Expert Gynaecology Care
Built Around Your Long-Term Health.

Gynaecology Beyond the Symptom

Gynaecology is more than treating a single complaint. It is understanding your reproductive endocrine system, your metabolic health, your fertility timeline, and how today’s symptoms shape tomorrow’s outcomes. Every condition we manage is approached with that long-term lens.

Gynaecology — a deeper clinical reference

The sections below are written for patients who want to understand each condition in detail before a consultation, and for clinicians who want to know how this centre approaches each presentation. The tone is intentionally calm and descriptive. The goal is informed conversation, not persuasion.

What gynaecology covers

Gynaecology is the branch of medicine concerned with the health of the female reproductive system across the life course — adolescence, reproductive years, perimenopause, and menopause. At Balaji Horizon, the work covers four broad domains:

• Menstrual and hormonal disorders — polycystic ovary syndrome (PCOS), endometriosis, adenomyosis, abnormal uterine bleeding, dysmenorrhoea, premenstrual disorders.
• Structural and surgical conditions — fibroids, ovarian cysts, endometriomas, polyps, pelvic organ prolapse, adhesive disease, congenital uterine anomalies.
• Reproductive and fertility care — pre-conception consultation, recurrent pregnancy loss, fertility preservation, fertility evaluation, integration with the IVF programme.
• Preventive and screening care — cervical cancer screening, breast awareness counselling, vaccination (HPV), perimenopausal and menopausal health, bone-health risk assessment.

Where a presentation is best handled by a sub-specialty within the institution — endometriosis surgery, IVF, fetal medicine, advanced laparoscopy — the patient is moved within the team without leaving the centre.

The outpatient flow

A first gynaecology consultation typically follows a structured sequence:

1. History — symptoms, menstrual pattern, reproductive history, sexual and contraceptive history, medical and surgical history, family history. Time is taken on the chronology of the symptoms, not only their current state.
2. Examination — general physical examination, abdominal examination, and where clinically indicated, a pelvic examination. Examinations are explained in advance and a chaperone is offered.
3. Targeted investigation — only the tests that change management are ordered. Routine “all blood tests” panels and repeated scans without indication are avoided.
4. Discussion — the working diagnosis, the differential, the proposed plan, and the alternatives are explained in plain language. Written notes are provided on request.
5. Follow-up — most concerns are followed up at 6 to 12 weeks. Urgent findings are addressed immediately. Routine yearly reviews are offered where appropriate.

Consultation appointments are scheduled with enough time that the conversation is not rushed. The clinic deliberately limits the number of patients seen per session.

Investigations commonly used

Investigation choice is guided by the presenting problem, the patient’s age, and the implications of each result.

• Pelvic ultrasound (transvaginal and transabdominal) — the workhorse of outpatient gynaecology. Performed in-house by clinicians trained in gynaecological ultrasound to ISUOG-aligned standards. Useful for assessing the uterus, endometrium, ovaries, and pelvis.
• Saline-infusion sonography (SIS) / hysterosonography — adds detail when an intra-cavity lesion (polyp, submucous fibroid) is suspected on routine ultrasound.
• Diagnostic hysteroscopy — direct visualisation of the uterine cavity. Used selectively where imaging is non-conclusive or where targeted biopsy is needed.
• MRI of the pelvis — reserved for cases where ultrasound cannot answer the question — for example, deep infiltrating endometriosis mapping, complex adnexal masses, suspected adenomyosis with atypical features, or congenital uterine anomalies.
• Hormonal panels — used selectively. TSH, prolactin, AMH, day-2 to day-3 FSH and oestradiol, mid-luteal progesterone, total and free testosterone, DHEAS, SHBG, fasting insulin and glucose — chosen by what the clinical question is rather than ordered in bulk.
• Cervical screening — Pap smear, liquid-based cytology, or HPV DNA testing. Frequency follows current evidence-based intervals rather than annual reflex testing.
• Endometrial biopsy — for abnormal uterine bleeding in patients over 45, in post-menopausal bleeding, or where the endometrium appears thickened or atypical on imaging.
• Cultures and STI panels — where infection is in the differential. Counselling and confidentiality are central to this conversation.

