• Mr Ken Emmanuel, Consultant Gynaecologist

Day in the life of a consultant gynaecologist


This week's events started with planned surgeries early in the morning at the start of the week, followed by a general gynaecology clinic.


This weeks cases involved a biopsy, operations to treat heavy periods (uterine ablation), and a camera assessment inside the womb (hysteroscopy).

Some women may need a biopsy of irritating, itching, or painful lesions of the outer (vulva) and inner part of the vagina. A number of skin problems affect the genital area as they would elsewhere on the body. Depending on the woman’s age, some conditions will be more common. Younger women may have had trauma to the vagina as a result of childbirth, or may have painful areas, or cosmetic skin tags that they do not like the appearance of. These can be excised or biopsies depending on the likely diagnosis. Older women may suffer with intractable itching due to common conditions such as lichen sclerosis.

Turning to women with heavy periods. This is a common problem affecting 1 in 3 women, and is a purely subjective diagnosis. This means that if the woman say her periods are heavy, we take their word for it. I would often investigate this by clinical examination and an ultrasound scan. Occasionally other blood tests may be needed depending on the history given by the woman. Screening for anaemia, thyroid disease and platelet problems may sometimes be required. Often the GP would have done these tests already so saving me time. Broadly speaking, the management should be straightforward as I follow the UK national advice on the management of heavy periods published by NICE. I carried out three endometrial ablation procedures this week. This is a procedure that burns away the lining of the womb in order to minimise the amount of lining that the woman bleeds from during menstruation. This weeks equipment that I used was called Novasure, and is one of the most common devices for performing such a procedure in the UK. It may achieve up to 70-80% success rate whereby a woman is able to say her periods are significantly better. Hopefully my patients this week will fall into that category.

My final procedure this week was a camera assessment of the womb. This may be done for a variety of reasons such as prior checking of the womb before the ablation procedures that I mentioned above. It may also be used to exclude abnormalities inside the womb such as polyps or cancer. These operations are often very straightforward, and in many cases are able to be performed with the woman awake.

My clinic in the afternoon had a good variety of different gynaecological problems, many of which I see very frequently.

Later in the week was my obstetric on call. This was extremely busy as usual. There were no emergency cesarean sections this week, I managed pregnant women with problems such as high blood pressure, pre-term labour, intractable vomiting and nausea in early pregnancy, induction of labour, and bleeding in pregnancy. During my on call, I undertook my usual on call teaching of the junior doctors working with me, trying my best to impart some of my 25 years of accumulated knowledge in my speciality.

Finally, there was the usual wide ranging emails that I deal with weekly. Currently my inbox is sitting with 70 emails.

The interesting topic that I am sharing with you is on corpus luteum ovarian cysts, and are they a worry

Corpus luteum cysts are generally harmless. They are a normal part of a menstrual cycle. Basically, a woman makes an egg every month and while it is development on the ovary we call it a follicle. That follicle develops from over the initial 14 days of your menstrual cycle, and then pops at around day 14 on a 28 days cycle. This is called ovulation. At ovulation the egg is released and tries to make the journey along the fallopian tube into the uterus. The popped cyst is then called a corpus luteum, and it releases a hormone called progesterone which helps to support the early pregnancy if a woman falls pregnant. Occasionally, the follicle does not rupture (but may still release progesterone hormone) and develops into a fluid filled structure called a corpus luteum cyst that has the potential to reach 10 cm in size, but usually does not. Although most corpus luteum cysts will resolve by themselves, occasionally them may twist or bleed into themselves causing pain or problems. This would not usually directly affect a pregnancy were a woman to be pregnant.


Ovarian cysts refer to many different types of cyst from benign to cancerous. Thankfully, the vast majority are not cancerous. If you want to know more about ovarian cysts you can visit the NHS site explaining that by clicking here.



Well, that's enough for this week. There has been lots of other matters arising but more behind the scenes matters.


Come back soon, and remember to link to this blog for further updates.


Ken

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