Women’s Health Management

Regular assessments are important for women’s health. Cervical cancer and precancerous changes of the cervix are common problems that should be assessed and treated early. 

Approximately one in eight women will be diagnosed with breast cancer in their lifetime so breast examinations should be a part of your overall health plan.

Our doctors perform these examinations and assessments. We also have a fully functional treatment room with registered nurses. 

Areas of Women’s Health where care is provided include:

 

• Regular Health Checks
• Breast checks
• Pap smear
• Cervical cancer vaccinations
• Contraception
• Pregnancy 
• Menopause
• Incontinence
• Polycystic ovarian syndrome
• Endometriosis
• Menstrual problems
• Menopause
• Ovarian cysts
• Prolapse

 
If you have any questions or need advice, make an appointment to see your doctor.

 

Regular Women’s Health Checks

Physical Examination

From time to time your height, weight, and body mass index (BMI) will be checked during examinations. Depending on individual risk factors, women over the age of 40 may need to undergo a physical examination once every 3 years.

 

Blood Pressure Check

Women with a history of borderline or high blood pressure should have their blood pressure checked at least every year. Women with diabetes, heart disease, kidney problems, or other related conditions also need to have their blood pressure checked regularly.

Diabetes Screening

Women aged 40 or above should get tested for diabetes every 3 years. Women with blood pressure above 135/80 should regularly check their blood sugar for diabetes.

 

Bone Density

A bone density test should be performed in all postmenopausal women with fractures. Women under the age of 65, depending on their risk factors may need to be screened for osteoporosis.

Colon Cancer Screening

Women between the ages of 50 and 75 need to be screened for colon cancer. The National Bowel Cancer Screening Program invites Australians aged over 50 to screen for bowel cancer using a free, simple test at home. The aim is to continue to reduce deaths from bowel cancer through early detection of the disease. Additional studies may be scheduled by your doctor if you have a history of ulcerative colitis or any family history of colon cancer.

 

Eye Examination

An eye examination is recommended every two years for women older than 45 or with vision abnormalities. You may need to be checked for glaucoma after the age of 45.

 

Flu Vaccinations

A flu vaccine is recommended once a year.

 

Breast Checks

Women should perform a monthly self-exam of their breasts. Any lumps or other abnormalities noted in the breasts should immediately be reported to the doctor. Depending on their risk factors for breast cancer, women over the age of 40 may need to have a mammogram performed every one to two years.

The current recommendations are for two-yearly mammograms from the age of 50 years or from 40 years for women with a strong family history of breast cancer. Women are encouraged to be 'breast aware' and to self-examine regularly so that any changes can be detected and discussed with their doctor. It is also important to report symptoms such as nipple rash and bloody discharge to your GP as these may require further investigation.

Breast problems are the most common health concern among women and can affect women at any age. In women, the development of breasts usually begins around puberty and they may undergo various changes throughout the life cycle, especially during menstrual periods, pregnancy, lactation and advancing age. Other than the normal physiological changes, the breast may also undergo a few other changes which may be a cause of anxiety among women.

Breast checks include self-inspection, clinical examinations and the use of diagnostic devices. It has been proven that breast examinations are essential for the early detection of breast cancer and are also useful for breast cancer prevention.

Types of Breast Changes

The common pathological breast changes can be categorized into non-cancerous and cancerous changes.

Non-cancerous changes include generalized breast lumpiness; enlarged lymph nodes; painless, movable and firm lumps; the presence of cysts; breast pain; abscesses or nipple discharge.

Cancerous changes in the breast include invasive ductal carcinoma and lobular carcinoma.

 

Symptoms of Breast Cancer

The symptoms of breast cancer include a persistent irregularity or lump within the breast or near the underarm, swelling around the breast, changes in the appearance of the breast or nipple, nipple discharge which may be blood-stained or clear fluid, hardness or dimpling felt over the breast or any unusual changes in the breast.

