Gynaecology (women's health)

This runs 24 hours a day.

It is for women who attend our Emergency Department with vaginal bleeding in early pregnancy or with a gynaecological problem.

We also take referrals from GPs. 

We treat emergencies in Ward D47. 

These are where you come in to hospital for an appointment or procedure but don't stay overnight.

Our outpatient clinics take place in Ward D47 at Sunderland Royal Hospital. 

Why has my GP referred me?

There could be many reasons. For example:

• You have seen your GP and they want help managing your care
• Your GP has done some tests and the results are not normal
• You have had some treatment for your symptoms, but it has not worked

What will happen at the clinic?

This will depend on what your appointment is for.

Usually, we will start by talking to you and asking about your symptoms. We will then ask to examine you. This can involve feeling your tummy and you may also have a speculum examination. This is like a smear test. You may also occasionally have a pipelle biopsy. This is where we take a sample of your womb with a fine tube.

Speculum examination

Do I need to do anything to prepare?

No.

What happens?

We will gently pace a speculum inside the vagina. We will look at your vagina and cervix. Sometimes we need to take samples from your vagina and cervix (a pipelle or cervical biopsy).

Sometimes, we can start your treatment and place a hormonal coil inside your womb at this point.

How long does it take?

It takes a couple of minutes, sometimes a little longer.

Will it hurt?

The speculum can feel stretchy. The biopsy or coil can cause cramping. Most people find it manageable. Please know that if you are not happy at any point we will stop.

Will I need any other tests?

Sometimes we will recommend other tests. For example, blood tests or an ultrasound scan. The blood tests will usually be taken at the clinic. We will need to make a separate appointment for any ultrasound scans. We will call you or send a letter to you to let you know when these are.

How long will I be at the clinic?

Your appointment will likely take about 20 minutes. Sometimes there are delays for emergencies.

What happens next?

We will tell you as much as possible at the appointment. We will go over any more tests and any treatments that you can consider. Often you can start this from the clinic.

If we have done tests we will contact you with the results. This will usually be by letter. Sometimes we will give you another appointment to go over them.

These are where you come in to hospital for an appointment or procedure and are admitted to hospital.

This could be for an operation or a procedure. We also might need you to stay overnight if you have been admitted through the Emergency Department and we need to observe you for longer.  

Our inpatient services are in Ward D47 at Sunderland Royal Hospital. 

Our Early Pregnancy Assessment Unit (EPAU) is a clinic that helps people who have problems or worries in the first weeks of pregnancy, usually up to about 12–16 weeks.

It is at Chester Lodge at Sunderland Royal Hospital. 

Our trained nurses, doctors and ultrasound staff can check symptoms like bleeding, pain or concerns based on previous pregnancies. 

At the appointment, we might:

• Ask about your symptoms and medical history
• Do blood tests or urine tests
• Offer an ultrasound scan to check the pregnancy, which may be on the tummy or sometimes an internal scan for clearer images 

We help find out what is happening with the pregnancy, offer support and give you clear advice on next steps. Some people might need more than 1 visit because very early scans do not always give clear answers. 

Our EPAU also supports people who have had previous problems such as ectopic pregnancy or miscarriage, or anyone who needs extra reassurance in early pregnancy.

Our Fertility Unit is located on level 2 in the Chester Lodge building at Sunderland Royal Hospital.

Dr Madhavi Gudipati is the lead for Fertility.

We provide: 

• testing 
• investigation 
• treatments including intrauterine insemination (IUI)
• counselling 

Our team includes doctors, nurses and other professionals who are are specialised in infertility in both men and women. 

We treat lots of different early pregnancy-related conditions. These include: 

Ectopic pregnancy

An ectopic pregnancy is when a pregnancy starts to grow outside the womb. In the UK, 1 in 90 pregnancies is an ectopic pregnancy. 

