FAQs Archive | Alana Healthcare

General

How do I make an appointment?

To schedule an appointment please telephone one of our friendly reception staff on 9009 5255. To book your appointment correctly, our staff may be required to ask the reason for your consultation. Our staff will triage your concerns and book you an appointment with the practitioner best suited to your needs. Our staff are trained to protect your privacy so you can feel reassured discussing your needs with them.

Do I need a referral to see a doctor at Alana Healthcare?

If you are a Medicare card holder and wish to claim the Medicare rebate, you will require a referral from either a GP or specialist to entitle you to claim your Medicare rebate. GP referrals are valid for 12 months from the date of your first consultation, and specialist referrals are valid for three months from the date of your first consultation. Your referral needs to have:

relevant clinical information about the condition for investigation, opinion, treatment and management
the date of the referral
the signature of the referring practitioner

The referral must be presented prior to attending your appointment to be eligible for Medicare rebates. It does not need to be addressed either to Alana Healthcare or the doctor you will be seeing. Patients can present a referral to any doctor of their choosing. Medicare ineligible patients or patients who do not wish to claim the Medicare rebate do not require a referral to attend our service. If you are attending an appointment with our specialist physiotherapist you may be eligible to claim a Medicare rebate if you are referred from a GP under a GP Management Plan (GPMP). Not everyone is eligible and you will need to speak to your GP to find out. You can find more information about eligibility criteria on the Services Australia website. If you are not eligible to claim your physiotherapy visit through Medicare, you may be able to claim through your private health insurance, subject to your level of cover.

How much does it cost to see a specialist at your clinic?

Fees vary depending on whether it is your first visit to the clinic or a follow up, what service is being provided, and who you are seeing, and how long it takes. Appointments are time billed per 15 minutes or part thereof. Please telephone us on 02 9009 5255 and speak to one of our staff to find out the possible costs for your appointment. Alternatively you can visit our Consultation Fees page. Medicare rebates apply to medical appointments covered by a valid referral letter. Health fund rebates apply to physiotherapy appointments only, not outpatient doctor appointments, subject to your level of cover. All of our consultation fees are outlined on our Consultation Fees page. Surgical fees are provided by Informed Financial Consent once you have seen a doctor. Payment is due at the time of consultation, and we accept American Express, Visa, Mastercard and EFTPOS payments. We do not accept cash and we do not bulk bill.

What are your opening hours?

Alana Healthcare is open Monday to Friday, 8:00am to 5:00pm, by appointment only. We are closed on weekends and on Public Holidays.

Where are you located?

Alana Healthcare is located at 88 Anzac Parade, Kensington, diagonally opposite the famous (and very pink!) Peter's of Kensington, and in between McCyclery and Anytime Fitness. Enter via the staircase (or accessible platform lift) shared with McCyclery. We are approximately 10 minutes drive from the hospital campus housing the Royal Hospital for Women, the Prince of Wales and Prince of Wales Private Hospitals, and Sydney Children’s Hospital. Please visit our Contact Us page for further information.

What parking or public transport is available?

1/4 hour, 1/2 hour and 1 hour, 2 hour and some untimed on street free parking is available on both Goodwood Street and Elsmere Street. We always recommend you allow a little extra time to find a car park so that you do not have to rush for your appointment. Our practice is accessible by both bus and light rail. The ES Marks light rail stop is located outside our front door, within a short 100m walk. There are also plenty of buses that run along Anzac Parade. For details or to plan your trip, please visit Transport NSW.

Do you offer video or telephone consultations under Telehealth?

Yes. Patients who are already known to us are able to access Telehealth services for geographical reasons with the approval of their Alana specialist. Not all patients are eligible for rebateable Telehealth services under Medicare, so please liaise with us regarding booking a Telehealth appointment. Telehealth appointments have also been made available in response to the COVID-19 pandemic. Please note, a face to face appointment with your Obstetrician or Gynaecologist is always preferred, and generally required for patients seeing a doctor for the first time. Telephone consultations are available to patients with the approval of their Alana specialist, but do not attract a Medicare rebate.

Do you bulk bill?

No. Alana Healthcare is a private clinic and therefore we do not bulk bill. For appointments funded under Medicare you should contact the Royal Hospital for Women Outpatients Department on 9382 6248.

What if I need to cancel my appointment?

Everyone’s time is valuable and we understand that sometimes you will need to cancel a scheduled appointment. To protect you, the other patients waiting for an appointment, and our practitioners, Alana observes the following Cancellation Policy: If you have provided us with your mobile phone number, you will be sent an SMS reminder at least 2 working days prior to your scheduled appointment. You must reply with only a “Y” to confirm or an “N” to cancel. If you have not provided us with a mobile phone number, or not consented to SMS contact, we will telephone you on the number/s you have provided in the days leading up to your appointment to confirm. If you have not received an SMS from us in the lead up to your appointment, please telephone us on 9009 5255. PLEASE NOTE: If we do not receive an SMS or verbal confirmation from you by 12:00pm the working day prior to your appointment, your appointment will automatically be cancelled and allocated to another patient. You will then need to call us and reschedule to the next available appointment time. If for any reason you are unable to attend your confirmed appointment we require that you call us on 9009 5255 by 12:00pm the working day prior, otherwise you will be charged a cancellation fee as outlined below.

For cancellation of any appointment by 12:00pm the working day before there will be no charge
For late cancellation of a confirmed appointment after 12:00pm the working day before, 50% of the normal consultation fee will be charged
For missing a scheduled confirmed appointment, 100% of the normal consultation fee will be charged

By booking an appointment with us you accept this Cancellation Policy, which will also be notified to you in writing prior to your first appointment. The 12:00pm deadline for confirmations and cancellations allows us to spend the remaining time filling the available appointment times with other patients on the waiting list.

Do you participate in Gap Cover for private surgery?

No. The Alana specialists are generally available through the public health system also, so patients choosing to access care at Alana Healthcare will be charged the full fee for services.

Do you offer Veteran’s Affairs, pensioner or student concessions?

We are happy to provide medical services to Gold Veteran’s Affairs card holders and will invoice the Department of Veterans’ Affairs directly, with no out of pocket cost to you. As all of our doctors are available also through the public health system, we do not offer pensioner nor student concessions.

