Other Procedures & Conditions
PMS Counselling & Treatment
What is premenstrual syndrome?
Premenstrual syndrome (PMS) is a combination of symptoms that occurs right before a woman gets her monthly period. Many women get mild PMS but for some the symptoms can feel severe.
What are the symptoms of PMS?
PMS and premenstrual dysphoric disorder (PMDD) cause body symptoms as well as changes in mood. The most common symptoms are bloating, and feeling tired, angry or worried.
Other symptoms can include:
- Mood swings
- Feeling sad or hopeless, or crying a lot
- Eating more than usual or craving certain foods
- Trouble concentrating
- Sleeping too much or having trouble sleeping
- Breast soreness or swelling
- Headaches
If symptoms are severe, women can be impacted at work, school, or have trouble getting along with family and friends.
Is there a test for PMS?
No, there is no test for PMS. If you are concerned about any symptoms, a consultation with Dr Kothari should help to determine if you are experiencing PMS. He will discuss the type of symptoms you are experiencing and when you have them. To do this, he may ask you to write down your symptoms each day for 2 monthly menstruation cycles.
It is important to remember that having PMS should only show symptoms that:
- Only happen 1 to 2 weeks before your period starts, and not during or right after your period
- Affect both your body and mood
Is there anything you can do on your own to feel better?
Yes, to help feel better and manage your symptoms, you can
- Exercise regularly – Exercise usually helps improve mood and wellbeing.
- Find a way to relax – For example, you can try yoga or relaxation exercises.
- Avoid salty foods and eating large meals when you feel bloated.
- Take a ‘NSAID’ medicine to treat pain or headaches – NSAIDs are a group of medicines that includes ibuprofen (sample brand names: Neurofen).
- You might hear or read about herbs or vitamins that can help improve PMS. It’s a good idea to discuss this with Dr Kothari before you try them.
Can Dr Kothari treat PMS with medicines?
Yes, Dr Kothari can treat PMS and PMDD with a number of different medicines, including
- A group of medicines called ‘SSRIs’ – SSRIs include fluoxetine (sample brand names: Prozac) and sertraline (brand name: Zoloft). These medicines are also used to treat depression and anxiety.
- Birth control pills – Some women find that their PMS improves after they start taking birth control pills. There are different types of birth control pills, and Dr Kothari will help you choose the one that’s right for you.
STI Testing & Treatment
What are sexually transmitted infections?
Sexually transmitted infections, often called STIs, are infections you can catch during sexual intercourse. They are also sometimes referred to as sexually transmitted diseases, or STDs. Some STIs are caused by bacteria, and others are caused by viruses.
The most common STI’s include
- Chlamydia
- Gonorrhoea
- Genital herpes, also called ‘herpes simplex virus’ or ‘HSV’
- Genital warts, also called ‘human papillomavirus’ or ‘HPV’ – some types of HPV can cause cervical cancer in women
- Hepatitis A, B, and C
- Syphilis
- Trichomoniasis
- Human immunodeficiency virus, also called ‘HIV’ – This is the virus that causes AIDS
Many of these infections can be transmitted through any type of sex. That includes not just penis-in-vagina or penis-in-anus sex, but also oral sex and other types of sex play. HIV and hepatitis can be transmitted in other ways, too, such as exposure to body fluids.
What is STI screening?
STI screening includes a series of tests that doctors use to find out if a person has any STIs. STIs often don’t cause any symptoms, so it is common for people to have STIs and not know it. That’s what makes screening so important.
Dr Kothari recommends that people who are at risk for STIs be screened even if they have no symptoms. For example, you could be at risk for chlamydia if you had unprotected sex with a new partner. Screening for chlamydia or other STIs will alert Dr Kothari if you have an infection and he will then notify you and discuss your treatment options. Treatment will prevent the infection from getting worse and keep you from spreading the infection.
There are different types of tests that screen for different infections. Many STIs can be found through a blood or urine test. If you decide to be screened for STIs, Dr Kothari will work with you to figure out which specific tests are needed.
