In adolescents with physical and/or intellectual disability, many parents or paediatricians will consider menstrual suppression to be an appropriate decision. In adolescents with various disabilities, ranging from mild to severe, the onset of menstruation can cause significant suffering in terms of exacerbation of behaviour or mood or sleep, issues with managing hygiene, and cause additional burdens for parents and carers. In adolescents with significant or several other medical issues, having menses can make life significantly more difficult and also impacts their needs and care. In children with epilepsy, menarche can often exacerbate or lead to a deterioration of seizure control.

In adolescents with disabilities or complex medical conditions it is important that all options be considered, taking into account each girl’s individual needs including contraceptive requirements in the longer term, type of disability, medical history and comorbidities, and personal and carer preferences. Often oral hormonal contraceptives, such as the OCP, are contraindicated due to medical comorbidities or are not as effective due to other medications taken by the patient, such as behavioural or anti-seizure medications, and a more individualised approach is required.

Where the aim of therapy is for menstrual suppression, the goal of treatment is that no menses will occur and amenorrhoea will be achieved. In some cases, it may be the preference to allow  menstruation to occur, however with menstrual regulation, where medications can be used to make menses more manageable for the adolescent.

Medical modalities are highly effective in achieving menstrual suppression and it is nearly always unnecessary for adolescents with even the most severe disabilities to undergo a hysterectomy. A range of options for menstrual regulation or suppression will be discussed, including hormonal therapy which can be given orally, as injection form  and an intrauterine device, which have been demonstrated to have a high safety and efficacy in adolescents with disabilities requiring menstrual suppression and contraception. 

Menstrual suppression in adolescents with disabilities is an important aspect of care in these girls, given the anxiety around the management of this aspect of their lives that is often present for these patients and their carer.  Menstrual suppression in adolescents may be required to manage the complexities of menstrual hygiene, pain and other discomfort associated with menses.

It may be beneficial to consult Dr Brooke about a plan for menstrual suppression prior to the first period, or when early signs of puberty occur, so a plan can be made in advance to reduce anxiety and commence therapy as soon as menarche occurs.

The post Management of Menses in Adolescents with Disabilities or Complex Medical Conditions appeared first on Northside Gynaecology.

Heavy menstrual bleeding (HMB) is a common gynaecological complaint among adolescents with up to 40% having experienced HMB. In the majority of cases, it is an immaturity of the process of ovulation that leads to irregular, either more frequent or longer cycles, and prolonged menstruation. In young women with HMB, particularly in those who are presenting with anaemia and those who are not responding to the usual hormonal attempts to manage HMB, it is prudent to exclude the presence of an underlying bleeding disorder which are not uncommon.

Heavy menstrual bleeding (HMB) is a common gynaecological complaint among adolescents, with up to 40% having experienced HMB. In the majority of cases, it is an immaturity of the process of ovulation that leads to irregular (either more frequent or longer) cycles, and prolonged menstruation. In young women with HMB, particularly in those who are presenting with anaemia and those who are not responding to the usual hormonal attempts to manage it, it is prudent to exclude the presence of an underlying bleeding disorder which is not uncommon.

History should include an assessment of the duration of menses and the pattern of the menstrual cycle. An assessment quantifying the bleeding should be attempted with simple questions such as “how often would you need to change a pad or tampon?”. Adolescents presenting with HMB should be specifically asked about symptoms of anaemia, including fatigue, difficultly concentrating on homework and participating in sports, shortness of breath, and palpitations. Any history of easy bruising, bleeding after dental or surgical care, or family history of bleeding or bleeding disorders should also be sought.

In adolescents with heavy or prolonged menstrual bleeding, it is important to check the full blood count, iron studies[MOU1] , and in some cases screen for abnormalities in blood clotting or bleeding disorders, such as von Willebrand disease or platelet function disorders. In some cases, it is necessary to do a transabdominal pelvic ultrasound.

Sometimes a conservative watch and wait approach is appropriate. However, early and appropriate management of menses in adolescents with HMB is of considerable benefit in preventing morbidity such as iron deficiency and anaemia. The combined oral hormonal pill, progesterone-only hormonal options (Provera or Primolut), and non-hormonal medications to reduce bleeding such as Tranexamic acid (TEXA) are considered first-line treatment. Once regular menses is established on oral hormonal medications, the adolescent may bi-cycle or tri-cycle to reduce menstrual loss. In some cases, where the goal is menstrual suppression, Depot Provera or Mirena IUS can be used. The levonorgestrel intrauterine system (Mirena, Bayer) has been found to be safe and highly effective at achieving menstrual suppression in adolescents with HMB; however, it should only be inserted in consultation with a Paediatric and Adolescent Gynaecologist under general anaesthetic.   

In approaching the adolescent with HMB, education regarding the normal physiology and anatomy of the menstrual cycle should be discussed in detail, with aid of diagrams. When prescribing medication, an understanding of how medications work will improve compliance, and hence the efficacy of treatment. It should be checked that the adolescent and/or her parents/carer understand the instructions, which may require them to be provided in writing.  

Iron deficiency and/or anaemia contributes to morbidity seen in this population, and addressing this contributes to the wellbeing of the adolescent with HMB. It is very important to be specific when prescribing iron replacement, because there exist several over-the-counter supplements that have very low iron content and provide little benefit. I routinely recommend a combined iron formation such as Ferrograd C (Mylan Health) containing ferrous sulfate 325mg (equivalent to 105mg of elemental iron) and sodium ascorbate (equivalent to 500mg or ascorbic acid or vitamin C) for improved absorption, at a dose of one tablet daily. For adolescents who are unable to tolerate oral iron supplementation due to gastrointestinal upset or other symptoms, the availability of newer, safer, more cost-effective intravenous iron preparations such as iron carboxymaltose (Ferinject, Mylan Health) may be used.

In the majority of adolescents with heavy menstrual bleeding, effective management can be accomplished with either hormonal medications alone or in conjunction with antifibrinolytic agents. Management should be tailored to the needs of the individual adolescent, and in cases not responding to routine 1^st line hormonal management such as the COCP and/or TEXA, where there is a significant anaemia, or concern regarding a bleeding disorder, involvement of a Paediatric and Adolescent Gynaecologist and/or haematologist would be appropriate.  

References

1. O’Brien B, Mason J, Kimble R. Bleeding Disorders in Adolescents with Heavy Menstrual Bleeding: The Queensland Statewide Paediatric and Adolescent Gynaecology Service. J Pediatr Adolesc Gynecol 2019; 32(2): p.122-127.
2. Alaqzam TS, Stanley AC, Simpson PM, Flood VH, Menon S. Treatment Modalities in Adolescents Who Present with Heavy Menstrual Bleeding. J Pediatr Adolesc Gynecol 2018. 31(5): p. 451-458.
3. , Santos XM, Dietrich JE, SrivathL. Levonorgestrel-Releasing Intrauterine Device Use in Female Adolescents with Heavy Menstrual Bleeding and Bleeding Disorders: Single Institution Review. J Pediatr Adolesc Gynecol 2017. 30(4): p479-483

The post Heavy Menstrual Bleeding, Iron Deficiency Anaemia and Bleeding Disorders in Adolescents. appeared first on Northside Gynaecology.

