Brought to you by BMI Ross Hall Hospital

Q&A with Dr Andrew Paterson, Consultant Gynaecologist at BMI Ross Hall Hospital

What is a smear test?

A sample is taken from the cervix (neck of the womb) using a speculum to visualise the cervix through the vagina.

This is tested looking for changes that could indicate a precancerous change in the cervix or very rarely an actual cancer.

Until recently abnormal cells were looked for but now the system is changing in that it is first screened for high risk HPV (Human papilloma virus or ‘wart’ virus) – if they are present they check for abnormal cells.

If they are present a ‘Colposcopy’ is required.

Why have a smear test?

Smears were introduced in the 1960’s and have significantly reduced cervical cancer – but it still remains the commonest cancer in young women.

Cervical screening saves around 5,000 lives in the UK every year and the resulting treatment prevents 8 out of 10 cervical cancers from developing.

Who is given a smear test?

All women aged 25 to 64 in Scotland are invited for cervical screening. Women aged 25 to 49 are invited every three years and women aged 50 to 64 are invited every five years.  In 2016 the age range increased from 20 to 25 and frequency of cervical screening changed to 3-yearly from age 25 and 5-yearly from age 50 to 64.

What is HPV?

There are over a hundred different human papilloma viruses (HPVs).

Almost everybody has been exposed to HPV.

Some of them have been shown to cause cervical cancer - they are also involved in causing mouth and throat cancers.

The high risk viruses don’t cause the classic genital warts.

Teenage girls are vaccinated against the most common high risk varieties but this does NOT protect from all and vaccinated girls must still go for smears.

The ability to clear these viruses from your body is how to avoid the dangerous effect and all explains why smokers are at higher risk as their immune system is less effective because of cigarettes.

What is a coloscopy?

If there is an abnormality on a smear the woman is offered a colposcopy appointment.

This involves looking at the cervix and using a special stain to show up abnormal cells.

The doctor will then discuss what is best option.

These include –

Check again in six months

Take a tiny biopsy – often a local anaesthetic isn’t required

Perform a treatment to destroy the abnormal cells – normally done using a local anaesthetic.

Follow up smears and colposcopies are usually required and a test of cure will show if the HPV has been cleared.

What are fibroids?

A Fibroid is a very common, benign (non cancerous) growth of muscle most often found in the wall of the womb. They rarely are single, often several are present and occasionally there are many.

About 10% of women over the age of 40 will have fibroids.

They become more common as a woman get older and tend to shrink after the menopause.

Can they be harmful?

Often they cause no symptoms at all but if they do it depends on where in the womb they grow.

If they grow under the lining of the womb they can make periods heavier and more painful. They may cause bleeding in between periods or after intercourse.

If they grow in the wall of the womb or under the outer surface of the womb then they may also have a mechanical effect caused by their size and what the press on. They can cause a feeling of bloating, press on the bladder causing a need to pass urine more often or urgently. They can worsen stress incontinence. Pressing on the bowel can change the bowel habit – most often causing constipation. They can also cause back ache and pain with sex.

A rare cause of miscarriage is the distortion of the cavity affecting a pregnancy develop.

A pelvic examination will often reveal fibroids and then an ultrasound scan will show exactly their size, shape and position in the womb.

Sometimes a camera is inserted into the cavity of the womb (Hysteroscopy under local or general anaesthetic) to assess how distorted this is by fibroids and very rarely a camera is inserted into the abdomen (Laparoscopy under general anaesthetic)

What treatments are there for fibroids?

Treatment depends on the symptoms and also whether you wish to get pregnant soon or in the future.

The Contraceptive pill may make periods lighter

The mirena coil is effective also if the cavity isn’t to distorted or enlarged.

Tranexamic acid may also reduce bleeding and isn’t contraceptive.

Oral or injected progesterone may also help.

Two different drugs have been shown to shrink fibroids

GnRH analogue injection cause a menopause and this can allow fibroids to shrink – it has the same effect as menopause with flushing sweats etc. and can only be used for 6 months as thins bones.

Ulipristal acetate does shrink fibroids but needs careful monitoring in case of damage to the liver.

The blood supply of a larger fibroid can be blocked causing the fibroid to shrink under x-ray control.

What about surgery?

There are three possible surgical interventions:

Hysteroscopic resection of the fibroid in the cavity of the womb restoring normal anatomy – obviously beneficial if fertility still required.

Myomectomy – opening the uterus and removing each fibroid. This can be done either through a cut in the abdomen or laparoscopically (keyhole).

If fertility no longer required a hysterectomy may be the best option. Again this could be an open or laparoscopic operation and the ovaries and or cervix could be preserved.

How can I find out more?

Email enquiries.rosshall@bmihealthcare.co.uk or call 0141 303 1405.