Gynaecological Problems

Many women are not sure about the differences between common gynaecological diseases such as uterine fibroids, ovarian cysts, and endometriosis.

These are common benign tumours. Approximately 1 in 4 women in Hong Kong are affected by uterine fibroids, with a higher prevalence among women of reproductive age and an increased risk associated with advancing age. Patients usually have no symptoms, but when the fibroids grow larger, they may experience symptoms such as abdominal pain, abnormal menstrual cycles, or abnormal menstrual bleeding. Most patients with uterine fibroids do not require surgery, but they should consult a doctor as soon as possible to avoid affecting their chances of pregnancy. 

These are benign cystic structures filled with fluid that often form on the surface or inside of the ovaries. They are common in women of reproductive age. Patients generally have no symptoms, but when the cysts become larger or rupture, they may experience symptoms such as abdominal pain or infertility. Doctors will determine the treatment method based on the type and size of the cyst, as well as the patient's age and symptoms, including observation, medication, or surgical treatment.

Endometriosis is a common gynaecological condition in which endometrial cells grow outside the uterus, causing chronic inflammation, resulting in a wide range of symptoms and affecting the patient's quality of life. Endometriosis affects about 10% of women of reproductive age worldwide. [1]

This is a condition in which the tissue that normally lines the inside of the uterus grows outside of it, often on the ovaries, fallopian tubes, and pelvic cavity, and forms cysts filled with brown fluid, also known as "chocolate cysts." About 10 out of every 100 women are affected by endometriosis, which can cause symptoms such as menstrual pain, heavy menstrual bleeding, painful intercourse, pelvic pain, difficulty urinating or defecating, diarrhea, and even infertility.

Symptoms

Symptoms of endometriosis include:

• Menstrual pain
• Chronic pelvic pain
• Pain during or after sex
• Excessive menstrual blood or irregular periods
• Painful urination and defecation
• Infertility

Causes and risk factors

The cause of endometriosis has not yet been determined by the medical profession. One of the theories is that it is caused by the backflow of menstrual blood. During menstruation, menstrual blood accompanied by endometrial cells flows backwards into the pelvis, causing endometrial tissue to grow outside the uterus. The ectopic endometrium will also periodically thicken and shed, and bleed.

• If the endometrial tissue is lodged in the ovaries, when the menstrual blood accumulates in the ovaries, the menstrual blood oxidises to a brownish colour similar to that of chocolate and forms a cyst, commonly known as a "chocolate tumour".
• If the endometrial tissue grows in the muscular layer of the uterus, adenomyosis will form.
• If the endometrial tissue grows in the abdominal cavity or on the surface of the peritoneum, it is prone to inflammation and pain. Continuous inflammation will cause scarring and adhesion between surrounding tissues and organs, and even affect the normal functioning of organs.

Diagnosis

The doctor will perform the following tests to help make a diagnosis:

• Pelvic examination
• Imaging tests, including ultrasound or MRI (to detect ovarian endometriomas, adhesions and deep nodules)
• Depending on the circumstances, the doctor may need to perform laparoscopic surgery and tissue sampling to help confirm the diagnosis.

Treatment

Currently, there is no cure for endometriosis, but the main focus is on treating the symptoms. Depending on age, symptoms and the need to have children, it can be treated with medication or surgery.

Prevention

There is no known way to prevent endometriosis. However, the following measures are recommended to help diagnose endometriosis early and manage the progression of the disease:

• Women can undergo regular gynecologic check-ups
• Maintaining a healthy lifestyle, e.g. appropriate exercise, healthy diet, etc.
• Raise awareness of the condition and seek medical advice if you experience any symptoms that suggest endometriosis.

[1] World Health Organization - endometriosis. Retrieved February 3, 2023, from https://www.who.int/zh/news-room/fact-sheets/detail/endometriosis

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder of the female reproductive system. It affects 1 in 10 women of childbearing age, causing menstrual disorders, pregnancy and other health problems.

Symptoms

Symptoms of Polycystic Ovary Syndrome  include the following:

• Irregular menstrual cycle (no periods, menstrual disorders (no periods, fewer than nine periods a year), etc.)
• Excessive body hair
• Acne
• Weight gain
• Infertility
• Oily skin
• Thickened, dark patches of skin

On pelvic ultrasound, multiple follicles are often seen in the ovaries, hence the name. It can also lead to fertility problems, as it can cause irregular ovulation or prevent ovulation altogether. Many women don't realise that oily skin, hair growth or acne can be a precursor to Polycystic Ovary Syndrome (PCOS) until they have difficulty getting pregnant, experience menstrual irregularities or stop menstruating, and are then diagnosed with PCOS.

Causes

The exact cause of PCOS is unknown, but it is believed to be related to hormonal imbalances, genetic factors and lifestyle factors.

The cause of Polycystic Ovary Syndrome (PCOS) is still unknown, but it is related to a hormonal imbalance to some extent. Normally, the ovaries produce the female hormones oestrogen and progesterone and the male hormone androgen. When too much androgen is produced, it can prevent ovulation during menstruation. Follicles that are not ovulated can form multiple sacs in the ovaries, causing menstrual disorders and a variety of problems. In addition, family history and insulin resistance also affect the endocrine system, which is one of the causes of polycystic ovaries.

Diagnosis

The doctor will ask about the patient's medical history and family history, and conduct a detailed diagnostic questionnaire for related symptoms, followed by a blood test to check the patient's hormone levels.

Ultrasound is one of the main diagnostic methods for Polycystic Ovary Syndrome (PCOS), which can detect the size of the ovaries and the number of follicles.

Treatment

There is no complete cure for polycystic ovarian disease, but there are treatments that can help improve symptoms and reduce the risk of other health problems:

• Medication
  • Oral contraceptives to regulate menstrual disorders
  • Insulin sensitisers
  • Ovulation stimulants to treat infertility caused by polycystic ovary disease
• Lifestyle modification
  • A healthy diet, increased exercise and weight loss can help improve symptoms
• Surgery

If medication fails, surgery can be used to treat infertility caused by PCOS by using heat or lasers to destroy the androgen-producing tissues in the ovaries

Impact

Women with PCOS may be at a higher risk for other health conditions, such as type 2 diabetes, high blood pressure, and sleep apnoea. PCOS can also increase the risk of developing endometrial cancer, so it's important for women with PCOS to have regular gynaecological check-ups and screenings.

Preventive screening

People with risk factors, including those with the diseases mentioned above, are advised to undergo the following tests to assess the likelihood of Polycystic Ovary Syndrome (PCOS) and the risk of related complications:

• Ultrasound examination of the ovaries
• Regular monitoring of blood glucose and lipid levels

FAQ

Q: PCOS is associated with various diseases, how should it be managed?

A: Patients with polycystic ovary syndrome (PCOS) may have a higher risk of developing cardiovascular diseases. Maintaining a healthy lifestyle, such as controlling weight, increasing physical activity and modifying diet, can help control the risk of cardiovascular disease.

Q: Does PCOS affect pregnancy?

A: In addition to difficulty in conceiving, women with Polycystic Ovary Syndrome may have a higher risk of complications during pregnancy, such as gestational diabetes and toxemia of pregnancy. It is recommended to control weight and maintain good blood glucose level before pregnancy. Pregnant women may need to monitor their blood glucose level regularly; if necessary, they can discuss with their O&G specialists about the monitoring plan.

Women with PCOS may benefit from working with a healthcare provider who specializes in PCOS, such as an endocrinologist or a reproductive endocrinologist. With proper management, women with PCOS can live healthy and fulfilling lives, and many are able to conceive and have successful pregnancies.