Gynaecology

Ambulatory procedures are minor procedures that can be performed in a clinical setting whilst you are awake and able to talk to your doctor or nurse. Some examples include:

• Removal of small polyps (small tissue growths which are commonly benign)
• Endometrial ablation (a treatment for heavy periods which removes the lining of the womb)

Some of the common benefits of opting for an ambulatory procedure include:

• You won't need a general anaesthetic
• Your treatment will be quicker
• Speedy recovery in your own home around friends and family
• Less invasive treatment which avoids surgical scars.

Whilst in our care, you may be seen by a pre-procedure nurse to assess any additional needs you may have before your procedure. You can still eat and drink as normal on the day, and we encourage patients to take some pain relief soon after arrival. We’ll provide you with a relaxing environment for 60-90 minutes before your procedure, and a nurse will be with you throughout. We recommend that a partner, family member or friend collects you after the procedure and accompanies you home.

Clinics are held in our Colposcopy units at:

• Bishop Auckland Hospital (first floor) on Mondays, Wednesdays and Thursdays from 2pm-5pm
• Darlington Memorial Hospital (women's centre) on Mondays from 8am-12 midday and Wednesdays from 9am-12 midday and again from 2pm - 7pm
• Chester-Le-Street Community Hospital (first floor) on Mondays from 9am-12 midday, Tuesdays from 9am-12 midday and Wednesdays from 1:30pm -5pm
• Shotley Bridge Hospital (first floor) on Mondays from 2pm-5pm and Wednesdays from 8:30am -12:30pm and 2pm-5pm

Colposcopy is an investigation to examine the vagina and the cervix. It is normally undertaken on women with abnormal smear results. The procedure uses a colposcope, which is a special magnifying instrument, to examine the cervix and vagina more closely.

After a colposcopy, you may have dark vaginal discharge for up to three days, and some bleeding for up to one week. Your vagina may be sore and you may experience mild cramping. If no biopsy was taken, you may resume normal activity right away.

A hysteroscopy is a procedure used to examine the inside of the womb (uterus). It's carried out using a hysteroscope, which is a narrow telescope with a light and camera at the end. Images are sent to a screen or monitor so your doctor or specialist nurse can see inside your womb. The hysteroscope is passed into your womb through your vagina and cervix (entrance to the womb), so no cuts need to be made in your skin.

Hysteroscopy is a procedure that investigates the cause of abnormal bleeding from the uterus. At our outpatient hysteroscopy clinic, we diagnose and treat many gynaecological conditions. It’s a friendly and relaxed environment for patients and offers the advantage of delivering a modern 'see and treat' service without the need for a general anaesthetic. Most women feel able to return to their normal activities the following day, although some women return to work the same day.

While you're recovering:

• You can eat and drink as normal straight away
• You may experience cramping - similar to period pain and some spotting or bleeding for a few days, which is normal and nothing to worry about unless it's heavy
• You should avoid having sex for a week, or until any bleeding has stopped, to reduce the risk of infection

Menopause is the time after you have your last period. Because your final periods can be irregular, menopause is confirmed 12 months after your last period. Bleeding or spotting after this point is called postmenopausal bleeding (PMB). PMB represents one of the most common reasons for referral to gynaecological services, largely due to suspicion of an underlying endometrial malignancy. Women presenting with postmenopausal bleeding will therefore be referred to our rapid access clinics.

Most of the time, postmenopausal bleeding is caused by:

• Inflammation and thinning of the lining of your vagina (called atrophic vaginitis)
• Thinning of the lining of your uterus
• Growths in the cervix or uterus (called polyps) which are usually not cancerous
• Thickened endometrium (called endometrial hyperplasia) often because of hormone replacement therapy (HRT)
• Abnormalities in the cervix or uterus

These are all generally not serious problems and can be cured relatively easily. However, in about 10% of cases, post-menopausal bleeding is linked to cancer of the cervix or uterus and so it is very important to have it investigated. Therefore, the aim of our rapid access clinic is to provide the highest quality evidence based service for all women. Our specialist staff will perform preliminary diagnostics and ultrasound scanning. Referral will be via the cancer two week urgent referral pathway.

Clinics are held in our Colposcopy units at:

• Bishop Auckland Hospital (first floor) on Tuesdays from 9am-5:30pm
• Chester-Le-Street Community Hospital (first floor) on Thursdays from 9am-5:30pm

We provide a confidential and accessible service for women who are considering a termination. We support choice and provide a non-judgemental, non-directional approach in assisting women with their decision. As well as supporting and caring for women seeking a termination, we also provide a contraceptive service, advice on sexual health and on healthy lifestyle choices.

