General gynaecological conditions

Conditions and symptoms

Heavy menstrual bleeding

Heavy or prolonged menstrual bleeding can significantly affect quality of life and may lead to iron deficiency or anaemia. Causes include fibroids, adenomyosis, endometrial polyps and hormonal changes. Treatment options range from medications and hormonal therapies to procedures such as endometrial ablation or hysterectomy.

Irregular bleeding and bleeding between periods

Bleeding between periods or changes in menstrual patterns may occur for several reasons, including hormonal changes, polyps and other conditions affecting the uterus or cervix. Assessment helps identify the cause and determine whether treatment is required.

Postmenopausal bleeding

Any vaginal bleeding after menopause, even light spotting, should be investigated. Most cases are caused by benign conditions, such as thinning of the vaginal or uterine lining or endometrial polyps. However, investigation is important to exclude endometrial cancer or precancerous changes.

Postcoital bleeding

Bleeding after sexual intercourse can occur due to benign cervical changes, polyps, inflammation or vaginal conditions. Occasionally, it may be associated with cervical precancerous changes or cancer. Assessment may include examination, cervical testing and colposcopy where appropriate.

Uterine fibroids

Fibroids are common, non-cancerous growths of the uterus. They may cause heavy bleeding, pelvic pressure or discomfort, although many cause no symptoms. Management depends on their size, location, associated symptoms and individual circumstances.

Adenomyosis

Adenomyosis occurs when tissue similar to the uterine lining is present within the muscular wall of the uterus. It can cause heavy or painful periods and pelvic discomfort. Treatment options include hormonal therapies and surgery, with hysterectomy providing definitive treatment when appropriate.

Endometriosis

Endometriosis occurs when tissue similar to the lining of the uterus grows outside the uterus, commonly affecting the pelvis. It can cause painful periods, pelvic pain, pain during intercourse and sometimes fertility difficulties.

Management may involve hormonal therapies, pain management strategies or surgery. Laparoscopic or robotic surgery may be appropriate for selected patients, particularly when symptoms persist despite medical treatment or when more extensive disease is suspected.

Endometrial polyps

Endometrial polyps are growths arising from the lining of the uterus. They may cause irregular bleeding, heavy periods or postmenopausal bleeding. Some require removal, usually through a hysteroscopy, to relieve symptoms or exclude abnormal cells.

Pelvic pain

Pelvic pain may be associated with conditions such as endometriosis, adenomyosis, ovarian cysts or pelvic adhesions. Assessment aims to identify possible causes and determine appropriate treatment, which may include medication or surgery.

Investigations and treatment

Depending on your symptoms, assessment may involve:

• Pelvic examination and ultrasound
• Cervical testing or colposcopy
• Endometrial biopsy
• Hysteroscopy to examine the uterine cavity
• Additional imaging or other investigations where appropriate

Treatment may include medication, hormonal therapies, monitoring or surgery.

Where surgery is recommended, minimally invasive laparoscopic, robotic or hysteroscopic techniques may be appropriate, depending on the condition and procedure required.

Not all gynaecological conditions require surgery. Treatment recommendations take into account your symptoms, overall health, reproductive goals and preferences.

Further information and support

• Jean Hailes for Women's Health: Periods and menstrual health
• Australian Commission on Safety and Quality in Health Care: Heavy Menstrual Bleeding Clinical Care Standard
• Healthdirect Australia: Women's health