Other Services
Gynaecological Problems
A wide range of gynaecological problems are dealt with by the service.
If you cannot find help within the links below please e-mail mike@mums.me.uk with specific enquiries.
Abnormal periods and period pains
Heavy periods, painful periods, painful sex and bleeding between periods can all be symptoms of medical problems. The sequence of events
to investigate these problems is to take a detailed account from you about what is happening, when it started and your medical and
gynaecological history. We would then undertake a physical examination to see if there is an obvious problem to see. We might need to take
samples of the cells from the cervix, or the lining of the womb, or to take swabs to rule out infections. Detailed ultrasound scanning
can be very helpful in assessing the pelvis and can identify uterine fibroids, endometrial polyps, ovarian cysts, areas of tenderness
which might indicate endometriosis, or fluid within the pelvis suggesting inflammation. See gynaecological ultrasound for details of what
is involved in having an ultrasound scan.
If a problem is found the treatment options would relate to the problem. For example is we were to find large uterine fibroids the treatment
options would be to either have a series of injections to shrink the fibroids, to have an X-Ray based treatment to inject directly into the
fibroids (Embolisation), to have an operation (myomectomy) to remove the fibroids without removing the whole of the uterus (womb) or to have
a hysterectomy.
Heavy Periods (menorrhagia)
A common problem is heavy periods without anything obviously wrong on examination or on ultrasound scan. This is called dysfunction uterine
bleeding (DUB) and can be effectively treated. The options for treatment are to have tablets at the time of the period to slow down the
bleeding; to have a Mirena coil fitted which stabilises the endometrium (lining of the womb) to slow down heavy periods in 85% of cases; to
have a microwave endometrial ablation (MEA) which is a day case surgery to destroy the endometrium using heat generated from a microwave
probe (90% success) or to consider having a hysterectomy. Our general philosophy is that everyone is different, and everyone has different
needs and priorities. It is therefore impossible to for us to tell you what is best, we need to explain the options, and for you to chose
the best one for your problem and your lifestyle. All options are available, some through simple prescription, coils can be fitted in the
clinic and operations are undertaken at BUPA Parkway
Pelvic pains (Dysmenorrhoea & Dysparunia)
Pelvic pain, painful periods and deep pain during and after having sex can be symptoms of endometriosis. This is a condition in which the
endometrium (the lining of the womb) comes back up through the fallopian tubes and seeds into the pelvis. Although scanning can sometimes
identify tender areas or cysts (chocolate cysts) the best way to diagnosed endometriosis is to look directly within the pelvis by doing a
laparoscopy. This is an operation with a full general anaesthetic, and involves putting a telescope through the umbilicus (tummy button)
and looking for the signs of inflammation and established endometriosis. The treatment of endometriosis is complex and would require a
detailed assessment of your symptoms and the results of scans and laparoscopy findings. Many people are successfully treated by different
forms of medical therapy, but for some a surgical approach is required, either using minimal access (keyhole) surgery or open surgery.
Contraception and sterilisation
Female Sterilisation
Sterilisation is an operation based around laparoscopy. You would require a general anaesthetic under which the operation involves two 1 cm
long cuts. One is in the umbilicus (tummy button) and one just above your pubic bone in the hairline. The operation takes about 15 minutes
to do, and is usually done as a day-case. The advantage of sterilisation is that it is highly effective and does not involve hormonal
treatment. The operation is designed to be permanent and although it can be reversed this would require a much larger operation and several
months to recover. It is only therefore right for someone who has definitely decided not to have any more children.
Coil fitting
We fit coils within the practice, either you can get the coil from your own doctor or we can provide one for you. The coil fitting requires
that you are not already pregnant (although it can be fitted immediately after an episode of unprotected sex to prevent implantation).
If you have not had a period for a while we would ask you to either bring a negative pregnancy test with you or we can provide one on the
day (small additional charges would apply). Both normal and Mirena coils are available, and can be discussed with you prior to fitting.
Coil fitting costs £150, with the cost of the coil which you chose being added (Mirena £100, Normal coils £30). The coil fitting includes a
pelvic ultrasound to ensure the coil is correctly sited high in the uterus. Subsequent coil checks with ultrasound are £50 (only needed if
problems or strings not seen)
Implanon (contraceptive implant)
The contraceptive implant is an alternative method of delivering a progestagen hormone and is similar in action to the Mirena coil and
Depot provera (Pill injection). The advantage over the Mirena is that it is fitted in your arm, so if you don’t like the idea of having a
coil fitted, or you have had problems with smear taking etc it can get over these problems. The main advantage over the Depot injection is
that it can be taken out at any stage, and you periods and fertility will be back to normal within a few months. The pill injection can
often have a carry-over effect for 12 or 18 months in some people The implanon implant costs £100, with a further £100 for fitting under
local anaesthetic. Fitting takes about 10 minutes, but your arm will be sore so you need someone to drive you home Some GPs will give you
an NHS prescription for the Implant, if you only want it to be fitted by us.
