Dr Wang Junjie, Head and Senior Consultant from the Department of Gynaecological Oncology at KK Women's and Children's Hospital (KKH), answers your questions about gynaecological conditions.
Dr Wang Junjie, Head and Senior Consultant from the Department of Gynaecological Oncology at KK Women’s and Children’s Hospital (KKH), a member of the
SingHealth group, addresses your questions about common gynaecological conditions.
This Ask The Specialist forum has closed. Thank you for participating. Scroll down to see all questions and answers submitted for this forum.
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Gynaecological conditions include irregular menses, fibroids or even gynaecological cancers.
Common gynaecological conditions include:
While some of these conditions are common and may appear innocuous initially, it is important to seek medical help if there are signs of them progressing.
Ignoring these signs can lead to serious health complications.
In this ‘Ask the Specialist’ Q&A forum, available only for a limited time, don't miss the chance for Dr Wang Junjie to address your concerns about common gynaecological conditions.
About Dr Wang Junjie
Dr Wang Junjie is Head and Senior Consultant of the Department of Gynaecological Oncology at KK Women's and Children's Hospital (KKH).
Dr Wang specialises in pre-invasive gynaecological conditions and treatment of gynaecological cancers. He is an accredited surgeon in gynaecological cancer surgery. In Singapore, he is one of the few accredited surgeons to use minimally invasive surgery for gynaecological cancers.
An avid educator, Dr Wang holds teaching appointments in all three medical schools in Singapore.
Questions and answers on avoiding gynaecological conditions
1. Question by Mdm Lim
Hi doctor,
My daughter is a special needs adult, 26 years old, for the first time missed her period for more than two months. (Since 20 March). She is unlikely and not pregnant after tested her with pregnancy kit.
However, there is no complaints of pain and no discharge found in her underwear. Please advise.
Answer by Dr Wang Junjie
Dear Mdm Lim,
An irregular period can be due to many reasons such as endocrine disorders, hormonal imbalance, medications, etc.
If your daughter’s period does not return to normal or it is persistently irregular, it is advisable to see a gynaecologist for further investigations such as a pelvic ultrasound and blood tests.
2. Question by Jessie
Hi Doctor Wang,
I am 65 years old this year. And I have a 7.4cm subserol fibroid in the Uterus. 9 years ago it was 6cm.
I don’t have pain or discomfort. At the moment, I think it didn’t affect my bladder so I don’t need to frequent the bathroom except my tummy is getting bigger.
Years back I have considered of going for hysterectomy, somehow was told to just leave it by an oncologist though I didn’t go through any test with them.
My question is what can happen to me in 10 to 15 years down the road. Will the situation be worse off than now? And at the end I still need to go for the op?
I have menopause at age 55, & currently have been doing my ultrasound yearly since 2015.
Just very concern about the danger I will face on the issues of the organs being punctured during the process of the op.
Would really appreciate if you can advise. Thank you.
Answer by Dr Wang Junjie
Dear Jessie,
Surgery for treatment of fibroid is usually performed when the fibroid causes symptoms like heavy menstrual flow or cause compressive symptoms like difficulty in urinating and defecating.
Usually after menopause, fibroids do not continue to increase in size. Rapid increase in size of fibroids may indicate malignancy and hence warrant surgical removal.
3. Question by Judith
Dear Doctor Wang,
My question is:
I am 69 years old. An ultrasound pelvic scan for an urology issue revealed "bulky uterus".
The report stated: CT KUB showed bulky uterus.
- size: 6.1 x 3.1 x 2.6 cm
- position: retroverted
- endometrial thickness: 5mm, within normal limits
- no obvious uterine lesion seen
- cervix: normal
The report also stated it is unusual for my age but both the urologist and polyclinic doctor did not flag any alarm or arrange for further evaluation. I am worried my condition has a health risk though.
Appreciate your advice and guidance.
Answer by Dr Wang Junjie
Dear Judith,
A bulky uterus can be due to benign conditions like fibroids or adenomyosis (when the tissue that normally lines the womb grows into the womb’s muscular wall instead). As you may require further investigations, I would advise you to seek an assessment with a gynaecologist.
