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Common Queries Regarding Gynaecology
Cervical cancer means cervical surface cells have cancerous cell changes as well as signs of cancer “invasion” outside the cells.
An abnormal Pap smear rarely means cervical cancer. Sometimes, a Pap test is found to be abnormal for simple reasons such as a minor vaginal infection. There are three levels of cell changes in the non-cancer range before progression into cervical cancer. The pre-cancer cell changes are the ones diagnosed by Pap smears and they are classified as CIN I, CIN II and CIN III.
Accuracy of Pap smear tests are about 95%. In addition to Pap tests, there is an additional test called Colposcopy. This is performed by a qualified gynaecologist to improve the accuracy of diagnosis, be it CNI I, II or III.
Generally speaking, CIN I has about 50% chance of reverting back to normal. CIN II and III are more likely to progress to cancer. It is hard to say how long it takes for cells to go from normal to CIN II or III and then to cancer. If the progression occurs at all, it is likely to happen in years, rather than weeks to months.
Usually, doctors would recommend treatment if a woman was found to have CIN II or CIN III. Treatment is in the form of day surgery. Effectively, one cuts out the affected small area so the cervix will not be at risk of cancerous changes.
To date, there is no proven medical treatment for CIN II or III in the form of tablets or topical cream. Women need to be very weary if they are offered such treatment with the promise of cure.
Abnormal cervical cell changes are usually thought to be the result of past HPV infections.
One can simply look at HPV viral infection on the cervix as if it were viral infections associated with colds and ‘flu. This means, after a brief period of infection, the viruses are cleared by the person’s own immune system and is usually of no consequences.
The difference to colds and ‘flu is that the person usually has no symptoms with the infection. The problem is that certain types of “high risk” HPV viruses can incorporate the viral DNA into cervical cell DNA structures and with time lead to more and more abnormal changes and finally cancer change.
It is thought the HPV viruses are usually sexually transmitted, but unlike other sexually transmitted infections (STIs) such as Chlamydia or Gonorrhoea, HPV viruses do not cause tubal obstructions or infertility. As the cell changes can take some time to develop, it is impossible for doctors to say when the infection happened or which ex-partner was the culprit.
There are many different types of HPV viruses. Only some types of HPV cause cervical cell changes.
PCOS stands for polycystic ovarian syndrome. It is a very common gynaecological condition. The origin of the disorder shares similarity with that of diabetes. It is charactersed by irregular cycles and infrequent ovulation in young women. On examination with pelvic ultrasound, these women often have multiple small cysts on the ovaries. In the long term, there is somewhat increased risk for diabetes.
Many people feel devastated by the diagnosis, but there are really only three problems to address and all these problems can be easily corrected.
Firstly, irregular cycles may not be good for one’s health in the long term. There is hormonal treatment one can take to address this problem and the treatment has minimal and mostly no side effects.
Secondly, infrequent ovulation may result in infertility. However, this is usually easily treated with medication. Once ovulation occurs, women with PCOS usually have excellent fertility.
Finally, the future risk of diabetes can be significantly reduced with lifestyle changes in the form of regular exercises and a healthy diet.
The cysts found on the ovaries of PCOS women are not tumors or pathological cysts. These are small (usually less than 15 mm diameter) physiological cysts related to the hormonal changes in PCOS. They do not require removal and really just serve as diagnostic markers for the condition of PCOS.
What needs to be clarified is that whilst the problems related to PCOS can be easily treated, doctors are unable to cure PCOS with a magical pill or surgery.
Fibroids are extremely common benign (non-cancerous) overgrowth of the uterine muscle. The overgrowth forms a lump in the muscle layer and may be big enough to protrude outward (towards the abdominal cavity) or inward (towards the uterine cavity). Generally, they are of little consequences and do not required much medical intervention. Treatment is only required if they cause problems for the woman.
They problems they can cause include: increased menstrual bleeding, pressure effect from their bulk and potential fertility issues.
Increased menstrual bleeding tends to be the most common problem associated with fibroids. It is thought the fibroids distort the uterine architecture and affect blood flow and thereby cause increased bleeding.
When the fibroids are big, they can press on the bowels at the back of the uterus or the bladder at the front of the uterus and cause bowel habit changes such as constipation or urinary symptoms such as needing to urinate frequently. Occasionally, the fibroids may be so big that the woman may feel it herself by rubbing her own abdomen. Pain can occur as a result of fibroid enlargement or pressure effect on surrounding organs. However, fibroids are generally painless.
Fibroids rarely cause infertility. Even very big fibroids do not cause infertility. Occasionally, fibroids may contribute to miscarriages or presumed implantation failure if they protrude into the uterine cavity (submucous fibroids). Even this is a may be. Most women with fibroids go through their pregnancies without any problems.
Therefore, although fibroids are very common, they do not always need to be treated. The location rather than the size of the fibroids are more predictive of the likelihood of fibroids requiring treatment. The fibroids with a large portion protruding into the uterine cavity (submucous) are more likely to cause problems such as heavy periods and miscarriages and thus requiring treatment.
There is a school of thought that fibroids do not turn cancerous and the very rare “cancerous fibroids” (leiomyosarcoma) arise independently and did not come from benign fibroids.
Even if fibroids could turn into cancer, the likelihood of this happening is extremely rare (<1%).
In the clinical setting, doctors consider it a risk factor for cancer transformation if the fibroids are found to grow in size rapidly.
However, when fibroids are removed for this reason, they are rarely found to be cancerous when tested by histopathology assessment.
Menopause means a woman has exhausted all her egg supplies in her ovaries. Clinically, it is defined as the cessation of periods for 12 months or more.
The health impact related to the menopause is largely due to a decline in the female hormone (oestrogen) level as a result of the lack of egg production. The other important change is that one is also getting older since menopause usually occurs in a woman’s early 50s.
The most important health issues at this stage are bone health and cardiovascular health. This means one should take measures to minimise the risk of osteoporosis, hypertension and heart attacks.
The most important measure is probably regular exercises as exercises are beneficial to the protection of both heart and bones. A good regimen of exercises should include aerobic exercises, weight training and balance building.
Regular bone density screening is also advisable in addition to regular Pap smear and breast mammogramme. One’s calcium intake and vitamin D exposure should be assessed as they are relevant to osteoporosis and cardiovascular health.
In the presence of menopausal symptoms, short-term standard HRT is still very effective and safe treatment.