Consultation
Contraception is complex, many people need time to talk different options through and to be given literature to read. Your busy GP or Practice Nurse may not always have the time to go through everything with you. We can offer a private consultation with Mike Wyldes (Gynaecologist). Consultation fee is £120.
Infertility
Many couples have problems getting pregnant, about 1 in 10 will not achieve a pregnancy in the first 6 months of trying, and we would
recommend further investigations if this is the case.
Our practice does not specialise in advanced fertility treatment such as IVF etc, but we can make an initial assessment of the couple,
start some basic tests on both the partners and try to identify where the problem lies.
If further treatment is required we can advise and refer you to specialist centres, either locally within Birmingham or National centres
with particular facilities available.
Cancer screening and treatment
Cervical smears
Most women should have a cervical smear from the time they start to be sexually active every 3 years until 65 years of age.
GP surgeries will usually offer a good service, but some people like to have a smear done privately so they can get to know who is going
to do it, and how. Usually taking a smear is easy, but if the uterus is retroverted, or the vagina is narrow it can be difficult to find
the cervix. Our cervical smears use liquid based cytology, with the advantage of more cells preserved for the laboratory assessment (not
yet available in the NHS). This reduces the number of “inadequate smears” which means there is less risk of having to go through it all
again. We can offer either an experienced female GP (Anna) or a consultant gynaecologist (Mike). Once you get to know one of us, you can
book in to see us again, hopefully in 3 years time.
Abnormal smears
Many borderline or mildly abnormal smears need to be repeated, but if there is a severe abnormality or the mild abnormality persists the
cervix needs to be assessed more carefully. This is done by Colposcopy which is an out-patient procedure to closely examine the cervix,
and usually to take a biopsy (removal of areas with abnormal cells). This is done under local anaesthetic using a wire loop. This procedure
is not currently offered within the practice, and anyone requiring Colposcopy would be seen at BUPA Parkway Hospital in Solihull
Endometrial cancer
Cancer of the endometrium (lining of the womb) will usually present with abnormal bleeding, often after the menopause. Ultrasound and
endometrial biopsy are used initially to assess the uterus and in most cases no further investigation is required. If the endometrium is
thickened on ultrasound scan then a formal hysteroscopy and curettage will be undertaken under a general anaesthetic. This allows samples of
the lining of the womb to be examined closely to exclude cancer. A full medical assessment, clinical examination, detailed abdominal and
vaginal ultrasound, endometrial sampling and a timely report to yourself and your GP would costs £ 250. This type of consultation would
normally be covered by your medical insurance policy.
Ovarian cancer
Ovarian cancer is often hidden until quite late stages. The abnormal cells in the ovary cannot be sampled easily (as with cervical smears)
and it is rare to have abnormal bleeding The common symptoms are a feeling of bloating, sometimes disturbances to the bladder and bowel
function with pelvic discomfort Although there is no universally accepted method of ovarian cancer screening, and currently nothing offered
within the NHS the combination of blood testing for a tumour marker called Ca 125 with transvaginal ovarian volume measurement (with blood
flow studies in some cases) can give an early diagnosis, and for most people reassurance that the problem is not present. Women with a
family history, and those with certain cancer genes are at high risk. We can offer Ovarian screening on an annual basis, with the back-up
of laparoscopic assessment in borderline cases where the ovaries are enlarged or cystic.Ca 125 and pelvic ultrasound
(abdominal & transvaginal) is £170 and is either undertaken by an experienced sonographer or consultant.
Cancer treatment
If any cancer were to be diagnosed immediate referral to an oncology (cancer) team would follow The oncologists (cancer specialists) can
either see you as an NHS patient or privately through BUPA Parkway. All necessary referrals would be made.
Menopause and related problems
The menopause can be an incredibly difficult time for some women. The issues surrounding hormone replacement therapy are becoming more
and more difficult to fully understand, and sensible balanced advice can be difficult to find.