Methods of Breast Checks

The most popular methods of breast checks involve breast self-exam (BSE), clinical breast exam (CBE), and advanced imaging such as mammograms. Other diagnostic measures such as ultrasound and magnetic resonance imaging (MRI) can also be used. These methods are commonly used for diagnostic purposes, for early detection of breast cancer.

Mammograms

Mammograms are one of the most effective diagnostic tools for identifying breast cancer. They detect the changes of the underlying soft tissue and assess the depth and cause of the pathological condition. The benefits of a mammogram include early detection of breast changes through high-quality images which provide a clear picture of the involved tissue and help detect all types of lumps. Annual mammogram screenings, in women over 40 years of age, significantly reduce the mortality from breast cancer.

Clinical Breast Exam

This method of breast check is performed by a physician to identify any unusual changes in the breast or the presence of any lumps. It involves a careful physical examination of the breast that helps in detecting any abnormality and devising an appropriate treatment plan.

Breast Self-Exam

In breast self-exam, a woman checks her own breasts to identify any abnormalities or unusual changes. It includes observation and physical examinations of the breast. Breast self-exam is simple and can be easily performed at home. Your family history and your risk for developing breast cancer are a factor in deciding the age at which you need to initiate breast self-exam. Always inform your doctor about any change in the appearance of your breasts or any related abnormality. Breasts may swell and become tender at different stages of your menstrual cycle, so plan the breast self-exam at a convenient time every month to avoid discomfort.

Ultrasound and MRI

Ultrasound and MRI are often used to confirm an examination finding as well as to evaluate any abnormalities detected during mammography. MRI is one of the most sensitive diagnostic techniques for detecting breast cancer.

Cervical Screening Test (CST)

Australian guidelines recommend five-yearly CST's between the ages of 25 - 74 years of age. Regular screening enables early detection of HPV which is the main cause of cervical cancer to prevent progression to cervical cancer. Abnormal vaginal bleeding patterns such as intermenstrual bleeding or postcoital bleeding should be discussed with your GP as this may indicate cervical abnormalities.

Abnormal Cervical Screening Test

An abnormal CST could be managed in a number of ways - it is important to follow up with your GP after your CST. If you have an abnormal CST, you may need to have the CST repeated in 1 year, or may need follow up with a gynaecologist.

Cervical Cancer Vaccinations

Women after the age of 19 should have a tetanus-diphtheria booster every 10 years. Human papillomavirus (HPV) vaccination is recommended for women between the ages of 18 and 26. Women born after 1980, who have never had chickenpox, should receive two doses of varicella vaccine. Other vaccinations will be recommended by your healthcare provider if you are found to be at high risk for other diseases, such as pneumonia and shingles.

What is the HPV Vaccine?

Human papillomaviruses (HPV) are the major cause of cervical cancer in women.

HPV vaccine triggers the formation of antibodies to produce immunity and therefore protects the body from disease.

The HPV vaccine currently available in Australia is called Gardasil. This vaccine prevents infection with HPV types 16, 18, 6 and 11. HPV 16 and 18 are responsible for the majority (70% internationally; 80% in Australia) of cervical cancers. HPV 6 and 11 are responsible for 90% of genital warts. Having the vaccine will protect those who have never been exposed to these types of HPV.

Does the Vaccine Protect Against All HPV Types?

There are over 100 different viruses in the HPV group. Some HPV types are more likely to lead to the development of cancer than others. At least 14 types of HPV have been found to cause cancer however the vaccine only protects against two out of the 14. Therefore, Cervical Screening Tests are still critically important. Women between the ages of 25 - 74 years need to have a CST test every five years whether or not they have been vaccinated.

Who is Eligible for the HPV Vaccine?

The vaccine is most effective if given to girls and boys before the start of sexual activity and, therefore exposure to HPV. Under the National Immunisation, Program Gardasil is free for three groups:

• 12-13-year-old girls in a school-based program, generally delivered in the first year of high school
• 12-13-year-old boys in a school-based program, generally delivered in the first year of high school
• A catch-up group of 14-15-year-old boys in a school-based program, delivered in Year 9 during 2013 and 2014.