Do you offer Medicare or Private Health Fund claiming?

Yes. Alana Healthcare can process your Medicare claim on the spot via our practice management software. To be eligible, you will need to have provided us with your current Medicare number and your appointment will need to be covered by a valid referral letter. Medicare will then process the rebate directly into the bank account you have registered with them. We can also process fund claims for physiotherapy appointments via our HICAPS system, subject to your level of cover. This means that you will only ever have to pay the gap on your consultation. Inpatient services will need to be claimed directly with your Private Health Insurer and/or Medicare. We will issue you an itemised invoice for claiming purposes.

Is there wheelchair / pram access?

Yes. While our entrance is situated as a shop front and our front door located up a flight of stairs, there is an accessible platform lift co-located with the flight of stairs to provide easy access for wheelchairs and prams.

Do you have a GP on site?

No. Alana Healthcare is a specialist health practice. We have Obstetricians, Gynaecologists, Fertility Specialists, Endocrinologists, Physiotherapists and Naturopaths.

What is the cost of private antenatal care at Alana Healthcare?

Our full fee disclosure is available here.

What should I do if I need medical assistance during my pregnancy?

Once you have booked your antenatal care with us, you have access to medical assistance 24 hours a day, 7 days a week. If at any stage you feel something is not right, telephone us at any time of the day or night on our emergency number 0499 525 000. If you are beyond 24 weeks gestation telephone either us or the Prince of Wales Private Delivery Suite on 02 9650 4444.

What if I have an urgent problem, do I need to wait?

If your condition is life threatening or of a serious urgent nature we recommend you present to the Emergency Department of your nearest hospital. All other urgent requests we always try to accommodate, and we have a daily appointment time kept for the most urgent of issues related to abnormal bleeding. Our Alana Bleeding Clinic (ABC) is here to help your issues relating to abnormal bleeding and by contacting Alana on 9009 5255 we can arrange a soon appointment. For all other referrals, we run a triage service. This means we review your clinical needs and prioritise your clinical issue according to risk. Our administration team may also suggest the soonest available clinician to assist you with your problem.

Gynaecology

Do you have a female gynaecologist?

Yes. Alana has both female and male gynaecologists. Visit the Our Team page to find out more, and then speak to our staff about who is the best doctor for you to see based on your concerns.

Do I need a referral to see a Gynaecologist?

If you are a Medicare card holder and wish to claim the Medicare rebate, yes, you will require a referral from either a GP or specialist to entitle you to claim your Medicare rebate. Medicare ineligible patients or patients who do not wish to claim the Medicare rebate do not require a referral to attend our service.

Can I choose my gynaecologist?

Yes. We have both female and male gynaecologists and you may be referred specifically to a particular gynaecologist or we can suggest the best fit for you and your particular problem.

What if I have an urgent problem, do I need to wait?

If your condition is life threatening or of a serious urgent nature we recommend you present to the Emergency Department of your nearest hospital. All other urgent requests we always try to accommodate, and we have a daily appointment time kept for the most urgent of issues related to abnormal bleeding. Our Alana Bleeding Clinic (ABC) is here to help your issues relating to abnormal bleeding and by contacting Alana on 9009 5255 we can arrange a soon appointment. For all other referrals, we run a triage service. This means we review your clinical needs and prioritise your clinical issue according to risk. Our administration team may also suggest the soonest available clinician to assist you with your problem.

Can I have my cervical screening test with the clinical team?

Yes. We do provide cervical screening tests in accordance with best practice from Australian guidelines. Your primary care practitioner will usually perform this for you and send you reminders when this needs to be done. If you are referred and need your usual cervical screening test (the old term was Pap smear) we can perform this for you.

Alana Bleeding Clinic

What are my chances of falling pregnant after an ectopic pregnancy?

It depends. Some ectopic pregnancies are caused by certain conditions like endometriosis or as a result of previous pelvic inflammatory disease (PID) commonly caused by Chlamydia infection. In these conditions the remaining fallopian tube may be scarred and increase the likelihood of another ectopic pregnancy. In general, the risk of recurrence is up to 8-10% after one ectopic pregnancy. The recurrence risk is of course dependent on whether or not you have any underlying conditions. Many women (and doctors) think that the ovaries are taking turns in releasing an egg (left than right etc.) but this is not true. The other commonly held belief is that, for example, the right fallopian tube only can pick up the egg released from the right ovary, which is not true either. We know that in reality the ovaries are located rather close to each other (not like in the anatomy pictures), and ovulation occurs more “randomly” from each ovary (sometimes at the same time!) and that the fallopian tubes can pick up the egg from the ovary on the other side. This is because of a complex process attracting the fallopian tube to move towards the ovary where the ovulation (release of the egg) has occurred. Therefore a previous ectopic pregnancy doesn’t half your chances of a next pregnancy. Research has shown that around 65% of women with a previous ectopic pregnancy have an intrauterine pregnancy within 18 months. This figure may go up to as high as 80% in two years, so that is promising. If you do fall pregnant it is important to have an early pregnancy scan determining the location of the pregnancy, making sure it is inside the uterus. If you have trouble falling pregnant than depending of your age and underlying conditions we would recommend you to see one of our Alana specialists as the other fallopian tube may be scarred and preventing you from conceiving naturally. There is an ultrasound test called a HyCoSy (“Hysterosalpingo Contrast Sonography”) which can determine whether your other fallopian tube is functioning normally. During this ultrasound investigation a speculum is inserted to allow a thin plastic tube to be placed inside the uterus. Through this tube a mixture of air and normal saline is injected and this shows up on the ultrasound scan. You can see if the fallopian tube is open (“patent”) as there is spill seen around the end of the fallopian tube and ovary. This test may reassure you if normal. If the fallopian tube is blocked it is worthwhile seeing one of our fertility specialists at Alana who will discuss alternative ways for a pregnancy to occur (like IVF).

How long do I have to wait after my miscarriage to try to conceive again?