Pelvic organ prolapse is an uncomfortable reality for many Australian women. In fact, statistics indicate that 1 in 2 women who have had a baby^[1] will experience prolapse at some point.

Prolapse is when your pelvic organs (uterus, bladder or bowel) bulge down into your vagina. It happens because the support structures that hold your pelvic organs in place have become stretched or torn.

So as you might expect, having a baby vaginally is a common cause of pelvic organ prolapse. As is menopause, when reduced oestrogen levels cause tissues to become thinner and lose their elasticity.

But there are many other factors that can contribute to prolapse.

Causes of pelvic organ prolapse

Pregnancy

The hormones released during pregnancy can cause pelvic ligaments to soften, which weakens them. Combine this with an average 10kg weight gain during pregnancy, as well as the pressure of holding your growing baby in place, and you have a very stressful load!

Long labour and / or big baby

There’s a lot of stretch and strain involved with delivering a baby vaginally. If you have a large baby (over 4kg), the stress on your pelvic muscles can be extreme. An active pushing phase of labour more than 2 hours long can also wreak havoc on your pelvic tissues and nerves.

Heavy weight lifting

Whether you have a job involving manual labour, if you regularly lift heavy weights at the gym, or if you carry heavy things regularly during your day-to-day activities, the increase in intra-abdominal pressure as you lift can put extra strain on your pelvic ligaments. Over time, that can cause some wear and tear.

Constipation

Pushing and straining on the toilet causes enormous damage to your muscles, nerves, and tissues in your pelvis. It’s a huge contributor not only to haemorrhoids, but pelvic organ prolapse too.

Menopause

Once you transition into menopause, your oestrogen levels begin to drop. Oestrogen is an important hormone for promoting healthy tissues, so as your body loses access to it, your ligaments and muscles will start to become thin and lose their elasticity.

How do I know if I have a prolapse?

You might experience any of the following symptoms:

• Feeling a bulge in your vagina, or protrusion from the vagina
• A feeling of fullness or heaviness in the vagina
• Trouble going to the toilet
• Discomfort in your abdomen or lower back
• Regular urinary tract infections
• Pain or discomfort during sex

What can I do to avoid prolapse?

If you’ve been diagnosed with prolapse, or think you may be at risk of developing it, there are things you can do about it.

Stay regular

Avoid constipation by maintaining good fluid and fibre intake. Try to drink 2 litres of water and consume 30g of fibre every single day. Fibre is abundant in loads of healthy foods such as wholegrains, nuts, fruits and vegetables.

Don’t strain

If you are feeling constipated, don’t strain! Instead, increase your fruit and water intake, or drink a soluble fibre supplement.

Lift sensibly

This means gently contracting your pelvic floor before you bend down to life something. Also, make sure you breathe throughout your lifting exercise – many people hold their breath when lifting, which puts extra pressure on your pelvic muscles.

Maintain a healthy weight

Carrying extra weight adds to the burden of your pelvic muscles. Gravity is something that none of us can escape – and the more weight it pulls downward, the more stress your ligaments endure every day.

Quit smoking

There’s a million reasons why smoking is bad for you… and here’s another one. Smoking not only does significant damage to your cells and tissue health, but it also is the cause of smoker’s cough. Constant coughing has an effect on your pelvic ligaments kind of like snapping an elastic band – sooner or later, the band loosens.

Do Kegels

Pelvic muscle exercises strengthen and retrain the muscles of the pelvic floor. Doing them daily can help improve (or prevent) prolapse and its wicked little sister – urinary incontinence. Doing them is easy – just squeeze your muscles as though you’re stopping urine mid-stream. Try for 4-8 sets of 10 squeezes over the course of each day. You’ll soon notice the difference!

See your GP

If you notice something feeling different in your vagina, or experience symptoms associated with pelvic organ prolapse, it’s important to talk to your doctor about it. Although it can be an unpleasant thing to have to talk about, early intervention can help you avoid ending up needing surgery to correct the problem.

At Northside Gynaecology, our all-female gynaecologist team are dedicated to providing compassionate and quality care for your gynaecological health. To book an appointment at one of our convenient North Brisbane locations, click here.

^[1] https://www.ncbi.nlm.nih.gov/pubmed/19629013

The post How to reduce your risk of prolapse appeared first on Northside Gynaecology.

Read on for the full transcription of the podcast, or listen to it here.

Jess Rendall:
Okay.

Archna Saraswat:
All right, let’s go.

Jess Rendall:
Shall we?

Archna Saraswat:
We shall. Yep, absolutely.

Jess Rendall:
So. Hey, thanks for tuning in to Convo Radio, your go-to podcast for chats on career, identity, the highs, lows, and pretty much anything that makes up this crazy thing called life. We’re bringing you real stories from everyday people, giving you an insight into their journey. So if you’re feeling particularly nosy today, you’ve come to the right place. I’m your host Jess Rendall. Grab a seat. Let’s have a convo.

Jess Rendall:
Our guest on this episode is Brisbane-based gynaecologist Archna Saraswat. She’s had years of experience in the game down under, pun intended, and chats to us today about vaginal health, how often you should be seeing your gyno, debunking myths and helping break the stigma around talking about your vagina. Ladies and supportive boyfriends and partners out there, this one’s for you. Keep listening for a crash course on keeping your lady parts fresh and fancy.

Jess Rendall:
Also, this podcast has definitely got a break some sort of record for the most times the word vagina is used in a podcast. My first question, can you tell us a little bit about your life so far and how you came to be a gynaecologist? Because I’m always so fascinated by gynos because are there kids out there that are dreaming of becoming a gyno? Or do you just wake up one day and you’re like, “You know what I’m going to be …” How did you–

Archna Saraswat:
I would love to look at vaginas.

Jess Rendall:
Yeah, how did you come to find yourself in this career?

Archna Saraswat:
I don’t think it happens like that for anyone. Unless you have a parent who’s a gynaecologist, and you just kind of fall into it there. One thing I always wanted was medicine. There was nothing else I ever wanted to do right from grade 10. Grade 10 I knew I wanted medicine. Getting into medicine in India is very, very, very hard. You have hundreds and thousands of kids who sit into a qualifying exam and then a small percentage gets picked up to go into a med school. So it is, it’s very hard. So, I kind of knew in grade 10 this is what I want to do. I still remember having these conversations with my best friend that if I don’t get into medicine, what am I going to do? So I always knew I wanted medicine.

Archna Saraswat:
Then I used to think that I wanted to do dermatology because your patients never die. They never, they never get cured. They’re yours for life. You have an easy life and it’s pretty good. So, I always thought I wanted to do dermatology. Then when I was an intern, I thought, I got interested into ophthalmology, but somehow that; so this is, this is the way life was going to go. I eventually thought I was going to the U.S. I did my qualifying exams. I had interview calls for there, but I had my life charted out. I was going to be either a psychiatrist or a GP in the U.Ss I wasn’t going to do anything else. But the way life panned out, I didn’t go to the U.S. either and I had all these interview calls lined up, but things happened and I didn’t go. What happened in the meantime though, I was thinking I’ll go to the U.S., and if I had gone to the U.S. yes, I would have been a psychiatrist probably.

