Polycystic ovary syndrome

smiling woman standing in a sunny garden

Polycystic ovary syndrome is a condition that can cause you to have irregular periods, get oily skin and pimples, and grow extra facial hair. The condition can also make it hard to get pregnant by preventing you from ovulating. People sometimes refer to polycystic ovary syndrome as “PCOS).” It is very common; about 5 percent of all women have PCOS.

What causes polycystic ovary syndrome?

About once a month, the ovaries should make a structure called a follicle. As the follicle grows, it makes hormones and releases an egg, and this is called “ovulation.” In women with PCOS, the ovaries don’t work very well, and the follicle often does not develop. Instead, the ovary makes many small follicles instead of one big one, and hormone levels can get out of balance. This can prevent ovulation from occurring, which makes it difficult to become pregnant. The hormone imbalances are what leads to the excessive facial hair.

What are the symptoms of polycystic ovary syndrome?

Women with PCOS can have all or some of the following symptoms:

  • Fewer than 8 periods a year
  • Weight gain
  • Growth of thick dark hair in a male pattern, such as on the top lip, chin, sideburns, chest and belly
  • Male pattern balding
  • Oily skin, pimples or acne
  • Difficulty becoming pregnant

Should I see a doctor?

If you have symptoms of PCOS, it is important to see a doctor. PCOS symptoms are treatable, plus  women with PCOS are more likely to end up with other health problems, such as:

  • Endometrial hyperplasia, a pre-cancerous thickening of the uterus’ lining
  • Diabetes
  • High cholesterol
  • Sleep apnoea

What tests need to be done?

Tests required for women with PCOS include:

  • Blood tests to measure hormone levels
  • Sugar and cholesterol tests
  • Pregnancy test
  • Ultrasound of the uterus and ovaries

How is polycystic ovary syndrome treated?

The treatment of PCOS mainly depends on whether you want to become pregnant now or later. For women who want to become pregnant later, the combined oral contraceptive pill is the most common treatment. The pill reduces the hormonal symptoms such as excessive hairiness, and regulates the menstrual cycle. Other treatments are available if using the pill doesn’t suit you. Women who want to become pregnant now can’t go on the pill. These women need “ovulation induction” therapy. Women who don’t become pregnant while taking oral medications can then either try fertility injections (FSH ovulation induction), ovarian drilling or IVF. A consultation with a fertility specialist is necessary to understand the pros and cons of these options.  If you are overweight or obese, losing weight can improve many of your symptoms. Losing just 5 percent of your body weight can help a lot to treat the symptoms (hairiness) and make you ovulate, therefore helping you become pregnant.

To make an appointment, call (03) 9418 8299 or book online.

Managing IVF pregnancies

pregnant woman seated holding her belly with another person next to her hand on clipboard

If you required help to conceive, it may feel like you have reached the end of one road and the start of another. IVF pregnancies are special – much time, love and care has been invested in getting this far. It’s important to choose an obstetrician who understands the unique journey you have travelled and any implications it may have for your pregnancy.

IVF pregnancies require expert management

As both a fertility specialist and practising obstetrician, I have a special interest in managing IVF pregnancies. Medically, I understand the challenges you have overcome and how these may impact on your pregnancy and the care you now receive. Perhaps just as importantly, I understand how precious the next nine months are to you – but also how quickly and uneventfully you want those months to past.

So if you’re looking for an obstetrician who appreciates that an IVF pregnancy needs its own special brand of care, I can provide the specialist expertise and high-level support you require.

Not all fertility specialists practise obstetrics so if another doctor has assisted you to become pregnant but does not also provide antenatal care, you can simply request a new referral from your GP or contact my rooms directly. To make an appointment, call (03) 9418 8299 or book online.

Fertility treatment options

two chicken eggs side by side on different coloured backgrounds

There are many different fertility treatments that can be used to help you start your family.

During a consultation, I’ll take the time to thoroughly assess your situation and discuss in detail the treatment options that are available to you, the likelihood of success from each treatment, and any other advantages and disadvantages. There will be plenty of time for questions and you’ll leave being able to make an informed decision about how you want to proceed.

First-line treatments

These are all done through my rooms, and include:

  • Cycle tracking
    • Ultrasound to check for ovulation, ovulation trigger injection, and ‘timed intercourse’ meaning having sex at home at the correct time
  • Ovulation induction with Clomid
    • Involves taking Clomid tablets to bring on ovulation, usually in patients with polycystic ovary syndrome (PCOS), then cycle tracking as above
    • The most efficient and effective way to use Clomid
  • Ovulation induction with FSH injections
    • The same process as with Clomid above, but using injections instead
    • Requires considerable expertise from an experienced doctor, and close monitoring
  • Endometrial scratch
    • Biopsy of endometrial lining
    • Shown to increase natural pregnancy rates.