We recommend you have at least one normal period after your miscarriage. If the first bleed is not quiet as normal than wait until you have a normal menstrual period in your next cycle as it takes time for your body to clear the pregnancy hormone. When you have had a normal period we know your cycle has returned to normal, the pregnancy hormone is out of your system and that your body is ready for a new pregnancy. Record the first day of your menstrual period (LMP) as this is important in dating your next pregnancy. Physically you do not need more than one period but allow yourself enough time to emotionally be ready as well. Some time is also necessary to allow yourself to grieve about your pregnancy loss. We find that most women after a miscarriage are a little more anxious in their next pregnancy. Your GP can refer you to the Alana Obstetricians for an early pregnancy scan and we recommend it to be done at around 8 weeks from your LMP as at this stage you should really be able to see your baby’s heartbeat.

I thought I was 7 weeks pregnant but the scan says I’m only 5 weeks and no heartbeat is seen, how is this possible?

To answer this question we firstly go back to basics to understand your cycle. The pregnancy is calculated based on the average menstrual cycle which is 28 days. The first day of menstrual bleeding marks the first day of the menstrual cycle. This is called your LMP (or “last menstrual period”). Right in the middle of this picture perfect 28 day cycle is when ovulation occurs (day 14 of the cycle) and roughly 2 days before and after is when you are most fertile. In real life not everyone has this picture perfect 28 day cycle, it may be longer or shorter, but we know that ovulation occurs roughly 14 day before your next period. This is why many fertility doctors recommend to have intercourse every 3 days if you really are trying to have a baby because the ovulation may occur a little earlier or later than you may think. When calculating the weeks of pregnancy we include those two weeks from the first day of the LMP as this is the easiest part of the cycle to notice and to record. We also will enquire about the length of your cycle and whether it is regular or irregular. All of this is helpful in trying to establish the gestation. For example, if your cycle is regular and 33 days long we would expect your ovulation to have occurred later (5 days) and an early pregnancy scan will most likely show a baby that measures 5 days less than you were expecting. Now to answer your question, it may be that you ovulated later in the cycle or have a longer cycle. The pregnancy is truly only 5 weeks, a follow up ultrasound in 10-14 days is likely to show your baby’s heartbeat and all is well. The other possibility is that unfortunately the pregnancy is not developing as expected at 7 weeks gestation and a follow up scan may reveal a miscarriage. We understand that this is an anxious time and to have to wait for 10 -14 days seems very long but it is important to have this time in between scans to determine accurately what is taking place.

Why do I have spotting or mild bleeding in early pregnancy?

It is common to have some bleeding in early pregnancy. It may occur in 20% (or one out of five) mums to be, and it is unlikely to be harmful to your baby. It usually happens at about the same time that your period would have been due, and may last for a couple of days. The bleeding is usually light (no large clots) and is not accompanied by strong period pains. There are many different causes for bleeding in pregnancy, and in the first trimester the bleeding may be caused by:

Breakthrough bleeding: which happens as the pregnancy hormones interfere with the hormones of your normal menstrual cycle. This causes some the endometrial lining to be shed. Spotting or light bleeding may come and go for several days.
Implantation bleeding: which happens when the fertilised egg implants in the endometrial lining of the uterus. The endometrial lining has been prepared for the nestling of the fertilised egg during the menstrual cycle and has now got a very good blood supply. The implantation may therefore be associated with some light bleeding.
Other causes: which may include changes to your cervix by the pregnancy hormones; it softens the cervix and causes an area of cells covering the cervix to move towards the outside of the cervix. These cells are more prone to bleeding, especially when touched during intercourse. It is important to be up to date with your Pap smear screening tests as bleeding may also be caused by abnormal cells. Bleeding can also be linked to vaginal or cervical infection which would require further investigation with a vaginal swab and may need treatment. A harmless growth on the cervix called a polyp may also cause bleeding at any stage in the pregnancy. A speculum examination (as is done with the Pap smear) will reveal this polyp, and usually nothing needs to be done about it during your pregnancy.

Bleeding in early pregnancy is common but it’s important to tell your doctor about it. At Alana we will perform a physical examination which may include a speculum examination to see if the cervix is open or not and what the cervix looks like in general. Depending on other symptoms we may take a vaginal swab if we think there is an infection. We may also perform an (internal) ultrasound to measure the gestation and to determine where the pregnancy is located. We would recommend testing your pregnancy hormone level (“quantitated HCG”) which also helps in dating the pregnancy, and we would test your blood group. In general if the bleeding is light and settles down, and is not accompanied by bad period type pains, there is a good chance that all is well and that your baby is fine.

What if I have an urgent problem, do I need to wait?

If your condition is life threatening or of a serious urgent nature we recommend you present to the Emergency Department of your nearest hospital. All other urgent requests we always try to accommodate, and we have a daily appointment time kept for the most urgent of issues related to abnormal bleeding. Our Alana Bleeding Clinic (ABC) is here to help your issues relating to abnormal bleeding and by contacting Alana on 9009 5255 we can arrange a soon appointment. For all other referrals, we run a triage service. This means we review your clinical needs and prioritise your clinical issue according to risk. Our administration team may also suggest the soonest available clinician to assist you with your problem.

Antenatal Care

Do you have a midwife?

Yes! Karen Grey is our very experienced midwife and can consult with you at any point throughout your pregnancy and postnatally. Karen also works at the Prince of Wales Private Hospital so you may see her in hospital when you deliver. Karen offers comprehensive antenatal and postnatal advice, education and support, including breastfeeding and lactation.

How much does antenatal care at Alana cost?

For Medicare eligible, privately insured patients, you can read our Obstetric Fee Disclosure located on our fees page. If you are Medicare ineligible and/or don’t have private health insurance, please telephone us on 02 9009 5255 and we can provide you with the relevant fee information.

When should I book in to see my obstetrician?

We usually see you for your first antenatal visit between 8-10 weeks of the pregnancy, but in some circumstances you may need to come in earlier. If you are experiencing severe early pregnancy symptoms, have bleeding or pain, or are uncertain of how far through the pregnancy you are we can see you as early as required. Alternatively, if you find out that you are unexpectedly further along in a pregnancy you can book in as soon as possible.

Who will attend my delivery?

A familiar face! The Alana Obstetrician on call will attend your delivery. While this may be your primary Obstetrician who has cared for you throughout your pregnancy, it may also be one of the other Alana Obstetricians who you will meet at planned visits throughout the course of your antenatal care. This means that you will never have a stranger attending you when you go in to hospital.