If you are referred to us we will ask you about your medical history and your symptoms. The doctor will then examine your abdomen and might also do a vaginal (internal) examination. 

Most women are offered a transvaginal scan (where a probe is gently inserted into your vagina) to look at the uterus, ovaries and fallopian tubes. You might also be asked to do a blood test. If a diagnosis is unclear, you might need an operation called a laparoscopy. 

Early pregnancy loss support 

It can be a huge shock when you lose a baby. You may find the time after your loss to be sad, stressful and overwhelming.

We know that you may have support with family and friends. But it may be helpful to meet with other mothers who may have gone through something similar with their baby loss.

We have an early pregnancy loss support group where you will get a chance to share your story. It will help you develop ways of coping (coping strategies). It will also give you ideas to help you process your loss and grief. Sometimes sharing can help you to feel more connected and less alone or isolated.

Group support sessions are private (confidential) and you do not need to pay. They take place every other week. They run for 2 hours, from 1pm to 3pm. 

Pregnancy terminations (abortions)

If you choose to end your pregnancy you will have a termination (abortion). There are different ways this can happen.

At home

You can have a medical termination at home. This is suitable if you are less than 10 weeks pregnant. This will happen in 2 stages - stage 1 at an appointment and stage 2 at home. 

In hospital 

There are 2 different types of surgical terminations in hospital: 

• using suction to remove the pregnancy through the vagina – this can be done between 7 to 14 weeks of pregnancy and usually takes about 5 to 10 minutes
• using forceps to remove the pregnancy through the vagina – this can be done from around week 15 and usually takes 10 to 20 minutes

Pregnancy of unknown location (PUL)

Pregnancy of Unknown Location (PUL) means that your at home pregnancy test said that you were pregnant but your ultrasound scan showed that your womb is empty. This can mean one of the following:

• You are in the very early stages of pregnancy
• You have had an early miscarriage or your pregnancy is failing
• You are pregnant, but somewhere other than your womb (ectopic pregnancy)

To help us find out which one you have, you will need to have a blood test.

Unexpected vaginal bleeding without pain while less than 7 weeks pregnant

Some vaginal bleeding in pregnancy can be because of an implantation bleed. This is light spotting or bleeding that happens when the pregnancy implants in the womb. It is normal.

Sometimes we don’t know what is causing the bleed.

Bleeding in pregnancy is not caused by anything you have done. Even if you have had a miscarriage, most happen because there is something wrong that we cannot stop.

If you are less than 7 weeks pregnant with a positive urine pregnancy test, we do not usually arrange appointments for you for vaginal bleeding only. This is because it is usually too early to see anything on a scan. We will talk to you about expectant management. This means going home and following advice we have given you to keep you safe. 

If you have any of these symptoms, you should go to the Emergency Department (ED):

• Bleeding. If you are filling more than 2 large pads per hour, or passing clots the size of your palm.
• Fainting or feeling faint.
• Very bad pain or pain that is getting worse in your pelvis, abdomen or shoulder.
• Suffering from a new bowel or bladder problem. For example, diarrhoea (pooing more often or your poo being watery or runny) or pain and pressure in your bottom or when peeing. 

We have lots of fertility-related treatments. A lot of these take place in our Fertility Unit (link to ward) at Chester Lodge. 

Some of the most common are explained below: 

Ovulation induction 

You will have ovulation induction treatment if you do not produce eggs (ovulate) regularly each month. This means it is harder for you to get pregnant.

There are different types of ovulation induction: 

• Ovulation induction with Letrozole. This works by reducing your levels of oestrogen (a hormone). This then stimulates your ovary to produces eggs. This means it should be easier for you to get pregnant. 
• Ovulation induction with Clomifene. Clomifene stimulates your ovary to produce eggs. This means it should be easier for you to get pregnant.

Long term sperm cryostorage

Sperm cryostorage or cryofreezing is where you have your sperm frozen. It is done at a laboratory in the Fertility Unit. 