Archna Saraswat:
I did this little house job, this two month job in cardiac surgery. This was my real exposure to operating theatres and working in an operating theatre, which was a very complex scenario. That’s when I discovered that I was very passionate about working in theatres. So, that’s how everything else got chucked out, and I discovered that I love operating. So, now when you start to look at what are you going to do as long term when you’re—as a surgeon, as an operating person, you could either be a general surgeon. You could be a cardiac surgeon, a neurosurgeon, an eye surgeon or ENT, the ear, nose, throat people and or it’s gynaecology.

Archna Saraswat:
So it started ruling out, I hated general surgeons as I didn’t like the people I worked with as in general surgery. So, general surgery was out. Cardiac surgery messes up your life forever. You have no life at all. So, that was out. Same thing with neurosurgery. You have, practically speaking, you have no life. So, that was out. I do enjoy my life. Somehow, it came down to what is it that gives you a lot of operating, a lot of patient exposure and, which is complete in itself and that was gynaecology.

Jess Rendall:
It’s interesting how life pans out. Hey, like you never really expect it, but just sort of somewhere along the way I narrowing things down.

Archna Saraswat:
Yeah, absolutely. I’d never thought I’d be a gynaecologist. It was never part of the plan. The plan was to have a very easy life. So, that changed.

Jess Rendall:
Okay. So I know there’s a massive stigma around talking about your privates. I guess they’re called privates for a reason, and this stops a lot of people from attending a gynaecologist. Do you have any advice for ladies out there who are nervous about the kinds of questions a gyno I might ask them or anything or they’re sort of hesitant about going?

Archna Saraswat:
I think—first thing, this is what—nervousness is not going to the gynaecologist. The nervousness I think is going to the general physician. Going to your GP and telling them you have a problem, because what will happen most of the time is when you go and see your GP and this happens. They are busy people, they have slots. You’ve gone for, let’s say, a fever. They’re probably not going to ask you, do you have a bad period or do you have pain or whatever else. Which means the patient has to now come up with and say, “Hey, I’m going through such and such.” That’s number one. So if in case you have—you somewhere down the line are able to get over that hesitation to talk to your GP. After that, it’s easy. It’s that first step. The second thing is knowing that something is wrong.

Archna Saraswat:
Now, let’s just say because every woman has only one period. How would you know that period is abnormal? You don’t. Nobody knows you have an abnormal period unless it’s suddenly changed drastically and if it hasn’t, then you will have no clue. Not being able to even identify there’s a problem, you’re never going to talk about it.

Jess Rendall:
Do you think that comes from the stigma around people not talking about it with each other?

Archna Saraswat:
The women don’t talk about this. It’s a very simple thing. Let me ask you this way. How many times have you asked your friends how many pads or tampons would they be using on a really heavy day?

Jess Rendall:
Zero.

Archna Saraswat:
Nobody talks about it. So, that means if someone’s using more than four or five even, in a day, that’s not good. That’s not normal. If somebody has clots of flooding, that’s not normal, but nobody talks about it.

Jess Rendall:
So then you don’t know, if it’s not—you don’t know if your friend’s having it.

Archna Saraswat:
I have patients coming in, who go eight to 10 times to change during the day and they maybe get up to two, three times in the night to change, and they’ve done that for years.

Jess Rendall:
Wow. And they’ve just never known that it’s…

Archna Saraswat:
Nobody talks about it.

Jess Rendall:
Exactly. So, you don’t—that’s a very good point. How often should I be seeing a gynaecologist? So, I know pap smears now that every three to five years, but what’s the difference between getting a pap smear and going to a gynaecologist?

Archna Saraswat:
So, the first thing is there are new pap smear guidelines, and it’s no longer called a pap smear anymore, it’s a cervical screening test. It’s a CST. With the new guidelines, now what has changed is initially pap smears is what they were called, were done when a woman was sexually active. That could be at the age of 18 or whatever it was, and you would look for changes on the cervix, which means you’re looking for something which goes from being normal through a series, reaching that end point cancer. You’re looking for changes in between so that nobody ever reaches that end point. What we now understand about cervical changes is that they are caused by the human papilloma virus.

Archna Saraswat:
So, what the new cervical screening guideline is, look for the virus. If someone has no viral infection, then they don’t have to be tested for five years and your GP can do that. You don’t have to go and see a gynaecologist for that. So, frankly speaking, you don’t see a gynaecologist till you’re referred. You go and see your GP, you talk about your problems and if in case it needs a referral, your GP will organize it.

Jess Rendall:
What kind of questions should we be asking our gyno?

Archna Saraswat:
That’s interesting. It’s not what questions you ask your gyno. If you go to your gyno with the problem, it’s what questions she’ll ask you. And because now the job is to find out. Let’s say someone comes to me with…and you know what? That’s the thing. I have patients, older women or even younger ones sometimes, and let’s just talk about something really simple. Itching, itching on the vulva. Vulva is the skin on the outside. They will have itching for years and they have never been to the GP and said, “it’s just so embarrassing.” So, unfortunately it’s the embarrassment. So, it’s not about what you’re going to ask your gynaecologist. It’s what you have told your GP and then you will go to your gynaecologist and hopefully she will not just ask you that one question, she’ll ask you everything. That’s what I do. I ask my patients. They might come with an X problem, but I want to know everything, which means we’ll dig out more stuff.

Jess Rendall:
What role does your diet play in the health of your vagina?

Archna Saraswat:
Not much. No. There is not—interestingly, there is not much evidence that diet plays a role, but then every person is different. If you thought you were doing something that works for you, go for it.

Jess Rendall:
I’ve heard this a lot and I’m not sure if this is a myth, but is pineapple juice supposedly good? Is that a thing?

Archna Saraswat:
All right. When we talk about things that affect the pH of the vagina and there is really not much evidence for food, but we do know that it will help bladder. So things that, as are defined, the urine will help the bladder, but there is really not much evidence on whether diet changes will make a change to the vaginal health.

Jess Rendall:
Okay. That’s really interesting because it’s such a big—again, another myth, and people are like “it’s what you eat and if you don’t then…”

Archna Saraswat:
But if it works for you, there’s no harm in doing it either.

Jess Rendall:
Yeah. Are normal body washes and soaps bad for your vagina? Should we be using like a specialized wash, with the whole pH level thing?

Archna Saraswat:
Yeah, I know. All soaps are bad for you. First thing is you don’t need to—now, first people have—people don’t understand what a vagina is. Most women have no clue what a vulva or what a vagina is. Vagina is on the inside, the vulva skin is on the outside and everyone should be using a soap-free wash for all over their body. All these scented soaps are horrible, especially if you have an itchy skin, go soap free. Something – you know, Dermavene, QV – go to the pharmacy. There’s a whole range there of soap-free washes. So, any wash which is scented is bad for you. Baths are terrible for you. So, especially with the bubble baths and things like that, they’re not really good. Showers are great. Please go for that. At the same time though, if we are talking about; and I know there are women who will douche their vaginas on a regular basis. Nobody should ever do that. It changes the vaginal flora. It changes the vaginal bacterial, what we have; we have healthy bugs there and you don’t want to change their composition.

Jess Rendall:
I did not know that. I always thought, you know douching was quite a regular thing that people do and cause they sell them in the chemist. You’d go to the section for vaginal health and there’s all these washes and then there’s douches and stuff like that. So, that’s interesting that it, you should not be doing that.

Archna Saraswat:
Never ever, ever. Nobody needs to do that.

