For Patients

Information Resources

A. Emergency Contraception

Emergency contraception

Unprotected intercourse can result in unplanned pregnancy. The risk of pregnancy is highest close to the time of your ovulation.

Emergency contraception is a backup method for preventing pregnancy after unprotected intercourse. It is designed to be a one-time emergency treatment.

Important questions:

  • When was the first day of your last menstrual period?
  • When was the exact date and time of unprotected intercourse?

Emergency Contraception Treatment Options

The morning after pill:

  • Can be used up to 72 hours after unprotected intercourse
  • Contains the progestagen Levonorgestrel (1.5mg)
  • Can be taken as a single dose
  • Available over the counter from Australian pharmacies (prescription not needed)
  • Ulipristal acetate (an alternative to Levonorgestrel) is not yet available in Australia.

Copper IUD (Intra-Uterine Device)

  • Can be used within 5 days (120 hours) of unprotected intercourse.

When emergency contraception should be used

  • You have had unprotected intercourse and do not use any regular contraception
  • You forgot to use your regular contraception (condom, pill, vaginal ring)
  • Your partner’s condom was used incorrectly or broke while you were having intercourse.

How emergency contraception works

The morning after pill works by giving a strong short burst of hormones to prevent ovulation (the time in your cycle you are most likely to become pregnant).

The copper IUD works by preventing fertilization/ implantation. If left in the uterus, it will continue to protect against pregnancy for 10 years or until removed.

You should have your next period within 2 to 4 weeks of using emergency contraception. If you skip your period, contact Dr Raelia Lew or your GP.

Safety

Emergency contraception is safe and does not cause birth defects or affect the health of future pregnancies

Side effects

  • Usually well tolerated
  • Can cause nausea and irregular bleeding

Regular Contraception

If you have become sexually active and are not planning a pregnancy, you should consult either Dr Raelia Lew or your GP to discuss a reliable form of regular contraception.

B. Endometriosis

What is Endometriosis?

Endometriosis is a condition where abnormal tissue outside of the uterine cavity reacts to the hormonal changes of the menstrual cycle. Endometriosis lesions are structurally similar to the endometrium (lining) of your womb. Active endometriosis is associated with inflammation and scarring. Lesions, nodules and endometriomas (endometriosis lined ovarian cysts, known as chocolate cysts) can cause anatomical damage to important pelvic organs, leading to impaired fertility. Inflammatory mediators of endometriosis in a woman’s pelvic environment can have toxic effects on eggs and embryos.

Endometriosis can cause a spectrum of pelvic pain syndromes, which are cyclical in nature. Pain tends to be worst in the days leading up to and during your menstrual period. Endometriosis can also cause pain associated with your bowel and bladder function and “deep“ pain with sexual intercourse.

Why do I need to have a Laparoscopy?

Currently no blood, urine or imaging test is sensitive and specific enough to clearly diagnose or exclude endometriosis with absolute certainty. Laparoscopy is both the gold standard test for diagnosing endometriosis and  a way that endometriosis can be surgically treated. It is critical that in women seeking future fertility, a conservative surgical approach is taken. Extensive surgery to a woman’s ovaries can destroy normal surrounding ovarian tissue, containing her eggs.

Dr Raelia Lew is an expert in minimally invasive laparoscopic surgery, aiming to both remove endometriosis and maximise a woman’s future fertility.

Will I ever need another laparoscopy?

Most women will not require any more laparoscopic procedures in the future, but some may. This depends on many factors, including the severity of your endometriosis and of any returning pain symptoms.

Treating your endometriosis with suppressing medications (e.g. the pill) reduces your risk of requiring further surgery.

The exception is where endometriosis diagnosed at your primary laparoscopy significantly involves your bowel or bladder. In this scenario, a second definitive procedure may be planned in collaboration with a specialist Gastro-Intestinal Surgeon or Urologist.

Will my Endometriosis stop me from becoming pregnant?

Infertility can result if endometriosis causes inflammation and changes in your pelvic anatomy (e.g. fallopian tubes and ovaries). However, many women with  mild or even moderate endometriosis can conceive naturally.

How long do I need to be followed up for my endometriosis?

Endometriosis is a chronic condition. It can be well controlled but currently there is no cure. Long–term medical follow–up is recommended to monitor hormonal therapies, control of endometriosis symptoms and fertility, especially before your family is complete.