Freezing it means there is more chance of it working long term. It means you can use your sperm in the future to help get pregnant.

Intrauterine insemination (IUI)

Intrauterine insemination (IUI) is a treatment to help you get pregnant. It is sometimes also called ‘artificial insemination’.

This involves us using a sperm sample. In a lab, we take out the sperm that are slow, not moving or a strange shape. Only the better quality sperm is left.

We then give tablets and/or injections to the person who will carry the child. These help them to produce more than one egg. This is also called a ‘stimulated cycle’.

Eggs are released into the womb on a monthly basis (ovulation). We inject the better quality sperm directly into your womb when you are ovulating.

Sterilisation 

Sterilisation is an operation to stop someone from getting pregnant in the future. It is permanent. 

There are 3 different types of sterilisation:

• Blocking the tube that carries sperm from your testicles to your penis (vasectomy)
• Putting clips on your fallopian tubes (laparoscopic clip sterilisation)
• Removing your fallopian tubes (laparoscopic tubal removal)

Counselling 

People going through fertility treatment might experience lots of different feelings. Because of this they might benefit from counselling. This could be fore, during and after treatment. 

Counselling is when you talk to a trained professional (called a counsellor) who helps you understand your feelings and solve problems in a safe, private way.

We offer counselling and information for people who may be using donated:

• sperm
• eggs
• embryos

Cancers that start in the female reproductive system are called gynaecological cancers.

The treatment you need depends on where the cancer started.

Gynaecological cancers include: 

Cervical cancer

This is when abnormal cells in the lining of the cervix grow in an uncontrolled way. The cervix is part of the female reproductive system. 

Ovarian cancer

This is when abnormal cells in the ovary, fallopian tube or peritoneum begin to grow and divide in an uncontrolled way

Womb (uterine) cancer including endometrial cancer

The womb is the pear-shaped muscular bag that holds a baby during pregnancy. Most womb cancers start in the lining of the womb. They are also called uterine or endometrial cancer. 

Vaginal cancer

Vaginal cancer is very rare. It starts in the vagina and is more common in older women. 

Vulval cancer

Vulval cancer is a rare cancer. It can start in any part of the female external sex organs, the vulva. 

If you are diagnosed with a gynaecological cancer, you will be supported by a gynae oncology clinical nurse specialist. Their job is to look after you during and after your treatment. They will look after you if your cancer is suspected or confirmed. 

They have specialist knowledge and experience in gynae cancer. They are often known as your key worker.

There may be different healthcare professionals involved in caring for you. Your key worker acts as a link between them.

Endometriosis is a long‑term condition where tissue similar to the lining of the womb grows in places it should not. This tissue can grow around the ovaries, fallopian tubes, or other areas in the pelvis. Each month, this tissue reacts to hormones like the lining of the womb does. It may swell and bleed, but the blood has nowhere to go.

This can cause pain, heavy periods and sometimes problems getting pregnant. Some people also feel tired or have pain during sex or when using the toilet.

Endometriosis is common and it is not your fault. Treatments are available to help manage symptoms and improve quality of life.

Heavy menstrual bleeding is common, particularly in teenagers. As you get older, your periods tend to become lighter. 

If they don't, it could be because of a different condition. You should see a doctor if: 

• your period regularly lasts more than 7 days
• you are soaking through pads / tampons more than every 2 hours
• you are needing to use pads and tampons at the same time
• you are flooding or leaking onto your underwear or clothes regularly
• your periods are stopping you from doing day to day things like going to school or work, sports or socialising 

Some people lose much more blood than expected and become anaemic. If this happens, you might get dizzy, breathless and tired easily. A blood test will tell your doctor whether you need iron replacement therapy.