Jess Rendall:
Can you tell us a little bit more about pH levels and what that means in the vagina talk? I guess we mentioned that a little bit.

Archna Saraswat:
So, the normal pH for the vagina is acidic and that prevents bacterial growth. So, that is what the vagina does by itself because of the normal bacteria, which live there. So, you don’t really have to do anything for it.

Jess Rendall:
Okay. Can we talk about bodily fluids, discharge periods, stuff like that? I know everybody’s different, but what kinds of signs maybe colours or things like that should we be looking for in our discharge to know that there’s an issue?

Archna Saraswat:
The first thing is to understand a discharge as normal because sometimes I’d have young girls coming to me for advice because they have this continuous discharge for months and years. That is normal. Some vaginal discharge is normal and it will change character based on which part of the cycle you are in. So in the first half of the cycle; so, the cycle starts from the day one of your period and it could be anything between 21 to 35 days, which is normal. Anything less than that or more than that is not normal. So the first half of your cycle is when the period, the discharge is thin and watery and the second half of the cycle it can get really thick and sticky. So, some discharge is normal. That is there. When we talk about something which is abnormal, that means it is causing other symptoms. It could be irritation, itching, pain, it smells really bad. Then again, some smell and some odour from the vagina is normal. So unless you’re having symptoms like itching, burning pain you would normally say it’s the normal discharge.

Jess Rendall:
That’s a really relieving thing to hear like a gynaecologist say, because I know a lot of girls and because of that stigma around it being you don’t talk about it with your friends. So you could just be looking down and being like, “Oh my gosh, what’s happening? Am I—is this wrong? Is something wrong with me?” But that’s good to know that burning and itching and until there’s pain then that’s assigned to sort of look out for

Archna Saraswat:
Plus if, in case, you see a sudden change in character, it becomes like cottage cheese or something, that’s different. But if in case it is, this is something you’ve observed for months and there are no other symptoms and most likely it’s just a normal discharge. Yeah.

Jess Rendall:
I also really liked the point that you mentioned before that baths are really bad for you.

Archna Saraswat:
Especially the bubble baths.

Jess Rendall:
Can you expand a bit more on that? Because people love, “Oh treat yourself, I’m going to go home, have a nice bath with a nice glass of wine.

Archna Saraswat:
That’s right isn’t it? It is relaxing, I guess. Maybe if you use some simple bath oils, maybe. The thing is if you’re going to be using chemicals, especially with the bubble baths and stuff, it irritates the skin. So, especially if you are a sensitive skin person, you should not be doing that at all.

Jess Rendall:
People are so obsessed with bath bombs and all these things that they’re putting into—

Archna Saraswat:
And all that. You think of all those chemicals now going into the vagina and changing the vaginal flora. So, not really.

Jess Rendall:
Stick to showers.

Archna Saraswat:
Stick to showers. Hot baths are not good for the skin and especially if you have sensitive skin. So if you have an issue, you’re making it worse by having a hot bath.

Jess Rendall:
Wow. Well, If I learned anything today, it’s that baths are bad. I never knew that before. What’s something that you can do every day? Something that you can like incorporate into your daily routine that will keep your vagina healthy, fresh as a daisy?

Archna Saraswat:
The simple answer to that is nothing.

Jess Rendall:
Wow.

Archna Saraswat:
You don’t need to do anything at all. Soap-free washes, have your shower. That’s it. That’s all you need to do. Cotton underwear are the best. Having said that, of course it’s not very sexy. This is not what the models are wearing. This is not what you see on all those stars wearing when they have pictures done, but that’s the best. Cotton underwear. Avoiding hot baths. This is vulval hygiene, avoiding hot baths, especially in the summer months. With the summer coming up, skirts are better than trousers.

Jess Rendall:
Air it out.

Archna Saraswat:
Skirts are better than trousers. If you went to the gym and you’re wearing Lycra and it is all wet and yuck, when you come home, change.

Jess Rendall:
Healthy, that keeps it fresh.

Archna Saraswat:
That’s right. Keeps it fresh.

Jess Rendall:
I know there’s no such thing as a silly question, but can you take us through maybe some of the crazier, craziest encounters or some of the silly questions you might’ve been asked as a gyno?

Archna Saraswat:
I don’t know. That’s a very hard one, actually. I like, which is a silly question? You’re right. There are no silly questions.

Jess Rendall:
I feel like I’ve asked you a few silly questions today, and you’re like, “don’t do anything.”

Archna Saraswat:
I don’t really. I don’t think there are any silly questions at all, but I think a lot of times people just carry these notions in their head of let’s say, what a normal vulva should look like. I would really urge all the listeners maybe to—there’s something called the vaginal wall, the wall of vagina, that is what it is called. If you Google the wall of vagina. It’s a misnomer though, because it is not vaginas they’re showing, they’re showing vulvas and this is an artist who has actually taken moulds from normal women and who— I’m like, “wow, those women were fantastic because they allowed someone to take a mould of their vulva and put it out there on the wall. So what he has done, he’s gone around asking normal women taking some moulds and those are put together as the wall of vagina. What that shows is that every person is different. Every woman is different and you don’t have to look like anybody else. So, which is where sometimes you feel, when you have these young girls coming and they’re like, “Oh, I don’t look right.” No, you look right.

Jess Rendall:
Yeah, because there’s no one way that it should— I think that’s a big thing as well, especially in younger girls. They see, wherever that they’re looking, and they see these images of vaginas that are supposedly so perfect, and they look at their own and then they think, “Oh, is there something wrong with me?” Then they get insecure, maybe when they start interacting with males and all this sort of stuff. So, I guess it’s just about breaking that stigma. There is no normal.

Archna Saraswat:
Every person is different and every person has a different normal. Having said that, what you looked at on the net, it was probably airbrushed.

Jess Rendall:
So, it’s not exactly…

Archna Saraswat:
It’s probably not normal either.

Jess Rendall:
Just like there are with models and their faces. I guess it’s no exclusions for vaginas as well.

Archna Saraswat:
I would really say it’s a misnomer though. It says wall of the vagina, the wall of vagina, but it is not the vagina. They’re showing the vulva, but it is what–I showed that to my patients and whatever it’s worked with. I think it is really important to understand. It doesn’t just—doesn’t mean if you don’t look like the other person you have normal, not normal. You are normal still.

Jess Rendall:
Everybody’s different. What do you love most about your job?

Archna Saraswat:
I love every bit about my job. I completely adore what I do and I really enjoy my work. I think it’s—I don’t know, it’s very hard to put together and say what do you love the most? I love the operating. I love looking after my patients. Being able to talk to them when they come with their problems and you’re trying to figure out what and how can you help them. So I love every bit of what I do and I think it’s really important. It doesn’t matter what you do. If you don’t enjoy what you do, then it is work and you’ll never get good at it. If you enjoy what you do, then it’s not work anymore and it’s fantastic.

Jess Rendall:
I love hearing that. It’s just so inspiring to see people who are doing their careers and you wake up in the morning and it’s not like, “Oh God, I’ve got to go to work.” Or, “Oh, I can’t wait for the weekend.” I just really hope that one day I find that something where I wake up and it’s like, “yes, I’m excited.” You’re excited for your week, not just your weekend.