4. Question by Doris
Hi Doctor Wang,
My daughter, age 14, has irregular menstruation cycle.
She has had her first menstruation at 11 years old.
Initial menses cycle was 6-8 months, with each cycle lasted 1-2 day, light spotting. (From 11-13yo)
Her cycle has improved slightly to 4-5 months, lasting 5-7 days, light/normal flow. (From 13-14yo)
She has not experienced any pain or cramp so far.
She is in sport cca, normal weight and has about 7 hours sleep a day.
Please advise if she needs to see gynaecologist for treatment. Thank you.
Answer by Dr Wang Junjie
Dear Doris,
It is not uncommon for teenage girls to have irregular periods. The part of the brain involved in menstrual regulation is still not mature and their hormones are still adjusting. Hence, their menstrual cycles may not be regular yet. It can take several years for a teenage girl's menstrual cycle to become more consistent and regular.
If a teenage girl's periods remain irregular after a few years, or if she is experiencing other concerning symptoms such as very heavy bleeding or severe pain, it is a good idea for her to see a gynaecologist for further evaluation.
5. Question by Shirley
Hi Dr,
I am 55 years old and think I’m going into menopause soon.
I like to know what things I need to look up for what kind of treatment I need.
I will be happy to meet you if you think that you are the right doctor that I should meet.
Basically, I like to be able to look younger than I am even though go into menopause. Thanks.
Answer by Dr Wang Junjie
Dear Shirley,
One of my colleagues recently addressed questions on menopause on HealthXchange - Ask the Specialist recently. Do go through the questions and answers submitted by visiting the page here:
Menopause - Doctor Q&A (healthxchange.sg)
You can also get information on the KK Menopause Centre by visiting www.kkh.com.sg/menopause
6. Question by Cherrie
Dear Dr Wang,
In late Dec 2023, I had my 1st episode of acute body rash outbreak which started around the same time when I had a 3rd Covid infection. This has become chronic and the Dermatology doctor is now treating it as Urticaria with antihistamines when necessary.
Around the same time, I also started to have very bad itching and soreness in my vagina (not previously experienced). It was so unbearable that I was homebound for almost 3 weeks and countless sleepless nights!
The Dermatology doctor opined that it's got nothing to do with the Urticaria, and the Gynaecology doctor is treating it as post-menopausal "Atrophic Vaginitis" and prescribes the Vagifem 10 micrograms on a 2 doses per week regime.
I am apprehensive and have yet to start using the Vagifem as firstly it is a struggle and painful process for me to insert the pessary.
Also, I have the following queries and concerns on the use of the Vagifem and would appreciate your kind advice and guidance.
Can I stop using the Vagifem after starting? Can I use it only once instead of twice a week, or only when there's itching?
I understand that HRT regimes may predispose one to breast and uterine cancers. How long can one go on Vagifem to minimie this risk?
Vagifem or any vaginal inserts may cause bacterial infections. Is there a high incidence rate of this happening with Vagifem?
The Gynaecology shared that if I do not use the Vagifem she will not be able to know if it's Atrophic Vaginitis in my case. But, for the past 3 weeks, whenever I start to feel some itching on my body, I also felt the itch at the vagina. After popping in a Fexofenadine tab (180mg), it appeared to be able to stop the vagina itch. Unfortunately, the Fexofenadine tab appeared to control the itching for only around 4 to 5 days in the past 3 weeks, and then I will need to pop in another tab when the itching is felt again. If Fexofenadine works to also stop the vaginal itching, can I rely on this instead of using the Vagifem?
I thank you for your time and look forward to hearing from you.
Answer by Dr Wang Junjie
Dear Cherie,
Vagifem is a topical estrogen used in the treatment of vagina atrophy. There is no risk of bacterial infection. As it is inserted into the vagina and locally absorbed, the risk of breast and uterine cancers is minimal.
Fexofenadine is an antihistamine which relieves itch but it does not treat vaginal atrophy.
7. Question by Bliss
Dear Dr,
What options are available for a 42-year-old with endometrioma & myoma who experiences severe pain & bleeding during her monthly period? Thank you for your advice.