Surgical versus conservative — the institutional philosophy

A great deal of gynaecological care is best delivered non-surgically. At the same time, when surgery is the right answer, it should be precise, minimally invasive, and performed by an experienced operator with a clear surgical plan.

The decision to recommend surgery balances:

• The symptom burden and quality of life impact
• The patient’s reproductive goals and ovarian reserve
• The likely benefit of the procedure versus its risks
• The expected recurrence rate and what happens after recurrence
• The availability of equivalent non-surgical options
• The patient’s own values and preferences

Surgery is not framed as a “fix-all”. Repeated ovarian surgery in particular carries a measurable cost to ovarian reserve and is approached carefully in patients who have not yet completed their family. Hysterectomy is offered where indicated, not as a default response to bleeding or pelvic pain. Where conservative management — medical therapy, hormonal modulation, levonorgestrel intrauterine system, or watchful waiting — is reasonable, it is presented as a first option.

Common conditions — in depth

Related reading: painful intercourse and involuntary pelvic-floor tightening are covered in our guide to vaginismus, and if you have been newly diagnosed with fibroids, see “I have fibroids — now what?” for a calm, decision-focused overview.

Polycystic ovary syndrome (PCOS)

PCOS is a heterogeneous condition diagnosed by the Rotterdam criteria — two of three of irregular ovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound — after exclusion of mimics. It is associated with a range of long-term metabolic, reproductive, and psychological implications.

Our management approach is individualised by the dominant clinical phenotype:

• Cycle-dominant — patients whose primary concern is irregular cycles. Lifestyle, cyclic progestogen or combined hormonal contraception, and periodic endometrial protection are central.
• Hyperandrogenic-dominant — patients with hirsutism, acne, or alopecia. Combined hormonal therapy, anti-androgens where appropriate, and dermatological co-management.
• Metabolic-dominant — patients with insulin resistance, weight gain, dyslipidaemia, or pre-diabetes. Structured lifestyle intervention, metformin where clinically warranted, and cardiometabolic risk monitoring.
• Fertility-dominant — patients trying to conceive. Ovulation induction (letrozole as first-line per current ESHRE/ASRM guidance), and clear pathway into the IVF programme if indicated.

Patients are screened for related conditions — obstructive sleep apnoea, depression and anxiety, and (where risk factors exist) impaired glucose tolerance. A dedicated PCOS page covers this in further detail at /gynaecology/pcos/.

Uterine fibroids (leiomyomas)

Fibroids are common benign uterine smooth-muscle tumours. They are classified by location (submucous, intramural, subserous), by the FIGO numerical system (0 to 8), and by their impact on the patient. The classification matters because it predicts both symptoms and treatment options.

Management is guided by the symptoms — not by the fibroid size on imaging alone. Asymptomatic fibroids do not always need treatment. When symptoms warrant intervention, options include:

• Medical therapy — tranexamic acid for menorrhagia, NSAIDs for dysmenorrhoea, combined hormonal contraception, levonorgestrel intrauterine system, GnRH analogues for short-term shrinkage before surgery, ulipristal acetate where regulatory status permits.
• Hysteroscopic myomectomy — for submucous fibroids causing bleeding or fertility issues.
• Laparoscopic or open myomectomy — for fertility preservation when indicated.
• Hysterectomy — when the family is complete and conservative options have not resolved symptoms.
• Uterine artery embolisation and focused ultrasound — discussed where access and indication align.

The conversation with the patient explicitly covers recurrence risk and what happens at each life stage. A 35-year-old with two desired pregnancies and a 6 cm intramural fibroid has a different decision tree from a 48-year-old with completed family and the same fibroid causing flooding.

Abnormal uterine bleeding (AUB)

AUB is described using the FIGO PALM-COEIN classification — Polyp, Adenomyosis, Leiomyoma, Malignancy/hyperplasia, Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified. The framework matters because the underlying cause determines treatment.