For all other people, the cost of the vaccine is around $460; this does not include the cost of the visit to the GP who must prescribe the vaccine.

How is the HPV Vaccine Administered?

GPs will administer the vaccine in three injections in the upper arm or thigh over a six-month period.

Is the HPV Vaccine Safe?

Tests of the vaccine showed only minor problems. Some people had a slight fever; others had redness or irritation of their skin at the site of where the vaccine was administered.

Should I Have My Son Vaccinated?

The HPV vaccine will be offered to 12-13-year-old boys from 2013 as part of the National Vaccination Program. Genital warts and some cancers in males are related to HPV, including most anal cancer, and some cancers of the penis, head and neck.

I am Sexually Active. Will the Vaccine Benefit Me?

You will not be protected if you have already have been infected with the HPV types covered by the vaccine, prior to vaccination. The Cancer Council recommends regular Pap tests every two years for all women who have ever had sex. For these women, Pap tests are still the best protection against cervical cancer.

 

What Trials have been Undertaken to Test the Vaccine?

Clinical trials across Australia and in the US have shown the vaccine to be close to 100% effective against HPV types 16 and 18.

Contraception

Family planning is the method of planning your family in terms of the desired number of children, and comfortably spacing your pregnancies. Family planning is achieved with the use of contraceptives. 

There are many different methods of contraception to avoid pregnancy including the oral contraceptive pill (OCP), the mini-pill, a condom, an intrauterine device (IUD) such as Mirena, an Implanon rod, the natural family planning method and more permanent measures such as tubal ligation and vasectomy for men. 

Some of these methods are confined for women and others for men, while some of the methods are reversible and some are permanent methods.

Abstinence

Abstinence means not having sexual intercourse. It is the only birth control method that is 100% effective in preventing pregnancy as well as sexually transmitted diseases.

Natural Family Planning Method

Natural family planning (NFP) or fertility awareness does not require medication, physical devices, or surgery to prevent pregnancy. This method relies on the woman's body physiology to know the time of ovulation. This method involves monitoring different body changes such as basal body temperature or cervical mucus variations. The woman then abstains from unprotected sex for approximately 7 to 10 days when she may have ovulated.

Barrier Methods

It is one of the most common contraceptive methods and involves forming a physical barrier to obstruct the sperm from entering a woman's uterus. Barrier methods include the use of male condoms, female condoms, spermicides, diaphragm, cervical cap, and contraceptive sponge. The male condom is a thin covering made of latex or polyurethane that is rolled over an erect penis before sexual intercourse to prevent the sperm from entering a woman's vagina. The female condom is a polyurethane (plastic) tube that has a flexible ring at each end and is inserted into the vagina before sexual intercourse. Spermicides are chemicals that inactivate or kill sperm and are available as foams, suppositories, and jellies. A diaphragm is a flexible dome that covers the cervix inside the vagina. The cervical cap is a smaller cup made of latex rubber or plastic. These should be used in conjunction with a spermicidal gel and are placed in the vagina before sexual intercourse. The sponge is a soft, round barrier device made of polyurethane foam.

Hormonal Methods

In this method, synthetic hormonal preparations containing oestrogen and progesterone will be taken orally (pills), implanted into body tissue (implants), injected under the skin (injections), absorbed from a patch on the skin (skin patches), or placed in the vagina (vaginal rings). These methods work by preventing ovaries from releasing an egg for fertilisation. The intrauterine device (IUD) is a small device made of copper that is inserted into the uterus. It works by thickening the mucus around the cervix and by thinning the womb's lining, making it difficult to accept a fertilised egg.

Withdrawal

The withdrawal method involves the complete removal of the penis from the woman's vagina before ejaculation.

Sterilisation

This method is a permanent solution and is meant for men and women who do not intend to have children in the future. Male sterilisation involves vasectomy, a surgical blocking of the vas deferens, the tubes through which sperm pass into the semen. Female sterilisation involves tubal ligation, a surgical procedure that blocks the fallopian tubes which carry the eggs from the ovaries to the uterus.

