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Dr Marlena du Toit

Understanding the menstrual cycle PDF Print E-mail

Understanding the physiology of the normal menstrual cycle is imperative when evaluating a woman with abnormal uterine bleeding.

The normal menstrual cycle is characterized by

  • its length (mean 28 ± 7 days),
  • duration of flow (mean 4 ± 2 days)
  • amount of blood loss (mean 40 ± 20ml)

A diagram of the normal cycle:

Endometriosis PDF Print E-mail

What is endometriosis?

Endometriosis is a very common condition where cells of the lining of the womb (the endometrium) are found elsewhere, usually in the pelvis and around the womb, ovaries and fallopian tubes. It mainly affects women during their reproductive years. It can affect women from every social group and ethnicity. Endometriosis is not an infection and it is not contagious. Endometriosis is not cancer.

Endometrial ablation PDF Print E-mail

Hysteroscopy and endometrial biopsy is now the first-line investigation of women with abnormal uterine bleeding since it allows direct visualization of the endometrial cavity and the opportunity to obtain a directed endometrial biopsy.

If medical and hormonal treatment fails as management options for menorrhagia, surgical options should be explored.

When surgery is considered for management of menorrhagia, endometrial ablation can be considered in the first place. Endometrial ablation is the elimination of the endometrium by thermal energy or resection. The aim is to destroy the full thickness of the endometrium and also the endometrial glands in the superficial myometrium. With endometrial ablation the uterus is preserved and this is less costly and less invasive than hysterectomy. It is designed to treat AUB in women with no intrauterine pathology. It is therefore good practice to perform a hysteroscopy prior to this procedure.

A woman who has had ablation still has all her reproductive organs. Routine Pap tests and pelvic exams are still needed.

Polycystic ovary syndrome PDF Print E-mail

What is polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS) is a condition which can affect a woman’s menstrual cycle, fertility, hormones and aspects of her appearance. It can also affect your long-term health.

What are polycystic ovaries?

Polycystic ovaries are slightly larger than normal ovaries and have twice the number of follicles (small cysts). Polycystic ovaries are very common affecting 20 in 100 (20%) of women. Having polycystic ovaries, does not mean you have polycystic ovary syndrome. Around 6 or 7 in 100 (6-7%) of women with polycystic ovaries has PCOS.


Metformin & PCOS PDF Print E-mail

1. Introduction

The key clinical features of polycystic ovary syndrome (PCOS) are hyperandrogenism (hirsutism, acne, alopecia) and menstrual irregularity with associated anovulatory infertility.1 The consensus definition of PCOS recognises obesity as an association and not a diagnostic criterion1 as only 40–50% of women with PCOS are overweight. Ovarian hyperandrogenism is driven primarily by luteinising hormone (LH) in slim women, while in the overweight insulin may augment the effects of LH.1 Women with polycystic ovaries are more insulin resistant than weight-matched women with normal ovaries. Insulin resistance is seen in 10–15% of slim and 20–40% of obese women with PCOS and women with PCOS are at increased risk of developing type 2 diabetes.2