Archna Saraswat:
I’m not saying we don’t look forward to it. Then I’d be abnormal.

Jess Rendall:
It’d be weird if you didn’t.

Archna Saraswat:
That’d be super weird. Definitely look forward to the weekends, but completely adore and enjoy every bit of what I do. Having said that, we are a team of people here where we work. I can’t take the Northside Gynaecology is where I am obviously. We are a group of gynaecologists and with the staff and I think it’s the whole team. Our team is fantastic and I don’t know how many specialists you’ve ever seen in your life, Jess. I don’t know that, but have you ever been to a specialist waiting room where people are laughing?

Jess Rendall:
Not really, no.

Archna Saraswat:
Sometimes, I can be sitting in the office and I know the girls are outside and the patients waiting out there and they’ll all be having a big laugh.

Jess Rendall:
Guys, I’m trying to do my work.

Archna Saraswat:
Oh my God, they’re having a party there. So, I think all of us as a team, we really enjoy what we do.

Jess Rendall:
That’s really important as well, it’s the people that make it. What is the biggest challenge that you’ve had to overcome in your career or maybe in the period leading up to getting in your career as a gynaecologist?

Archna Saraswat:
It’s interesting. I think if you are getting into medicine, be prepared for a long, hard road. There is no other way around it. You can’t you—there’s nothing in which can say that it is easy. It’s not, it’s really long. It’s 15 to 20 years to get to this point. So, it is long. It is hard and if you don’t enjoy the process, don’t do it. That’s number one. It’s especially because I’m an immigrant. I immigrated from India. I’ve done my basic degree and I did my specialization in India and then in 2004 I moved with the boys and I came to Australia and I really wanted to learn something different.

Archna Saraswat:
I wanted a different—just to see how it is done somewhere else. I remember we moved, my oldest son, Arush, was seven, the younger one was turning four and my husband didn’t come with us. We lived apart for almost two and a half years before we got together back again as a family. It was very hard with the kids. I think if I look back, the hardest thing I’ve ever, ever done in my life is where I did one week of nights in Melbourne as a training registrar and I had no one to look after the kids, and I couldn’t afford a nanny. Frankly speaking, I couldn’t afford a nanny. I didn’t have enough money at that time to afford it.

Archna Saraswat:
So, I used to take the boys for the hospital with me. They would sleep in the duty room and we were very lucky. We had an apartment across the road. Literally 15–10 meters across the road was my apartment from the hospital. They would sleep in the hospital duty room because I was too scared to leave them alone in the house. What if you have a fire? What’s going to happen? At 6:30, 6 o’clock, whenever I had five minutes in the morning, I would drop them back to the apartment. Their job was to get ready, get dressed, eat your breakfast, which is sitting in the fridge, all you have to do is take it out and heat it and get your lunch boxes. They’re ready. It’s all in the fridge. All you have to do is take it out. Which we would have done that prep the night before, the day before because I was working nights. I would finish my handover at 8:30 and run home and we’d roll around to the school.

Jess Rendall:
Wow.

Archna Saraswat:
So I think that was the toughest week in my life ever.

Jess Rendall:
So it’s just that sort of, you really wanted it that badly, that you were willing to sacrifice and give it 110%.

Archna Saraswat:
It is, but you know what? You have to be. You have to be passionate about wanting medicine, otherwise it is a chore and it’s a very long chore.

Jess Rendall:
I guess with any career, it’s sort of hard for students. The majority of my listeners are still in university. I think it’s hard to kind of picture that journey. All the difficult times because all you sort of see is, you’re studying law or you’re studying medicine or journalism or whatever it is. All you’re thinking about is you’re looking up at all these role models and you’re saying, “wow, you know, they’re doing great things. I can’t wait till I’m there.” But what you don’t see is how hard that they’ve worked. All the late nights, all the sacrifices that they’ve had to make. What would be your biggest piece of advice to someone studying medicine?

Archna Saraswat:
Oh gosh. Just enjoy the process. Yeah. Because you know what? I think that all of us—and this is something; I work with a group of gynaecologists and I have known some of them when I was training at the registrar. What I like about the people; if it’s work, it’s work. That’s the way it is. You’ll have to do the work. There’s no other way around it. But if you’re going to whinge and do the work, then that’s awful.

Jess Rendall:
Yeah.

Archna Saraswat:
Enjoy the process for whatever, and you know what? It’s not just medicine. There are whole lot of other professions out there now which burn the night oil. Enjoy the process. That’s what it’s all about. If you can enjoy the process, the end product will be great.

Jess Rendall:
We’re going to move on to our next segment. So, I do a little thing called power questions, where I ask whoever I’m interviewing a power question.

Archna Saraswat:
Whatever that is.

Jess Rendall:
Whatever that it, I haven’t figured that out yet myself, but what’s a motto or a quote that you live by? Something that’s sort of always kept you going?

Archna Saraswat:
Winners don’t quit and quitters don’t win.

Jess Rendall:
That’s a good one. Keep going, keep working.

Archna Saraswat:
Get it done. That’s it. If it’s point a, you want to go, unless you change where you want to go and if it is going to take the X amount of work, you’ll have to do it.

Jess Rendall:
What’s one thing you wish you knew at 20?

Archna Saraswat:
Oh, I don’t know. That’s interesting. I don’t know. I don’t think anything else. No.

Jess Rendall:
No?

Archna Saraswat:
I seriously think, live what you have. Retrospect, hindsight is the worst thing you ever do. You made the best decisions you made on the day based on the information you had and there’s no looking back.

Jess Rendall:
That is a really good answer because I guess everything that you did leads you up to where you are now and if you’re happy with where you are now, then I guess, you wouldn’t change.

Archna Saraswat:
I wouldn’t want. I wouldn’t change a thing I wouldn’t, and believe me, there have been. There are days when you’re really struggling, but that’s all right. That’s part of the process. So no, I don’t think I would want to know anything else. Just leave it. That’s it. It’s good.

Jess Rendall:
Just leave it at that.

Jess Rendall:
okay. Now I have another segment called, “don’t get me started.” So it’s a little rant. It’s a little time for you. You can just vent. Get out whatever’s on your mind. Do you have a specific topic you want to vent about?

Archna Saraswat:
You know what? It’s interesting and I think my only rant would be you spend money and time to go and see a specialist, any specialist, and they give you advice based on 20 years of hard work they have gone through, based on evidence, which is not theirs, which is based on years and years of research, which has come together from the world over and they put together an advice for you and then you go home and talk to your friend or Google it and say, “nah, I won’t do this.”

Jess Rendall:
Yeah, I know what you mean.

Archna Saraswat:
That is probably my biggest frustration is I know it is good for you, but your friends said it wasn’t so it’s okay,

Jess Rendall:
So, who are you going to listen to? Your medical practitioner who’s had years of training and experience or your friend who says, “nah.”

Archna Saraswat:
Having said that, this is interesting. People don’t do that to plumbers. You never ask your neighbour, is this plumbing going to go this way or that way? You just do what your plumber tells you to do, but when it comes to your body, you don’t want to listen to your specialist. You’d rather listen to someone who probably doesn’t really know that much.

Jess Rendall:
And as you said before, everybody’s different. So it’s someone’s experience. Whereas, all the pipelines in your sink are all the same and every house, give or take. So I guess the plumber can be doing his job similar, but when it comes to your bodies and everybody’s so different, you can’t be comparing.