Implanon

This is a contraceptive implant inserted in the arm under local anaesthetic. It is a highly effective contraceptive and lasts for up to three years. It is an ideal method for young women leading busy lifestyles requiring safe and effective contraception. Implanon is the brand name for the contraceptive implant containing the hormone progestogen?

Implanon is a small flexible rod, which is inserted under the skin of the upper arm. It slowly releases progestogen (a hormone similar to the hormone progesterone, which is naturally produced by the female body) into the bloodstream to prevent pregnancy for up to three years.

The implant works by preventing ovulation (egg release from the ovary), preventing thickening of the mucus of the cervix so that sperm cannot enter the uterus (womb), and changing the lining of the uterus, making it unsuitable for pregnancy.

Implanon is at least 99.9% effective. This means that if 1,000 women use Implanon for a year it is possible that 1 woman could become pregnant. Some medications can reduce the effectiveness of Implanon. It is important to inform doctors you have an Implanon when another medication is prescribed.

Mirena IUD

This is an intrauterine device that is a highly effective form of contraception with minimal hormonal side effects. It lasts for up to five years and like Implanon has the advantages of being a 'fit and forget method of contraception.

Intrauterine Contraceptive Device

We have practitioners who are experienced in both Implanon and Mirena insertions. Please ask reception for details.

The choice of a particular method of contraceptive depends on an individual's age, health, frequency of sexual activity, number of sexual partners, plans for future pregnancy, and certain medical conditions. Discuss with your doctor the choices of birth control available for your particular situation.

Pre-Pregnancy

Pre-pregnancy counselling is a counselling session conducted before you conceive and is beneficial for the mother as well as the baby during the term of pregnancy. It helps in checking for possible risk factors during pregnancy and also gives a way to resolve any medical issues you may have before you become pregnant. Pre-pregnancy counselling and care will help you to become physically healthy and emotionally strong before you enter into the phase of pregnancy.

What Happens During a Pre-Pregnancy Counselling Session?

You can discuss and clarify with your doctor, all the things that concern you before you get pregnant, like starting prenatal vitamins, diet or any hereditary health issues. Many important points will be discussed during your pre-pregnancy counselling session. They include:

Reproductive History

Your doctor will discuss your menstrual history, use of contraceptives, any previous sexually transmitted diseases, vaginal infections and Pap test results.

Medical and surgical history: You should inform the doctor about any past health problems so that this can be controlled while you plan your pregnancy. Any past surgeries or hospitalizations should also be brought to the doctor's notice.

 

Current Medications

Discuss with your doctor any prescription, over-the-counter medications or herbal supplements that you may be currently taking. This can help the doctor plan your medications so as to prevent any potential problems during your pregnancy.

Weight

It is always better to have an ideal weight before you conceive. Gaining weight if you are underweight will reduce the risk of having a low birth-weight baby, and reducing weight if you are overweight will prevent the risk of high blood pressure during pregnancy.

Workplace and Home Environment

Your doctor will discuss potential hazards to the conception or maintaining a pregnancy, such as exposure to lead or certain toxic solvents, radiation and cat faeces.

Lifestyle

The effect of certain habits like alcohol consumption, smoking and use of recreational drugs on pregnancy will be discussed. You and/or your partner may be advised to stop these habits for a healthy pregnancy.

Exercise

Inform your doctor about the type of exercises you perform or if you don't exercise. Based on this, you may be advised to continue normal exercises during pregnancy until your doctor suggests otherwise.

Diet

Having good dietary habits is beneficial during pregnancy. You will be advised to consume food rich in folic acid, calcium, fibre and other nutrients, and reduce the intake of caffeine, which is present in coffee, chocolates, soft drinks and medications, before getting pregnant.

Family Health History

Inform your doctor about the presence of hereditary medical conditions and multiple births in the family.

Prenatal Vitamins

You should start taking folic acid supplements before you conceive, as folic acid reduces the chances of neural tube defects in your baby.

