Patients often complain about the problem of too substantial menstruation. In the normal cycle of a woman, another monthly bleeding should start every 28 (+/- 6) days , lasting up to 7 days. What is normal menstruation? Most women don’t really know how much blood they lose every month. When should you start worrying? Whenever sudden changes occur, menstruations become irregular, very heavy and make everyday life difficult. Spotting bleeding during the cycle and especially postmenopausal bleeding may also be a worrying symptom.
Abnormal bleeding from the genital tract may be a symptom of hormonal disorders, it is also the first signal given by the cancer of the uterine body. It’s a terrible disease, but if detected early enough, it can be completely cured! All you have to do is test yourself. In the past an endometrial biopsy was a complex procedure that required a hospital visit and general anaesthesia. Today, thanks to the use of a Cormier probe, called a pipella, it is a simple and painless procedure that can be performed in the doctor’s office. If you are worried about the nature of your bleeding, make an appointment to see a gynaecologist in the second half of the cycle! One simple test can start the treatment process and save your life.
By – Filip Dąbrowski PhD
Colposcopy significantly increases the diagnostic specificity and allows to make the right decisions regarding the further treatment of the patient. A colposcopy can be performed on any woman who can be given a vaginal speculum to examine cervix provided she is not bleeding at the moment. The placement of the speculum is the main inconvenience to which a woman is exposed. The examination itself is painless and non-invasive and consists of viewing the surface of the cervix at high magnification using a suitable microscope called a colposcope. Usually, the cervix is washed with physiological salt to remove vaginal secretion and to look at the area of interest. An acetic test is then performed to assess the epithelial boundary, if visible, and to locate the most suspicious areas. Under the influence of acetic acid they undergo variously intensified secondary convergences. Abnormal blood vessels may be present on their surface. The acetic test is the most important element of the colposcopic test.
In most patients (those who do not have hyperthyroidism, are not allergic to iodine and are not in early pregnancy) the Schiller test is performed. It consists in watching the neck after washing it with Lugol’s fluid. The normal, mature squamous epithelium containing glycogen is then stained brown. The glandular, metaplastic and abnormal epithelium does not stain and remains iodine-negative. This attempt is not very specific and is not performed by all colposcopists.
The indication for colposcopy is not only the abnormal result of cytological examination. It should also be performed in case of the presence of anxiety-inducing macroscopic changes on the cervix. This applies, among other things, to patients with so-called “erosions”. Real erosions are extremely rare. This term is often used to describe so-called erythropoles, i.e. red spots on the neck visible during inspection. They usually do not require any treatment, including treatment. Quite often erosions turn out to be glandular ectopia and heal spontaneously, covering themselves with a flat epithelium. A red spot is still visible in the speculum, but there is no justification for cryotherapy or electrocoagulation. In patients with cervical erosion or “crawled” glandular epithelium from the neck canal, such treatment is recommended when they are often troubled by recurring vaginal inflammation, contact bleeding, e.g. after intercourse or glandular epithelium produces significant amounts of mucus, which can cause discomfort.
In most women, the use of destructive methods such as cryotherapy and electrocoagulation is not necessary or sometimes even inappropriate. It may cause difficulties in cytological and colposcopic diagnostics in the future due to the shift of the epithelial boundary to the cervical canal or premenstrual bleeding associated with cervical endometriosis. Every decision about the cervical surgery should be made after full diagnostics, including colposcopy. It is best for this procedure to have photographic documentation, which makes it objective and allows the comparison of successive results.