Archna Saraswat:
True. Very true.

Jess Rendall:
Okay. So our next segment is called “check it out.” This is something I do where I ask the person I’m interviewing to recommend something they’ve been obsessed with lately, whether it’s like a workout, maybe going for walks, or it’s a food item, music, TV show.

Archna Saraswat:
Okay. All right, and this is interesting because I think the one thing I have been really doing it for a while, that’s intermittent fasting.

Jess Rendall:
Oh, okay.

Archna Saraswat:
So, I have exercised regularly all my life. Seriously, I’ll get up and I’ve gone for swims, or whatever. I exercise regularly all my life. I can’t think of when I haven’t. Then I was stuck at this weight and I was trying to lose a little bit more and it wouldn’t budge. Then my husband and my oldest son Arush, they started, they all right, we’ll do intermittent fasting. They started it in January last year and I was like, “Hey, if you’re going to do it, I may as well do it, too.” So, I think that’s one thing I found that you know what? It works.

Jess Rendall:
Wow. That’s actually a very good point. I know a lot of people are starting to do that. My dad was doing that for a while.

Archna Saraswat:
Did it work for him?

Jess Rendall:
Yeah, he dropped from a 36 to a 34 or something or no, 38 to a 36. Two sizes down. I guess there’s just this thing in your mind, you have your set times. Breakfast, lunch and dinner. I must eat at all these times, but there’s a study that was done on this community in Japan. I think they were an Eskimo community or something like that, and they only ate when they were hungry. That changed the whole ballgame for them. So, kind of listening to your body and not just—I guess our bodies had been trained to be hungry at breakfast, and lunch, and dinner, and all these kind of meal times in a day, but it’s really not that normal to be having three full meals.

Archna Saraswat:
That was very exciting because initially it was hard and you’re right, the body thing. “Ah, breakfast,” and now we are doing intermittent fasting. So, not today, but it works. It works really well. So, I think that’s probably been my thing for the last year or so.

Jess Rendall:
Nice. I like that. That’s a good thing to have for people to check out.

Jess Rendall:
I have this little game that I play. Basically, I give you a letter of the alphabet. We can have a little fun here.

Archna Saraswat:
I might fail miserably on this one, but let’s see.

Jess Rendall:
It’s fun. It gets your memory jogging. So, and there’s two, four, six, eight, 10 different categories I’ll ask you. So, I’ll give you a letter of the alphabet, and then I’ll say the category. So, for example, I don’t know a food type or whatever as fast as you can, but you only have a minute.

Archna Saraswat:
God, now I’m sweating.

Jess Rendall:
Okay, so your time starts after I finished the first question and your letter is A for Archna. Okay. What is a boy’s name?

Archna Saraswat:
Arush.

Jess Rendall:
A city?

Archna Saraswat:
Amritsar.

Jess Rendall:
Girl’s name?

Archna Saraswat:
Archna.

Jess Rendall:
Country?

Archna Saraswat:
Argentina.

Jess Rendall:
Occupation?

Archna Saraswat:
An occupation?

Jess Rendall:
It’s a hard one.

Archna Saraswat:
Yeah.

Jess Rendall:
You can pass and I can get back to you.

Archna Saraswat:
We’ll get back to that one, I’m thinking.

Jess Rendall:
Animal?

Archna Saraswat:
Antelope.

Jess Rendall:
Celebrity?

Archna Saraswat:
Angelina Jolie.

Jess Rendall:
Movie?

Archna Saraswat:
America. Whatever, it must be something.

Jess Rendall:
Song?

Archna Saraswat:
I only know Bollywood songs. I wouldn’t even be able to think of English songs, I’m sure.

Jess Rendall:
Is there a Bollywood song beginning with A?

Archna Saraswat:
Oh, there are plenty.

Jess Rendall:
You want to name one?

Archna Saraswat:
Oh my god. Oh God. Now I’m on the spot. Song?

Jess Rendall:
You’ve got one more left after this. Do you want to pass this one for now?

Archna Saraswat:
Okay, let’s leave it for a second.

Jess Rendall:
Okay, colour.

Archna Saraswat:
There is a colour by A?

Jess Rendall:
Is there?

Archna Saraswat:
Amaranth or something like that. No?

Jess Rendall:
Amethyst is a colour?

Archna Saraswat:
Amethyst is a stone, though. A colour. God. That’s bizarre. I don’t think—

Jess Rendall:
Arush is looking at us.

Archna Saraswat:
A-purple?

Jess Rendall:
All right, well, you got seven out of 10 that’s pretty good. That’s pretty good. I reckon, what would be the colour Arush is dying to say?

Arush:
Amber.

Archna Saraswat:
What occupation would you have by A?

Arush:
Architect.

Jess Rendall:
Ah, architecture, architects.

Arush:
I would’ve gotten 10 out of 10.

Archna Saraswat:
And the name of a song? Song. [Bollywood Song] That’s right.

Jess Rendall:
Do you guys want to sing it for us?

Arush:
No.

Archna Saraswat:
You do want people to want to keep on listening to your podcast in the future. So, I don’t think we go there.

Jess Rendall:
Oh, well, we like a bit of multiculturalism here. Well, that brings us to the end of the podcast for today. Thank you so much for letting me interview you.

Archna Saraswat:
It’s been fun. Thank you so much for having me and it’s been brilliant.

Jess Rendall:
Awesome.

Archna Saraswat:
Wonderful experience.

Jess Rendall:
Thank you, Archna.

Archna Saraswat:
You’re very welcome. It’s been a pleasure.

The post Everything Your Gynaecologist Wishes You Knew (Podcast) appeared first on Northside Gynaecology.

Northside Gynaecology celebrated its 5th birthday on Friday, 18th October 2019. We had a great night reminiscing over the past 5 years and anticipating what the future holds. We would like to take this opportunity to thank each and every person who has walked through the NSG doors, both patients and staff. The future is bright and we look forward to continuing to support and improve women’s health. 

The post NSG turns 5! appeared first on Northside Gynaecology.

Four presentations on the topic, The Enigma of Pelvic Pain were given to 62 attending GPs over a three course meal. Northside Gynaecology’s newly appointed team member, Dr Brooke O’Brien spoke on Pelvic Pain in Adolescence, Dr Liana Tanda explored Acute Pelvic Pain, Dr Caroline Wewengkang talked on Chronic Pelvic Pain, and Dr Archna Saraswat wrapped up the night with Pain in Menopause.

A big thank you to all the guests and organisers for such a successful night. We’re looking forward to seeing everyone again next year!

The post GP Symposium | 4th September 2019 appeared first on Northside Gynaecology.

A popular method of temporary contraception among women is the Intrauterine device, or IUD, which may be hormonal or non-hormonal. In Australia, the hormone-releasing IUD available is called Mirena™.

Mirena™  is a T-shaped device that is placed into the uterus to prevent pregnancy. It works by slowly releasing a progestin hormone into your uterus, which help create an environment that’s unsuitable for fertilisation to occur.

Reasons why Mirena™ is an attractive choice for many women include:

• It’s designed to stay in place for 5 years, making it a long-term solution
• It is over 99% effective in preventing pregnancy
• After it’s removed, your fertility will go back to normal within a month
• You don’t have to remember to take a pill every day
• It only costs around $40 (plus the cost of your medical visits to insert and remove it)

But the benefits don’t stop there. Did you know that an IUD can also help treat other gynaecological conditions too?