Answer by Dr Wang Junjie
Dear Bliss,
Endometriomas are cysts that form on the ovaries as a result of endometriosis, a condition where tissue similar to the lining of the uterus grows outside of the uterus. Treatment options for endometriomas may include:
Pain management: Over-the-counter pain medications such as ibuprofen or acetaminophen may help relieve pain associated with endometriomas.
Hormonal therapy: Hormonal treatments such as birth control pills, hormonal intrauterine devices (IUD), or GnRH agonists may help manage symptoms and slow the growth of endometrial tissue.
Surgery: In some cases, surgery may be recommended to remove the endometriomas. This can be done through laparoscopic surgery, where the cysts are removed while preserving the ovaries.
It is important for individuals with endometriomas to work closely with their healthcare provider to determine the best treatment approach based on their symptoms, overall health, and fertility goals.
Myomas, also known as uterine fibroids, are non-cancerous growths that develop in the uterus. Treatment options for myomas may include:
Watchful waiting: In some cases, especially if the fibroids are not causing symptoms, a healthcare provider may recommend a "watch and wait" approach to monitor the growth of the fibroids over time.
Medications: Over-the-counter pain medications such as ibuprofen can help relieve pain associated with fibroids. Hormonal therapy, such as birth control pills or GnRH agonists, may also be prescribed to help shrink the fibroids and manage symptoms.
Minimally invasive procedures: Procedures such as uterine artery embolisation, myomectomy (surgical removal of the fibroids), or focused ultrasound surgery may be recommended to treat fibroids while preserving the uterus.
Hysterectomy: In some cases, if the fibroids are large, causing severe symptoms, or impacting fertility, a healthcare provider may recommend a hysterectomy to remove the uterus.
The best treatment option for myomas will depend on the size, location, and symptoms of the fibroids, as well as the individual's overall health and reproductive goals.
8. Question by Carol
Dear Dr Wang
May I know will new fibroid grow and on hardened fibroid OR existing hardened fibroid become alive and enlarged after menopause? Thank you for your advice.
Answer by Dr Wang Junjie
Dear Carol,
New fibroids do not typically grow on hardened or calcified fibroids. Usually after menopause, fibroids (including hardened or calcified fibroids) do not grow in size.
9. Question by Stacey
Dear Dr Wang
I have a health check reviewed, the issue is the Alpha Fetoprotein marker
1) 23 Dec 2023 was 14.9
2) 27 Feb 2024 was 17.7 (under Gastro Lab Test)
In Apr 2024, I have CT scan Abdomen and Pelvis at SGH and confirmed my Liver has no issue.
I am 59 years old woman and menopause at 54 years old, do you think what is my problem?
May I get your advice on the matter? Thank you.
Answer by Dr Wang Junjie
Dear Stacy,
Alpha-fetoprotein (AFP) is a protein produced by the liver of a developing fetus and is also produced by certain cancer cells, as well as by the liver or other tissues in adults. Raised levels of AFP in the blood can be caused by various factors, including:
Pregnancy: Elevated AFP levels can be seen in pregnant women, especially during the second trimester. It is commonly used as a screening test for certain fetal abnormalities, such as neural tube defects.
Liver disease: Liver conditions such as hepatitis, cirrhosis, or liver cancer can cause elevated AFP levels.
Germ cell tumors: AFP levels can be elevated in certain types of germ cell tumors, such as ovarian cancer.
Pancreatic cancer: Some cases of pancreatic cancer can cause increased AFP levels.
Non-cancerous liver conditions: Conditions such as liver cysts and liver injuries can also lead to raised AFP levels.
It is important to note that elevated AFP levels do not always indicate the presence of cancer or other serious conditions. You may want to see a gynaecologist to undergo further investigations to rule out liver diseases.
10. Question by Phyllis
Hi Dr
My daughter has been having painful periods of 1 to 2 days since age 10. She is currently 16+. Her menstruation period is normal last 7 days and usually come exactly on the same day the next month or a few days later. The flow is regular too. It is just that she is having pain during the first 2 days. Is it normal? Thank you for your advice.