There are different treatments for heavy periods depending on the reason for them. They include:

• Tranexamic adic (TCA) tablets
• Non-steroid anti-inflammatory drugs (NSAIDs)
• Iron supplements
• Non-contraceptive hormones
• Contraceptive medications 
• Progesterone only contraceptive pill (POP)
• Contraceptive injection
• Progestogen-containing implant 
• Copper or hormonal coil

Menopause is a natural part of life for women. It usually happens between ages 45 and 55.

During menopause, the body’s levels of certain hormones, like oestrogen and progesterone, begin to drop. These hormones help control your monthly period. When they get lower, periods become less regular and eventually stop.

Menopause is reached when you have not had a period for 12 months in a row.

What Happens During Menopause?

As hormone levels change, the body may react in different ways. Common symptoms include:

• Hot flashes - sudden feelings of heat in the face or body
• Night sweats - hot flashes that happen while sleeping
• Mood changes - feeling more upset, stressed, or emotional
• Trouble sleeping
• Dry skin or hair changes
• Vaginal dryness

Not everyone has the same symptoms. Some people have only a few, and others have many.

Menopause can be uncomfortable. We can help with treatments like: 

• Lifestyle changes
• Hormone therapy
• Non-hormone medicines
• Support and education

PCOS stands for polycystic ovary syndrome. The name can be confusing because PCOS does not mean you have real cysts on your ovaries. The “cysts” are actually follicles, which are small eggs that have not been released. People with PCOS often have more follicles than usual.

PCOS happens because of a hormone imbalance, which can stop the body from releasing an egg each month.

PCOS can look different for everyone. One person might have only a few symptoms, while another might have many. 

Symptoms can include:

• Irregular or heavy periods
• No periods at all
• Bad acne
• Extra hair on the face or body
• Thinning hair on the head

The best way to diagnose PCOS is through hormone blood tests. 

A prolapse happens when a body part that is usually held in place by muscles and tissues slips downward because those muscles become weaker.

Inside our bodies, organs like the uterus sit in certain positions. Strong muscles act like support straps to keep everything where it should be. When these straps weaken, an organ can drop lower than normal. This drop is what is called a prolapse.

We can treat a prolapse in different ways:

• Exercises to strengthen the muscles
• Support devices
• Procedures or surgery in more serious cases

A colposcopy is an examination of the cervix with a special microscope called a colposcope.

We will put a smooth, tube shaped tool (a speculum) in your vagina which makes it easier to see inside your cervix. We will then use the colposcope to make the image bigger. This helps us to find any abnormalities.

What happens during the examination?

We will put the speculum into your vagina. This is similar to when you had your cervical sample. We will then look at your cervix and apply vinegar to it. This helps us find any abnormalities on your cervix. The image is also on a monitor so you watch the exam too.

When the exam is over, we will remove the speculum and ask you to sit for a few minutes. If you feel ok, you can get dressed. We will give you a sanitary pad but you can bring your own if you prefer. We will then have a chat with you in the room and will let you know if we need to do anything else. For example:

• Nothing at all if things look normal
• Take a cervical sample if you were referred for this
• Take a small biopsy (punch biopsy) from your cervix
• Do a loop diathermy excision of Transformation Zone (LETZ)

A laparoscopy is an operation we do if you are either having pelvic pain or a problem with your pelvic organs.

It allows the doctor to check your:

• womb (where the baby grows)
• ovaries (where the eggs form)
• fallopian tubes (how the eggs get from the ovaries to the womb)

If the doctor doesn't find anything unusual it helps them decide what to do next.

We often do this to:

• diagnose the cause of pelvic pain
• tell if you have endometriosis 
• check if your fallopian tubes are blocked
• remove ovarian cysts
• treat an ectopic pregnancy 
• remove pelvic adhesions (scar tissue)

You will be under general anaesthetic. This means you will be asleep so will not feel anything.

A hysteroscopy is a simple procedure that lets a doctor look inside the uterus. The doctor uses a thin tube with a light on the end. This tool is called a hysteroscope. It goes through the vagina and cervix, so no cuts are needed.