Let’s look three non-contraceptive benefits of using Mirena™.

Mirena™ can help relieve heavy and painful periods

Mirena™ has been found an effective nonsurgical alternative in treatment of heavy bleeding (menorrhagia). It’s estimated that around ⅓ of women^[1] will experience heavy bleeding in their life.

Signs of heavy bleeding include:

• If you soak through a tampon every 2 to 3 hours
• If you have to wear both a tampon and pad for extra protection
• If you have to get up during the night to change your tampon or pad
• If you stain your clothes or sheets as a result of a heavy period or passing clots

Mirena™ has been shown to provide such impressive symptom control for women with heavy periods, it’s considered a comparable option to surgery^[2] to manage heavy bleeding.

In a clinical trial of Mirena™ in women with heavy periods, the majority of women reported an 80% reduction in bleeding after just 4 months of inserting the device. What’s more, that reduction in bleeding progressed to 95% within 2 years of using the Mirena™^[3].

Mirena™ can help ease endometriosis pain

Although Mirena™ has been used as a contraceptive since the 1990s, in recent years gynaecologists have begun investigating its possible use for the treatment of endometriosis.

Hormonal therapies aim to reduce the pain of endometriosis by suppressing the growth of endometrial cells, as well as reducing bleeding. Considering that oestrogen helps the growth of endometrial tissue, hormonal contraceptives such as the Mirena™ can help suppress this tissue growth by providing a progestin predominant environment.

Studies have found that progestins (such as those used in Mirena™) have been proven to provide pain relief for 3 out of 4^[4] women with endometriosis. So if you suffer from endometriosis, the Mirena™ is something to consider speaking to your gynaecologist about.

Mirena™ can help prevent some gynaecological cancers

Research has shown^[5] that using an IUD can prevent the uterine lining from building up, which in turn can stop abnormal cells from developing.

In some cases, the IUD can even lead to a reversal of abnormal cell growth, making it a potential treatment for early stage endometrial cancer.

This is potentially great news for women who are considered high-risk surgical candidates due to obesity or cardiovascular risk factors.

Additionally, women who cannot take oestrogen (such as breast cancer survivors or those that suffer from migraines) may consider using a progestin-releasing IUD such as Mirena™ for contraception.

That being said, the relationship between IUDs and breast cancer is not definitively clear, so it’s important to discuss your case with your gynaecologist to weigh the risks and benefits of an IUD if you have a history of breast cancer.

Where to get more information

The Mirena™ is not suitable for everyone. That’s why it’s important to speak with a gynaecologist when considering this option for yourself.

Northside Gynaecology is an all-female, Brisbane-based women’s health practice. If you’d like to discuss using Mirena™ to manage a gynaecological condition, we’re here to guide and support you.

Call us on 1300 780 138 or click here to book an appointment at our Kedron, North Lakes, or Caboolture gynaecology clinics.

^[1] https://www.ncbi.nlm.nih.gov/books/NBK532913/

^[2] https://www.ncbi.nlm.nih.gov/books/NBK279293/

^[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389381/

^[4] http://endometriosis.org/treatments/progestins/

^[5] https://www.obgyn.net/endometriosis/iud-may-effectively-treat-early-stage-endometrial-cancer

The post 3 Extra Benefits of Using Mirena™ You May Not Know About appeared first on Northside Gynaecology.

Although it’s believed to affect up to 37% of Australian adult women, most women aren’t comfortable openly talking about urinary incontinence. Embarrassment often prevents women from seeking help for their condition.

Instead, they avoid joining in on their favourite sport, say ‘no’ to dinners with friends, and in worse cases even avoid leaving the house for fear their bladders will betray them.

Ladies, there is no need to let your bladder compromise your quality of life! Treatment for urinary incontinence can be very effective, and is often relatively simple.

Let’s explore what causes urinary incontinence, and how to combat the problem… so you can start enjoying life instead of worrying about wee!

What is Urinary Incontinence?

Urinary incontinence is defined as an involuntary leak of urine from the bladder. Whether it’s a few drops to an entire bladder full, it’s a problem that can affect people of all ages.

Pregnancy, childbirth and menopause increase the likelihood of incontinence problems. However this isn’t an absolute rule. In fact, 12% of Australian women under 30 who have never had children are affected by incontinence.

What Causes Urinary Incontinence?

The kidneys constantly filter our blood, and produce urine as a waste product of this process. Usually this urine leaves our bodies through our urethra.

The urethra sphincter muscles works with the bladder neck and pelvic floor muscles to act as a valve that keeps the urethra shut. But when these bladder neck muscles are weakened, the urethra doesn’t close as tightly and urine can leak out.

Types of Urinary Incontinence

There are 4 main types of urinary incontinence. They may sometimes occur in combination with each other.

Stress Incontinence – Losing a few drops when running, coughing, sneezing, or exerting pressure on the bladder when lifting or pushing objects. This is the most common type of urinary incontinence in women, and is often caused by physical changes from pregnancy, childbirth or menopause.

Urge Incontinence – A desire to urinate so sudden and urgent that urine cannot be held in time to reach the toilet. It’s usually caused by the bladder muscle contracting involuntarily, and often happens when least expected. A wide range of problems can lead to this condition, including poor bladder habits, nerve damage, neurological conditions, infections, menopause, and more.

Functional Incontinence – Leaking urine because a person is unable to get to or use the toilet due to a physical disability, an intellectual problem such as dementia, or a barrier in their environment (such as a toilet not suitable for wheelchair access).

Overflow Incontinence – When urine leaks because the bladder hasn’t completely emptied. The bladder fills up again and become swollen, putting pressure on the urethral sphincter muscles and causing them to open. It can be caused by conditions such as multiple sclerosis, damage to the nerve supply to the bladder, or an obstruction in the bladder itself.

Symptoms of Urinary Incontinence

Women with bladder control issues may experience:

• Leaking urine when coughing, sneezing, or exercising
• Passing urine on the way to the toilet
• Experiencing an intense and sudden need to urinate
• Wetting the bed during sleep
• Feeling like their bladder isn’t completely empty
• Getting up twice or more at night to pass urine, or going more than 7 times during the day

Urinary Incontinence Treatment Options

Many women are reluctant to seek medical advice for their problem. Instead, they rely on incontinence pads to manage their condition. It doesn’t have to be this way – there are actually a range of effective treatments available.

Common treatments include:

• Pelvic floor exercises to tighten the muscles that help control your bladder.
• Adequate fluid intake of two litres of water a day (this helps to keep your urine diluted).
• A new toilet habits schedule to retrain your bladder.
• Only going when you have the urge to go (instead of going ‘just in case’).

Not every form of incontinence needs surgery. MonaLisa Touch laser can be an effective treatment for incontinence. Stress incontinence can be treated surgically with a midurethral sling. It is recommended to see a gynaecologist to treat an urgent bladder.

What Is A Mid-Urethral Sling?

A mid-urethral sling is a thin ribbon of material that is placed under the middle section of the urethra. The sling then acts as an extra support when the urethra is put under pressure from acts such as exercise, coughing, and lifting. The slings are made of medical mesh (polypropylene) similar to the material used in hernia repairs.