Clinic information, locations and times

• Bishop Auckland Hospital on Mondays from 5pm-8pm and on Wednesdays and Thursdays from 8am-8pm for day case procedures
• Darlington Memorial Hospital on Mondays from 1pm-3pm
• Chester-Le-Street Community Hospital on Tuesdays from 9am-12 midday

We hold clinics at Bishop Auckland Hospital and Chester-le-Street Community Hospital. If you wish to access our service please call: 01388 455333 for an appointment and/or to discuss your options. If you are unsure of your decision we offer a counselling service with a trained nurse counsellor, Trudy Oliver. To book an appointment with Trudy please call: 01388 455153 between 8am - 5pm Monday to Thursday.

To book an appointment for a termination of pregnancy please phone Monday - Friday 9am - 5pm on 01388 455333.

Important information

The legal limit for a termination of pregnancy in this country is up to 24 weeks. In this Trust we offer it until 16 weeks. So, while it is important to have an early appointment, please ensure you are at least 5 weeks pregnant when you phone. Our receptionist will ask you some questions regarding this. If at your consultation appointment you are greater than 16 weeks pregnant, we will give you information of other providers.

Consultation appointment

Consultation appointments are carried out at Bishop Auckland Hospital, Chester-le-Street Community Hospital, Darlington Memorial Hospital and University of North Durham Hospital.

At your consultation appointment you will be seen by a specialist doctor/nurse who will discuss your general medical history and help you decide your future contraception. It is our policy that you are seen initially on your own. You may take someone in with you after this.

You will then see a gynaecologist who will perform an abdominal scan to determine how many weeks pregnant you are. Occasionally you may need to have a vaginal scan and this will be discussed with you at clinic. Once your pregnancy has been seen on scan you will be consented for your termination.

Our nurse specialist will see you to book you in for your termination, give you more details, answer any questions that you may have and take blood if required.

Treatment for termination

Medical termination - this involves a further 2 visits, the second of which will be at Bishop Auckland Hospital. You will be required to take two different tablets. Click here for further information.

Medical termination at home - this involves a further 2 visits, the second of which will be at Bishop Auckland Hospital. You will be required to take two different tablets. You need to fit strict criteria. Click here for more information.

Manual vacuum aspiration (MVA) - this involves 1 visit to Bishop Auckland Hospital, where you will need to stay approximately 3 hours. You need to be less than 8 weeks pregnant to have this procedure.

Surgical termination of pregnancy - this involves 1 visit to Bishop Auckland Hospital. You will stay approximately 4 - 6 hours. You need to be less than 12 weeks pregnant and have a responsible adult to accompany you, and stay with you for the remainder of the day. Click here for more information.

The team are supportive, non-judgemental and  we respect your right to change your mind at any time. Please just talk to us.

Our vulval clinic offers a service to women with vulval conditions such as skin complaints of the vulva like lichen sclerosus and vulval pain known as vulvodynia. We can assess vulval conditions in a relaxed friendly atmosphere. Investigations such as swabs and biopsies can be taken during your visit and referral to other specialities can be arranged if required. The clinic is consultant-led and staffed by both male and female doctors, clinicians and nurses.

Your GP can refer you to us – you should receive appointment details through the post. Women referred via the urgent cancer pathway are seen within two weeks.

Other support and resources

Vulval problems can be very distressing, and good patient information is essential to reduce anxiety and help you to cope - we aim to provide you with as much information as possible, so please just ask us if you have any questions.

Please find below some helpful links to evidence based websites:

• Vulval Pain Society
• British Society for the Study of Vulval Disease
• International Society for the Study of Vulvovaginal Disease
• Royal College of Obstetricians and Gynaecologists
• National Vulvodynia Association

Urogynaecology specialises in treating disorders involving the pelvic region. Patients are often women with pelvic floor disorders or conditions involving the organs, muscles or connective tissues in the pelvic area.

Our outpatient urogynaecology clinic support women who are experiencing urinary incontinence, pelvic organ prolapse or lower urinary tract disorders. We offer a range of investigations and treatments for overactive bladder, stress urinary incontinence, pelvic organ prolapse, both simple and complex, interstitial cystitis, recurrent urinary tract infections, perineal trauma and urinary voiding dysfunction.