Initial evaluation includes ultrasound, full blood count, thyroid function, and — depending on age and risk — endometrial sampling. For chronic AUB, the bleeding pattern (heavy, prolonged, frequent, irregular, inter-menstrual, post-coital) is documented in standard FIGO terms. Treatment is then matched to the cause — surgical for structural causes (P, L), hormonal or medical for non-structural causes (COEIN), and individualised for adenomyosis.

Adenomyosis

Adenomyosis is the presence of endometrial-type tissue within the myometrium. Symptoms include heavy and painful periods, chronic pelvic pain, and infertility. Diagnosis has shifted from histology after hysterectomy to imaging-based diagnosis using transvaginal ultrasound (MUSA criteria) and MRI.

Management is individualised. Medical options — levonorgestrel intrauterine system, combined hormonal contraception, progestogens, GnRH analogues — are first-line in patients who want to retain the uterus. Surgical options include localised adenomyomectomy in selected cases, with hysterectomy reserved for completed family and refractory symptoms. The interplay between adenomyosis and IVF outcomes is discussed in the IVF programme consultation.

Pelvic organ prolapse

Prolapse is staged using the POP-Q system and managed across a spectrum — pelvic-floor physiotherapy, pessaries, and surgical repair. Patient values matter here — many patients with prolapse are entirely comfortable with a well-fitted pessary and physiotherapy and do not need surgery. Where surgery is indicated, native-tissue repairs are favoured, and the mesh conversation follows current safety evidence and individual risk-benefit.

Chronic pelvic pain

Chronic pelvic pain is a syndrome, not a diagnosis. It overlaps with endometriosis, adenomyosis, interstitial cystitis or bladder pain syndrome, irritable bowel syndrome, pelvic-floor myalgia, and central sensitisation. Care is multidisciplinary by design — the gynaecologist, pelvic-floor physiotherapist, and where needed pain physician and mental-health support — and the goal is functional improvement, not always cure. The endometriosis cluster covers the endometriosis-specific evaluation in detail at /endometriosis/.

Perimenopause and menopause

The transition through menopause is a clinical phase, not a single event. Symptoms — vasomotor, sleep, mood, cognitive, urogenital, and bone — vary widely between patients. Management is highly individualised and includes:

• Symptom-targeted therapy — menopausal hormone therapy where indicated and not contraindicated, with shared decision-making about risks and benefits per current IMS, NAMS, and BMS guidance.
• Non-hormonal options for vasomotor symptoms — SSRI/SNRI, gabapentin, fezolinetant where access and indication align.
• Vaginal oestrogen for urogenital symptoms, with reassurance that local therapy has a different risk profile from systemic therapy.
• Bone-health risk assessment with FRAX and DEXA where indicated.
• Cardiovascular risk modification — blood pressure, lipids, glucose, weight, activity.

Patients are reminded that perimenopause can begin years before the final menstrual period and that contraception is still required until 12 consecutive months of amenorrhoea (under 50) or 24 months (under 45 with confirmed early menopause).

Cervical cancer prevention

Cervical cancer is largely preventable. The institutional approach combines HPV vaccination (where eligible), evidence-based screening intervals (HPV-primary or co-testing per current guidance), and prompt colposcopy when indicated. Annual Pap testing as a default has been replaced in most international frameworks by less frequent but more accurate testing — and the rationale is explained to patients during the consultation.

Vulval and vaginal complaints

Vulval and vaginal symptoms — itching, burning, discharge, painful intercourse, lichen sclerosus, vulvodynia — are common and frequently under-diagnosed. The clinic provides structured evaluation including targeted examination, swabs, and where indicated biopsy. Treatment is tailored to the specific condition rather than empirical antifungal therapy on every complaint.

Pre-conception consultation

A pre-conception consultation is offered to any patient planning pregnancy — particularly where there is a known chronic condition (diabetes, hypertension, thyroid disease, epilepsy), advanced maternal age, prior pregnancy complications, or family history of inherited disease. The consultation covers folic acid timing, immunisation status, medication review, baseline investigations, and a structured discussion about the timeline ahead. This consultation is often the most under-used and most high-value gynaecology visit.