Surgical treatments

These are done under anaesthetic in a surgical centre, and include:

  • Hysteroscopy, dilatation and curettage (D&C), laparoscopy and tubal flushing
    • Can be diagnostic and therapeutic
  • Tubal flushing with lipiodol (‘poppyseed oil’)
    • Done in conjunction with hysteroscopy or laparoscopy
    • Rinses out the fallopian tubes
    • Results in 60% more natural pregnancies compared to flushing with water
  • Ovarian drilling for PCOS
  • Surgical correction of anatomical issues (polyps, fibroids, uterine septum)
  • Tubal reanastomisis (reconnection of the fallopian tubes after a tubal ligation).

Laboratory treatments – IVF

I perform IVF (in vitro fertilisation) at Monash IVF in Hawthorn.

Monash IVF is committed to offering the best possible outcomes to its patients. It is a full service IVF laboratory, meaning it offers ALL recognised treatment options, including standard IVF, ICSI, HA-ICSI, surgical sperm extraction (PESA, TESA, micro-TESE), PGS, PGD, egg freezing, sperm freezing, donor egg program (TWEB) and donor sperm program.

Monash IVF’s pregnancy rates are consistently excellent. It was the first laboratory in Melbourne to routinely grow embryos to the blastocyst stage (day 5–6) and freeze all embryos by vitrification.

There are cheaper clinics in Melbourne, but they do not offer the full suite of services offered by Monash IVF.

Most fertility specialists in Melbourne are contracted with an IVF company, and have non-compete clauses preventing them from leaving the company or providing IVF services elsewhere. I do not, and deliberately so – I am not a contracted doctor with Monash IVF, and have no restrictions on my practice. I send my patients to Monash IVF because I believe they offer my patients the highest chance of pregnancy.

Other laboratory treatments

Aside from IVF, I also perform intrauterine inseminaton.

Other specialised treatments

I offer endometrial receptivity analysis, a novel investigation that checks whether a woman’s endometrial lining is mature enough to accept an embryo at the time of implantation.

Overseas donor egg programs

I am experienced in initially discussing then preparing women to travel overseas to undergo treatment with donor eggs. I do the initial work-up, arrange all investigations and necessary prescriptions, then take over care on the patient’s return.

Patients commonly travel to Greece (embryoland) or South Africa (Cape Fertility Clinic).

To make an appointment with me, call (03) 9418 8299 or book online.

Nausea and vomiting

pregnant woman holding a water bottle and water glass

While nausea and vomiting is an almost normal part of pregnancy, it is unpleasant and in rare cases can lead to serious complications such as dehydration. Sometimes all that is required to improve your symptoms is to make some changes to the way you eat and drink. Sometimes medications are required, and it’s important to know which ones you can safely take during pregnancy.

Hydration

The most important thing is to ensure adequate fluid intake. You should drink at least 2000ml of fluid a day in addition to replacing fluid lost from vomiting. Fluid tends to be best tolerated when it is cold and drunk in frequent small amounts (sips) between meals (this avoids over-filling your stomach). If you are drinking enough fluid, you will urinate normal volumes and it should be clear or yellow.

If you aren’t passing much urine or if it is becoming concentrated, this is a sign you are dehydrated. Try to increase the amount you are drinking. Water is the best fluid, or otherwise rehydration drinks from a pharmacy, such as Gastrolyte (it is easier for your stomach to absorb and contains important electrolytes). If you feel you are dehydrated and unable to keep fluid down, contact my rooms on (03) 9418 8299 or Freemasons Maternity on (03) 9418 8302 for advice, or alternatively attend the Epworth Richmond Emergency Department.

Controlling Nausea

Diet

Meals should be eaten slowly and in small amounts every one to two hours. An empty stomach should be avoided, as should an over-full stomach. A snack upon waking and before getting up may help.

It’s difficult to be sure what foods are best; however, historically simple foods like toast and crackers are most tolerable when nausea is at its worst. Everyone is different, so you might have to experiment. Try avoiding spicy, odorous, high fat, acidic and very sweet foods first and replace with higher protein and salty foods like nuts.