Answer by Dr Wang Junjie
Dear Phyllis,
Many women suffer from painful cramps, known as dysmenorrhoea, immediately before or during their menstrual periods. There are two types of dysmenorrhoea: primary dysmenorrhoea and secondary dysmenorrhoea.
Primary dysmenorrhoea or common menstrual cramps is due to excessive levels of the hormone-like prostaglandin causing contractions of the wall of the womb, producing cramp-like, aching pain in the lower abdomen or back that can range from mild to severe. These often start shortly before or at the onset of the period, and last for one to three days. These cramps often resolve with age or after having the first baby.
Secondary dysmenorrhoea is menstrual pain with an underlying cause often related to problems in the female reproductive organs, such as uterine fibroids, pelvic inflammatory disease and endometriosis. It might also be caused by the use of an intrauterine device (IUD), especially in the early months after insertion. Pain from secondary dysmenorrhoea usually begins earlier in the menstrual cycle and lasts longer than common menstrual cramps.
You may wish to bring your daughter to seek further assessment with a gynaecologist if the menstrual cramps affects her function.
11. Question by MdmTan
Dear doctor
I have a history of Uterus prolapse and did a 'U' band operation at KKH. Something like that. Can't remember which year, might be more than 10 years ago. Now using sanitary liner daily.
Please advise and if need would like to see a Urogyn experienced Dr? Hope for a favourable reply.
Answer by Dr Wang Junjie
Dear Mdm Tan,
Pelvic organ prolapse including womb prolapse is a common condition. While it is not life-threatening, it can cause discomfort, distress or affect functionality.
If you feel that your condition is worsening, or have symptoms that are concerning, you may wish to seek a review at the
KK Urogynaecology Centre.
For more information on pelvic organ prolapse, visit
here.
Adopting a healthy lifestyle helps to prevent the worsening of a prolapse. To keep healthy, find out more tips
here.
12. Question by Judith
Dear Dr,
I had my full hysterectomy on Dec 2020 and currently on HRT. I am taking 2mg of progynova daily. I am now age 56.
a) Will there be any risk of breast cancer (I had my mammogram on July 2023, next appointment in 2025)?
b) Shall I stop taking progynova? But I learnt that my cholesterol, and other health will be showing if I stop taking.
c) Last year, I have knee issue due to wear & tear, is it the cause of the removal of my uterus?
I would like to arrange gynae consultation with KK, kindly advise.
Answer by Dr Wang Junjie
Dear Judith,
You may wish to seek a consultation with your doctor who had prescribed the menopause hormone therapy (MHT), to make a more meaningful review along with your other investigation results including medical history and physical examination. Furthermore, you may need to assess your knee or chronic medical issues, as a hysterectomy does not increase wear and tear of the knees.
Generally, MHT has been shown to be safe and effective in most women under the age of 60 with bothersome menopausal symptoms who are not at risk of breast cancer or blood clots. We encourage all women who have experienced moderate to severe menopausal symptoms to seek a detailed consultation to assess their suitability for MHT.
One of my colleagues recently addressed questions on menopause on HealthXchange - Ask the Specialist. You may wish to find out more by reading here:
Menopause - Doctor Q&A (healthxchange.sg)
For more information on the KK Menopause Centre, visit
www.kkh.com.sg/menopause
To make an appointment, please visit
here
13. Question by Annie
Dear Dr,
If an ultrasound of pelvic shows cystic lesions on the cervix suggesting nabothian cysts, what should I do and what tests to take? Thank you.
Answer by Dr Wang Junjie
Dear Annie,
Cystic lesions are growths in the body that are filled with fluid and can occur in various parts of the body. In the context of the cervix, such cystic lesions are known as nabothian cysts and are typically benign.
Treatment is typically not required, but regular monitoring will be encouraged. Factors such as location or size of the cystic lesions, and whether they cause symptoms or complications, will determine whether you should see a gynaecologist for further assessment or investigations.
14. Question by Tanya
Dear Dr Wang
May I know what are the differences between MRI and CT scan of the pelvis? Would MRI or CT scan be better for gynaecological conditions?
Do you need contrast to detect lesions in the pelvic area for MRI scan? Thank you for your advice.
