Is it normal to feel so much pain when I'm having my menses? My menses has not come in more than 2 months, is this normal? These questions are more common than you would think so here is a tell-all guide to the treatment of gynaecological conditions in Singapore.
You can also read about menopause and how to treat its symptoms here on Human!
What are Gynaecological Conditions?
2. Menorrhagia
3. Amenorrhea
4. Dysmenorrhea
Gynaecological conditions refer to conditions which affect women’s health, with a focus on the female reproductive system. Some gynaecological conditions include:
- Menstrual Disorders
- Endometriosis and Fibroids
- Ovarian Cysts
- Vaginitis
- Polycystic Ovary Syndrome (PCOS)
- Urinary Tract Infections
- Cervical cancer
- Menopause
Some gynaecological conditions commonly occur in women and are sometimes neglected because of its common occurrence. While some conditions are indeed harmless, others with similar symptoms can be detrimental to a woman’s health and fertility. In this article, we address some common gynaecological conditions.
1. Menstrual Disorders
Medical professionals categorise menstrual disorders into 3 types - menorrhagia, amenorrhoea and dysmenorrhoea.
2. Menorrhagia
Menorrhagia refers to a condition where a woman suffers from heavy or prolonged menstrual bleeding [1].
It is defined as excessive blood loss such that interferes with a woman’s physical, social, emotional or quality of life. Some signs and symptoms of menorrhagia include:
- Going through 4 to 5 pads/tampons per day when menstruating
- Menstrual bleedings which last longer than a week
- Restriction of activities due to heavy flow
- Shortness of breath and dizziness with exertion (symptoms of anaemia)
Treatments for menorrhagia of organic causes are offered based on general and fertility concerns. If the cause is suspected to be chronic endometritis, a course of antibiotics is enough to treat it.
There are various considerations to make when deciding on the type of treatment to take up but generally, the treatments are divided into 3 lines.
Cervical cancer is another disease that affects women. You can learn about getting a Pap smear here so that you know whether or not you need to take medical steps!
1st Line
- Levonorgestrel intrauterine system (LNG-IUD). This is a hormone-releasing device which lasts up to 5 years and has proven to be one of the most effective medical treatments, reducing blood loss by up to 94%.
2nd Line
Tranexamic Acid. Tranexamic acid works by stabilising a blood-clotting protein which reduces blood flow by 50%. It is taken 3-4 times a day for a maximum of 3-4 days when on their menstruation period. It is a non-hormonal drug and hence does not affect fertility.
Non-steroidal anti-inflammatory drugs (NSAIDs). NSAIDs decrease the body’s production of a certain hormone which reduces blood loss by up to 55% and also acts as painkillers.
They are taken during the period of menstruation and will not affect fertility. However, nausea, vomiting and diarrhoea are some side effects that may occur.
Combined oral contraceptive pills (COCP). These pills contain both oestrogen and progestogen. They reduce blood loss by 40% and can act as birth control, helps regulate the menstrual cycle, improve premenstrual symptoms and many other benefits.
3rd Line
Norethisterone. It is a man-made progestogen to be taken from day 5 to 26 of the menstrual cycle.
It is usually taken for short-term treatment of menorrhagia and can have side effects like weight gain, breast tenderness and acne. Unlike contraceptive pills, they are not effective forms of birth control.
Progestogen injection. These are usually given every 3 months and are limited to a usage period of 2 years due to the risk of bone loss with prolonged use.
GnRH analogue. These are hormone medication taken to mimic menopause and can be used to shrink fibroids before operations or control bleeding so that anaemia can recover before surgery.
Surgery is also an option but it depends on both the patient’s uterine size and desire to retain her uterus. We recommend consulting your doctor and having a thorough check before deciding on surgical options.
3. Amenorrhoea
While menorrhagia refers to excessive blood loss, amenorrhoea refers to the absence or lack of a menstrual period. This condition is more common and is considered normal in prepubertal girls (primary amenorrhoea), pregnant women, or women who are undergoing menopause [2].
However, if the condition is present in other women (secondary amenorrhoea), it can be an indication of a gynaecological problem. Secondary amenorrhoea refers to the situation where women who previously experienced the menstrual cycle cease to experience it for 6 months or longer.
You might be surprised to learn that the most common cause of secondary amenorrhoea is pregnancy. Hence, you should take a pregnancy test to investigate the cause of the secondary amenorrhoea.
Some other causes of secondary amenorrhoea include:
- Low weight or body mass index (BMI)
- General health problems like tuberculosis or sarcoidosis
- Severe head injury, previous radiotherapy to the brain or, rarely, brain tumours
- Polycystic ovarian syndrome (PCOS)
- Premature ovarian failure
Treatments for amenorrhoea are dependent on the cause of the condition. Women who have a low BMI can look towards changes in their lifestyles or diet. If the women are not wishing to conceive, they can start hormonal treatment by taking the combined pill or progesterones mentioned in the 2nd line of treatment.
Also read: Abortion In Singapore: The Essential Guide (2020)
4. Dysmenorrhoea
The last type of menstrual disorder is dysmenorrhoea. Dysmenorrhoea refers to a defined pain experienced during the menstrual cycle. 90% of women have this condition [3]. Some risk factors of dysmenorrhoea include:
- Having a body mass index (BMI) lower than 20kg/m2
- Smoking
- A history of sexual assault
Primary dysmenorrhoea is where the pain has no underlying cause while secondary dysmenorrhoea is pain caused by an underlying condition such as endometriosis, adenomyosis, fibroids or pelvic infection.
Treatment of primary dysmenorrhoea would generally be lifestyle changes while treatments of secondary dysmenorrhoea would rely on the underlying condition that has been identified. The most common cause of dysmenorrhoea would be endometriosis.