Medications

Blackmore’s Morning Sickness
This contains ginger and vitamin B6 and should be taken regularly (4 times a day) to suppress your nausea. If you only take it when you have severe nausea, it probably won’t work. If you don’t like the ginger, you could instead take vitamin B6 50mg tablets 4 times a day.

If this doesn’t provide adequate relief, there are some other medications you can try. However, these are either pharmacist-only medications (only available behind the counter at a pharmacy after consulting with a pharmacist) OR require a prescription. Advertising regulations prevent me from naming these kinds of medications here, but I can provide you with more details during your appointment.

Contact my rooms on (03) 9418 8299 if you would like to understand what other options exist and/or need a script.

When to seek further help

If the above measures are not working and you are still troubled by significant symptoms, you should make an appointment with me by calling (03) 9418 8299 or booking online. Don’t worry – there are plenty more options available.

You should go to hospital if you are unable to tolerate any fluids or if you are not passing enough urine.

Nausea and vomiting late in the pregnancy is not normal, and you should contact my rooms if this occurs.

Prognosis

The vast majority of women’s symptoms resolve by about 12–13 weeks, and at the very least, you can expect symptoms to begin to subside by this stage.

Bleeding or pain during pregnancy

woman kneeling on bed holding back and belly

Bleeding in pregnancy, and to a lesser degree pain, are common symptoms in the early stages of pregnancy.

The most likely outcome of bleeding or pain is a normal viable pregnancy; however, these symptoms should always be investigated.

Investigations required for women with pain and bleeding in early pregnancy are hCG level (accurate pregnancy hormone test), blood group typing and an ultrasound scan.

An ultrasound scan is only useful if the pregnancy is big enough to be seen (usually about one week after missing a period). It is only able to confirm that the pregnancy is viable (or healthy) by seeing a fetal heart beat, and this can be seen approximately two weeks after missing a period. Ultrasounds prior to this often give an ‘equivocal’ result, meaning it needs to be repeated after one week to check that the pregnancy is growing or for the presence of a heart beat.

Bleeding and pain may be due to miscarriage

Miscarriage can present with any combination of pain and bleeding, or indeed no signs at all, so these symptoms should always be investigated. While it can occur at any stage in the first trimester, the more advanced your pregnancy is, the less likely you are to have a miscarriage. Once a fetal heart has been seen on ultrasound, the chance of miscarriage is only about 1%. Overall, miscarriages are common and account for about 20% of all known pregnancies.

Possible miscarriage is diagnosed with a pregnancy hormone level and an ultrasound scan. Occasionally, these don’t tell the whole story and an additional blood test two days later or ultrasound scan a week later is needed.

The treatment for miscarriage includes doing nothing and waiting for the pregnancy to pass, or an operation (curette). There are advantages and disadvantages to both, and we will discuss your options. Ultimately, most women choose a curette because it is timely, reduces the risk of infection and bleeding, and follows a more predictable course.

Following a single miscarriage, the chance of future miscarriage is low and comparable to other women in the general population of the same age, so does not usually need any special investigations.

Pain or bleeding can signal an ectopic pregnancy

Like miscarriage, ectopic pregnancy can present with bleeding or pain or both. Most ectopic pregnancies occur in the fallopian tube, but can very rarely occur in other places. The danger of ectopic pregnancies is that they can rupture, causing potentially life-threatening haemorrhage. This typically does not occur until about 6 weeks of pregnancy, but ideally ectopic pregnancies should be diagnosed as early as possible to prevent rupture and allow for choice of treatment.

Ectopic pregnancies are uncommon, occurring in just 1% of pregnancies. Some women are at higher risk, and should automatically have a pregnancy ultrasound at 5 weeks pregnancy. These include women with a previous ectopic pregnancy or damaged tubes for any reason, and conception with an IUD or while using progesterone contraception (minipill, implanon etc).

Ectopic pregnancy is diagnosed with a combination of ultrasound and pregnancy hormone blood test results. Sometimes, like with miscarriage, serial testing is needed.

The gold standard for treatment of a tubal ectopic pregnancy is laparoscopic (keyhole) removal of the entire tube. Removing the tube reduces the chance of another ectopic pregnancy because the damaged tube is removed. Many women fear that removing one tube will halve their fertility; this is absolutely not the case. Fertility is reduced by about 1/6 because it is possible to ovulate from one ovary and the egg travel down the opposite tube.

