These are benign tumours of the womb muscle and occurs commonly in women of all ages. Majority (more than 99%) of such tumours are benign. Common symptoms include heavy periods, pelvic pressure and urinary problems, depending on where the fibroid is situated. Fibroids can also your ability to get pregnant if they distort the womb cavity.

Women are more likely to have fibroids if they are above the age of 35 years old and never had any children. Treatment options depend on the symptoms and location of the fibroid. Surgery to remove the fibroids can be done via the keyhole (laparoscopic) approach, via the open (laparotomy) approach or through the vagina/cervix (transcervical approach).

There are many different types of ovarian cysts. These grow from the ovaries and can be filled with clear fluid, altered blood or solid substances. Cysts can cause pain when they leak, burst or twist (tort). Surgery is necessary when severe or persistent pain is present.

Most cysts are benign and can be removed via the keyhole method unless they are very large. If the cyst is suspected to be cancerous, it is advisable to undergo open surgery and remove both ovaries and the uterus. The exact nature of the surgery and the surgical approach requires a detailed discussion regarding the pros and cons. After surgery there is still a chance of cysts growing back again over time if the ovaries are not completely removed.

This is a condition that causes pain before, during and sometimes after the menstrual period. Endometriosis can also cause pain during sex, and when passing motion. It is associated with infertility and is more common in women who have never been pregnant.

The cause of endometriosis is unknown, although one of the theories is that of menstrual blood flowing back into the pelvis (retrograde menstruation), causing inflammatory blood deposits to accumulate on surfaces of the ovary, uterus and large intestine. Sometimes these inflammatory deposits accumulate to form blood cysts (endometriotic cysts). Endometriosis often cannot be seen on a pelvic scan. It is a diagnosis based on history and symptoms described, further supported by a thorough pelvic examination. The only way to confirm the presence of endometriosis is through surgery.

Treatments for endometriosis consist of both medical and surgical methods, depending on the needs of the patient. A combination of both medical and surgical treatments may be necessary to control symptoms and enhance fertility.

This is a condition that results from weakening of the pelvic floor after childbirth. Parts of the vagina which support the bladder and rectum can “drop out”, causing a sensation of a lump below. In severe cases the entire womb can fall out of the vagina, a condition called procidentia. Surgery is the definitive solution for such problems, but patients who are unable to undergo surgery may opt for insertion of a device called a ring pessary.

In severe cases, a ring pessary may not be helpful and surgery may be the only solution. Untreated prolapse can lead to chronic urinary problems and skin changes in the vagina and cervix, leading to ulceration, bleeding and even cancerous changes.

Urgency, frequency and incontinence are common problems that women feel embarrassed to discuss with their doctors. However, most of these problems can be effectively addressed with medication or surgery.

Urinary problems can be linked to medical disorders such as poorly-controlled diabetes, recurrent infections and kidney problems. It is important to exclude these conditions first before considering any form of surgery.

Other causes of urinary problems include an overactive bladder as well as a weakened pelvic floor. Symptoms caused by an overactive bladder can be controlled by lifestyle modifications and medical treatment. A weakened pelvic floor can rise to leakage of urine during coughing/sneezing/running or laughing. This can be addressed by pelvic floor exercises and/or surgery. Sometimes more than one condition may exist and may require multiple treatment modalities. Various investigations can be performed to evaluate the causes for the urinary symptoms experienced.

One of the commonest reasons a woman consults a gynaecologist for is vaginal discharge.

Women of all ages can experience abnormal vaginal discharge. Fortunately, the majority of the cases are due to minor infections that are easily treatable. A small number of women have persistent symptoms that are refractory to treatment, and may require long-term oral medications.

It is important to elucidate the cause of the discharge in order to provide effective treatment. Vaginal infections can also be prevented by lifestyle changes and maintaining a healthy level of lactobacillus in the vagina.

This affects up to 10-15% of all couples who have been actively trying to conceive for one year. Both male and female causes can affect conception so it is important for investigations to be conducted together as a couple. The cause of subfertility may not be evident even after several investigations – a condition called unexplained infertility.

After investigations have been performed, the cause of the problem may require oral fertility pills, surgery, insemination or IVF. Fertility problems are often complex and require time and commitment in order for any particular treatment plan to succeed. If the woman is above the age of 35 years, it is advisable to seek treatment as soon as possible as female fertility declines with age.

This is the era when a woman will experiences many changes her life as aging and bone loss become serious issues. A cessation of menstrual periods for one year will confirm the diagnosis. Most women will reach menopause by the age of 49 to 52 years of age.

Prior to the complete cessation of periods, the woman may already experience symptoms such as hot flushes, mood swings, difficulty sleeping and skin changes. These symptoms may start as early as a couple of years before menopause and persist for the same period after menopause. For some women, the symptoms can be debilitating and affect work and family life.

Hormone therapy may be suitable for women and is the most effective solution to relieve severe symptoms. There are many different types of hormones and hormone-like therapies that can help. Some women respond well to supplements and a modification of lifestyle. Regular exercise and diet modifications have also been shown to be helpful.

Bone health and screening for cancers are especially important at this age as well. Women should ensure they are consuming adequate calcium and consider getting screened for cancers and cardiovascular diseases.

Cancers in general are on the rising trend in Singapore. A rich diet and sedentary lifestyle may contribute to the increase in some cancers.

The latest data from the Ministry of Health show a drop in the cervical cancer incidence in recent years, thanks to available screening through regular Pap smears. However, we should not be complacent as there are still many women who are not getting regular screening. Women should also consider the cervical cancer vaccine, which gives added protection against cervical cancer.

Currently the most common gynaecological cancer in Singapore is endometrial cancer. It ranks as the fourth most common cancer in women in Singapore. Close behind at No. 5 is ovarian cancer. Unfortunately there is no reliable screening method to prevent these 2 cancers. Fortunately a large number of endometrial cancers are detected early and can be cured if treated appropriately. Ovarian cancer remains a challenge to manage as it is often detected at later stages.

Effective Pap smear screening leads to the detection of pre-invasive disease (pre-cancer changes) of the cervix and vagina. These may progress to become cancer if left untreated, depending on the severity of the condition. In mild cases, treatment may be with held if the woman agrees to be closely monitored. Different treatment strategies can be offered and pros and cons of each discussed, depending on the type of disease and fertility concerns of the woman.

Vulval itch is a common complaint and may be linked to vaginal infections such as fungus. Treatment given for fungal infections will relieve symptoms. Vulval itch can also be caused by a number of dermatological skin conditions which may require co-management with a dermatologist. Occasionally a biopsy of the vulval skin may be necessary in order to establish the diagnosis.

Pain in the vulva, or vulvodynia, is an uncommon condition that is difficult to treat. Medications are the first-line treatment and rarely is surgery performed.