Although we have some knowledge in this area, our main skills within the practice would surround the assessment of the endometrium
(lining of the womb) in women having unusual bleeding patterns whilst on HRT. Abdominal and Vaginal ultrasound is a very important
investigation for any woman having abnormal bleeding. Detailed ultrasound assessment with a report to your Consultant or GP costs £180.
For the majority of other problems we would recommend referral to Mr David Sturdee, Consultant Gynaecologist at Solihull Hospital (NHS)
and BUPA Parkway (Private patients). He is a leading figure in the management of the menopause and Hormone replacement therapy, with a
wealth of knowledge both from the problem management perspective, and also from the research and scientific point of view. Appointments
by GP letter referral only.
Bladder problems and Incontinence
It is quite common for women to leak a little urine when they couch or strain. It is also common for the sensation from the bladder
to keep making women go to the toilet, even when their bladder is not very full. These problems can usually be cured without resort to
surgery.
Pelvic floor physiotherapy is an important starting point in all cases of bladder problems. An initial assessment and advice regarding a
pelvic floor training program together with advice regarding bladder drills is available with a private specialist physiotherapist.
The initial consultation fee is £120 (1 hour appointment) with follow-up visits £40 (15 minutes).
Urodynamic assessment of the pressure changes within the bladder during filling and emptying can be helpful in some cases. Referral to a
specialist in Urogynaecology can be arranged if the physiotherapy fails to deliver the desired results. Some patients do require surgery,
with the Tension Free Vaginal Tape (TVT) being the most popular operation currently. Urodynamic assessment and all surgery is undertaken
at BUPA Parkway Hospital
Early pregnancy scanning
Early pregnancy problems
Miscarriage
Ectopic pregnancy
Uncertain dates
Early pregnancy problems can usually be resolved easily by using high quality ultrasound. Normally an abdominal scan will give a definite
diagnosis, but at less than 10 weeks the images are better when the scan is done vaginally. The vaginal scan is painless, and is not a
threat to the pregnancy in any way. Clear pictures of a normal on-going pregnancy can be obtained from about 6 weeks gestation (counting
from the last period, 4 weeks from conception).Urine pregnancy testing and blood pregnancy testing are sometimes required to help to make
the situation clear.
Once a diagnosis has been reached the treatment options would be discussed.
Surgical evacuation of the uterus
If a miscarriage is diagnosed the options are either to wait for events to take a natural course, to have tablets and vaginal pessaries
to encourage the miscarriage to complete naturally or to have a surgical evacuation of the uterus (Womb). These options would be discussed
with you and treatment plans made. A fixed price surgical evacuation option is available through the hospitals we use including BUPA
Parkway. The cost is around £1400, with a consultant anaesthetist (usually Maria) and consultant gynaecologist (Usually Mike) undertaking
the operation for you.
Ectopic pregnancy
Ectopic pregnancy can be a life-threatening event causing internal bleeding. If an ectopic pregnancy is diagnosed or strongly suspected we
would recommend a laparoscopy under general anaesthesia. If the diagnosis is confirmed the pregnancy can almost always be safely dealt with
by minimal access surgery (which is a special area of expertise of Mike). Heavy internal bleeding causing collapse etc might necessitate
undertaking the surgery urgently, but the majority of cases are highly suitable for BUPA Parkway hospital and can be scheduled as day-case
procedures.
Alternative to surgery do exist, and in rare cases it might be appropriate to watch an ectopic pregnancy using blood pregnancy test levels.
Injections have also been used to manage these situations where operations seem to be risky. All of these things can be discussed with you.
Early pregnancy scanning £50 Consultation and discussion of management with management plan £50.
Why people chose the Private Patient option
The NHS style of care for emergency gynaecology would be for your surgery to be fitted in around other work. It is very common for the
anaesthetic and the surgery to be undertaken by doctors in training (usually registrars) who would generally do an extremely good job.
You would have no way of knowing how experienced your anaesthetist and surgeon were, and would not usually get to meet them before the
surgery. Your choice to go privately puts you in control of the situation. You can choose who is doing your surgery, and you will
have a theatre time allocated to you. Even very simple anaesthetics and operations can go wrong, and by having a consultant team dealing
with your case you both minimize the chances of a problem, and have the right people on hand to deal with any problems which arise.
Private care is not a cheap alternative, but many people feel that it is worth considering both to give peace of mind, and to give
convenience of choice in timings of procedures to fit into your life-style.
Scale of charges
Operations – See BUPA Fixed price structure. You pay a fixed price to cover the hospital, surgeon and anaesthetic fees. This price
includes covering any problems which might arise.
The practice will give you a written quotation as a fixed price for your surgery