INFORMATION

Empowering you with knowledge on Women's health, Infertility, Pregnancy & Menopause

Abnormal menstrual period

Are you troubled by heavy or erratic menstrual period? 

You are not alone. Period-associated problems are very common and most women put up with these for quite some time hoping they would go away on their own. Whilst this may be possible for some, many endure countless days of heavy menstrual flow, erratic bleeding and/or associated pain, and more often than not, end up feeling exhausted, becoming anaemic or finding it hard to cope with daily living, study and/or work.

There are many factors that can contribute to abnormal vaginal bleeding. Some are related to hormonal changes which are usually seen in adolescents, perimenopausal women, women with ovulatory problems, or women taking hormonal medications; while others may be due to underlying diseases such as fibroidsadenomyosispolyps, infections, pregnancy loss and cancers, to name a few.

At Yap Specialist, our gynaecologist will listen to your concerns and evaluate your history which may include treatments you have previously tried and what methods work best for you. A comprehensive assessment will then be performed to help determine the cause and the severity of your problem; this can include physical examination, blood tests, and/or ultrasound scan .  A range of treatment options will then be discussed and our specialist will assist you in selecting not only the most effective but the most suitable treatment to meet your needs. Treatment options can range from non-hormonal tablets, hormonal pills / injection / implant, or surgery. Thereafter, we shall continue monitor your progress until your problem is resolved or at least managed up to your satisfaction.

Further reading: how can I reduce or stop the heavy bleeding?

In-vitro Fertilisation (IVF)

This is currently the most popular fertility treatment in modern history, so much so couples seeking fertility treatment invariably expect to have this treatment as a wonder therapy to resolve all forms of infertility. Far from the truth, IVF treatment is basically a technique allowing fertilisation to occur in the laboratory, so that we can observe the fertilisation and early embryo development, thereby allowing us the opportunity to select and transfer embryo(s) which will improve your chances of conceiving.

Let’s clarify what IVF treatment can and cannot do. For a start, IVF treatment cannot be expected to perform the following miracles:

  1. alter or improve the quality of the sperms or eggs because the quality is determined by the sperms and eggs during developmental stages, well before IVF technique come into effect;

  2. modify any abnormal development of embryos – there is no such thing as embryo therapy; and

  3. significantly improve the implantation process other than working out the optimal timing of transferring the embryo back into the womb and giving you progesterone supplement to support the womb lining.

So what does IVF treatment entail and what can IVF actually do to help you conceive?

A typical IVF treatment would involve the following steps:

  1. proper counselling, planning and preparation to ensure you understand the treatment is right for you and that you and your partner are mentally, physically and emotionally ready for the treatment cycle(s); 

  2. going through the stimulation stage which the female will be given injectable medications to help the eggs grow to maturity (e.g. Puregon, Gonad F, Menopur, Elonva) and prevent premature release (e.g. Orgalutran, Cetrotide), 

  3. monitoring the ovarian response and progress with the combined use of serial blood tests and ultrasound scanning; 

  4. determining the date of having the trigger injection (e.g. Ovidrel, Pregnyl) after seeing an adequate number of mature eggs on ultrasound scan;

  5. performing surgical egg pickup under ultrasound guidance and under anaesthetic cover;

  6. obtaining & preparing sperms (either fresh or frozen-thawed) for fertilisation which takes place on the same day as egg pickup;

  7. applying fertilisation technique – a choice between conventional IVF where >200 sperms are placed together with an egg, and ICSI where a sperm is selected and injected straight into the egg under a microscope;

  8. observing for fertilisation and early embryo development, with the option of extended embryo culture till day 5-6;

  9. selecting and transferring embryo(s) – preferably one – into the womb using a fine catheter which passes through the vagina and cervix, preferably under ultrasound guidance; and

  10. undertaking specialised freezing technique (i.e. vitrification) to store excess embryos for future treatment.


As you can appreciate, IVF treatment can perform more than what you can expect from a natural conception. For a start, IVF treatment can artificially stimulating more eggs to reach maturity – not create but stimulate more eggs which would otherwise not reach maturity and which would normally get discarded in the natural selection process whereby only one of the many eggs per cycle get to maturity and subsequently be released. By obtaining more eggs, IVF treatment improves the chances of finding the right match in one cycle, thereby fast-tracking the selection process; and by carrying out the fertilisation process in the laboratory, it allows us to monitor and see whether the fertilisation and early embryo development have reached their appropriate milestone.

  

IVF treatment also allows opportunity to inject a sperm into the egg (a technique called Intracytoplasmic Sperm Insemination – ICSI) if there are very few good sperms present OR if there are fertilisation difficulties like sperm-egg binding problems.