Advice for Older Women

Women older than 35 years of age will be advised on the risks of infertility, abnormalities in the child and pregnancy complications, such as miscarriage and labour problems.

Your Doctor May Also Recommend

• Physical exam of your abdomen, heart, breasts, thyroid and lungs
• Pap smear and pelvic examination
• Lab tests to screen for hepatitis, HIV, rubella, syphilis and other conditions
• Chart menstrual cycles to monitor ovulation and determine the most favourable time to get pregnant
• Advise appropriate vaccinations against rubella or chickenpox, and recommend delay in conception for a month
• Conduct genetic counselling for older mothers or those with a risk of hereditary diseases to help you understand the chances of birth defects or intellectual disability in the child
  

 

Pregnancy Care

What is Shared Care?

Shared care with a local doctor provides an option for women to have some of their pregnancy care with their GP and some visits at the hospital’s antenatal clinic (or midwives’ clinic or birth centre). 

Essentially, shared care with a local doctor is usually an option for women who have no pre-existing health conditions (such as diabetes) and whose pregnancies are progressing relatively normally with one baby (no twins or more). The local doctor would seek advice from an obstetric registrar or consultant at the hospital you are booked into if there were any health concerns or if complications arose. If complications do develop (such as high blood pressure, bleeding during pregnancy or the labour starting prematurely) then your care will most likely be transferred from the shared care arrangement to the doctors in the hospital’s antenatal clinic. Policies and guidelines for what is acceptable for care by local doctors will vary from hospital to hospital.

Shared care can be a convenient option for women who have a good relationship with their local doctor and find travelling to the hospital difficult (especially if they have other children). Most shared care arrangements require the GP to be accredited by the hospital you are attending.

If you require the services of a dietician, social worker, genetic counsellor, physiotherapist and childbirth educator, your local doctor will usually refer you to the services provided by the hospital you are booked into or services in the local community.

 

Pregnancy Visits

Some of your pregnancy visits will be done at your local doctor’s rooms, and some will be done at the hospital by your chosen caregivers (antenatal clinic, midwives’ clinic or birth centre). Each hospital usually has its own recommended guidelines for how often you see your local doctor and how often you come to the hospital. Your GP may take blood and order ultrasounds or these may be done by the maternity service at the hospital (depending on when your visits are scheduled throughout the pregnancy).

 

The Birth

Your local doctor will not be involved in your labour and birth.

 

Pain Relief Options

Pain relief availability will depend on your birthplace and will be in line with the care arrangements you have made with your hospital.

 

Postnatal Care

Postnatal care will be in line with the care arrangements you have made with your hospital. Local doctors do not provide postnatal care home visits if you decide to go home early, but the hospital midwives can provide this.

 

6-8 Week Postnatal Check

You can go back to your local doctor for your 6 to 8-week postnatal check or you may prefer to see a caregiver at the hospital, such as the antenatal clinic, midwives’ clinic or birth centre.

 

Fertility

Fertility is your ability to produce a child. Infertility is when you have had 12 months of unprotected sexual intercourse and you have not become pregnant. Fertility can be affected by many things and there are also ways to increase your chances of becoming pregnant. Not being able to conceive can be distressing but talking with your doctor, counsellor or psychologist can help you to understand your options and decide what to do next.

 

Incontinence

Are you suffering from an accidental, involuntary flow of urine from your body? While this issue can be embarrassing, it’s very common and can be treated.

Urinary incontinence can affect patients differently. You may be experiencing loss of bladder control, a sudden urge to urinate or an overactive bladder. 

There are three main types of incontinence:

• Stress urinary incontinence usually occurs due to weakened or damaged pelvic floor muscles. This could be as a result of pregnancy, childbirth, previous pelvic surgery, aging or obesity. You may experience loss of bladder control when you place stress on your bladder, especially when coughing, sneezing, lifting heavy things or laughing.
• Urge incontinence is the consequence of overactive muscles that contract too often around the bladder. You may feel a sudden, intense urge to urinate.
• Mixed incontinence can include a combination of the symptoms above.
• If the symptoms begin to affect your daily activities, it’s time to seek help from an expert.
  