Answer by Dr Wang Junjie
Dear Tanya,
Magnetic resonance imaging (MRI) and computed tomography (CT) scans are imaging techniques that can be used to visualise the pelvis.
An MRI scan is a specialised examination using a strong magnet and radio waves to produce medical images for diagnostic purposes. It is particularly useful for evaluating soft tissues such as the reproductive organs and can provide excellent contrast between different types of tissues. It is often the preferred option for gynaecological conditions as it does not involve radiation exposure and yet able to provide detailed images.
A CT scan uses a combination of X-rays and computer technology to produce cross-sectional images of the body, giving detailed information for diagnosis. It is typically used to visualise bones, dense tissues or to detect abnormalities in the bony structures of the pelvis. In the context of gynaecological conditions, a CT scan will be useful to identify fractures, tumours, or other conditions affecting the bones and dense tissues in the pelvis.
Contrast agents may be used in MRI scans to enhance the visibility of certain structures, abnormalities or lesions. The decision to use it will be based on the clinical situation and determined by the attending doctor.
15. Question by Jasmine
Hi Dr,
I just start my dienosis medication. But I am having my period. I just took in 6th day and my period also in 6th day. Still having heavy. My question is will it stop the blood? I'm very worry it won't stop and can still drink alcohol?
Answer by Dr Wang Junjie
Dear Jasmine,
Dienogest is a medication to reduce menstrual bleeding and pain associated with endometriosis. However, the effect can vary from person to person. Some women may experience lighter menses when taking it while some may not experience much difference.
It is generally recommended to avoid taking alcohol while on medication. If you are concerned about your heavy menses, please consult your doctor who has prescribed the medication to obtain a more personalised advice.
16. Question by Livia
Hi Dr Wang,
'If a patient in her early 40s had a few uterine polyps identified a few years ago and has been monitoring these via annual checks (with PAP and HPV) to the gynaecologist and was told she now has one uterine polyp but still urged to go for a removal procedure due to the potential cancer risks, given the polyp has been stable in size (as per the gynaecologist), is it really necessarily to remove it if she has no symptoms or intention to have kids.
Must the removal be done under GA as some countries don’t seem to require GA? How safe is the procedure?
What happens if she does not remove the polyp and when she eventually enters menopause? Does it matter that she is anaemic and possibly has endometriosis (not diagnosed but another non-gynaecologist mentioned in passing she may have this but her gynaecologist didn’t address her question)?
Thanks.
Answer by Dr Wang Junjie
Dear Livia,
The decision regarding uterine polyp removal, anesthesia option for the procedure, and the implications of non-removal should be discussed in detailed with a gynecologist.
Considerations should encompass the individual's medical profile, history, symptoms, potential health risks, and investigations’ findings. Additionally, the presence of anemia and potential endometriosis must be factored into the decision-making process.
Uterine polyp removal, when conducted by a proficient gynecologist, is generally a safe procedure. Nevertheless, as with any medical intervention, potential risks and complications will be addressed by the gynecologist. The procedure can be performed with local anaesthesia but the choice of anesthesia depends on the nature of the procedure, the patient's medical history, and considerations of safety and comfort.
In the event that the decision leans towards non-removal of the polyp, ongoing monitoring will be necessary.
17. Question by Meng Kwok
Hi Dr Wang Junjie,
I have been having many years of UTI and the urge to pee is unbearable. So I have been prescribed flavoxate and also Ural satchels to address this problem.
I am currently very dependent on these medication and condition has not really improved. And I have also many times of bacteria infection, urine culture was taken and prescribed course of antibiotics, many times. I observed all the hygienic practice advised.
I hope Dr Wang you can advise how can I have this UTI completely cured. Please help me from this misery which I have been suffering for the past years.
Thank you and much grateful.
Answer by Dr Wang Junjie
Dear Meng Kwok,
A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract (the kidneys, ureters, bladder and urethra). UTIs are very common in women, with up to 50 per cent of them experiencing it at least once during their lifetime. If you have UTI thrice or more in a year, it is considered a recurrent UTI (RUTI), which can be caused by the same or different types of bacteria.