What is the cost of private antenatal care at Alana Healthcare?

Our full fee disclosure is available here.

What should I do if I need medical assistance during my pregnancy?

Once you have booked your antenatal care with us, you have access to medical assistance 24 hours a day, 7 days a week. If at any stage you feel something is not right, telephone us at any time of the day or night on our emergency number 0499 525 000. If you are beyond 24 weeks gestation telephone either us or the Prince of Wales Private Delivery Suite on 02 9650 4444.

How long will I be in hospital for when I deliver my baby?

If you give birth via vaginal delivery, your hospital stay will generally be 4 nights/5 days. If you give birth via caesarean delivery, your hospital stay will generally be 5 nights/6 days. If you are admitted after midnight that counts as day 1 not as night 1!

Antenatal Ultrasound

Why do I need to have an ultrasound during my pregnancy?

Ultrasound can take high quality images of many parts of your body, which makes it an excellent diagnostic tool. During pregnancy, an ultrasound is recommended for a number of reasons:

For confirming the age of the baby and to predict the due date;
To look at the baby as it develops throughout the various stages of pregnancy;
To screen for chromosomal and other abnormalities (such as Down syndrome).

Ultrasound during pregnancy is safe and does not harm you or your baby. You can read our blog on this topic here.

Is having an ultrasound safe for my baby?

Ultrasound has been used in obstetrics for over 50 years. Ultrasound services provided to you in the context of your pregnancy care follow the ALARA (as low as reasonably possible) principle and the recommendations of The Australian Society for Ultrasound in Medicine. This means that we will only perform an ultrasound when indicated, and minimise the exposure time and intensity. We have written more about the use of ultrasound in pregnancy in our blog .

Will I be exposed to ionising radiation during my ultrasound?

No. Ionising radiation is radiation containing enough energy to cause damage at a cellular level in the human body. We are all exposed to ionising radiation from our environment in our daily lives (from the sun, rocks, plants, building materials, etc). This is known as “background radiation”. While ionising radiation is used during some diagnostic imaging examinations, ultrasound uses high frequency sound waves to obtain an image of inside your body. Ionising radiation is not used to perform an ultrasound.

Asherman's syndrome

Does this condition have to be treated?

No. If you have no symptoms such as pain and you are certain that you do not want to have any more children, then there is no need to treat Asherman’s syndrome. No harm will come from the scar tissue itself, though you may have reduced or no periods until you reach menopause.

Can the condition recur?

It is possible that the uterine cavity is cleared of adhesions and a pregnancy ensues and a baby delivers. Subsequent to this scar tissue may recur. In this situation it may be necessary for repeat procedures to be performed so that normal periods are re-established or the normal uterine cavity may re-establish for further pregnancies.

How do I know that the cavity is normal?

There are direct and indirect assessments. The only direct assessment is to look inside the uterus with a hysteroscopy. This may require a further anaesthetic. Indirect assessments include the patterns of menstruation and a pelvic ultrasound that looks at the uterine shape and the thickness of the endometrium.

How long will it take to become pregnant?

The length of time it takes to become pregnant is variable and it is recommended to try for no less than 12 months after you have had confirmation from your Alana doctor that the uterine cavity is normal.

When can I become pregnant after my surgery?

It is recommended that you wait for one complete cycle after your have stopped hormonal preparations and have had approval from your Alana doctor that the cavity is normal.

Will one surgery fix my adhesions?

There are two main factors that contribute to the number of surgeries required: The first is the location of the adhesions, and the second is the extent of the adhesions The average number of surgeries required to reconstruct the cavity is 2, though this may vary from 1 – 6.

Cervical Screening

Do I need to continue to have cervical screening after hysterectomy?

If you have had a subtotal hysterectomy, where the cervix is left behind, then you will need to continue to have cervical screening at the routine intervals. You should consult your Alana doctor to ask how often these need to be taken. If you have had a radical hysterectomy for a cancer then you will need to continue cervical screening as directed by your doctor. If you have had any other type of hysterectomy and your cervical screening history has always been normal, then you do not need to have further cervical screening. If you have had abnormal cervical screening results in the past, then you should ask your Alana doctor if these need to be continued.

Can I have my cervical screening test with the clinical team?

Yes. We do provide cervical screening tests in accordance with best practice from Australian guidelines. Your primary care practitioner will usually perform this for you and send you reminders when this needs to be done. If you are referred and need your usual cervical screening test (the old term was Pap smear) we can perform this for you.

Chronic Pelvic Pain

Can I have physiotherapy for pelvic floor issues including urinary issues or pelvic pain?

Our specialised physiotherapy team offer services for women with problems related to pelvic floor function. This may be issues related to bladder or bowel problems (leakage or needing to toilet frequently) and problems associated with pelvic pain. Our team work together to formulate a plan specifically for you.

Early Pregnancy Care

Can the ectopic pregnancy be reimplanted in my uterus?

No. There is no potential for an ectopic pregnancy to be introduced into the uterine cavity.

What happens if both tubes are removed?

If a situation arises where both tubes have been removed, then the only alternative for future pregnancy is IVF treatment.

What is the safest treatment?

For most ectopic pregnancies, surgery by laparoscopy is the safest treatment. Generally removing the tube with the ectopic pregnancy will be performed, as it has the same chance of achieving a normal pregnancy in the future, with a reduced risk of complications.

If I choose medical or conservative treatment can I change my mind?

Yes. There are two possibilities. If you are continuing with one of these two management plans, then your doctor may recommend a different management approach if there are changes in your medical condition (for example a static or rising pregnancy hormone level, or new/sudden onset of pain). The other possibility is that you may wish to have a different form of treatment. If this is the case, then you should discuss with your doctor what other treatment options are available.

Do I have a choice over treatment?

Your doctor will discuss the various forms of treatment with you, with reference to your particular case. You should be guided by your doctor’s expertise in the area, since there may be special factors involved in any particular case. In the event of a life-threatening emergency, you should always be guided by your doctor and what is safest for your immediate health. Conserving a tube is dangerous if it has burst and in these circumstances it should always be removed.

What happens if the tube without the ectopic pregnancy is abnormal?

