes symptoms such as: painful or heavy periods, bleeding between periods, pain, swelling and fertility problems.
A laparoscopy will confirm endometriosis. A biopsy may be taken for laboratory testing and surgical instruments can be inserted during the laparoscopy to treat the endometriosis. Endometriosis can come back so you may need surgery again. A hysterectomy may be offered if you don’t want to have children in the future.
A hysterectomy is an operation that removes your womb. This means that afterwards you won’t be able to get pregnant, so it’ll only be recommended if other treatments haven’t been unsuccessful.
A hysterectomy may be advised if you have: heavy periods, chronic pelvic pain, fibroids (non-cancerous tumours), a uterus prolapse or, cancer of the womb, ovaries or cervix.
The decision on the type of hysterectomy is based on the reason for the operation and how much of your womb and reproductive system can be left. Main hysterectomies include: total hysterectomy (most frequently carried out, involves removing the womb and cervix), subtotal hysterectomy (removal of the main part of the womb, leaving the cervix), total hysterectomy with bilateral salpingo-oophorectomy (removal of the womb, cervix, fallopian tubes and the ovaries) and radical hysterectomy (removal of the womb and surrounding tissues: fallopian tubes, part of the vagina, ovaries and lymph glands).
There are three ways to carry out a hysterectomy:
- vaginal hysterectomy –a cut in the top of your vagina is made to remove the womb using general, spinal or local anaesthetic.
- laparoscopic hysterectomy – several small incisions in your abdomen are made to allow the removal of the womb under general anaesthetic and is often favoured.
- abdominal hysterectomy – a cut in your lower abdomen is made to remove the womb under general anaesthetic
Ovarian cyst removal
Ovarian cysts are very common. They’re fluid-filled sacs that develop on a woman’s ovary. Often ovarian cysts disappear after a few months without treatment. Surgery will be recommended if your ovarian cyst is large, long lasting, causing symptoms or, may be or become cancerous.
Most cysts are removed using laparoscopy. Your gynaecologist may choose laparotomy to remove a cyst if it’s particularly large, or if it could be cancerous. A laparotomy is performed under general anaesthetic and a single larger cut is made in your stomach to allow better access to the cyst. The cyst and ovary are then removed and sent to a laboratory to check for cancer.
Removal of ovaries
An oophorectomy is surgery to remove one or both of your ovaries. It’s advised if your ovaries are damaged or to treat conditions including ovarian cancer or endometriosis.
Ovary removal is performed under general anaesthetic either laparoscopically or by open surgery. It can be performed on its own or sometimes it’s carried out as part of a hysterectomy to remove the womb.
The removal of one ovary will not affect a woman’s ability to menstruate and have children but if both are removed menstruation will stop and a woman will no longer be able to have children.
Laparoscopic sterilisation is a type of female contraception. Simply, the fallopian tubes are blocked to stop the eggs from reaching the sperm and becoming fertilised. The ovaries release the eggs as normal but then the body absorbs them naturally.
Laparoscopic sterilisation is the most common method of sterilisation and the fallopian tubes are blocked using clips, rings or tying and cutting the tubes.
Sterilisation can be performed by way of hysteroscopic sterilisation. This involves inserting a tiny piece of titanium metal into the fallopian tubes using a hysteroscope. Scar tissue will then form around the metal and eventually block the tube.
HRT (hormone replacement therapy) may be recommended to relieve symptoms of the menopause (when a woman permanently stops releasing eggs from her ovaries causing her menstrual cycle to stop and she will no longer have periods).
Women moving into the menopause often experience symptoms such as: hot flushes, mood swings, night sweats, vaginal dryness and a reduced sex drive. HRT replaces hormones that are at a lower level as a woman approaches the menopause and relieves some of the symptoms.
Treatment for miscarriage
A miscarriage is defined as a pregnancy loss in the first 23 weeks. Miscarriages are often due to abnormal chromosomes in the baby that result in the baby not develop properly. Following a miscarriage most women will go on to have a successful pregnancy in the future.
Pregnancy tissue may be left in your womb after a miscarriage. You can wait for it to naturally come away, you can take medication that causes the tissue to pass from your womb or you can have it surgically removed. These options will be discussed by a consultant gynaecologist.
Stress incontinence treatment
If you unintentionally leak urine when you sneeze, cough or do physical activity, then you may have stress urinary incontinence (SUI). It’s caused when the muscles that control your ability to hold urine become weak or don’t work.
Initially conservative treatments will be advised including: pelvic floor muscle exercises and bladder training.
If these aren’t successful, then your gynaecologist will recommend an operation. Surgical options for SUI include: tape procedures (tape is used to hold the urethra up in the correct position – for women only), sling procedures (a sling supports the bladder neck and urethra), colposuspension (laparoscopic or open surgery to lift the tissues between the bladder and urethra - for women only) and artificial urinary sphincter (artificial replacement of the urinary sphincter).