A doctor might do a hysteroscopy to:

• Check the cause of heavy or unusual bleeding
• Look for polyps or fibroids
• Find out why someone is having trouble getting pregnant
• Remove tissue that should not be there
• Find or remove a coil that has moved

What will happen during the procedure?

• You lie on an exam table, like during a regular pelvic exam.
• The doctor gently puts the hysteroscope through the vagina and into the uterus.
• They may use a little fluid or air to open the space so they can see better.
• The doctor looks at the lining of the uterus and may treat any problems right away.

Some people feel mild cramping, like a period cramp, but it usually does not last long.

Most people:

• Go home the same day
• Have light cramping or spotting for a day or 2
• Can return to normal activities within a day or 2

A hysterectomy is surgery to remove your uterus (womb) and usually the cervix (neck of the womb).

We might also remove the tubes (salpingectomy) and ovaries (oophorectomy). Your surgeon will talk to you about the benefits and risks of this.  

You will be under general anaesthetic. This means you will be asleep so will not feel anything.

There are three main types of hysterectomy:

1. Abdominal Hysterectomy

The doctor removes the womb through a cut on your lower tummy. This cut is usually 10–12 cm long and sits just above the pubic hair line. Sometimes a up‑and‑down cut is needed instead.

2. Laparoscopic Hysterectomy

This is a keyhole surgery. The doctor makes several small cuts on your tummy and uses special tools to free the womb. The womb is then removed through the vagina.

3. Vaginal Hysterectomy

The womb is removed through the vagina. All the cuts are made inside the vagina, so you won’t be able to see them.

You might need this operation for:

• Heavy periods
• Fibroids (non-canerous growths in the womb)
• Prolapse of the uterus (when the womb drops down)
• Cancer of the uterus, ovaries or cervix
• Pelvic pain, including pain caused by endometriosis

A biopsy is when a doctor takes a small piece of tissue from your body to check it under a microscope. This helps the doctor understand what is causing symptoms and make sure everything is healthy.

Biopsies can be taken from places like the cervix, lining of the womb (endometrium), vulva or vagina, depending on what the doctor needs to look at.

Why might I need a biopsy?

You may need a biopsy if:

• A test shows abnormal cells. For example, if a smear test or HPV test shows changes that need a closer look.

• You have unusual bleeding. This includes heavy periods, bleeding between periods, or bleeding after menopause.

• You have long‑lasting pelvic pain. A biopsy can help find out if a condition like endometriosis is causing the pain.

• There are patches or changes on the skin. A biopsy can check sores or areas on the vulva that look different.

• Your doctor is checking for cancer. A biopsy is the best way to find out if cells are normal, changing, or cancerous.

What can I expect?

Most biopsies are quick. You might feel some cramping, but most people can go back to normal activities soon after.

A vaginal wall repair is an operation that helps fix the muscles and tissues that support the vagina.

These tissues can become weak over time, often after childbirth, ageing or long‑term pressure on the pelvic area.

When they weaken, the bladder or bowel can bulge into the vagina, causing discomfort.

A repair helps put everything back in the right place and gives the area stronger support.

Why might I need this operation?

You may need a vaginal wall repair if you have:

• A bulge or pressure feeling in the vagina
• Trouble holding pee or needing to go often
• Discomfort when walking, exercising, or standing
• Trouble with the bowel, like feeling like you haven't fully emptied it

These symptoms can happen when the front wall (near the bladder) or back wall (near the bowel) becomes weak.

How will it help me?

During the surgery, the doctor:

• Tightens and repairs the weak tissues
• Supports the bladder or bowel so they no longer push into the vagina
• Helps reduce pressure, discomfort, or leaking

What can I expect after my surgery?

Most people:

• Feel some soreness for a few days
• Can walk and move gently soon after
• Need to avoid heavy lifting and strenuous exercise for a few weeks
• Feel less pressure and discomfort once healing begins

Hormonal and copper coils are types of intrauterine devices (IUDs) that help prevent pregnancy. They can also be used to treat heavy periods.