The procedure itself can be performed under general anaesthetic with an overnight stay in hospital. After the procedure, women are restricted from activity for at least 4-6 weeks.

Mid-urethral slings have been found to cure or significantly improve stress urinary incontinence in 80 to 90% of women.

What To Do Next

Even though urinary incontinence is common, it’s not a normal part of life. If your body is leaking urine, it’s a sign that there’s a problem that should be addressed.

Northside Gynaecology is an all-women practice offering advice, treatment and support for a wide range of gynaecological issues including incontinence. Book an appointment at one of our convenient Brisbane locations by calling us on 1300 780 138.

The post What Nobody Tells You About Urinary Incontinence appeared first on Northside Gynaecology.

For many women, menopause can bring a range of unwelcome symptoms, such as hot flushes, sleep disturbance, night sweats, loss of libido, and vaginal dryness. While there are a number of ways to manage these symptoms, hormone replacement therapy (HRT) is perhaps the most commonly known solution.

But HRT is not necessarily a cure-all option. Its effects vary depending on a variety of factors such as the type of hormone used, the form in which it’s given, and the body’s reaction to it. Therefore while it may work for some women, for others HRT is ineffective. After all, every woman’s body is different, so there’s never going to be a ‘magic pill’ that is right for everyone.

Additionally, many women choose not to take HRT due to the potential side effects of the treatment. For while it may reduce the likelihood of developing osteoporosis, bowel cancer and heart disease, HRT may increase the chances of developing blood clots, endometrial cancer or breast cancer – particularly for women who are already at increased risk.

Non-HRT treatment options for menopausal symptoms

Menopause is a different experience for each woman, and a range of non-hormonal options are available to help manage its symptoms as shown below:

Hot flushes, night sweats and mood problems

Regular exercise and a diet full of nutritious food lower the risk for many health problems associated with ageing, and menopausal symptoms are no exception. Not only does a healthy and active lifestyle improve quality of life, it also may help reduce menopausal symptoms such as hot flushes, sleep disturbance, and mood issues including depression and irritability.

Other lifestyle factors that may help deal with these menopausal symptoms include:

• Not smoking
• Reducing consumption of alcohol
• Wearing cotton clothes that aren’t too tight on the body
• Maintaining a healthy weight
• Practicing good sleep hygiene

Vaginal dryness

During menopause, the loss of oestrogen causes changes in the tissues of the vagina, vulva and bladder. This can cause problems such as vaginal dryness, pain during intercourse, and irritation of the sensitive tissues in the area.

Some ways these symptoms may be managed include:

• Vaginal lubricants
• Vaginal moisturisers
• Black cohosh pessaries
• Flaxseed added to food (2 tbsp per day)
• Vaginal oestrogen creams or tablets
• Vaginal laser therapy such as the MonaLisa Touch

As with HRT treatments, these are not cure-all solutions. Additionally, some women are medically unsuitable to use HRT. For instance, vaginal oestrogen may not be suitable for women post-breast cancer, DVT or stroke. While black cohosh may increase the possible risk of liver damage.

Before beginning any treatment for symptoms of menopause, visit a gynaecologist for a professional assessment and treatment plan suited to your individual needs.

Treating vaginal dryness with the MonaLisa Touch

The MonaLisa Touch is a non-surgical treatment that is used to counteract the effects of vaginal dryness and restore the health of the vagina. During the simple 5 minute procedure, an intra-vaginal device delivers a precise amount of laser therapy to stimulate regeneration of vaginal tissue and structure.

It results in new collagen formation, and restoration of the pH balance of vaginal mucosa, reversing the symptoms of vaginal dryness. It can result in improvement in the hydration and elasticity of their vagina in as little as 30-40 days.

The MonaLisa Touch requires 3 x 5-minute sessions spaced at monthly intervals. It has a high success rate, is a walk in walk out procedure and requires no down time from regular activities.

Where to get further advice

Northside Gynaecology is an all-women practice offering treatment for menopausal symptoms, including the Mona Lisa touch, in Brisbane, Queensland. Our practice is located at three convenient locations in Kedron, North Lakes and Caboolture.

To book an appointment, call our suites on 1300 780 138, or click here to request an appointment online.

The post Is HRT the only option for managing menopause? appeared first on Northside Gynaecology.

The potent tools that are often used to fight cancer, such as chemotherapy, hormonal therapy and radiation therapy, can have long lasting effects on your body. In particular, a portion of women who undergo breast cancer therapy find themselves in premature menopause.

Women experiencing premature menopause as a result of cancer treatment may experience menopausal symptoms such as hot flushes, joint aches and night sweats. Another common symptom many women experience is vaginal dryness, which can affect a woman’s sexual enjoyment and the quality of her intimate relationships.

How does breast cancer treatment affect vaginal health?

The vagina needs adequate levels of oestrogen to maintain healthy tissue and keep vaginal walls thick and elastic. But oestrogen can also stimulate certain types of breast cancer cells, causing them to grow.

Therefore, certain therapies work to stop oestrogen from ‘feeding’ breast cancer cells.  As a result, the lowered levels of oestrogen cause other, more unwelcome side-effects throughout the body, particularly in the vagina.

Maintaining your vaginal health after breast cancer treatment

Women who are breast cancer survivors or patients have many options to help keep their vagina healthy.

Vaginal care products

Vaginal moisturisers can temporarily ease symptoms of vaginal dryness and are available at any chemist. Vitamin E, either taken orally or applied as an ointment can also promote good skin health all over the body, including the vagina.

When it comes to sexual intercourse, use a water or silicone-based vaginal lubricant if you’re noticing a lower level of lubrication that is comfortable.

If you’re experiencing a high level of discomfort when attempting intercourse, you may consider using vaginal oestrogen. It comes in the form of pessaries or creams, and most act locally instead of being absorbed into the bloodstream. Although there is no definitive evidence showing that vaginal oestrogen leads to breast cancer recurrence, many women choose not to use it. If you do consider going down this road, speak with your oncologist first.

MonaLisa Touch

For women who are experiencing symptoms such as dryness or pain during sex, a non-hormonal treatment is available called the MonaLisa Touch.

The Mona Lisa Touch is an intra-vaginal laser that stimulates the regenerative processes of the vagina safely and quickly. It’s a 5 minute non-surgical procedure that has no down-time – women walk out of the clinic after treatment and get back to their daily routine without fuss.

It typically takes just 3-5 sessions with the MonaLisa Touch to alleviate vaginal dryness, itching and painful sex, as well as other menopausal-related symptoms such as urinary incontinence. The laser stimulates rapid turnover of the cells lining the vaginal wall, increases collagen production, and triggers the growth of new blood cells. The vagina is essentially ‘woken up’, and can soon go back to feeling normal.

Where to get further advice

Your vaginal health is incredibly important, so make sure you take care of it as best you can. If you’re experiencing symptoms of vaginal dryness, or would like to find out more about the MonaLisa Touch, speak to your GP for a referral to Northside Gynaecology.

Our all-female gynaecology practices are conveniently located in Brisbane and surrounding suburbs. To book an appointment, click here or call 1300 780 138.

The post Maintaining Vaginal Health After Breast Cancer appeared first on Northside Gynaecology.