How we work with the IVF programme

The general gynaecology clinic and the IVF programme are run from the same institution. Patients are not bounced between unaligned teams. When a fertility concern emerges in a routine gynaecology visit — for example, a 36-year-old with declining AMH and 14 months of trying — the conversation about the IVF pathway is started in the same consultation, with the relevant clinician brought in. Conversely, when an IVF patient has a coexisting gynaecological condition — endometriosis, fibroids, adenomyosis — the surgical and reproductive sides are planned together rather than sequentially.

When to consult a gynaecologist

• Periods that are noticeably heavier, longer, or more painful than usual — particularly when interfering with work or sleep.
• Bleeding between periods or after intercourse.
• Missed periods outside pregnancy or hormonal contraception.
• Pelvic pain that lasts beyond a routine period.
• Painful intercourse.
• Persistent vaginal discharge, itching, or odour change.
• Lumps or swelling in the vulva, vagina, or groin.
• Difficulty conceiving — 12 months of regular unprotected intercourse, or 6 months if the patient is over 35.
• Recurrent pregnancy loss.
• Approaching perimenopause with bothersome symptoms.
• Routine well-woman review — cervical screening, contraception review, vaccination update.
• Any symptom that is causing worry — a consultation does not require a “serious” symptom.

What this clinic deliberately does not do

• We do not over-investigate. A test is ordered only when its result changes management.
• We do not perform surgery primarily for imaging findings without a clinical correlate.
• We do not use fear-based language to push toward intervention.
• We do not run “package deal” gynaecology offers. Each patient is evaluated individually.
• We do not discourage second opinions — they are welcomed and supported with the relevant records.

Where to read further

For specific conditions and procedures, please see the dedicated cluster pages:

• Polycystic ovary syndrome — /gynaecology/pcos/
• Endometriosis programme — /endometriosis/
• IVF and fertility — /ivf/
• Advanced laparoscopy — /laparoscopy/
• Pregnancy care — /pregnancy-care/
• Fetal medicine — /fetal-medicine/
• Postnatal care — /postnatal-care/
• Female reproductive anatomy — /female-reproductive-anatomy/
• Menstrual cycle physiology — /menstrual-cycle-physiology/

Guidelines we follow

Clinical decisions at this centre are aligned with current international evidence-based guidance — including but not limited to:

• ESHRE — European Society of Human Reproduction and Embryology
• ASRM — American Society for Reproductive Medicine
• FIGO — International Federation of Gynecology and Obstetrics
• NICE — UK National Institute for Health and Care Excellence
• RCOG — Royal College of Obstetricians and Gynaecologists
• ESGE — European Society for Gynaecological Endoscopy
• AAGL — American Association of Gynecologic Laparoscopists
• ISUOG — International Society of Ultrasound in Obstetrics and Gynecology
• IMS / NAMS / BMS — international and regional menopause societies

Where local context or individual patient values warrant a deviation from a guideline default, the reasoning is explained and documented.

PRINCIPLED MEDICINE · NOT PROMOTION

• ✓Long-term outcomes over short-term intervention
• ✓No surgery without clear indication
• ✓Ovarian reserve protected at every step
• ✓Patients as decision-makers, not service buyers
• ✓No overpromising IVF success or surgical cure

PATIENT PATHWAY

When should you see a gynaecologist?

Women presenting with abnormal uterine bleeding should be assessed with a structured history, clinical examination, and appropriate imaging before considering medical or surgical management. Conservative management should be considered first-line where appropriate.

FREQUENTLY ASKED

Common Gynaecology Questions

Dr. Priyadatt Patel

Senior Gynecologist · Advanced Laparoscopic Surgeon · IVF and Endometriosis Programme Lead

MS OBGyn · Pregnancy Care · Advanced Gynaecological Ultrasound · Fertility Preservation

ESHRE / ESGE / AAGL / ASRM guideline-aligned practice. 3D Karl Storz precision technique. Fertility-preservation-first philosophy. Evidence-based decisions, honest counselling, long-term outcomes orientation.