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Topics

  • Breastfeeding

  • Endometriosis
  • Menorrhagia
  • Polycystic Ovarian Syndrome
  • Breastfeeding

    The Ten Steps to Successful Breastfeeding

    1. Have a written breastfeeding policy that is routinely communicated to all health care staff.

    2. Train all health care staff in skills necessary to implement this policy.

    3. Inform all pregnant women about the benefits and management of breastfeeding.

    4. Place babies in skin-to-skin contact with their mothers immediately following birth for at least an hour and encourage mothers to recognize when their babies are ready to breastfeed, offering help if needed.

    5. Show mother how to breastfeed and how to maintain lactation even if they should be separated from the infants.

    6. Give newborn infants no food or drink other than breast milk, unless medically indicated.

    7. Practice rooming-in, allow mothers and infants to remain together 24 hours a day.

    8. Encourage breastfeeding on demand.

    9. Give no artificial teats or dummies to breastfeeding infants.

    10. Foster the establishment of breastfeeding support and refer mothers on discharge from the facility.

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    Endometriosis

    Endometriosis is a condition where tissue similar to endometrium (the lining of the uterus) grows outside the uterus.

    The common locations for endometriosis are:
  • Ovaries, uterus, and fallopian tubes
  • Uterosacral ligament
  • Pelvic side wall near the ureters
  • Pouch of Douglas
  • Rectal surface
  • Bladder / Vagina

    Endometriosis is common in women (about 10%) within their reproductive age. The presenting symptoms are variable ranging from no symptoms to urinary and bowels symptoms, pelvic pain and infertility. The symptoms often improve during pregnancy or after menopause.

    The causes of Endometriosis are not fully understood. However, it may be related to the back flow of menstrual blood through the fallopian tubes and into the pelvis. There is also an association with family history of this condition.

    Two important complications associated with Endometriosis if left untreated are:
    1. Infertility
    2. Chronic pelvic pain

    Endometriosis may be diagnosed with the detailed history, clinical examination, and imaging for suspected individuals. However, the Gold Standard for the diagnosis is laparoscopy with tissue biopsy or excision.

    Treatment options for Endometriosis depend on:
  • The age of the woman
  • The severity of the symptoms
  • The fertility desire

    There are three main categories of treatment option available:
    1. Analgesia (Pain killer)
    2. Hormonal treatment
    3. Surgical treatment
        a. Laparoscopy
        b. Laparotomy (Open Surgery)
        c. Hysterectomy

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    Menorrhagia (Heavy Menstrual Bleeding)

    Menorrhagia is a common complaint affecting one in five women. It is defined as a total menstrual blood loss of more than 80mls during menstrual period. Women usually complain of increasing frequency of changing pads, passing moderate to large clots, and iron deficiency anaemia.

    The causes of Menorrhagia are:
    1. Dysfunctional Uterine Bleeding (DUB)
  • This condition is diagnosed by excluding other medical or gynaecological (including cancers) causes
  • Treatment options can be offered as either medical or surgical depending on patient's situation

    2. Fibroids

  • These are benign growth of the muscle and connective tissue cells in the wall of the uterus
  • They can be located on either outside, within, or inside the uterus
  • Treatment options depend on the severity of the symptoms, the age of the woman, and the fertility desire.

    3. Endometrial Polyps

  • These benign growth occur on the lining of the uterus or the canal of the cervix

    4. Endometrial Hyperplasia

  • This is a thickening of the lining of the uterus
  • It is associated with obesity, PCOS, women taking medication for breast cancer treatment

    5. Adenomyosis

  • This is a diffusely enlargement of the uterus caused by the growth of the endometrial tissue into the wall of the uterus

    Treatment options depend on:
  • The age of the woman
  • The causes
  • The severity of the symptoms
  • The fertility desire

    Treatment options:
    1. Medical
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Iron supplementation
  • Oral contraceptive pills
  • Oral progesterone (Progestogen)
  • Tranexamic acid
  • Danazol
  • Progestogen intrauterine device

    2. Surgical

  • Endometrial ablation
  • Myomectomy
  • Hysterectomy i. Abdominal hysterectomy ii. Vaginal hysterectomy iii. Laparoscopic assisted vaginal hysterectomy iv. Total laparoscopic hysterectomy

    Please contact Dr Alan Tong should you require more information about the treatment options.

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    Polycystic Ovarian Syndrome (PCOS)

    Polycystic ovarian syndrome (PCOS) is a common disorder affecting women in their reproductive age. The classical features are:
  • Menstrual disturbance
  • Clinical or biochemical features of hyperandrogenism (over production of a male hormones) such as acne or excessive hair growth
  • Ultrasound features of multiple follicles in ovaries

    PCOS may also cause problems such as:

  • Subfertility or infertility
  • Cosmetics: acne or excessive hair growth
  • Obesity
  • High cholesterol levels
  • Diabetes mellitus
  • Heart diease
  • Endometrial hyperplasia (Precancer changes of the uterus)

    Diagnosis of PCOS
    PCOS can be difficult to diagnose. However, this condition can be diagnosed by the following suggestions:
  • Medical history
  • Physical examination
  • Blood tests to check hormones, sugars, insulin and lipids
  • Pelvic Ultrasound

    Treatment
    The aim of the treatment is to control the symptoms, and to reduce the risk of the medical complications. It can be divided in the following options:
    • Lifestyle changes
        1. Dietary advice
        2. Regular exercise program aims to reduce weight

    • Medications
        1. Contraceptive pills
        2. Spironolactone
        3. Anti-diabetes drugs

    • Infertility
        1. Metformin
        2. Ovulation induction
        3. Assisted Reproductive Technique (IVF)

    • Surgery
        1. Laparoscopic ovarian drilling

    Please contact Dr Alan Tong should you require further information regarding the management of PCOS.

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    TOPICS

    Breastfeeding
    Endometriosis
    Menorrhagia
    Polycystic Ovarian Syndrome

    Dr Alan Tong --- Sydney Obstetrician & Gynaecologist --- Copyright 2012. All Rights Reserved