The Obstetrics and Gynecology Center provides a holistic care for woman health from diagnosis, gynecological treatments, and to screening for gynecological cancer. The center also provides gynecological surgery, antenatal care and delivery with flat rate delivery package, and menopause counseling service. The team of experienced obstetrician-gynecologist in the center are available for excellent clinical care for woman and mother.

Services

1. 1. Antenatal care and childbirth
2. 2. Clinical care and follow up for pregnancies and pregnancies with risks
3. 3. Fetal development check with 4D Scan Test
4. 4. Lactation clinic
5. 5. Contraceptive consultation
6. 6. Gynecological cancer screening
7. 7. Obstetric-gynecological treatment and gynecological endoscopic surgery
8. 8. Medical tests before marriage or before having a child

Vaginal candidiasis

What is vaginal candidiasis?

Vaginal candidiasis is a fungal infection caused by a yeast called Candida, which normally lives inside our body and skin. With some factors altering conditions inside the vagina, such as hormones and medicines, Candida may grow more than usual and eventually cause infection. Treatment with medication is usually effective but may need to be adjusted individually by an ob-gyn doctor.

Risk Factors

• ◼️ Pregnancy (From increased estrogen level)
• ◼️ High dose estrogen birth control pills or estrogen hormone therapy
• ◼️ Antibiotics use
• ◼️ Uncontrolled diabetes
• ◼️ Weakened immune system – examples include HIV infections, prolonged corticosteroid medication, chemotherapy

Symptoms

 The symptoms include:

• ◼️ Vaginal itching and irritation
• ◼️ Pain or discomfort during intercourse or while urinating
• ◼️ Vaginal rash
• ◼️ Thick white vaginal discharge
• ◼️ Watery vaginal discharge

Treatment

Treatment with medication is determined by severity and frequency of the infection as diagnosed by your doctor. Options include:

• ◼️ Anti-fungal medications in several dosage forms: creams, ointments, tablets, and suppositories as prescribed by doctor
• ◼️ Single dose fluconazole oral medication

When to see a doctor

If you experienced any discomforts and symptoms which may indicate candidiasis, make an appointment with an obstetrician-gynecologist for accurate diagnosis and treatment.

Endometriosis

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What is endometriosis

Endometriosis is a painful condition when the tissue similar to the lining of the womb called endometrium which grows in other places such as ovaries, fallopian tubes, and pelvis. With this condition, this tissue will act just like endometrium in each normal menstrual cycle. The tissue will thicken and eventually bleeds but the tissue would then become trapped and surrounding tissue will be irritated.

Risk Factors

• ◼️ Early menstrual period
• ◼️ Never given birth before
• ◼️ Short menstrual period
• ◼️ Late menopausal age
• ◼️ Family history
• ◼️ High exposure of estrogens in lifetime

Symptoms

Signs and symptoms can be nonspecific and hard to distinguish. Patients with endometriosis usually describe the intense pain experienced far worse than the usual menstrual cycle. Symptoms can include:

• ◼️ Dysmenorrhea (Disabling painful menstrual period)
• ◼️ Pain with urination and sexual intercourse
• ◼️ Excessive bleeding
• ◼️ Infertility
• ◼️ Feeling sick, constipated, and diarrhea during menstrual period

Treatment

• ◼️ Pain medication as symptomatic treatments such as the nonsteroidal anti-inflammatory drugs (NSAIDs)
• ◼️ Hormone therapy such as hormonal contraceptives, gonadotrophin-releasing hormone (GnRH) analogues, and aromatase inhibitors
• ◼️ Conservative surgery to cut away the endometriosis implants
• ◼️ Surgery to remove uterus (hysterectomy) and ovaries (oophorectomy) in which must be considered very carefully weighing risk versus benefits

When to see a doctor?

If you have trouble with menstrual pain and suspected to have endometriosis, make an appointment with an obstetrician-gynecologist to diagnose and carefully plan for early treatment which would be more effective in the long run.

Menopause

What is menopause?

Menopause is a period of time where your menstruation ends. The definition of menopause is a 12 months period without menstruation. It is a natural part of aging and marks the end of woman’s reproductive period. Hormones’, namely estrogen and progestogen, level is changed and patients will experience symptoms such as hot flashes and vaginal dryness. Complications from menopause include cardiovascular diseases, altered sexual function from vaginal dryness, urinary incontinence, osteoporosis, and weight gain.

Causes

• ◼️ Natural aging
• ◼️ Oophorectomy – surgery to remove ovaries
• ◼️ Receiving chemotherapy or radiation therapy
• ◼️ Premature menopause (Before 40)

Symptoms

Symptoms may come as you are transiting into menopausal period (perimenopause). You might experience some or all of the following symptoms:

• ◼️ Hot flashes
• ◼️ Irregular periods
• ◼️ Sleep problems
• ◼️ Night sweats
• ◼️ Emotional changes
• ◼️ Vaginal dryness
• ◼️ Urinary urgency
• ◼️ Weight gain
• ◼️ Hair loss or thinning
• ◼️ Dry skin

Treatment

Menopause generally may not need any treatment. The treatments available aim to relieve symptoms, prevent, and manage any complications. Treatment includes two main types of treatment, hormonal and non-hormonal therapy which would depend on each patient’s needs.

