Signs and Symptoms | Rapid Access Gynaecology |

‘Intermenstrual bleeding’: Bleeding between periods.
‘Postmenopausal bleeding’ Bleeding after menopause.
‘Menorrhagia’ heavy menstrual bleeding.
‘Amenorrhoea’ no periods for 3 months.
‘Dysmenorrhoea’ painful periods. Pain or pressure in your pelvis that differs from menstrual cramps.
‘Dyspareunia’ painful sexual intercourse.

Endometriosis:

Endometriosis occurs when the lining of the uterus grows outside of the uterus.
It can cause significant pelvic and lower abdominal pain, pain with intercourse Dyspareunia and pain with bowel evacuation Dyschezia.
Chocolate Cysts: a common site for endometriosis is the ovary, and endometriosis can result in Endometrioma, or chocolate cysts, which are full of old blood and have the appearance of chocolate.
Endometrial Nodules form when the endometriosis invade the peritoneum by more than 5mm and occur near the rectum and ureter.

‘Stress Incontinence’ incontinence associated with coughing and sneezing.
‘Urge Incontinence’ unprovoked incontinence often large volume.
‘Urgency and Frequency’ passing urine every hour. Often small volume, and a burning sensation during menstruation.
‘Nocturia’ 3 episodes of incontinence at night.
‘Urodynamics’ investigations for incontinence.

Oestradiol: is a cholesterol steroid female hormone produced by the ovary.
Progesterone: is another female sex steroid hormone, mainly produced by the corpus luteum. It is also known as the ‘hormone of pregnancy’.
Testosterone: is a male sex steroid hormone, and is women its production is increased in polycystic ovarian syndrome.
Dehydroepiandrosterone (DHEA): is a sex steroid produced by the adrenal gland and is a male sex hormone androgen. It is increased in adrenal disease.

‘Polycystic Ovaries’. Ovaries with multiple cysts, and they can produce an increased amount of testosterone.
‘Hirsutism’ facial and coarse body hair.
‘Acne’ facial spots are common.
‘Acanthosis Nigricans’ dark patches of skin on the neck and in skin folds.

non-cancerous growths which form in the muscles of the uterus.
‘Submucosal Fibroid’. These are fibroids which grown into the uterine cavity, and cause infertility, and heavy menstrual bleeding.
‘Intramural Fibroid’. They grow in the wall of the uterus, and also can result in infertility and heavy menstrual bleeding.
‘Subserous Fibroid’. These fibroids grow out of the wall of the uterus and often have a stalk. They are not associated with infertility but cause pain.

Physiological Cysts: occur during the menstrual cycle.
The commonly occurring ones include ‘follicular’ and ‘corpus luteal’.
Occasionally a corpus luteal cyst can have a haemorrhage ‘haemorrhagic corpus luteal’, and this can be associated with pain.

The Benign Cysts include: Dermoid: Mucinous and Serous Cystadenocarcinoma.
Surgery is important and an ovarian cystectomy is performed to remove the cyst, but protect the ovary.
The Malignant Ovarian cysts include: Mucinous and Serous and Papillary Adenocarcinoma, and Endometroid Carcinoma. These tumours will require radical surgery and often chemotherapy.

In the UK all women are offered cervical smear screening from the age of 25.
The initial test is a PCR (polymerase chain reaction) test to look for the HPV (human papilloma virus). If it is positive, it means you have been exposed to the wart virus, and a cervical smear for cytology is performed.
This may be graded as normal, but can change the anatomy of the transformation zone in the cervix.
The cytology is then classified as: wart virus change only and borderline nuclear changes and then may change into mild moderate or severe dyskaryosis.
You will need an assessment with a colposcope microscope if you are HPV positive with persistent changes.