An alternative treatment for small ectopic pregnancies is an injection of methotrexate. Methotrexate is a chemotherapy drug that successfully treats 85% of ectopic pregnancies. The remaining 15% need the tube removed at laparoscopy because of rupture, suspected rupture, or persistence of the pregnancy. The response to injection is monitored by frequent blood tests (once to twice weekly), and future pregnancy needs to be delayed at least three months because of the persistent effect of methotrexate on a new pregnancy.

Always seek help for pain and bleeding in early pregnancy

Pain and bleeding in early pregnancy always needs to be investigated.

  • In the event of very severe pain, haemorrhage or collapse, call 000 for an ambulance immediately.
  • In the event of persistent heavy bleeding or severe pain, go to the Epworth Richmond Emergency Department.
  • For bleeding and pain that is mild to moderate, it is OK to call my rooms for advice on (03) 9418 8299. For severe symptoms after hours, contact my paging service on (03) 9387 1000.
  • For bleeding or severe pain prior to 20 weeks, contact my rooms on (03) 9418 8299 or my paging service on (03) 9387 1000 OR alternatively attend the Epworth Richmond Emergency Department.
  • For bleeding or severe pain after 20 weeks, call your hospital and they will give you instructions on what to do.

Food safety during pregnancy

woman sitting with a plate of artistically arranged fruit

A safe and healthy diet during pregnancy is vital to ensure normal development of your baby. You’ve probably heard that you shouldn’t eat raw fish and soft cheeses, but there’s more to making safe choices than simply steering clear of one or two foods.

As a general rule, it’s recommended that you avoid raw, unpasteurised or pre-prepared foods while you’re pregnant. These types of foods can carry potentially harmful bacteria, such as listeria and salmonella, which can cause premature labour, stillbirth or miscarriage.

If this sounds daunting or you need some help with your diet, please feel free to make an appointment with me by calling (03) 9418 8299 or booking online.

Additionally, you can use my quick and convenient guide to Food safety during pregnancy, which you can print out and refer to at home and on the go.

The World Egg Bank

a hand holding an egg

Lots of women are unable to have a child because they either have no eggs, or they have been unable to become pregnant because of poor egg quality or advanced age. Their only option is to source donor eggs – in Australia this is very difficult, because there are very very few egg donors available.

The World Egg Bank sources eggs from altruistic donors (women who donate their eggs for free) in the United States, imports the frozen eggs into Australia, and makes them available to couples wishing to have a baby.

The eggs are thawed in the laboratory then fertilised. Usually they are fertilised by the male partner’s sperm, but donor sperm can be used also. Once fertilised, the embryos are grown in the laboratory for between three and five days, at which point one of them is placed in the recipient’s uterus. There, hopefully, it implants in the woman’s uterus and leads to pregnancy.

Can I choose the egg donor?

Yes, you get to choose the egg donor yourself from The World Egg Bank database. You will be given photos of the donors and all of their non-identifying information, including a detailed family medical history, to allow you to choose an appropriate donor. The donors come from all sorts of backgrounds and circumstances, and may be, for example, Caucasian, African American or Asian, they may be married or single, may have children or may have never been pregnant. They are all young, aged between 21 and 29 years.

Are the egg donors screened for medical conditions?

All World Egg Bank donors available to Monash IVF have been rigorously screened for a wide range of known infectious diseases, psychiatric disorders and family medical history. All donors must have had the same screening tests that are performed on women having IVF treatment in Australia. The eggs are also quarantined for 6 months to ensure that infectious diseases are less likely to be transmitted.

Can I have more than one baby from the same donor?

Yes, you may request the same donor to donate to you again, so that potentially a biological sibling for your child is possible. However, the donor may not agree to donate again.

Does the World Egg Bank comply with Victorian law?

All World Egg Bank donors are thoroughly counselled, in the same way as recipients, to comply with Australian and Victorian legislation. They are required to have signed consent forms that allow them to be contacted in the future by children (after turning 18 years) who may be born as a result of their donation, in accordance with the Assisted Reproductive Treatment Act 2008.

For more information on the World Egg Bank, make an appointment by calling (03) 9418 8299 or book online.

Endometriosis

a bare female waist with one hand on hip and other over a red hotspot on belly

Endometriosis is a condition that affects women. It can cause pain in the lower part of the belly and trouble getting pregnant. Endometriosis occurs when tissue normally found in a woman’s uterus, called the endometrium, grows outside of the uterus. This tissue, which does not belong outside the uterus, can then break down, bleed, and cause symptoms.