What Causes Urinary Incontinence?

There are also other reasons why a woman may leak urine. Sometimes it’s caused by an illness, in which case bladder control returns when the illness goes away.

For example, bladder infections and infections in the vagina can cause incontinence for a short time. Being unable to have a bowel movement or taking certain medicines also may make it hard to control your bladder.

 

Polycystic Ovarian Syndrome

Polycystic ovary syndrome (PCOS) affects 12-18% of women of reproductive age and up to 21% in some high-risk groups, such as Indigenous women.

 

What is PCOS?

Polycystic Ovarian Syndrome (PCOS) is a hormonal condition commonly involving high levels of insulin or testosterone. The cause of PCOS is unclear.

 

Symptoms of PCOS

PCOS is often related to problems such as: 

• Irregular periods, 
• Acne, 
• Excess hair, 
• Hair loss, 
• Depression, 
• Anxiety, 
• Sex and relationship issues. 

 

Other health problems associated with PCOS such as:

• Metabolic syndrome, 
• Type 2 diabetes and 
• Cardiovascular disease 

mean understanding and treatment of PCOS is important. Your doctor can help you learn about the signs and symptoms of PCOS, diagnoses and the treatments available.

 

Endometriosis

Endometriosis is a condition that affects a woman's reproductive organs. It happens when the tissue that lines the uterus grows outside of it.

 

Symptoms of Endometriosis

Patients may experience:

• Painful cramps in the lower abdomen, back or in the pelvis during menstruation,
• Painful sex,
• Heavy menstrual bleeding,
• Painful bowel movements or urination and
• Infertility.
  

 

Treatment of Endometriosis

We can discuss all causes, symptoms, diagnoses and the possible options to manage and treat endometriosis including lifestyle, pain relief medications, hormone therapy and different types of surgery. 

Often women have questions about the effect of endometriosis on their bladder and bowel, fertility, emotional health and relationships. Knowing where to go for advice and support is important, and reading and listening to the personal stories of women who have endometriosis is helpful too.

 

Pelvic Floor Prolapse

Women with prolapse may have different symptoms depending on the type of prolapse. The signs and symptoms include: 

• Slow urinary stream, 
• Difficulty in bowel movements, 
• A vaginal lump, 
• Protrusion of vagina from the body,
• Painful sexual intercourse, 
• Vaginal pain,
• Irritation and 
• Bleeding.
  

 

Causes of Pelvic Floor Prolapse

The main cause of vaginal prolapse is weakness in the muscles, tissues, and ligaments that support the vagina and surrounding tissues and organs.

The factors that can cause vaginal prolapse include:

• Frequent lifting of heavy objects,
• Chronic cough,
• Severe constipation,
• Menopause,
• Childbirth,
• Previous surgeries in the pelvic area,
• Advanced age,
• Hysterectomy and
• Obesity.
  

 

Treatment Options for Pelvic Floor Prolapse

Treatment options include:

• Pelvic floor exercises
• Lifestyle changes - to avoid heavy lifting, constipation
• Local oestrogen treatment
• A Pessary, a removable device fitted in the vagina to reduce pain and pressure of pelvic organ prolapse.

If non-surgical treatment does not reduce the symptoms of pelvic organ prolapse, then surgery is considered. There are several types of surgeries to correct different types of pelvic floor prolapse.

The surgery can be performed laparoscopically or through the vagina, depending on the nature of the prolapse.

Women's Health

Why Is Women's Health Different?

Women's health issues are due to a complex reproductive system that makes them different from men.

A variety of diseases can affect women more severely than men. These may include: 

• heart attack, 
• depression, 
• anxiety, 
• sexually transmitted infections (STI), 
• osteoarthritis, and 
• urinary tract problems. 

These differences may necessitate them visiting their doctor at timely intervals in order to screen for various diseases. Screening tests can assess the risk for future illnesses and help in their early detection.