If the other tube is abnormal, then your doctor will try and save the tube with the ectopic. This does increase the recurrent ectopic rate and will mean that serial blood tests and even ultrasound may be necessary as follow-up. If this is not the first ectopic that you have had, and the other tube is abnormal, then it may be safer to remove the tube and consider IVF for pregnancy. Because a ruptured ectopic pregnancy can be life-threatening, trying to salvage a tube if there is a significant risk of a further ectopic pregnancy may not be in your best interests.

If my tube is removed, does that mean I can only fall pregnant every second month?

No. The tubes are up to 8 cm long and very mobile. Even if you ovulate (release an egg) from the ovary where the tube has been removed, then the other tube can pick up that egg.

Endometrial Ablation

What if I have fibroids or polyps and heavy bleeding?

If you have fibroids or polyps, then these may be removed at the time of an ablation and will be sent for testing. Click here for further information on fibroids. If you do have fibroids or polyps and heavy bleeding, then the diagnosis termed abnormal uterine bleeding polyp (AUB-P) or fibroid (the technical term Leiomyoma is used AUB-L) and you should ask your Alana doctor about your management.

When will I know if the procedure has been successful?

It takes between 3-6 months for the scarring of the uterine lining to become maximal. Therefore it is possible that you may have heavy periods initially, though these become lighter as time progresses. Whilst you could have further treatment at any time following the procedure if you wished, it is usually recommended to wait at least three months.

What if I am menstruating at the time of my procedure?

The timing of your cycle is not critical for resection, combined ablation or NovaSure. Whilst it is optimal to perform the procedure in the first week after your period has finished, this may be difficult to organise.

Can I have an endometrial ablation if I have had a caesarean delivery?

Yes. If you have had a usual caesarean (lower segment caesarean), then any of the endometrial ablation treatments are suitable for you. If you have had a classical caesarean (an up and down incision in the uterus), then you should not have the NovaSure procedure. The other procedures are possible and you should discuss this with your Alana doctor further.

What happens if the procedure is not successful?

Endometrial ablation will not be successful in about 10% of cases. Treatment options are as per the “Ladder of AUB -E” described above. It is possible to have a repeat endometrial ablation if the first has not been successful, with the same chance of success as noted above. It is not possible to have a second NovaSure endometrial ablation and a repeat procedure has to be a rollerball or resection type of procedure. Hysterectomy following an endometrial ablation may be for failure of the treatment, or the development of a new problem such as a fibroid or pain.

What will happen to my PMT?

Premenstrual tension (PMT) or pre-menstrual syndrome (PMS) is a combination of symptoms. It is unclear as to why it occurs and treatments are variably successful. Studies have shown that PMT symptoms are significantly reduced following endometrial ablation, however it is not recommended as a primary procedure for these problems.

Is this a good procedure for pelvic pain?

This procedure is not intended as a primary treatment for pelvic pain such as painful periods If you have painful and heavy periods, then studies have shown that an endometrial ablation is not only likely to reduce the heaviness of your periods, but also the amount of pain that you suffer with your period An endometrial ablation is not recommended as a treatment for undiagnosed pelvic pain.

Will I go into early menopause?

No. Endometrial ablation does not affect the ovaries or the hormone levels. You will still have normal hormone function and will go through menopause at the normal time for you.

When can I have sex again after the procedure?

You can have sex as soon as the bleeding and discharge have stopped or after 2 weeks. You should not use tampons immediately after the procedure, but can use them for a period that arrives 2 weeks after your procedure.

Will the procedure affect my sex-life?

No, there are no changes to sexual function. In fact studies have shown that sexual function improves after endometrial ablation, presumably due to less inconvenience from heavy periods.

How long will I have bleeding for after the procedure?

You are likely to bleed for approximately 48 hours following the procedure. There may be a red-brown discharge following this for up to 6 weeks. If you have pain, a foul smelling discharge or a discharge that is green-yellow you should contact your doctor at Alana Healthcare.

Endometriosis

What causes endometriosis?

The answer is not clear. It is likely that there is no one cause, but a number of factors, that may include genetics (i.e. inherited from either mother or father), environmental effects (chemicals, toxins, or viruses), the type of endometrium that you have and the flow of blood and the endometrium during a period.

Can it be cured?

Talking about a ‘cure’ requires knowledge of what causes the disease and ensuring that these causes do not return. This is not possible currently and the aim of treatment should be to maximise fertility and improve quality of life through reduced pain symptoms. Eradication of all areas of disease can only be confirmed by laparoscopy and is not essential. It is best to talk about a symptom free interval when considering outcomes for endometriosis treatments.

Will a hysterectomy (removal of uterus) cure endometriosis?

No. Significant surgery such as hysterectomy may be considered in women who have no desire for children in the future and as a symptom control measure. Having a hysterectomy does not guarantee reduction or eradication of pain and your Alana doctor will likely try alternate surgery (such as removal of the endometriosis alone) before considering a hysterectomy.

Does the amount of disease impact on the symptoms?

No. There is no connection between the amount of disease and the severity (or even presence) of symptoms. This means that you can have a small amount of disease and very significant symptoms or a very large amount of disease and no symptoms.

Can I become pregnant if I have endometriosis?

Yes. If you have trouble becoming pregnant and have known or suspected endometriosis then your Alana doctor will often suggest either conservative management (i.e. continue trying without intervention) or surgery. Research suggests that removing endometriosis surgically improves the chances of becoming pregnant without any additional treatments (such as IVF). No medication used for the treatment of endometriosis will help you become pregnant, and these medical treatments should not be used as they may prevent you from becoming pregnant. Your doctor may suggest that you see a fertility specialist to discuss IVF or other treatments to become pregnant.

If I have surgery once does this mean that I cannot have surgery again?

No. There is no ‘maximum’ number of surgeries, though repeat surgery may have a greater risk of complication due to scar tissue formation. When considering further surgery, your Alana doctor will assess your responsiveness to your first surgery, alternatives to surgery and the risk of surgery if it is repeated.

What if one treatment does not work?

If a treatment or procedure does not work or stops working then other treatments may be commenced. You need to discuss with your doctor your symptoms and your plans for current or future pregnancy. An individual plan will be made for your particular case.