You can be referred to this clinic via your GP, another hospital consultant or from other continence service providers. When we receive your referral, we will send you an appointment letter with a date and time to attend the clinic. Depending on your condition, we may send you a bladder diary to complete and an instruction letter for you to complete an online questionnaire about your symptoms and quality of life, known as an ePAQ questionnaire.

A consultation consists of a urine test, weight and height assessment, a full medical history and physical examination. If you need to have urodynamic investigations, you will be given information before you leave about which tests are required and an appointment will be arranged for you.

Our outpatient urogynaecology clinic is located on the first floor of the Women's Centre at Bishop Auckland Hospital and on the first floor of the Colposcopy Suite at Chester-le-Street Community Hospital

Urodynamics

Urodynamics are investigations to demonstrate how your bladder is working. Urodynamics are diagnostic tests that can help to identify the cause of incontinence problems so that the best treatment can be offered to you.

Nurse led urogynaecology clinics

These clinics, run by our urogynaecology specialist nurses, support patients with bladder retraining, pelvic floor physiotherapy, clean intermittent self-catheterisation, bladder instillations and advice for interstitial cystitis.

We provide the highest quality evidence based service in our menstrual disorders clinics, specifically for women who are having problems with their periods.

Heavy menstrual bleeding is defined as excessive menstrual blood loss which interferes with a woman's physical, social, emotional and/or material quality of life. It can occur alone or in combination with other symptoms. You may also attend this clinic if you are suffering with periods that are:

• Painful
• Irregular
• Absent, i.e. no period
• Bleeding in-between periods (break through bleeding)
• Bleeding during or after intercourse

Clinics are held in our colposcopy units at:

• Bishop Auckland Hospital (first floor) on Tuesdays from 9am-5:30pm
• Chester-Le-Street Community Hospital (first floor) on Thursdays from 9am-5:30pm

Early pregnancy assessment is offered to ladies who are 6 - 14 weeks pregnant with unexplained abdominal pain or bleeding, and is available at Bishop Auckland Hospital (Monday – Wednesday), Darlington Memorial Hospital and University Hospital of North Durham (Monday – Friday).

Please note that you must be referred by your GP, midwife or other health care professional. If you have had a previous ectopic pregnancy or two consecutive miscarriages with the same partner, you will be able to refer yourself.

If you are admitted for elective inpatient surgery, this will be undertaken in one of our acute sites, at either University Hospital of North Durham or Darlington Memorial Hospital. During your stay we will do everything we can to make sure we offer you and your family all the support you need, and that your stay is as comfortable as possible. We ensure that everyone is treated fairly and equally, and with dignity and respect. Experience of care, clinical effectiveness and patient safety are our priority. We aim to involve patients fully in their own care, making decisions in partnership with clinicians to provide positive outcomes.

From your first visit through to any follow-up treatment, and until you leave our care, as an inpatient or an outpatient visiting one of our clinics, your welfare and care is extremely important to us.

We acknowledge that preparing to come into hospital can be an anxious time for patients and their families. If you or your loved ones require any additional information about your time in hospital, the procedure or investigation you may be attending for, or the condition for which you are being treated, please get in touch.

What to bring into hospital with you

We advise patients to bring as little property into hospital as possible (particularly valuables), but, if you know you're being admitted, you may wish to consider the following suggestions:

Documents and paperwork

Ideally, you should bring all the necessary paperwork you have been given relating to your condition. All the medications you are currently taking, and a list of telephone numbers of family and friends. If you have a written power of attorney or living will, please bring those along with you too.

Toiletries

You may wish to bring your toothbrush, toothpaste, lotion, deodorant, soap, shampoo, a comb or hair brush, and any other toiletries that you may need. Please avoid perfumes or highly scented products. Lip balm is also a good addition to your toiletry bag.

A small amount of money

You may need a small amount of money to use at vending machines, or to buy something from our on-site facilities. We don’t recommend bringing credit cards or large amounts of cash with you. We would also recommend leaving all jewellery at home.

Clothing

Please bring comfortable clothes with you (you'll be able to wear your own clothing if you wish). We recommend bringing a supply of loose-fitting underwear and comfortable socks. Nightgowns or nightshirts are better than pyjama sets, and short-sleeved shirts are best to accommodate any intravenous (IV) lines you may require. A cardigan-style sweater or bed jacket may help with your comfort. Make sure you have slippers to walk around in and one pair of regular shoes (in case you can walk outside). Don’t forget to bring your spectacles.

Something to occupy your time

You may wish to bring books or magazines with you, to help pass the time, or pens and writing paper for making notes or journaling.