The primary investigation of sub-fertility, of polycystic ovarian syndrome, and general gynaecological complaints.
The investigation and management of abnormal vaginal/uterine bleeding, most commonly heavy menstrual Bleeding (Menorrhagia). This, like most areas in gynaecology, is managed with full consultation with you, offering a number of treatment options such as the Mirena IUS, hysteroscopic surgery and endometrial ablation and hysterectomy.
Hysteroscopy is used for the investigation of abnormal and heavy vaginal bleeding and post-menopausal bleeding. Hysteroscopic surgery is used to resect fibroids found within the uterine cavity, and either a resection of the lining of the womb, or endometrial ablation can used to manage menorrhagia, abnormal uterine bleeding, resection of fibroids and endometrial ablation.
Endometriosis is a common gynaecological problem, usually presenting with period pain and pelvic pain. It will usually require a laparoscopy for diagnosis, and specific laparoscopic surgery for excision of endometriosis.
Laparoscopy (keyhole surgery) is an extremely valuable tool not only for the excision of endometriosis, but also for the management of ovarian cysts, and potentially the removal of fibroids.
Pelvic Floor Prolapse becomes more prevalent as women get older. It can be managed conservatively, i.e. without surgery, but often a pelvic floor repair may ultimately be required. The use of vaginal mesh has been quite popular over the last decade or so. Unfortunately a small number of women have suffered significant complications from mesh. Although mesh does a place, I do not use mesh in pelvic floor repair.
It's important to make the distinction however, between the mesh used in pelvic floor repair, and the mesh tape used for urinary incontinence. The tape is a similar material, but the implications for complications are very different. I do use tape for the management of urinary incontinence, which has very good results.
Hysterectomy, when required, will usually be performed via the vaginal route, or by laparoscopy, as a total laparoscopic hysterectomy. Less commonly neither of these routes may be possible, because of very large fibroids for instance, and an abdominal approach may be required.
It is imperative as a gynaecologist that I have all the skills available to deal with all these conditions in the most appropriate manner. It is also important to have the communication skills to discuss the options with you, and together make the best decision to successfully manage your condition.