Symptoms of endometriosis

Some women have no symptoms, but most experience:

  • Pain before or during monthly periods
  • Pain between monthly periods
  • Pain during or after sex
  • Pain when urinating or having a bowel movement (often during monthly periods).

Other symptoms can include:

  • Difficulty getting pregnant
  • Ovarian cysts (sometimes called chocolate cysts or endometriomas) found on ultrasound.

All of these symptoms can also be caused by conditions that are not endometriosis. But if you have any of these symptoms, you may need to be investigated for endometriosis. The only way to know for sure if you have the condition is for a doctor to do a laparoscopy to look for endometrial tissue outside the uterus. Sometimes a specialised ultrasound can be useful, too.

Treatment of endometriosis

There are many treatments for endometriosis. The right treatment for you will depend on your symptoms and whether you want to be able to get pregnant now or in the future.

First-line treatments are medications, such as:

  • Pain medication – such as panadol and/or nurofen on the days the pain is present
  • Contraceptive pill – this can reduce the number of periods (by skipping periods) and the amount of pain. It is not suitable if you are trying for a pregnancy immediately
  • Mirena IUD – this is a device that sits inside the uterus for up to 5 years (it can be removed easily at any time). It has progesterone hormone within it that acts to suppress the growth of endometrial tissue. It is also not suitable if you are trying for a pregnancy immediately.

Some women choose to have surgery as their treatment. The most common surgery is a laparoscopy; this allows the surgeon to see and remove endometriosis tissue. It is usual to follow surgical removal with some attempt at preventing it growing back – either the contraceptive pill, Mirena IUD or pregnancy.

In more extreme cases, or in women who have definitely completed their family, a hysterectomy can help. A hysterectomy is a surgery to remove a woman’s uterus.

Pregnancy considerations

Endometriosis can affect your chances of becoming pregnant, although it should be noted that many women with the condition have no trouble at all becoming pregnant. Endometrial tissue can cause hormonal imbalances that change how your ovaries function and can block your fallopian tubes. Surgically resecting mild to moderate endometriosis probably improves your pregnancy chances. If you have endometriosis and have not become pregnant in 6 to 12 months (depending on your age), you should arrange a timely assessment with a fertility specialist to see if fertility treatment such as IVF might improve your chance of pregnancy. Once you have fallen pregnant, endometriosis is not associated with pregnancy complications.

To make an appointment with me, call (03) 9418 8299 or book online.

Polycystic ovary syndrome (PCOS) and fertility

woman in colourful sleeveless dress folding her arms and smiling

Polycystic ovary syndrome (or PCOS, as it’s typically called) is a common condition that affects women in their reproductive years. Because the condition influences hormone levels and can prevent ovulation, it can be difficult for women with PCOS to conceive.

Women with PCOS may need medical help to become pregnant

Regular menstruation cycle
PCOS is a complex hormonal condition that leads to changes in the body’s ovulation cycle. You’re probably familiar with a ‘regular’ menstrual cycle happening around once a month. Well, ovulation is the fertile phase of the menstrual cycle – when an egg is released from one of the ovaries – and should also occur monthly.

However, most women with PCOS don’t get regular periods, and that means that their ovaries are not releasing an egg regularly – in other words, they have irregular ovulation. The medical term for this is ‘anovulation’.

Every time an egg is released from the ovaries, it is a potential opportunity for a pregnancy to begin. So, if this doesn’t happen regularly, it reduces the chances of getting pregnant. Rare (or absent) ovulation is the reason women with PCOS often take longer than normal to conceive.

Most women with PCOS can become pregnant

The good news is that around 60% of women with PCOS become pregnant without medical help. And the even better news is that for women with PCOS who are struggling to conceive, there are ways that fertility specialists can help. Fertility treatments for PCOS work to increase ovulation and can range from lifestyle changes or medications to more invasive procedures.

Losing weight can improve fertility

Maintaining a healthy weight can be difficult for women with PCOS. They may find it easy to gain weight, and really hard to lose it. While this can be challenging, it’s really important for women with PCOS to maintain a healthy weight to improve their chances of getting pregnant. In fact, even losing 5% of body weight can improve the chances of conceiving.

Losing weight should be the first port of call if you have PCOS and are struggling to conceive. The improvements in fertility won’t happen overnight – you should give yourself up to 6 months to see if weight loss alone is enough to help you get pregnant. If it isn’t, rest assured that your efforts to maintain a healthy weight will improve your chances of getting pregnant if you go through fertility treatments. Having a healthy weight will also reduce the chance of many pregnancy complications.

