Management of pelvic pain comes down to first identifying the cause. In some cases, this may take time to identify. Pelvic pain can be managed by a number of different modalities ranging from TENS, acupuncture and simple pain control, to nerve injections and pelvic floor physiotherapy

Not necessarily. Pelvic pain can arise for a number of reasons and from a number of sources, so it isn’t always caused by endometriosis. All the organs in the pelvic area have the potential to cause pain as well as the ligaments nerves and muscles in the area too.

Treatments for endometriosis have come a long way over the years. Hysterectomy is very much a last resort, and the main stay of treatment is around hormonal therapies in the first instance, which suppress endometrial tissue activity.

If endometriosis goes untreated, its cumulative effects can cause adhesions and scarring which may affect fertility. However, this does not occur in all cases. Family planning is an important consideration when diagnosing and managing endometriosis.

¹ https://www.jeanhailes.org.au/health-a-z/endometriosis/fertility

The gold standard of diagnostics for endometriosis is a surgical keyhole procedure called a laparoscopy, which directly looks for deposits of endometrial tissue outside the uterus on the pelvic organs. However in recent years specialist sonographers have been able to detect on ultrasound scan some manifestations of endometriosis such as nodules and chocolate cysts. These are specialist clinics who provide this type of ultrasound and your Evoca GP may request this type of test for you

² Reference: https://www.jeanhailes.org.au/health-a-z/endometriosis/diagnosis

Up to 50% of couples will take 6 months to conceive naturally¹, so it’s worth remembering that half will actually take longer than this. Patience and persistence is key, while also being aware of limiting factors such as age or co-existing medical conditions which may make it harder for fall pregnant

1. 80-90% of couples will fall pregnant within one year of trying. The rest will take longer or require some help to conceive.

Reference: https://www.healthdirect.gov.au/getting-pregnant

AMH is commonly misunderstood. AMH (Anti Mullerian Hormone) is a hormone released by ovarian follicles (potential eggs). As such it can be used as an indicator of egg count but is not absolute in this regard. Furthermore, it doesn’t tell us the quality or calibre of the eggs released and as such only gives one part of the story. Additionally, multiple factors contribute to overall fertility, so while AMH measurement is very useful, there are many components which make up your fertility picture.

¹ Reference: https://www.ivf.com.au/planning-for-pregnancy/female-fertility/ovarian-reserve-amh-test

Egg freezing was once an option out of reach for many women, and often isolated for use in women post chemotherapy, or who have other medical conditions or receive treatment which may affect fertility. Now, egg freezing is more accessible and more affordable, and thus is an option to women who may want children in the future, but not be in a position to start trying to conceive. Critically, age at the time of egg collection for freezing is important. We know that egg quality declines with age, and studies have shown us that optimal egg thawing for fertility treatment occurs with eggs retrieved from women under the age of 35 years old. ¹

1 Reference: https://www.pregnancybirthbaby.org.au/trying-for-pregnancy-after-35#fertility

The fitting procedure only takes a few minutes, and you will be able to go home straight afterward. Your GP will routinely review you a month after the fitting to ensure all is going well and that you aren’t having any problems post insertion.

No, studies have consistently failed to demonstrate conclusively that the contraceptive implant causes weight gain.

The hormonal IUDs release a small amount of progesterone which thins the lining of the womb. This can make periods lighter, or sometimes even disappear, despite ongoing ovulation.

The copper IUD generally doesn’t change the cycle but can, in a small proportion of women, cause increased bleeding.

No, your partner should not feel the threads. Sometimes the threads may be a little long post insertion and we can trim these at your check-up visit, 1 month after insertion.

Inserting of the IUD involves a brief period of discomfort during the procedure, but after this and once the device has settled, you should not experience ongoing pain or discomfort.

No, IUDs can be inserted in any woman who is sexually active and does not have an abnormality of her vagina, cervix or uterus. The Kyleena is a specially developed smaller sized IUD designed to fit in women who have not given birth.

No, but the combined pill (with estrogen and progesterone) stops ovulation, so with prolonged use, it can take time after stopping for ovulation to return – this can be up to 12 months.

Generally speaking there are three main modes of antenatal care delivery which women can choose from in Australia

1. Shared care
2. Midwifery group care
3. Private obstetric care

The GPs at Evoca Women’s Health are able to support you in whatever choice you make regarding the above modes of care. The shared care model – whereby the care is shared between the GP and the midwifery and obstetric team at the hospital or in the community setting – means that your GP can still provide ongoing and postnatal care following the delivery. This valuable insight can make a big difference as you navigate life as a new parent and indeed into further pregnancies.

