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?

Are you wondering about having your own baby?

Having a baby is one of our greatest milestones in life – it is a wonderful experience to be able to give birth to our children and raise a family. There are many books and reading materials out there on pregnancy, but our specialist will help you focus on what is important and relevant to you. 

Here, we take a holistic approach to understand your needs, to demystify myths surrounding fertility, pregnancy and childbirth, and to manage problems which can affect your chances of having a healthy baby. Getting a pre-pregnancy counselling allows you to address all your concerns with our specialist who will listen to your queries, systematically assess your health and give you a comprehensive yet easy-to-follow roadmap. This process will start with a comprehensive history taking, an appropriate examination, and a set of blood tests and ultrasound scan. You will then receive counselling about your health status and ways you can do to enhance your health and your chances of having a spontaneous pregnancy. This would give you better preparation and greater confidence in going to the next stage of your journey to having a baby.

One pertinent point to note, don’t wait too long to start a family – get a fertility check-up which includes an assessment of your ovarian reserve to help you work out how much time left in your reproductive lifespan before it is too late. We can discuss the option of storing your valuable eggs or embryos if you wish to delay your childbearing plan.

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


Further reading on Pregnancy Planning

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

Sep 2017: Induction of Labour (IOL)

The traditional method of childbirth is awaiting for spontaneous labour and hoping for a safe vaginal birth.

Over the centuries, our scientific knowledge on childbirth has enabled us to induce labour with effective methods by imitating the physiological process of labour.

Current methods for IOL are: prostaglandin (PG) gel or tape; trans-cervical balloon inflation; membrane sweeping; artificial amniotic membrane rupture (ARM); and oxytocin infusion.

Is IOL indicated and/or beneficial?

IOL is considered without qualms when awaiting for spontaneous labour is felt to be more hazardous. Medical conditions like pre-eclampsia (PET), poorly controlled diabetes, foetal growth restriction (IUGR), macro-somia, chorio-amnionitis, post-term etc are well established indications for IOL.

However, IOL becomes more controversial when the indication is for social reason, maternal anxiety or discomfort at late third trimester.

The question is whether IOL at term (which is defined as 37 weeks gestation and beyond) would bring a better birth outcome or not when compared to expectant approach?

Cochrane review included 22 trials with a total of 9383 women and found that IOL at term was associated with fewer caesarean sections (CS), meconium aspiration syndrome and perinatal deaths when compared to expectant approach.

A large cohort study in Denmark spanning over a 12-year period from year 2000, with a total of 770,926 infants born at term, reported a better perinatal outcome in the IOL group as compared to the expectant group. In particular, the proportion of infants with a birth-weight ³4.5kg was decreased by one-third; while the risks of intra-partum acidosis, cerebral palsy, birth trauma and neonatal death were all significantly reduced in the IOL group.

In February 2017, Mater Mother’s Hospital (Brisbane) which is Australia’s largest maternity hospital, published its observation of 44,698 births from 2007-2013 comparing IOL at term and expectant management. They reported broadly comparable perinatal outcomes between the two groups, but found that IOL after 40 weeks had reduced vaginal birth rates and increased CS rates.

Zhao et al (2017) ANZJOG 57:40

Our View & Approach:

The recent studies raise a pertinent question as to whether we should consider IOL for post-dates at 41 weeks and beyond, or whether we should consider IOL at 38-40 weeks gestation for women wishing to have a vaginal birth.

We believe in providing women a birth plan that they understand and wish for after they have time to consider the relevant information on various birth plans.

For those who wish to have a vaginal birth, we routinely discuss strategies aimed at maximising their chances of having a successful vaginal birth while minimising the risks of perinatal trauma, neonatal asphyxia and poor maternal pain control.  

As such, we provide regular antenatal monitoring of foetal growth and maternal well-being, and offer women the option to consider IOL between 37-40 weeks, with the ideal period at 38-39 weeks.

This approach is consistent with recent studies demonstrating better perinatal outcome and lower caesarean delivery when compared to expectant group or IOL for postdates.

In our cohort of patients, 90% of women who wish to have a vaginal birth ended up having a vaginal birth with no intrapartum-related cerebral palsy.

Practice Hour

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

Phone: 08 8297 4338
Mobile: 0422 014 044

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