What symptoms should I watch for?
In general, watch out for any genital itching, burning, sores, or discharge. But be aware that many STIs do not cause any symptoms. The best way to know if you have an STI for certain is to be screened.
What if I have an STI?
If you have an STI, you will need treatment. The right treatment will depend on the type of STI you have. Treatment might include antibiotics or medicines called antivirals, which fight viruses. Treatment will cure your infection or keep it from getting worse. It will also reduce the chances of you spreading your infection to others.
If you do have an infection, you might need to notify any people you could have infected. Dr Kothari is committed to providing the right support, and can help you figure out which partners you need to tell based on the nature and timing of your relationship.
PCOS
What is Polycystic Ovary Syndrome (PCOS)?
PCOS is a hormonal disorder that affects 12-18% of reproductive women and up to 21% in those who are high risk, such as indigenous women. The term ‘poly’ suggests the ovaries may have multiple cysts, but this can be different from woman to woman. The term ‘cysts’ are referring to the partially formed follicles that each contain an egg. The real cause of PCOS is unknown, but some connections can be made to family history, lifestyle, and insulin resistance.
What are the symptoms?
Every woman can experience a different set of symptoms, but they are commonly indicated by acne, weight gain, excess hair growth, scalp hair loss, fertility difficulties, irregular periods, and mental health issues such as anxiety or depression.
What is the treatment for PCOS?
Creating a management plan is Dr Kothari’s preferred approach to treating PCOS. This includes a focus on healthy living such as a change in diet and physical activity to improve the lifestyle of our patients. This approach enables an increase in energy levels and helps to build a strong foundation for mental heath, thus decreasing anxiety and depression, and increasing motivation and self confidence.
Other approaches can include medical therapies, such as
- The oral contraceptive pill
- Insulin sensitising drugs
- Hormonal medication
- Testosterone lowering drugs
- Weight loss drugs
- Anti-depressants
- Anti-anxiety drugs.
Symptoms can be severe and impact women in all aspects of their life so it is highly recommended that you seek advice and treatment if you are suffering.
DOWNLOAD PCOS FACT SHEET
Family Planning
Wollongong Obstetrics and Gynaecology have a strong commitment to promoting improved reproductive and sexual health care for patients. We advocate a community-based approach, which educates and supports a number of issues and provides modern services to all Australians.
To discuss any concerns about your reproductive or sexual health, or consider what options are right for you, please arrange a consultation with Dr Kothari.
Birth Control
What is hormonal contraception?
Hormonal contraception is any pill, injection, device, or treatment that uses hormones to help prevent pregnancy in women. There are a variety of different kinds of hormonal birth control. Some contain the hormones estrogen and progestin, while some others contain only progestin.
All hormonal contraception methods are very effective. The methods differ in how easy they are to use and what side effects they have for different women. Ensuring you choose the most appropriate contraception for your individual lifestyle and needs is key. Dr Kothari will be able to assist you with this and explain the options available.
Contraceptive pills
Women who take contraceptive pills need to take a pill every day. Skipping pills can increase the chance of getting pregnant. Birth control pill packets usually include four to seven days of hormone-free pills, sometimes referred to as ‘inactive pills’, each month. It is during these hormone-free days that women get their period. Women who prefer not to get a period can skip the hormone-free pills and take a hormone pill every day instead. This is called continuous dosing, which can also be done with the patch and the vaginal ring. Most birth control pills contain estrogen and progestin, but there is a variety that contains only progestin.
Injections
Women who use hormone injections get a shot in the arm or bottom muscle every three months. Contraceptive injections (brand name: Depo-Provera) contain only progestin.
Vaginal Rings
A bendable ring is inserted in the vagina and can stay in place for three weeks at a time. This ring (brand name: NuvaRing) releases hormones in the vagina. It should not be removed when a woman has sex. If it is removed or falls out, it should be rinsed off and re-inserted as soon as possible. Women should be still protected against pregnancy if it is re-inserted within three hours.