  

IVF treatment also allows the choice of having embryo testing by carefully obtaining a few cells out of over 30 cells for testing of genetic or chromosomal problems which can affect the growth and development of the embryo. The method is called Pre-implantation Genetic Testing (or PGD) and the state-of-art technology being used for this test is called Comparative Genomic Hybridization (or CGH). This new technology now brings new hope to people with serious genetic inheritance or women with recurrent miscarriages by giving them a choice of transferring genetically / chromosomally normal embryos only, rather than leaving it entirely to chance or fate in having a normal baby.

  

When there are excess embryos resulted from an IVF treatment cycle, they can be stored for many years and be transferred at a later date (usually within ten years). Transferring these embryos can be done in a frozen-thawed embryo transfer cycle (or FET cycle) which can simply be a monitored natural cycle without the need for the stimulating hormone injections, surgical egg pickup and IVF. This option not only helps reduce the number of IVF cycles required to achieve a pregnancy, but also enables you to circumnavigate the negative impact of increasing parental age on the sperm / egg quality by simply giving you the option of storing the embryos at present for the future.

  

In short, IVF treatment can help maximise one’s fertility potential by obtaining more eggs per cycle than would normally be possible; select embryos of good quality to improve the chances of pregnancy and live birth per cycle; and keep excess embryos in storage for future transfers. As more innovative techniques are being introduced into IVF treatment, more and more couples who are facing difficulty having a baby can now hope to have their dream come through. Some of these methods are improved embryo culture techniques, embryo testing & selection, assisted embryo hatching, embryo glue to assist with implantation, donor sperm/egg program, surrogacy program etc. For individuals at risk of losing their fertility, particularly those needing to have potent cancer treatment like chemotherapy or radiotherapy, the option of freezing their eggs or sperms give them an opportunity to preserve their fertility potential, and modern IVF technologies are able to freeze, thaw and subsequently use these for fertilisation and producing embryos.

  

However fantastic you find IVF technologies, your reproductive capacity is still limited by your health and age, and one of our greatest challenges is finding enough good quality eggs in women aged over 40, or sperms in men aged over 55. Moreover, IVF treatment does not fix problems within the womb, and diseases like endometrial polypsfibroidsendometriosis, pelvic inflammatory disease etc can interfere with implantation and pregnancy, thereby diminishing your chances of having a healthy baby. With this in mind, it is important that you receive proper counselling and comprehensive assessment to ensure you optimise your chances of having a baby.

  

Refer to our Fertility Care section and Frequency Asked Question (FAQ) section.

Further reading on IVF treatment, ICSI treatment, embryo culture; assisted embryo hatching; pre-implantation embryo genetic testing (PGD); sperm extractiondonor programs; surrogacy 

Do you wish to have a baby in style?

Having a baby is a very personal journey. Some find it easy and straight-forward, others have a tougher and more risky journey. Whichever journey you go through, it is a personal one, which makes it sweeter if you have someone supporting you through, and have a specialist guiding you all the way to experience the best moment of your life – the birth of your precious baby. You may have read or hear stories about the things that could go wrong in pregnancy and childbirth, and may be constantly worrying about labour pain and how on earth the baby can come out. 

Yeap, those worries are legitimate because pregnancy and childbirth can be risky and potentially life-threatening to mother and/or baby, and these complications can happen even in young, healthy and supposedly low risk pregnant women. Looking back at history, it was not too long ago that our grandparents and the generations before them dreaded about the moment of not seeing their wife and baby survive through the childbirth process, and now these events are very uncommon, thanks to modern surveillance of pregnancy progress and childbirth in the labour ward with modern facilities like operating theatre, blood-bank, and nursery to provide emergency backup in case of any unexpected complications.

  

Our mission is to ensure you have a memorable pregnancy and childbirth experience; to support and guide you and your partner throughout this very personal journey; and above all, to make this process safe and comfortable.

  

In our clinic, you will see the same specialist throughout your pregnancy care, who is almost certain will be there delivering your baby. Your pregnancy care will include a comprehensive assessment and a personalised pregnancy care plan. With each subsequent antenatal visit, our specialist will monitor your health; the growth and well-being of your baby with an ultrasound scan to check your baby’s position, heartbeat, growth and fluid in the womb; and address any concerns along the way. You will be encouraged to attend antenatal classes organised by the private hospital you intend to have your confinement. The choice of delivery and pain management will be discussed to select the one you prefer, and although we would normally promote natural birth, how you wish to have a baby is entirely your choosing as long as it is deemed safe and reasonable. This would mean no homebirth or water-birth, and we would reason out with you why those choices pose a potential risk to you and the people looking after you.