What are other gynaecological conditions found in women?
1. Endometriosis and Fibroids
Endometriosis is a condition that occurs inside the pelvic area where the tissues around the uterus grow abnormally.
This abnormal growth creates cysts on the ovaries, irritate surrounding tissues and can scar the reproductive organs. Fibroids, on the other hand, are non-cancerous growths from the muscle walls of the uterus.
Both endometriosis and fibroids are common conditions found in fertile women and have shown to occur simultaneously in over 40% of women who initially had either condition [4].
Symptoms of endometriosis and fibroids, on top of menstrual disorders, include [5] [6]:
- Pain felt deep inside the vagina during or after sexual intercourse
- Pain felt while passing motion
- Difficulty in passing urine and more frequent urination
- Backache
- Deep vein thrombosis leading to swelling in the legs
For gynaecological conditions like endometriosis, treatments for the pain would start from medicinal treatments if the patient is not keen on undergoing a diagnostic laparoscopy to confirm the condition.
Medicinal treatments are equally effective in relieving pain but none of them improves fertility.
Related: Trying To Conceive: This Singaporean Gynaecologist Discusses Fertility Tips
Over-the-counter painkillers can be used to curb the pain but most women would have tried these drugs before seeing a gynaecologist.
Hormonal drugs like oral oestrogen and progesterone combined can also be used to improve endometriosis pain by mimicking the hormone levels found in pregnancy.
Hormonal drug injections can be used to mimic menopause during treatment periods but should not be used in the long-term.
Surgical options are also available to treat endometriosis and fibroids but they require gynaecologists who specialize in endometriosis and minimally invasive surgery.
The decision to undergo surgery should be discussed carefully with your doctors as they can be high-risk complex operations which may compromise your fertility.
2. Ovarian Cysts
Ovarian cysts are fluid-filled sacs which form in or on ovaries that are common in women. Most of these cysts are rather harmless, giving little to no discomfort at all.
In most cases, ovarian cysts will disappear after a few months even without treatment. However, some can result in serious symptoms, especially ruptured ones [7].
As mentioned before, most ovarian cysts are rather harmless and do not cause symptoms. But larger ovarian cysts can cause pelvic pains, heaviness in your abdomen or bloating and if you experience sudden, severe abdominal pains or pains with fever or vomiting, please do seek immediate medical attention.
The most common causes of ovarian cysts are:
Hormonal issues. This leads to the formation of functional cysts which develop from follicles that normally grow in your ovaries every month. Functional cysts form when the follicle in your ovaries fail to rupture and continues growing or when the follicle has ruptured but starts to accumulate fluid. However, functional cysts are often harmless and usually disappear within 2 to 3 menstrual cycles [8].
Endometriosis. Endometriosis tissues can sometimes attach to the ovary and lead to the development of endometrioma, a type of ovarian cyst. These cysts can be painful during sex and your menses period.
Pregnancy. Ovarian cysts normally develop in women to act as a support during the early stages of pregnancy before the placentas are formed. The cysts can stay in the ovary until the later stages of pregnancy and may need to be removed.
Severe pelvic infections. Pelvic infections increase the likelihood of developing an ovarian cyst since the bacteria can travel from the cervix into the uterus and cause a cyst to form [9].
Ovarian cyst treatment depends on your age, the type, the size of your cyst, and your symptoms. Simply waiting is one of the treatments that your doctor may suggest.
If there are no symptoms and the cysts show to be small, the treatment for this would be to just wait it out for a few months and get a re-examination to see if the cyst has gone away.
Your doctor might recommend 2 types of medication - pain medicine and hormonal contraceptives.
Pain medication would help to lighten the symptoms of severe ovarian cyst while hormone prescriptions would be used to lower the chances of a recurring ovarian cyst condition.
However, medication like birth control pills will not shrink or remove an existing cyst.
You may need surgery if the cyst:
- Developed after menopause,
- Increases in size,
- Causes pain
- Looks unnatural.
If the cystic mass is cancerous, you will be referred to a gynecologic cancer specialist and may need to undergo hysterectomy and possibly chemotherapy or radiation.
You can learn about cervical cancer in this article by the Singapore Cancer Society!
How much do gynaecological conditions cost to treat?
As mentioned above, hormonal pills like birth control medication are used for the treatment of gynaecological conditions. You can find out more on the estimated costs of birth control in our article The Complete Guide To Birth Control In Singapore (2020) [10].
For treatments involving surgery, estimated costs can be as low as $276 or up to $4413 depending on the hospital that you are receiving your surgery in and the severity of your gynaecological condition.
Treatments
Cost
Gynaecological surgery
$276-$4413
Are the treatment costs Medisave-claimable?
Fortunately, Medisave does cover certain gynaecological surgeries in Singapore and provides an exhaustive list on the type of surgeries that they cover.
The surgery coverage for Medisave goes up to $300 per day for hospital charges in addition to the surgical limit which you can find on the Ministry of Health website [11].
Treatment
Maximum amount you can claim
Gynaecological Surgery
$300
Please do consult your doctor or insurance provider for more information on the coverage of gynaecological treatments.
In conclusion
Gynaecological conditions in women are common and you should not panic if you suspect that you are facing any of these conditions. However, it is still in your best interest to visit your doctor and have a check-up done regularly to guarantee your safety, health and fertility.
Related: How should I choose a gynae in Singapore if I have just found out that I’m pregnant?
Gynaecological conditions can be an embarrassing topic for some women to talk about, so make sure that you find a gynaecologist you feel comfortable with.
Alternatively, you can ask partner gynaecologists anonymously on Human and have your questions answered before you proceed with your clinical check-up.
Also read the guide to Mummy Makeover in Singapore