Should my sisters and other family members be screened?

A history of endometriosis in a sibling increases a woman’s risk of having endometriosis herself seven fold. If your sister has painful periods and pelvic pain at other times during her menstrual cycle that interfere with social activities, it is a good idea to suggest she be evaluated.

C. Male Fertility Assessment: What to expect

On your first visit, you will be asked to provide details of past medical illnesses and of any surgeries you have had. You will also be asked to recall the details of your childhood and pubertal development. It is worthwhile asking your parents if you may have had any relevant childhood surgical interventions that you may not recall, such as inguinal hernia repair and correction of congenitally undescended testes.

A male genital examination is an important part of investigating a man with fertility delay.  There are important reasons to do this. The size and consistency of a man’s testes reveals important information about his hormonal and fertility status. Men with low fertility are at an increased risk of testicular malignancy than men in the general population. Testicular cancer is thankfully a rare diagnosis, but an important one that must not be missed.

You will be asked to perform a series of routine screening blood tests including Hepatitis C, B and HIV testing. You may also be offered genetic screening for chromosomal and other abnormalities (like cystic fibrosis) that may affect your future children.

You will be asked to perform a semen analysis test, which examines sperm count, motility and shape. On the same sample, a test will be run to detect the presence of anti-sperm antibodies. Sperm production occurs throughout a man’s life and can be affected by environmental and lifestyle factors. Examples include a recent febrile illness, cigarette smoking, cycling, or a preference for tight underwear.

If your first semen analysis reveals a problem, your will be ask to modify and optimize your lifestyle and testicular “environment”, and to then undertake a follow up test.

D. My sperm count was zero – what does this mean?

Azoospermia means absence of sperm in the ejaculate. This can result from either a sperm production problem or a blockage in the testis.

The cause can be determined by a combination of hormonal tests, clinical examination and testicular ultrasound.

Sperm production problems can in some cases be corrected – especially where a problem of the hypothalamus or pituitary gland is found to be the cause.

Genetic errors of the Y chromosome can sometimes be responsible for a zero sperm count. It is important to identify men who carry these mutations and to offer them access to appropriate genetic counselling before embarking on fertility treatments. Even in the most serious testicular problems, retrieval of testicular sperm for IVF/ICSI may be possible by performing microsurgery on the testis.

Donor sperm

Even with the most severe sperm related problems, most men through Dr Raelia Lew’s  help will be able to father children using their own sperm. There are however, some circumstances where this is not possible. Accessing donor sperm is another option. Dr Raelia Lew can help you make an informed decision about this treatment.

E. Ovarian Cysts

What are ovaries?

Ovaries are two small round organs near your uterus, containing your eggs and are responsible for the production of sex hormones (e.g. estrogen and progesterone). During a normal monthly menstrual cycle, hormone signals from your pituitary gland in your brain “tell” your ovaries to ripen and release an egg (ovulation).

What are ovarian cysts?

A cyst is a fluid-filled sac that develops in the ovary. There are different types of cysts.

Follicular cyst 

A follicular cyst is a normal (physiological) cyst that develops each month, containing an egg for release (ovulation). It can grow up to 3cm in diameter.

Corpus luteum cyst

A corpus luteum cyst is a normal (physiological) hormone producing cyst. Its function is to support an early pregnancy, prior to the placenta forming.

Simple cyst

A simple cyst is an ovarian cyst that has no solid components or internal tissue bridges (septations). The appearance is similar to a follicular cyst, but a simple cyst may be bigger and may persist for longer than a single menstrual cycle.

Complex cyst

A complex cyst refers to a cyst that has a mixture of components, fluid +/- solid. Examples include endometriomas or dermoid cysts.

How are ovarian cysts diagnosed?

Ovarian cysts that do not cause symptoms may be completely unnoticed. The best way to visualise and measure an ovarian cyst is by pelvic ultrasound.

What is a pelvic ultrasound

Ultrasound tests use sound waves to create a picture of your anatomical structures. No radiation exposure occurs. Ultrasound is particularly suited for visualisation of your ovaries and uterus.

A pelvic ultrasound can be performed on the belly or from the vagina (this achieves the clearest pictures of your uterus and ovaries).