How can I monitor progress?

Following treatment or a procedure, your Alana doctor may advise a specific follow-up regime e.g. 6 monthly for 1-2 years and then annually or biannually. This may be done by your GP when an examination of your pelvis may be done at the same time as your pap smear.

Evidence Based Natural Treatment for Infertility

Can I see a Naturopath at Alana to assist in my fertility goals?

At Alana our naturopath will be able to assist you in preparing for a pregnancy or optimising your general health during IVF, with a focus on your stress levels, digestive and immune systems and hormone balance. Natural treatments may include a diet, exercise, nutrients, homeopathy and life style adjustments.

Fertility

What are my chances of a pregnancy if I need IVF?

As there are so many factors involved it is in general hard to give an exact number. Depending on your age, successful pregnancy may occur in between 15-45% of women after an embryo transfer.

Can I see a Naturopath at Alana to assist in my fertility goals?

At Alana our naturopath will be able to assist you in preparing for a pregnancy or optimising your general health during IVF, with a focus on your stress levels, digestive and immune systems and hormone balance. Natural treatments may include a diet, exercise, nutrients, homeopathy and life style adjustments.

I’m considering starting a family in about 1 year. Can I just book a visit to make sure I’m well prepared?

You most certainly can. We will discuss your general and reproductive health, your life style and make sure all preventative health checks (like cervical screening test, vaccinations) are up to date. We will give you tailored advice on how to get to the most healthy version of you in preparation for a pregnancy.

Fibroids (Myomas)

Is a fibroid pre-cancerous?

No. Fibroids are benign growths of the muscle of the uterine wall that occur in more than 50% of women before the age of 50. They do not become a cancerous lesion and do not need to be removed for this reason. Cancer of the uterine muscle (called a leiomyosarcoma) is a very rare condition and is thought to occur by a separate pathway. That is it starts as a cancer, and does not become a cancer from a fibroid.

Do I need to have my fibroids removed if they are found?

If you have no symptoms, there is no reason to remove fibroids. The four most common symptoms of fibroids being present are:

Abnormal bleeding
Pelvic pain
Pressing on the bladder, bowel or causing a lump that you can feel
Difficulty in becoming pregnant

If you have symptoms and fibroids are present, then removing them may be an option.

Can I take medicines to shrink the fibroids?

There are no known medicines that will remove fibroids. Some medications can temporarily reduce their size, however these medications are powerful and may have side effects. Most are not registered to treat fibroids in Australia. Some medications may help with the symptoms associated with fibroids such as pain or bleeding and may be used in the long term.

If I want to have my fibroids removed, which is the best type of surgery?

This is very dependent on the location of the fibroids, since different locations and sizes require a different approach. At Alana, we provide every different approach for fibroid removal surgically and have developed specialised skills in many of these techniques to ensure you have the most safe and appropriate surgical treatment if needed.

If I have fibroids removed, will they come back?

Because fibroids are likely due to a combination of factors, including genetics, there is always the possibility of recurrence. However, studies have shown that whilst fibroids do recur, they only cause symptoms that need more treatment in about 5% of cases. Some women may be more prone to fibroid recurrence due to genetics or other specific factors and the initial number of fibroids, their size and rate of growth and the age at which they first become problematic should all be considered.

What happens to my fibroids after menopause?

Studies show that fibroids do not shrink away completely after menopause. They do decrease in size by 30-50% and their symptoms will depend on what they were causing before menopause. For example, if bleeding was the only issue, then this should not be a problem after menopause. If there are symptoms of pressure on the bowel or bladder, then this may continue to be an issue in the post-menopausal time

Do I need to have regular scans for my fibroids?

There is no need to have regular scans for fibroids, since once diagnosed, symptoms are the main driver for interventions or treatments. There are some situations that may require scanning and you should talk to your Alana doctor about whether this is required for you

What if I have fibroids or polyps and heavy bleeding?

If you have fibroids or polyps, then these may be removed at the time of an ablation and will be sent for testing. Click here for further information on fibroids. If you do have fibroids or polyps and heavy bleeding, then the diagnosis termed abnormal uterine bleeding polyp (AUB-P) or fibroid (the technical term Leiomyoma is used AUB-L) and you should ask your Alana doctor about your management.

Gynaecological Ultrasound

Will I be exposed to ionising radiation during my ultrasound?

No. Ionising radiation is radiation containing enough energy to cause damage at a cellular level in the human body. We are all exposed to ionising radiation from our environment in our daily lives (from the sun, rocks, plants, building materials, etc). This is known as “background radiation”. While ionising radiation is used during some diagnostic imaging examinations, ultrasound uses high frequency sound waves to obtain an image of inside your body. Ionising radiation is not used to perform an ultrasound.

Hysterectomy

If I have a hysterectomy will my hormones be changed?

Hysterectomy does not always involve taking out the ovaries and if the ovaries are not removed then the hormone levels will be the same. This means that for women who have a hysterectomy where the ovaries are not removed, you will go through menopause at the normal time. Because there are no further periods, the symptoms of menopause may be hot flushes or sweats, or may not occur at all.

Do I need to continue to have cervical screening after hysterectomy?

If you have had a subtotal hysterectomy, where the cervix is left behind, then you will need to continue to have cervical screening at the routine intervals. You should consult your Alana doctor to ask how often these need to be taken. If you have had a radical hysterectomy for a cancer then you will need to continue cervical screening as directed by your doctor. If you have had any other type of hysterectomy and your cervical screening history has always been normal, then you do not need to have further cervical screening. If you have had abnormal cervical screening results in the past, then you should ask your Alana doctor if these need to be continued.

How soon can I go back to work following hysterectomy?

Recovery following hysterectomy is variable and depends on the type of hysterectomy and the patient. The usual range would be 1-4 weeks for vaginal or laparoscopic hysterectomy and 4-8 weeks for abdominal hysterectomy. You can resume intercourse once there is no further bleeding and the pain has settled. This will usually be between 2-4 weeks.

Is bleeding normal after a hysterectomy?