As you have already sought treatment and are aware of the preventive measures, you may wish to seek an assessment with a urogynaecologist if you experience the following symptoms:
Symptoms of UTI persist even after treatment has been completed.
Infection develops three times or more in a year
Symptoms worsen or new symptoms develop such as persistent fever and back pain, while on treatment for UTI.
To know more about UTI and Recurrent UTI (RUTI), read these articles: UTI and
RUTI.
18. Question by Lim
Dear Dr. Wang, good day!
I have been experiencing heavy menstrual bleeding (menorrhagia) for some time and have been diagnosed with anaemia. My treatments have included tranexamic acid, NSAIDs, COCP, and a progestogen injection. After the first injection, I experienced continuous bleeding for a month, requiring a visit to the A&E for another injection and an increased dosage of COCP to stop the bleeding. Currently, the heavy bleeding is less frequent, but I still experience a few days of heavy bleeding with significant blood clots.
Prior to these issues, I underwent two endometriosis surgeries to remove chocolate cysts (last surgery was around 2017), which resolved the problem until a year ago when the menorrhagia began. Various scans have shown no cysts or cancerous growths, but the condition has led to my anaemia diagnosis and had to go to specialist.
Could you please help me understand the primary cause of this heavy bleeding? What are the available treatment options if medications and injections to be ineffective in the long run?
I am in my mid-40s and have never been pregnant. Is pregnancy still a possibility for me? Additionally, the hormonal treatments have caused bloating and weight gain. Is there a way to slim down while continuing with the hormonal treatment?
Thank you for your time and assistance.
Answer by Dr Wang Junjie
Good day to you too, Lim!
Given that you have a few complex issues at hand and there is a need to obtain more details of your personal medical history and investigation results, you will benefit from seeking further assessment with a gynaecologist to provide individualised treatment and advice.
Menorrhagia, heavy or prolonged menstrual bleeding, can be caused by various reasons such as womb bleeding with no identifiable cause, ovulation that does not occur during menstrual cycles, development of other gynaecological issues, thickening of the endometrium, womb cancer, or systemic disease.
Aside from the treatments that you have gone through, there are other surgical treatment options for menorrhagia, but you will need to discuss this with your gynaecologist. Some of the considerations include the size of the womb and desire to start a family in future.
Fertility does decline in the late 40s, but women can still get pregnant. As such, we encourage women to start a family earlier than later as there are maternal and fetal risks associated with advanced age pregnancies.
There are side effects to taking hormonal treatment and it is important to discuss these with your doctor who has prescribed it to you. There may be a possibility to adjust the dosage or explore alternative medications to minimise bloating and weight gain. Additionally, maintaining a healthy lifestyle including regular exercise and a balanced diet can help manage weight while on hormonal treatments.
19. Question by Ms SK
Dear Dr Wang,
I had a few episodes of endometrial polyp being removed. The recent removal is back in Nov 2023.
The diagnosis was thickened endometrium during the last surgery.
The medical report indicated that "sections show large amount of proliferative phase endometrium. There are a lot of polypoid pieces of tissue composed of haphazardly arranged and irregularly shaped glands surrounded by haemorrhagic, fibrotic and oedematose stroma, with prominent clusters of thick-walled blood vessels."
All testing is normal and within limits and is benign. Could you please tell me more about this result and the reason of those tissue glands that grew in my uterus?
Symptoms that I had was brownie or menses discharge (spotting) in between menses or before ovulation during some months. My menses is regular.
After the surgery back in Nov 2023, the brown spotting discharge coming back on and off.
May I know why this happen again and should I go for a thorough scan?
Hope to hear from you soon. Thank you.
Answer by Dr Wang Junjie
Dear Ms SK,
An endometrial polyp is a growth that occurs in the inner lining of the womb, known as the endometrium. These polyps are typically non-cancerous/benign.
The exact cause of endometrial polyps is not always clear. Some risk factors include hormonal factors, inflammation, advanced age, obesity, or women who have never given birth.
Brown spotting discharge after surgery could mean that there may be remaining or recurrent endometrial polyps or thickened endometrium. You may wish to consult your doctor again to discuss the need for further investigations or imaging studies to assess the status of the endometrial lining.
Ref: H24