  

We also put a strong focus on good pain management as we understand that labour can be painful and women can have varying degree of pain tolerance. Good pain management ensures you have control over your birthing experience, and help you avoid traumatic childbirth.

  

Our overriding goal is to provide you and your partner a comprehensive first-class professional care throughout your pregnancy journey til you have your baby in your arms, and to not only ensure a safe outcome but also bring you a memorable and wonderful experience. We call this, having your baby in extraordinary style.

  

The following is an example of a pregnancy care schedule.

Further reading on Pregnancy CareBirth plan and our Frequency Asked Question (FAQ) section.

Family Planning

Family planning is basically a strategy to influence the number of children one wishes to have and when. Although it is often not a precise method, it allows people to choose and to manage their family size and structure, and this is often a very personal choice influenced by one’s background, faith and society. There are many different methods to choose from and basically can be categorised into 5 groups: natural methods, barrier methods, contraceptive pills, non-pill alternatives, and sterilisation.

There is no right decision, just one which suits your needs and is compatible with your belief and values. It is also something that can change over time, and as such, it is important to choose methods which give you the flexibility to change your plan as your circumstances evolve.

Menopause

Reaching menopause can be a life changing event for women as it indicates the end of reproductive age. The experience of going through menopause is highly individualised, from minimal symptoms to significant disruption to one’s daily living. It can be influenced by various bio-psycho-social factors like health condition, lifestyle, family history and cultural factors etc. Click Read More to find out more about menopause and its management.

What is menopause?

Menopause is a natural aging process that usually begins at 45-55 years of age, with an average age of onset in Australia at 51 years. Sometimes, it can be brought on by medical or surgical treatments. As we know, the ovary produces female hormones (oestrogen and progesterone) in a cyclical fashion to stimulate breast development and to regulate menstrual cycles through the growth and subsequent shedding of the womb lining (also called the endometrium). These hormones are actually produced by the maturing eggs, and hence, as the egg reserve becomes depleted with aging, so also the ovarian hormone production which starts to become erratic and eventually the levels become negligible. This explains why women approaching menopause often experience irregular periods which can also be heavy. This duration, which is also known as perimenopause or the transitional phase, can last for several years which can be a rather disturbing time of one’s life. Medically, a woman is diagnosed to be in menopause after she has gone for one full year without periods. From then onwards, the woman is considered to be in the postmenopause.

What are the symptoms?

Typical symptoms are irregular period, hot flushes and night sweats. Other common symptoms are headaches, mood swings, sleeping difficulty, general aches and pains, and tiredness.

  • Period change: Irregularity or any change of period probably is the first thing you will notice. You may skip periods or they may occur closer together. Your flow may be lighter or heavier than usual.
  • Hot flushes: A typical hot flush lasts a few minutes and causes flushing of your face, neck and chest. Some women become giddy, weak, or feel sick during a hot flush. Some women also develop a thumping heart sensation (palpitations) and feelings of anxiety during the episode. Hot flushes tend to start just before the menopause, and typically persist for 2-3 years.
  • Sweats: It commonly occurs when in bed at night. In some cases, they are so severe that sleep is disturbed and bedding and clothing need to be changed.

In the long run, there are some recognised associated changes affecting other parts of the woman’s body like dry skin and hair, dry vagina, breast changes, increased urinary frequency, weak bladder and accelerated bone calcium loss resulting in osteoporosis.

How is menopause diagnosed?

Menopause can be diagnosed when your period has stopped for a continuous 12 months and you are over the age of 45. If you are taking specialised medications to suppress your FSH production, your menopause can be medically induced until such time you come off the effect of the medications. And if you have both ovaries are removed surgically, your menopause will occur soon after.

For women reaching menopause before the age of 45, your doctor can organise a simple blood test (for FSH and oestradiol levels) to help confirm the diagnosis, and consider further tests to screen out other medical conditions like hypothyroidism, anaemia or depression which can mimic, or sometimes co-exist with, menopause.

How is menopause managed?