A hormonal coil releases a small amount of hormone into the womb, which makes periods lighter and can reduce pain, while also stopping pregnancy by thickening the mucus in the cervix and thinning the lining of the womb.

A copper coil has no hormones. Instead, the copper slows down sperm and stops them from reaching an egg. It can make periods heavier at first.

Both coils sit inside the womb, work for several years.

What will happen at my appointment?

The nurse or doctor will talk to you about the coil and make sure it is the right choice for you. They will explain what will happen and answer any questions.

You will then lie on an exam bed, just like during a smear test. A small device called a speculum is gently put into your vagina so the nurse or doctor can see the cervix. We might numb the area so it's less uncomfortable.

The coil is then put into the womb using a thin tube. This only takes a few minutes. You may feel cramping for a short amount of time, but this usually settles quickly.

Once the coil is in place, the nurse or doctor will trim the strings and check everything is correct. They will tell you what to expect afterwards and when to get help if you need it.

After the appointment, you can usually go home right away and get back to your normal activities once you feel comfortable.

Ward D47 

This is at Sunderland Royal Hospital.

Use the Maternity entrance on the Chester Road side of the hospital. This is to the right of Entrance 5 (Outpatients). 

Use the stairs or lift to go to D floor. This is one floor up. Then, follow the signs to D47. 

Find out more by clicking this link: Ward D47. 

Early Pregnancy Assessment Unit 

This is based at Chester Lodge at Sunderland Royal Hospital.

This is the building to the right when you enter the site on Chester Road. It is opposite Chester Wing. 

Enter the building and follow signs to EPAU. 

Find out more by clicking this link: EPAU. 

Fertility Unit

This is based at Chester Lodge at Sunderland Royal Hospital.

This is the building to the right when you enter the site on Chester Road. It is opposite Chester Wing. 

Enter the building and follow signs to the Fertility Unit. 

Find out more by clicking this link: Fertility Unit. 

Conditions and treatment

• Polycystic ovary syndrome (PCOS)
• Vaginal prolapse and management
• Uterine artery embolisation 
• Using the copper coil or hormonal coil 
• Taking Ryeqo
• Dienogest - treatment for endometriosis
• Laparoscopy - keyhole surgery for endometriosis

Operations and procedures

• What to expect after gynaecological operations
• What is a laparascopy?
• Hysterectomy
• Colposcopy examination and punch biopsy
• A guide to your colposcopy
• Urodynamic assessment 
• Hormonal coil insertion 
• Diathermy loop excision of transformation zone (LETZ)
• Skin biopsy 
• Hysterpsalpinogram (HSG)
• After your pelvic floor repair or vaginal hysterectomy

Pregnancy

• Pregnancy of unknown location (PUL)
• Medical termination of pregnancy (abortion) at home (less than 10 weeks)
• Manual vacuum aspiration of pregnancy (abortion) (less than 13 weeks)
• Early pregnancy loss support group

Fertility

• Ovulation induction with Letrozole 
• Ovulation induction with Clomifene
• Sterilisation 
• Long term sperm cryostorage
• Simulated Intrauterine Insemination 
• Hysterpsalpinogram (HSG)
• Counselling service - infertility

Cancer

• Your gynae oncology clinical nurse specialist
• Your guide to supported self-management of endometrial cancer
• Your guide to supported self-management of ovarian cancer
• Patient initiated follow up after treatment for ovarian cancer

Young people

• Heavy menstrual bleeding (periods) for teenagers
• Managing periods in young people with disabilities 
• Young people and pelvic pain

Sexual health

• Patient guide to PEPSE 
• Information about test results
• Telling partners about STIs

Other

• Gynaecology outpatient clinic
• Fast track gynaecology clinic 
• Reviewing your cervical cancer screening history