References

¹ Reference: https://www.betterhealth.vic.gov.au/health/servicesandsupport/gps-shared-care-and-pregnancy

Antenatal classes are beneficial for both partners as they provide valuable insight into the stages of pregnancy and how the body changes during the pregnancy journey. They are especially beneficial if you are going to be new parents. Additionally, the classes help you understand the labour process and how you might choose to navigate that as well as breastfeeding and preparation for life postnatally when your baby has arrived.

As soon as you have returned a positive home pregnancy test, or a positive test from another health care practitioner, you should book an appointment with a shared care GP to start your antenatal journey.

• Many studies on HRT which have been published in the last decade highlight the potential risks of undergoing such a therapy, particularly around the incidence of breast cancer. However, recent evidence demonstrates that the risk of breast cancer from hormonal therapy is small, and in many cases the benefits of using therapy outweigh the risks.
• There is little or no change in the background risk of breast cancer if estrogen only hormonal therapy is used. This is used in women who no longer have a uterus and therefore do not require additional progesterone therapy.
• Combined hormonal therapy (estrogen and progesterone) can be associated with a small increase in breast cancer risk, though this increase in risk is also related to how long hormonal therapy is used, and the risk reduces when hormonal therapy use is ceased.
• Hormonal therapy should be discussed with your doctor and reviewed on a regular basis to ensure that an appropriate dosing and regime is used.  

¹ Reference: https://www.menopause.org.au/images/factsheets/What_is_MHT_and_is_it_safe_V7.pdf

Active ovaries release estrogen and testosterone into the body. While these hormones are critical for certain physiological functions, they also contribute significantly to a sense of female wellbeing. In menopause, the ovaries decline in function and eventually cease to function. As part of this decline, estrogen and testosterone levels fall. Testosterone is a critical hormone for sexual desire and libido. As levels fall so too does libido. While replacing testosterone in women has risks and is not yet straightforward, there are other lifestyle and psychological measures which can support some measure of increased libido.

² Reference: https://www.menopause.org.au/images/factsheets/AMS_Will_menopause_affect_my_sex_life.pdf

Symptoms of menopause are multiple and varied but broadly include:

•            Hot flushes
•            Night sweats
•            Sleep disturbance
•            Anxiety
•            Depression
•            “Brain fog”
•            Low libido
•            Vaginal dryness
•            Joint pains
•            Fatigue
•            Reduced energy levels

• Do nothing – if the prolapse is not causing significant problems then treatment may not be required
• Vaginal pessary – supportive removable devices inserted in the vagina which hold up the prolapse. These can be fitted by your Evoca doctor, and should be changes 6 monthly. Pessaries are usually used as a temporary measure but may be used as a more permanent option.
• Pelvic floor physiotherapy – can help with mild or moderate prolapse to reduce severity and improve symptoms
• Surgery – a variety of surgical options are available depending on the type and severity of prolapse.

• Vaginal delivery
• Family history of prolapse
• Menopause 
• Chronic cough (for example, asthma)
• Obesity
• Family history of vaginal prolapse
• Neurological diseases
• Forceps delivery

¹ Reference: https://www.nhs.uk/conditions/pelvic-organ-prolapse/#:~:text=Pelvic%20organ%20prolapse%20is%20when,can%20cause%20pain%20and%20discomfort.

• A lump or bulge felt in the vagina
• Pressure feeling in the vagina
• Dragging sensation in the vagina
• Sense of something falling out
• Urinary incontinence
• Difficulty passing urine
• Difficulty opening bowels
• Faecal incontinence
• Low back pain
• Discomfort or lack of sensation during intercourse

¹ Reference: https://www.nhs.uk/conditions/pelvic-organ-prolapse/#:~:text=Pelvic%20organ%20prolapse%20is%20when,can%20cause%20pain%20and%20discomfort.

Yes. HPV is transmitted via skin-to-skin contact and therefore women in same sex relationships are still at risk of carrying the virus and potentially developing cervical cancer as a result.

Yes. The HPV vaccine is very effective at protecting against some types of HPV but it does not protect against all types of HPV.

HPV (human papilloma virus) causes nearly all cases of cervical cancer. HPV is commonly transmitted without symptoms during sexual intercourse, and as many as up to 4 out of 5 people will carry HPV at some point in their life. Typically the body will clear HPV on its own, but in cases where the virus persists for a longer period of time, it can cause changes in the cells on the cervix which eventually lead to cervical cancer.