Medication can stimulate or regulate ovulation

To help women with PCOS get pregnant, there is a treatment called ‘ovulation induction therapy’. You can think of this as a way to encourage your body to produce and release eggs. Medication (or a combination of medications) is used to give your body the signals it needs to go through an ovulatory cycle to release an egg.

Generally, a tablet called clomiphene citrate (Clomid) is the first treatment choice. Studies have shown that Clomid can achieve pregnancy rates between 30% and 50% after 6 treatment cycles. One of the limitations of Clomid is that after 4 to 6 months it can lead to thinning of the endometrial lining and subsequently reduce the chance of pregnancy.

If Clomid is unsuccessful, the next treatment step tends to be ovulation induction therapy with hormones known as ‘gonadotropins’. These hormones, such as follicle-stimulating hormone (FSH), luteinising hormone (LH) and human chorionic gonadotropin (HCG), are normally produced by your body during a healthy reproductive cycle. So, to mimic the normal hormonal cycle, one or more of these hormones are injected at specific times during your cycle to stimulate the growth and release of eggs.

Surgery is an option for inducing ovulation

If other treatment options have not been effective, there is a surgical procedure that can help to increase ovulation, which is referred to as ‘ovarian drilling’ or ‘laparoscopy with ovarian surgery’. If you have PCOS, the surface tissue on your ovaries produces excessive amounts of androgens (‘male’ hormones), which reduces your fertility. The aim of ovarian drilling is to remove some of that tissue, by drilling small holes in it, so that you can ovulate more regularly for around 6 to 12 months. Because the surgeon only needs to make a small incision below your belly button, the surgery itself is minimally invasive and the recovery is quick.

IVF is another option for women with PCOS

Some women with PCOS may not be able to conceive naturally, even after using treatments to increase ovulation. In that case, it may be necessary to undergo in vitro fertilisation (IVF) to get pregnant. During IVF, the fertilisation step of pregnancy (joining the egg and sperm together) is facilitated in a specialised laboratory. The embryo is then implanted into the uterus to continue the pregnancy. Women with PCOS are given specific hormonal treatments to increase their chances of achieving a pregnancy through IVF. Interestingly, women with PCOS perform very well with IVF therapy. The high number of eggs in their ovaries usually means that many eggs can be collected and fertilised during IVF.

Do you have PCOS and fertility concerns?

PCOS is a complex condition that can be difficult to manage, particularly when it comes to getting pregnant. If you suffer from PCOS and would like a personal assessment and advice about ways to optimise your chances of conceiving, please call my rooms on (03) 9418 8299 or book online to make an appointment.

Laparoscopy

laparoscopy

A laparoscopy is a procedure to examine the appearance of the outside surfaces of the uterus, tubes, ovaries and lining of the pelvis. It is performed by placing a long skinny telescope (called a laparoscope) through a 5mm incision in the belly button. Air is then pumped in to create space around the internal organs, and the telescope sends pictures to a television screen. Another 5mm incision is placed discreetly within the bikini line to allow instruments through.

Laparoscopy diagram

When do you need a laparoscopy?

Reasons for doing a laparoscopy include:

  • Pelvic pain
  • Sub-fertility
  • Ovarian cysts
  • Fibroids
  • Sterilisation (tying your tubes to prevent pregnancy)
  • Ectopic pregnancy
  • Hysterectomy.

What happens during the procedure?

A laparoscopy must be done in hospital, and the vast majority are day cases, meaning you won’t need to stay in hospital overnight. It requires a general anaesthetic – you will be fully asleep with a breathing tube in your throat.

Once you are asleep, the operation takes about 20 minutes for a diagnostic laparoscopy and longer for an operative laparoscopy. A diagnostic laparoscopy is one where no operating is done. An operative laparoscopy is one where something is fixed – for example, endometriosis or removal of an ovarian cyst – and this can take a variable amount of time depending on the complexity of the operation. Some operative laparoscopies take 90 minutes and some take longer.

How long does it take to recover?

After the operation, most patients feel a bit groggy from the anaesthetic, and this generally lasts the whole day, and occasionally into the next day. It is usual to have some abdominal pain after the operation. Initially it can require relatively strong pain relief, like paracetamol, ibuprofen and oxycodone together, but this will become less necessary after a day or two.

The pain should get better every day – if it doesnʼt, this could indicate a complication. In that case contact me for advice. Most people need 4–5 days off work to fully recover, and occasionally up to a week.

To make an appointment, call (03) 9418 8299 or book online.