For the first 6 weeks it is not uncommon to have vaginal bleeding. This is because the top of the vagina is healing. As the stitches dissolve with time, you may sometimes experience bleeding when there has been none previously. You should contact Alana Healthcare if your bleeding is very heavy or there is an offensive odour to the blood that is coming away. If you have had a subtotal hysterectomy where the cervix is left in place, then you may have a small amount of spotting on a monthly basis.

Will a hysterectomy affect my sex life?

Studies have shown that overall there is no change in sexual life or pleasure after a hysterectomy. Individual women may notice some changes, with some reporting diminished sexual response whilst others report improved sex following their surgery. There is no way of predicting if there will be any change – good or bad.

What happens to the eggs that are produced from the ovaries?

If you have had a hysterectomy and the ovaries are left inside, then you will continue to produce eggs normally. These will be released from the ovaries and will be reabsorbed through the lining of your abdomen.

Will all pain be gone after a hysterectomy?

If you are having a hysterectomy for chronic pelvic pain, then you may not have complete relief of your symptoms. Period pain is likely to be reduced, but studies have shown that for some women, they may still experience period pain, even though they have no periods. This is not common. Some women who have hysterectomy for chronic pelvic pain will have no improvement in their symptoms.

Will a hysterectomy (removal of uterus) cure endometriosis?

No. Significant surgery such as hysterectomy may be considered in women who have no desire for children in the future and as a symptom control measure. Having a hysterectomy does not guarantee reduction or eradication of pain and your Alana doctor will likely try alternate surgery (such as removal of the endometriosis alone) before considering a hysterectomy.

Incontinence

Can I have physiotherapy for pelvic floor issues including urinary issues or pelvic pain?

Our specialised physiotherapy team offer services for women with problems related to pelvic floor function. This may be issues related to bladder or bowel problems (leakage or needing to toilet frequently) and problems associated with pelvic pain. Our team work together to formulate a plan specifically for you.

Obstetrics

Do you have a midwife?

Yes! Karen Grey is our very experienced midwife and can consult with you at any point throughout your pregnancy and postnatally. Karen also works at the Prince of Wales Private Hospital so you may see her in hospital when you deliver. Karen offers comprehensive antenatal and postnatal advice, education and support, including breastfeeding and lactation.

How much does antenatal care at Alana cost?

For Medicare eligible, privately insured patients, you can read our Obstetric Fee Disclosure located on our fees page. If you are Medicare ineligible and/or don’t have private health insurance, please telephone us on 02 9009 5255 and we can provide you with the relevant fee information.

Why do I need to have an ultrasound during my pregnancy?

Ultrasound can take high quality images of many parts of your body, which makes it an excellent diagnostic tool. During pregnancy, an ultrasound is recommended for a number of reasons:

For confirming the age of the baby and to predict the due date;
To look at the baby as it develops throughout the various stages of pregnancy;
To screen for chromosomal and other abnormalities (such as Down syndrome).

Ultrasound during pregnancy is safe and does not harm you or your baby. You can read our blog on this topic here.

Is having an ultrasound safe for my baby?

Ultrasound has been used in obstetrics for over 50 years. Ultrasound services provided to you in the context of your pregnancy care follow the ALARA (as low as reasonably possible) principle and the recommendations of The Australian Society for Ultrasound in Medicine. This means that we will only perform an ultrasound when indicated, and minimise the exposure time and intensity. We have written more about the use of ultrasound in pregnancy in our blog .

What are my chances of falling pregnant after an ectopic pregnancy?

It depends. Some ectopic pregnancies are caused by certain conditions like endometriosis or as a result of previous pelvic inflammatory disease (PID) commonly caused by Chlamydia infection. In these conditions the remaining fallopian tube may be scarred and increase the likelihood of another ectopic pregnancy. In general, the risk of recurrence is up to 8-10% after one ectopic pregnancy. The recurrence risk is of course dependent on whether or not you have any underlying conditions. Many women (and doctors) think that the ovaries are taking turns in releasing an egg (left than right etc.) but this is not true. The other commonly held belief is that, for example, the right fallopian tube only can pick up the egg released from the right ovary, which is not true either. We know that in reality the ovaries are located rather close to each other (not like in the anatomy pictures), and ovulation occurs more “randomly” from each ovary (sometimes at the same time!) and that the fallopian tubes can pick up the egg from the ovary on the other side. This is because of a complex process attracting the fallopian tube to move towards the ovary where the ovulation (release of the egg) has occurred. Therefore a previous ectopic pregnancy doesn’t half your chances of a next pregnancy. Research has shown that around 65% of women with a previous ectopic pregnancy have an intrauterine pregnancy within 18 months. This figure may go up to as high as 80% in two years, so that is promising. If you do fall pregnant it is important to have an early pregnancy scan determining the location of the pregnancy, making sure it is inside the uterus. If you have trouble falling pregnant than depending of your age and underlying conditions we would recommend you to see one of our Alana specialists as the other fallopian tube may be scarred and preventing you from conceiving naturally. There is an ultrasound test called a HyCoSy (“Hysterosalpingo Contrast Sonography”) which can determine whether your other fallopian tube is functioning normally. During this ultrasound investigation a speculum is inserted to allow a thin plastic tube to be placed inside the uterus. Through this tube a mixture of air and normal saline is injected and this shows up on the ultrasound scan. You can see if the fallopian tube is open (“patent”) as there is spill seen around the end of the fallopian tube and ovary. This test may reassure you if normal. If the fallopian tube is blocked it is worthwhile seeing one of our fertility specialists at Alana who will discuss alternative ways for a pregnancy to occur (like IVF).

How long do I have to wait after my miscarriage to try to conceive again?

We recommend you have at least one normal period after your miscarriage. If the first bleed is not quiet as normal than wait until you have a normal menstrual period in your next cycle as it takes time for your body to clear the pregnancy hormone. When you have had a normal period we know your cycle has returned to normal, the pregnancy hormone is out of your system and that your body is ready for a new pregnancy. Record the first day of your menstrual period (LMP) as this is important in dating your next pregnancy. Physically you do not need more than one period but allow yourself enough time to emotionally be ready as well. Some time is also necessary to allow yourself to grieve about your pregnancy loss. We find that most women after a miscarriage are a little more anxious in their next pregnancy. Your GP can refer you to the Alana Obstetricians for an early pregnancy scan and we recommend it to be done at around 8 weeks from your LMP as at this stage you should really be able to see your baby’s heartbeat.

