Gynaecology services at Luton & Dunstable

Services

General Gynaecology

The gynaecology service provides treatment and advice to women with a wide range of conditions including menstrual disorders; continence problems; non-cancerous ovarian pathology (or suspected pathology); uterine pathology including fibroids and atrophic vaginitis. The department is also happy to see patients for general advice on Hormone Replacement Therapy, contraception and sterilisation.

Procedures provided:

  • Colposcopy
  • Urodynamics
  • Hormone Implants
  • Out-patient hysteroscopy
  • Laparoscopic surgery
  • Prolapse treatment with pessaries
  • Ultrasound scanning
  • Insertion/removal of IUCDs
  • Termination of pregnancy
  • Fertility treatments

Clinics

Colposcopy- Women may be referred as part of a cervical screening programme.

Fertility Clinic- Gynaecological procedures treated at the clinic include:

  1. Laparoscopy for diagnostic or therapeutic purposes
  2. Hysteroscopy for fibroids, polyps and other abnormalities
  3. Myomectomy (including bloodless myomectomy)
  4. Tubal checking using x-ray

Assisted conception therapies offered at the clinic include:

  • Ovulation induction with Ultrasound scanning
  • IUI (Intra-Uterine Insemination) through NHS and self-funding

Gynaecological Cancer

Nurse-led Early Pregnancy Clinic provides a streamlined nurse led service supported by Doctors when necessary for pregnant women with pain and bleeding in early pregnancy. The clinic operates Monday to Friday 0800-1230 (Last scan appointment at 1130)

General Gynae including Post Menopausal Bleeding

Termination of Pregnancy - The clinic offers:

  • medical terminations for foetal abnormalities
  • medical terminations for gestations up to 13 weeks
  • surgical terminations under special circumstances

Following referral by a GP, the hospital endeavour to see patients within one week (average is 3 days).

The Acute Gynaecology Unit (AGU) - provides a clinician lead service for women with emergency gynaecological problems.

Gynaecological Urology

Pelvic Ultrasound

Outpatient Hysteroscopy
Urodynamics

Where the Service is based

Ground Floor, Maternity Building, Women's & Children's Unit  Luton & Dunstable Hospital

Who to Refer

General Gynae

  • Any kind of problem with periods - delayed onset, irregular or infrequent, heavy menstrual bleeding and problems with period pain
  • Pelvic pain (although not all such pain is gynaecological)
  • Pain with intercourse (dyspareunia)
  • Contraception and female sterilisation requests
  • Lumps arising from the pelvis (ovarian cysts and fibroids in particular)
  • Polycystic ovarian syndrome and certain other hormonal problems
  • Investigation and management of recurrent miscarriages

EPC

  • Pregnant women with pain or/and bleeding in early pregnancy up to 20 weeks
  • Pregnant women with high risk of an ectopic pregnancy
  • Pregnant women with pain or/and bleeding in early pregnancy up to 20 weeks

Dictation lists

Colposcopy

  1. Patients with an Abnormal Cervical Smear who have been recommended by the Cytology Lab to have a Colposcopy should be referred by their GP or directly by the Cytology Department. Patients should be prioritised into either "urgent" or "routine" appointments depending on the smear report.  Patients who have been found to have "severe" or "moderate dyskaryosis should be seen urgently and those with a mildly abnormal smear should be given a routine appointment.
  2. Patients who complain of post-coital bleeding need not be seen in the Colposcopy Clinic unless there are clinical signs of a cervical cancer such as an ulcerated or exophytic lesion on the cervix.
  3. Asymptomatic patients who are found to have "suspicious / abnormal" looking cervix at the time of a routine examination may be seen in the Gynaecology Clinic rather than in Colposcopy.

Pre-Referral Investigations in primary care

Infertility

The following investigations and the results available prior to referral are beneficial:

Men

  • Semen analysis x 2

Women

  • Rubella immune status;
  • day 21 plasma progesterone x 2

Amenorrhoea OR oligomenorrhoea

  • thyroid function tests,
  • plasma prolactin,
  • FSH and LH (on day 5 if she is having periods) are also helpful.

 

Who not to Refer

Early Medical terminations up to 9 weeks gestation (8+6)

BPAS is commissioned by NHS Bedfordshire to undertake termination of pregnancy services; plus related counselling, contraceptive and Chlamydia screening services.  BPAS is able to provide EMAs up to 9 weeks locally in Luton and Milton Keynes, but for procedures over 9 weeks (or those requesting a surgical termination) BPAS patients need to travel significant distances (London, Brighton, Leamington Spa). In terms of accessibility and patient choice it may therefore not be appropriate to refer for surgical procedures or EMA over 9 weeks to BPAS.  All Referrals are made via Action line: 08457 30 40 30

Termination of pregnancy briefing

Abortion in practice - a guide for GPs

General gynaecology

  • In an asymptomatic woman with functioning ovaries the coincidental finding of ovarian cysts up to 5cm in diameter does not warrant gynaecological investigation
  • Nabothian follicles are of no consequence and their presence does not constitute referral to gynaecology
  • Unless >5CM in diameter or palpable abdominally the presence of fibroids in an asymptomatic woman does not warrant referral. With the reduction in circulating oestrogen following the menopause fibroids shrink and may undergo degenerative change including calcification resulting in the coincidental finding on plain X-rays of "wombstones" which are again of no consequence

Management of Cervical Polyps

  • Cervical polyps are common coincidental findings in women undergoing cervical screening.  In the asymptomatic woman they are almost always benign.  They consist of an overgrowth of the endocervical columnar epithelium and are usually solitary although a small number may coexist.  More rarely a submucosal uterine fibroid on a long pedicle may be extruded through the cervical canal. Removal of a cervical polyp up to 2cm long by 1cm wide is a simple painless procedure requiring little skill and is not associated with significant bleeding and can be easily done in the primary care setting.  In asymptomatic patients where there is bleeding from an otherwise normal looking cervix after taking a cervical smear, there is no need to refer to Colposcopy.

Resources

Patient information leaflets

British Pregnancy Advisory Service (For termination of pregnancy)

BPAS self referral form

IVF treatment

IVF treatment EoE

Colposcopy

The colposcopy exam

Patient pathways

Infertility
Amenorrhoea
Irregular Bleeding
Heavy irregular bleeding
Menorrhagia
Abdominal/Pelvic mass
Postmenopausal Bleeding
Pelvic Pain
Urinary Incontinence
Vaginal discharge
Contraception
Sterilisation

Patient support groups

www.miscarriageassociation.org.uk
www.ectopic.org.uk
www.ectopicpregnancy.co.uk

BPAS- is the UK's leading independent provider of abortion care. As well as non-directive and impartial counselling for unplanned pregnancy and abortion treatment.  They also provide emergency contraception (such as the "morning after pill"), free pregnancy testing and vasectomy services. Available at www.bpas.org.uk



Last updated: 15/06/2012

Update due: 15/06/2013