Hormonal Therapy – There are two subtypes for Hormonal Therapy depending whether if you still have uterus or have had hysterectomy (Uterus removed) before

• ◼️ Estrogen therapy – Low dose estrogen alone prescribed in different dosage forms depending on each individual’s needs. Estrogen therapy aims to relieve menopause symptoms and also prevent osteoporosis. This suits the patient who have had hysterectomy or their uterus removed.
• ◼️ Estrogen Progesterone/Progestin Hormone Therapy (EPT) – Also known as combination therapy. This suits the patient who still have uterus as Progesterone reduces the risk of endometrial cancer with hormonal therapy. Taking Estrogen alone in this case may increase the risk of endometrial cancer.
• ◼️ Vaginal estrogen to relieve vaginal dryness administered by vaginal cream, tablet or ring.

Non-Hormonal Therapy – Useful for patients who may not be able to take hormonal therapy and help in relieving symptoms.

• ◼️ Low dose antidepressant for relieving hot flashes or mood disorder
• ◼️ helps relieving hot flashes and tends to be effective for patients with insomnia
• ◼️ helps relieving hot flashes
• ◼️ Prevention or Treatment of Osteoporosis (Refer to osteoporosis article)

When to see a doctor?

If you experience any of the symptoms and you think you might be going through a menopause, schedule an appointment with your obstetrician-gynecologist to treat your current symptoms and plan for health screenings in which each person may need differently in order to maintain a healthy well-balanced life.

Vaginal Bleeding

What is vaginal bleeding?

        Vaginal bleeding is a nonspecific term which can refer to bleeding from normal menstruation cycle or bleeding unrelated to menstruation. This article focuses on unusual vaginal bleeding which can be random and coincides with other symptoms such as pain. Vaginal bleeding other than the pattern of your menstruation cycle may occur and sometimes may not indicate a medical condition however it may be best to consult your obstetrician-gynecologist if you are in doubt.

Causes

There are various causes possible for unusual vaginal bleeding. Examples include:

• ◼️ Female Reproductive System Cancers
  •    ◽ Cervical cancer
  •    ◽ Endometrial cancer (uterine cancer)
  •    ◽ Ovarian cancer
  •    ◽ Uterine sarcoma
  •    ◽ Vaginal cancer
  • ◼️ Hyper- or Hypothyroidism
  • ◼️ Bleeding disorders
    •    ◽ Thrombocytopenia
    •    ◽ Von Willebrand disease
    •    ◽ Hemophilia
    •    ◽ Side effects from anticoagulant medications (blood thinners)
    • ◼️ Pregnancy related complications
      •    ◽ Ectopic pregnancy
      •    ◽ Miscarriage
      •    ◽ Pre-term labor
      •    ◽ Detachment of placenta (abruption)
      • ◼️ Infection in pelvic cavity, urinary tract, or sexually transmitted infections
      • ◼️ Cervical or endometrial biopsy from health check up
      • ◼️ Hormone replacement therapy for menopause
      • ◼️ Hormonal birth control pills
      • ◼️ Polycystic ovary syndrome
      • ◼️ Stress
      • ◼️ Blunt trauma or sexual abuse

Treatment

 Treatment can either be medication or surgery depending on the cause of the unusual vaginal bleeding. Medications include:

• ◼️ Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and mefenamic acid to help control heavy bleeding
• ◼️ Tranexamic acid to stop excessive menstrual bleeding
• ◼️ Antibiotics
• ◼️ Hormonal birth control medications
• ◼️ Intrauterine device

When to see a doctor?

For pregnant woman, immediately contact your doctor if you notice bleeding. Do not hesitate to call immediately even in the middle of the night as it can be a dangerous sign.

In general, most cases are not life-threatening. Consult your obstetrician-gynecologist when in doubt if you have any of these symptoms:

• ◼️ Noticeable change in menstrual cycle and/or amount of blood in each cycle
• ◼️ Bleeding after starting new medications or hormonal treatment
• ◼️ Bleeding with severe pain
• ◼️ Girls experiencing bleeding without signs of puberty
• ◼️ Excessive bleeding in newborn girls
• ◼️ Bleeding after sexual intercourse

Vaginal hysterectomy

What is Vaginal hysterectomy?

          Vaginal hysterectomy is a surgical procedure to remove the womb (uterus) through the vagina. This method reduces hospital stay, cost, and enable faster recovery time than abdominal hysterectomy. After removal of the womb, you will not be able to get pregnant.

Reasons for the procedure

        Vaginal hysterectomy is done to treat gynecological problems including:

• ◼️ Endometriosis
• ◼️ Cancers (Ovarian, womb, cervical, or fallopian tube)
• ◼️ Non-Cancerous tumors (Fibroids)
• ◼️ Chronic pelvic pain

Risks

        Generally safe but every surgery has risks. This includes:

• ◼️ Heavy bleeding
• ◼️ Damage to bladder or bowel
• ◼️ Infection
• ◼️ Reactions to anesthetics
• ◼️ Blood clots in legs or lungs

Procedures

        Your doctor will determine if you are a candidate for laparoscopic assisted vaginal hysterectomy or robotic hysterectomy. General steps of the procedures are as followed:

• ◼️ Incision is made inside your vagina
• ◼️ Uterine blood vessels are clamped and uterus is separated from connective tissue, ovaries, and fallopian tubes
• ◼️ Uterus is then removed through vaginal opening and absorbable stitches are used inside the pelvis

Obstetrics and Gynecology Clinic, 4th floor
Opening date and time
Open daily from 8:00 a.m. - 5:00 p.m.
In case of emergency, there is an obstetrician and gynecologist available 24 hours a day.
Telephone +662 220 7999 ext. 84000, 84001 or 0917988302