Normally women use the ring for three weeks and then go without a ring during week four when they have their period. Vaginal rings for contraception contain both estrogen and progestin.
Implants
A contraceptive implant is a tiny rod that releases hormones in the arm. It must be implanted by a doctor or nurse and can stay in the arm for up to three years. Implants for birth control (brand name: Implanon) contain only progestin.
Hormone-releasing IUD
An intrauterine device, or IUD, is a device that is placed inside the uterus. There are two types available in Australia; the copper IUD and the hormonal IUD (Mirena). The Mirena works by releasing hormones into the body, and they can stay in place for up to five years. The hormonal IUDs contain only progestin.
Hormonal contraception is a safe and reliable way to prevent pregnancy for most women. It is important to note that hormonal contraception does not protect women from infections that spread through sex (‘sexually transmitted infections’ or ‘sexually transmitted diseases’).
What is the IUD placement procedure like?
IUDs are inserted during a simple in-office procedure that takes just a few minutes to perform. The procedure begins the same way as a routine pelvic exam. A lubricated speculum is used to gently widen the vaginal canal so the IUD can be inserted through the cervical opening. In some cases, a local anaesthetic may be used to numb the cervix before insertion, but most women experience very little discomfort. Once the position of the IUD is confirmed, the speculum is removed and the procedure is complete.
How can I tell if my IUD is properly positioned?
Your IUD comes “equipped” with a long tail that extends into your vagina. You may be able to feel it. Please see Dr Kothari if you are having any doubts.
Can my IUD fall out?
Although it happens rarely, an IUD can fall out. That’s why it’s extremely important to check for the IUD tail before engaging in sex. If you cannot locate the tail, contact our clinic as soon as possible to schedule an appointment with Dr Kothari. In some cases, you may need a simple in-office procedure to determine if the IUD is still inside your uterus or if it has fallen out completely.
How do I choose the right hormonal contraception for me?
Having a discussion with Dr Kothari will help you choose the best option for you. He will make suggestions based on a number of factors that are personal to you, such as
- How likely you are to use each method the correct way?
- Can you remember to take a pill every day?
- Can you remember to change a patch once a week?
Long-acting methods (IUD, implant) are the most convenient because they work for three to five years, depending on the method. The injection, which works for many months, is considered more convenient than the pill, patch, or ring. It is also important to consider how each method will affect your period.
DOWNLOAD CONTRACEPTION WITH IUD FACT SHEET
Is hormonal contraception safe for all women?
Some women should not use estrogen-containing hormonal birth control. This includes women who
- Are aged 35 or older and smoke cigarettes – these women are at increased risk for heart attacks and strokes
- Are pregnant
- Have had blood clots or a stroke in the past
- Are being treated for breast cancer, or have had breast cancer before
- Have irregular or very heavy periods – women with this problem should discuss this with Dr Kothari before starting hormonal birth control
- Have some types of liver disease – Hormonal birth control can make some types of liver disease worse
- Get serious migraine headaches that cause vision problems (flashing or zigzag lights)
- Women who have high blood pressure can use hormonal birth control, but their blood pressure needs to be followed closely by a doctor.
- Many women who can’t take estrogen-containing hormonal birth control can take other kinds of hormonal birth control that contain only progestin.
What if I take medicines together with contraception medication?
- Some medicines can affect how well hormonal contraception works. These include some medicines used to prevent seizures (called ‘anticonvulsants’) and some antibiotics
- St. John’s Wort (an herbal medicine for depression)
If you take any of these medicines, talk to Dr Kothari about how to manage birth control. If you already take hormonal birth control, mention it to any doctor or nurse who might be prescribing medicines for you.
What if I forget to use my hormonal birth control?
If you have sex and have forgotten to use your birth control, you can take a ‘morning after’ pill to reduce the risk of pregnancy. Do this as soon as possible after sex.