Bleeding disorders are one of the most common reasons why women consult a gynaecologist. Depending on age, there are different possible causes of bleeding disorders, so the diagnosis is customised. You can support us by keeping a "bleeding diary", recording the frequency, strength and duration of bleeding. This is an important component in investigating the causes.

Possible benign causes:

• Organic causes (e.g. mucosal polyps, fibroids, inflammation or vessels on the cervix (ectopia))
• Hormonal factors (hormonal imbalances, especially during the menopause)
• Mechanical factors (trauma or foreign bodies, such as intrauterine devices = coils)

In addition to numerous benign diseases, in rare cases malignant changes in the female genital tract can also be responsible for vaginal bleeding. We therefore advise you to have bleeding disorders checked by your gynaecologist. They will refer you to us if there are any abnormalities.

Menopause refers to a woman's last menstrual period caused by physiological hormone production. During a phase of hormonal change lasting up to ten years with irregular cycles, the ovaries stop producing the majority of their hormones. If there are no periods for at least twelve months, this changeover process is considered complete and no further bleeding should occur.

Vaginal bleeding in the postmenopause (more than a year after the last period) may indicate a malignant degeneration of the uterine lining and should therefore be investigated by means of a small operation with histological examination. As part of the investigation, we can rule out other causes of bleeding, such as bleeding from the bowel or bladder.

In early pregnancy, normal progression is the basis for the further physiological development of the unborn child. Even minor abnormalities can lead to a halt in development or the loss of the pregnancy. This is called a miscarriage or abortion.

In a few cases, the pregnancy implants and develops outside the uterus, for example in the fallopian tubes or in the abdominal cavity. Under certain circumstances, this can lead to a life-threatening situation. You should therefore consult your gynaecologist immediately if you experience pain and/or bleeding in early pregnancy. They can then decide whether further examination in our emergency outpatient clinic is necessary.

Chronic lower abdominal and genital pain can have many different causes and therefore require a precise diagnosis.

Possible benign causes:

• Organic factors (e.g. fibroids, ovarian cysts, endometriosis)
• Infection with bacterial or viral pathogens
• Fungal infection
• Adhesions due to previous operations
• Psychological factors

In addition to a detailed medical history, a vaginal ultrasound examination and a smear test are also part of the basic diagnostic procedure. In some cases, a diagnostic laparoscopy is also necessary to clarify the cause of the symptoms.

You can find more information about endometriosis on the website of the Endometriosis Centre.

Vulvitis refers to inflammation in the area of the external female genital organs (labia majora and labia minora, vaginal entrance and Bartholin's glands). Possible pathogens include bacteria and viruses as well as various types of fungi. A disturbed vaginal flora - for example due to excessive intimate hygiene - can play a favourable role.

Common symptoms are

• Itching
• pain
• Changed discharge

The formation of abscesses is also possible. Infection can spread locally to the internal female reproductive organs (cervix, uterus, fallopian tubes and ovaries).

A detailed medical history including a careful clinical and sonographic examination as well as a microbiological examination are crucial for making a diagnosis.

Ovaries are made up of different types of tissue. Accordingly, ovarian tumours can have different origins. A distinction is made between physiological functional changes to the ovary and other neoplasms, most of which are also benign. Cycle-related changes are, for example, follicles, follicular cysts or corpus luteum cysts. Benign cystic changes are also possible, such as cystadenomas.

Ovarian masses are often incidental findings during regular check-ups with your gynaecologist. In some cases, however, they can cause non-specific lower abdominal discomfort or lower abdominal pain and lead to bleeding irregularities. Changes in the ovaries can usually be observed and monitored over a certain period of time. Sometimes they disappear on their own.

Surgical removal

In the event of an increase in size, discomfort or conspicuous features in the ultrasound examination, surgical removal of the findings may be necessary for further clarification or histological examination. However, this does not necessarily mean that an affected ovary must be completely removed. This decision depends, among other things, on the age of the patient, specific characteristics of the masses and, finally, the findings during the operation.

Myomas are benign lumps in the uterine muscles and are one of the most common tumours of the female reproductive organs. Up to 20 per cent of all women have fibroids, but only a fraction of these require treatment. As a rule, treatment should only be carried out if fibroids cause discomfort or are the cause of an unfulfilled desire to have children. The exact cause for the development of fibroids is not known, but a hormonal dependency is assumed. This is why they often grow during pregnancy or during the menopause.

Diagnosis & therapy

Fibroids can be visualised and monitored very well using ultrasound; no other imaging examination is usually necessary. The treatment depends on the size, appearance, growth pattern, location of the fibroids, whether there is a desire to have children and, of course, the age of the patient. Depending on the individual factors, medical or surgical therapy may be used.