What happens if I have an ovarian cyst?

Most ovarian cysts don’t cause any serious problems but a minority of ovarian cysts can be dangerous (e.g. associated with ovarian cancer).

It is important to monitor your ovarian cyst. Many cysts resolve over time. When a cyst persists, gynaecologists assess whether removal of the cyst is necessary (usually performed by keyhole surgery/laparoscopy).

Large ovarian cysts may be at risk of “twisting” (ovarian torsion). When this happens, the ovarian blood supply can be compromised. Ovarian Torsion can cause acute pain and is often also associated with a feeling of nausea and vomiting. It is a surgical emergency, requiring urgent action to save the affected ovary.

Can ovarian cysts be prevented?

Women taking the pill are less likely to develop ovarian cysts.

F. The Pill

The “Pill” refers to a medication, ususally containing a combination of an estrogen and a progestagen. The “Mini-Pill” contains only a progestagen.

The Pill is used for many reasons. Examples include:

  • For contraception
  • To achieve cycle control and endometrial protection in Polycystic Ovarian Syndrome
  • To replace estrogen and progesterone in women with low hormone levels
  • As part of an IVF (In Vito Fertilization) cycle

Contraceptive efficacy:

Perfect use (Up to clinical standards): <1 in 100 women taking the pill for 12 months will become pregnant

Typical use: 9 in 100 women taking the pill for 12 months will become pregnant

Possible Side Effects:

  • Nausea
  • Breast swelling/tenderness
  • Weight gain
  • Mood change
  • Headaches

Serious complications

  • Blood clots and Stroke

You should not be prescribed the Pill if:

  • You are over 35 and smoke
  • You have migraine with aura
  • You have high blood pressure
  • You have a strong personal or family history of stroke or blood clots
  • You have certain types of heart disease

Benefits of the Pill

  • Lighter less painful, regular periods
  • Clearer skin
  • Protection from ovarian and endometrial cancers
  • Reduces risk of ovarian cysts forming
  • Pregnancy planning

Pill Packs

Most pill packs come with 21 “active” hormone pills and seven sugar or “reminder” pills. The Pill is designed to help you form the habit of taking one pill at the same time every day (including during your period).

Starting The Pill

  • Take a pill on the first day of your menstrual period. This should correspond to the correct day of the week indicated on the blister pack in the red zone.
  • If you are using the Pill to avoid falling pregnant, you should not rely on it working until you have taken 7 “active” tablets consecutively. Use barrier contraception as back up (e.g. condoms) during this time.
  • Take one pill each day, at the same time of day. You may find it helpful to keep your pill pack near your toothbrush, or to set a reminder message on your mobile so you don’t forget to take your pill.
  • You may have slight nausea during the first month, but this usually goes away with time. This can be improved by taking the pill at bedtime.
  • After completing a 28-day pack, you should immediately start a new pack of pills the next day. In your fourth week on the pill cycle (sugar pills) you should get your menstrual period. Your period will stop when you start the new pack of active pills.

Continuously cycling the Pill (Skipping periods)

Some women prefer to “skip” sugar pills and go straight from active to active hormone tablets. You can safely do this for up to 3 packs in a row. Beyond this, you may experience unexpected spotting or irregular periods.

Forgetting the Pill

If you miss 1 active Pill, don’t panic.

  • Take the “missed pill” as soon as possible.
  • Take the next pill at the usual time.
    To catch up – it is ok to take 2 pills on the same day or even at the same time.

If you miss 2 or more active pills – Be very careful

If you have missed 2 active pills in a row, you may experience bleeding and you may ovulate. If you are sexually active, you will be at risk of pregnancy. Use back up barrier contraception (e.g. condoms) until you’ve taken “active” hormone pills for 7 days in a row.

If the two missed pills are the first two active pills of a new packet and you have had unprotected intercourse in the last 5 days, it may be advisable to use emergency contraception. Emergency contraception can be accessed “over the counter” from a pharmacy – a prescription is not needed.

Missing the Mini-Pill

The Mini-Pill regimen is very unforgiving – there is no real margin for error.

If you forget even one Mini-Pill or take a pill more than 3 hours late, take the missed pill as soon as you remember and use condoms for 7 days. Continue to take the rest of the pack as you normally would.