References

¹ Reference: https://www.cancer.org.au/cancer-information/types-of-cancer/cervical-cancer

An STI screen involves testing:

• Urine (chlamydia/gonorrhoea/trichomonas/ureaplasma/mycoplasma)
• Blood  (HIV/syphillis/hepatitis)
• Cervical/vulval/throat/anal swab (herpes/syphilis/chlamydia/gonorrhoea)

STIs can present in a variety of forms:

• Pain passing urine
• Frequency/urgency of urination
• Vaginal discharge
• Genital ulceration
• Genital lumps/spots
• Irregular vaginal bleeding
• Pelvic pain
• No symptoms

Yes. STIs can be transmitted via oral sex, though transmission rates are generally lower than with anal or vaginal sex. Symptoms of STI in the mouth or throat include, persisting sore throat or oral ulceration.

References

¹ Reference: https://www.nhs.uk/common-health-questions/sexual-health/what-infections-can-i-catch-through-oral-sex/#:~:text=Oral%20sex%20is%20the%20stimulation,risk%20of%20catching%20an%20infection.

• Breast screening by mammogram is focused around women aged between 50 and 74y

• Women aged 40-49y may access screening mammography if they have no symptoms 

• Women over the age of 74y can access screening mammography but should discuss it with a doctor first

References

¹ Reference: https://www.breastscreen.nsw.gov.au/about-screening-mammograms/am-i-eligible-for-a-mammogram#:~:text=priority%20for%20you.-,Breast%20screening%20is%20recommended%20for%20women%20aged%2050%2D74,until%20the%20age%20of%2074.

• Lumps
• Pain
• Skin changes (tethering/puckering)
• Nipple discharge
• New asymmetry

It’s normal to not feel like having intercourse in the immediate weeks after birth regardless of how you have delivered. All women should feel ready and comfortable for intercourse before they resume sexual activity. Contraception is an important consideration at this time, regardless of whether you are breast feeding or not, as breast feeding does not offer full contraceptive cover.

Recovery from pregnancy can take a varied length of time depending on the circumstances of the pregnancy and delivery. Gentle exercise, such as walking, is encouraged in the early postnatal period if you feel up to it, as it can improve your mental health as well as physical wellbeing. However, rushing to the gym to rapidly lose the baby weight gained during pregnancy is not recommended. It takes tome for the body to go back to its pre-pregnancy state after delivery, as the many physiological functions slowly transition according to feeding choices and then beyond.

References

¹ Reference: https://www.pregnancybirthbaby.org.au/safe-return-to-exercise-after-pregnancy

Generally it is recommended that you wait 4-6 weeks before driving after a caesarean section operation. This is because the surgery and the wound can leave you less able to perform an emergency stop efficiently and comfortably. Following a check-up, and provided that there are no other medical conditions which would make you unfit to drive, you should be able to resume driving.

References

² Reference: https://ranzcog.edu.au/wp-content/uploads/2022/05/Driving-after-abdominal-surgery-including-caesarean-section.pdf

There is no evidence to suggest that abortions without complications cause an adverse effect on female fertility. Complications such as infection or a form of scarring post-surgical procedure can lead to problems which can impair fertility, however these occurrences are rare and can also be treated. Commonly, fertility returns quite quickly post abortion, and for this reason contraceptive measures are often discussed soon after the time of the abortion.

¹ Reference: https://www.nhs.uk/common-health-questions/womens-health/can-having-an-abortion-affect-my-fertility/

Both methods of abortion are as effective as each other. They carry differing risks relating to the method used, however, actions are taken with both methods to mitigate these risks. Speak to your GP to understand more.

The fitting procedure only takes a few minutes, and you will be able to go home straight afterward. Your GP will routinely review you a month after the fitting to ensure all is going well and that you aren’t having any problems post insertion.

No, studies have consistently failed to demonstrate conclusively that the contraceptive implant causes weight gain.

The hormonal IUDs release a small amount of progesterone which thins the lining of the womb. This can make periods lighter, or sometimes even disappear, despite ongoing ovulation.

The copper IUD generally doesn’t change the cycle but can, in a small proportion of women, cause increased bleeding.

No, your partner should not feel the threads. Sometimes the threads may be a little long post insertion and we can trim these at your check-up visit, 1 month after insertion.

Inserting of the IUD involves a brief period of discomfort during the procedure, but after this and once the device has settled, you should not experience ongoing pain or discomfort.

No, IUDs can be inserted in any woman who is sexually active and does not have an abnormality of her vagina, cervix or uterus. The Kyleena is a specially developed smaller sized IUD designed to fit in women who have not given birth.

No, but the combined pill (with estrogen and progesterone) stops ovulation, so with prolonged use, it can take time after stopping for ovulation to return – this can be up to 12 months.