It is important to accept that menopause is a natural course of life and nothing to be embarrassed or worried about. Although nothing can be done to prevent menopause, unpleasant symptoms can often be reduced by maintaining a healthy lifestyle with a well-balanced diet and regular exercise; and having supportive friends and positive thinking. Some general tips you may wish to try are:

  1. Choose a wide variety of fresh & healthy foods, ensure adequate fluids, and go for low-fat dairy foods with high calcium content, but try to limit alcohol intake (e.g. to no more than one standard drink per day).
  2. Have regular exercise like walking at least 30–45 minutes on most days of the week.
  3. Have some sunlight for natural vitamin D. Daily sun exposure is about 7 min during summer and 15min during winter but avoid the mid-day sun due to skin-damaging intense ultra-violet ray. Alternatively, you can take daily vitamin D tablet. 
  4. Quit smoking. 
  5. Treat vaginal dryness with lubricants such as K-Y Lubricant before vaginal penetration. Vaginal hormonal cream / pessary can be considered if over-the-counter treatments do not work.
  6. Consider effective contraception for 12 months after the last period. Although the ovulation becomes irregular, there is a risk, albeit a very slim one, that you may fall pregnant during the transition period.
  7. Be social and maintain a positive outlook.

Talk to your doctor about the option of going on hormone replacement (HRT) so that you can consider the benefits and purported risks associated with HRT. Studies have demonstrated that HRT is by far the most effective therapy for controlling menopause-related problems. Most importantly, management should be individualised as each woman's experience is different and unique. A proper counselling in this regard is very worthwhile.

What to prepare before going to your appointment?

Because there are a lot of things to discuss during consultation, it is a good idea to do some preparation before you go and see your doctor.

  1. Keep track of your symptoms. For instance, make a list of what symptoms you have, how often you get hot flushes and how severe they are.
  2. Make a list of any medications, herbs and vitamin supplements you are taking, including the doses and the frequency you take them.
  3. Tell doctor your recent Pap smear, mammography result, past medical & family histories like osteoporosis, heart disease, breast cancer, DVT and mood disorder. 
  4. Prepare a list of questions you may wish to ask your doctor. List your most important questions first.


For further reading:

Menopause | Better Health Channel. 2015

Diagnosing Menopause | Australasian Menopause Society 2015 

Management of The Menopause | the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) 2014

Mar 2017: Vaginal Prolapse

Vaginal prolapse is very common in women, believed to be over 30% of the female population. Conservative treatment includes pelvic floor exercises, pessary support and vaginal oestrogen supplement (for postmenopausal women).

Surgical options can be divided into 2 main groups: 1) reconstructive, and 2) obliterative types. The former option is suitable for women who wish to retain vaginal sexual function.

For reconstructive surgery to be durable in preventing recurrent vaginal prolapse, the supportive fascia would have to be strengthened and reinforced, and this can be achieved by a combination of physiotherapy, oestrogen supplement, and native tissue repair using dissolvable sutures. Unfortunately, this approach still accounts for a recurrent rate of 10% to 70%.

To improve on our long term clinical outcome, several approaches have been introduced. Mesh was popularised in the 2000s and not long after, had been introduced worldwide as the panacea for vaginal prolapse.

In recent years, there have been quite a lot of bad publicity against the use of artificial meshes as more and more women reported unacceptable complications like dyspareunia and mesh erosion. Mesh erosion rate was reported as high as 25%.

Cochrane review recently reported a significantly higher rate of needing repeat surgery in women who had transvaginal mesh surgery compared to those who had native tissue repairs.

These complications resulted in some high profile lawsuit in the United States and review by the FDA.

Facing the threat of expensive lawsuits, many manufacturers of mesh began to withdraw their products from the market, e.g. Ethicon, AMS and Bard. AMS which became Astora in 2015 decided to settle more than 20,000 of its own cases for reportedly more than $2.4 billion.

Now, the only manufacturers left to provide transvaginal mesh in Australia is Boston Scientific and Restorelle. Studies on their mesh products are too limited to draw a conclusion on benefits & safety.

Our View & Approach:

We have always been sceptical of the use of transvaginal mesh because of the unique anatomy & function of vagina as opposed to abdominal hernias. So far, all our patients who needed vaginal prolapse repair did not end up having mesh put in.

Our approach to women needing prolapse repair is to have:

1) Good patient selection

2) Proper preoperative preparation

3) Careful anatomical repair

4) Long-term postoperative care

With patient selection, we offer vaginal reconstructive surgery in those whom we think have reasonable healthy native tissue. Those who have very weak tissue / fascia and are not sexually active are given the option for obliterative surgery, also called colpocleisis, which have a very low rate for recurrence and complications.

For those who wanted vaginal reconstructive surgery, every effort is made to strengthen their native tissue and maintain this long term. Our recurrence rate is comparatively low, with only two known cases in the last 5 years! As expected, there have been no reported failure rate for vaginal obliterative surgery in our cohort of patients.

Practice Hour

Monday-Friday 9am till 5pm
After hour by request only

Phone: 08 8297 4338
Mobile: 0422 014 044

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