I thought I was 7 weeks pregnant but the scan says I’m only 5 weeks and no heartbeat is seen, how is this possible?

To answer this question we firstly go back to basics to understand your cycle. The pregnancy is calculated based on the average menstrual cycle which is 28 days. The first day of menstrual bleeding marks the first day of the menstrual cycle. This is called your LMP (or “last menstrual period”). Right in the middle of this picture perfect 28 day cycle is when ovulation occurs (day 14 of the cycle) and roughly 2 days before and after is when you are most fertile. In real life not everyone has this picture perfect 28 day cycle, it may be longer or shorter, but we know that ovulation occurs roughly 14 day before your next period. This is why many fertility doctors recommend to have intercourse every 3 days if you really are trying to have a baby because the ovulation may occur a little earlier or later than you may think. When calculating the weeks of pregnancy we include those two weeks from the first day of the LMP as this is the easiest part of the cycle to notice and to record. We also will enquire about the length of your cycle and whether it is regular or irregular. All of this is helpful in trying to establish the gestation. For example, if your cycle is regular and 33 days long we would expect your ovulation to have occurred later (5 days) and an early pregnancy scan will most likely show a baby that measures 5 days less than you were expecting. Now to answer your question, it may be that you ovulated later in the cycle or have a longer cycle. The pregnancy is truly only 5 weeks, a follow up ultrasound in 10-14 days is likely to show your baby’s heartbeat and all is well. The other possibility is that unfortunately the pregnancy is not developing as expected at 7 weeks gestation and a follow up scan may reveal a miscarriage. We understand that this is an anxious time and to have to wait for 10 -14 days seems very long but it is important to have this time in between scans to determine accurately what is taking place.

Why do I have spotting or mild bleeding in early pregnancy?

It is common to have some bleeding in early pregnancy. It may occur in 20% (or one out of five) mums to be, and it is unlikely to be harmful to your baby. It usually happens at about the same time that your period would have been due, and may last for a couple of days. The bleeding is usually light (no large clots) and is not accompanied by strong period pains. There are many different causes for bleeding in pregnancy, and in the first trimester the bleeding may be caused by:

Breakthrough bleeding: which happens as the pregnancy hormones interfere with the hormones of your normal menstrual cycle. This causes some the endometrial lining to be shed. Spotting or light bleeding may come and go for several days.
Implantation bleeding: which happens when the fertilised egg implants in the endometrial lining of the uterus. The endometrial lining has been prepared for the nestling of the fertilised egg during the menstrual cycle and has now got a very good blood supply. The implantation may therefore be associated with some light bleeding.
Other causes: which may include changes to your cervix by the pregnancy hormones; it softens the cervix and causes an area of cells covering the cervix to move towards the outside of the cervix. These cells are more prone to bleeding, especially when touched during intercourse. It is important to be up to date with your Pap smear screening tests as bleeding may also be caused by abnormal cells. Bleeding can also be linked to vaginal or cervical infection which would require further investigation with a vaginal swab and may need treatment. A harmless growth on the cervix called a polyp may also cause bleeding at any stage in the pregnancy. A speculum examination (as is done with the Pap smear) will reveal this polyp, and usually nothing needs to be done about it during your pregnancy.

Bleeding in early pregnancy is common but it’s important to tell your doctor about it. At Alana we will perform a physical examination which may include a speculum examination to see if the cervix is open or not and what the cervix looks like in general. Depending on other symptoms we may take a vaginal swab if we think there is an infection. We may also perform an (internal) ultrasound to measure the gestation and to determine where the pregnancy is located. We would recommend testing your pregnancy hormone level (“quantitated HCG”) which also helps in dating the pregnancy, and we would test your blood group. In general if the bleeding is light and settles down, and is not accompanied by bad period type pains, there is a good chance that all is well and that your baby is fine.

When should I book in to see my obstetrician?

We usually see you for your first antenatal visit between 8-10 weeks of the pregnancy, but in some circumstances you may need to come in earlier. If you are experiencing severe early pregnancy symptoms, have bleeding or pain, or are uncertain of how far through the pregnancy you are we can see you as early as required. Alternatively, if you find out that you are unexpectedly further along in a pregnancy you can book in as soon as possible.

Do I need to have an ultrasound before I attend the clinic?

No, an ultrasound will be performed at your first visit to confirm the dates while you are seeing your obstetrician. If there are any concerns, we may refer you for a formal ultrasound.

What do I need to bring to my first antenatal appointment?

Your referral letter from your General Practitioner plus any antenatal screening bloods and/or scans that you have had performed, as well as any relevant medical history including medications. You should also bring your Medicare card and private health insurance details.

Where will my baby be delivered?

The Alana Obstetricians deliver at both the Prince of Wales Private Hospital and the Royal Hospital for Women, both located in Randwick, in the Eastern Suburbs of Sydney. For more information about Prince of Wales Private Hospital Maternity Services, please click here. For information about Royal Hospital for Women Maternity Services please click here.

Who will attend my delivery?

A familiar face! The Alana Obstetrician on call will attend your delivery. While this may be your primary Obstetrician who has cared for you throughout your pregnancy, it may also be one of the other Alana Obstetricians who you will meet at planned visits throughout the course of your antenatal care. This means that you will never have a stranger attending you when you go in to hospital.

What is the cost of private antenatal care at Alana Healthcare?

Our full fee disclosure is available here.

What should I do if I need medical assistance during my pregnancy?

Once you have booked your antenatal care with us, you have access to medical assistance 24 hours a day, 7 days a week. If at any stage you feel something is not right, telephone us at any time of the day or night on our emergency number 0499 525 000. If you are beyond 24 weeks gestation telephone either us or the Prince of Wales Private Delivery Suite on 02 9650 4444.

How long will I be in hospital for when I deliver my baby?

If you give birth via vaginal delivery, your hospital stay will generally be 4 nights/5 days. If you give birth via caesarean delivery, your hospital stay will generally be 5 nights/6 days. If you are admitted after midnight that counts as day 1 not as night 1!

What do I do if I am experiencing hand/wrist pain during my pregnancy or after the birth?

Correct diagnosis of a hand or wrist condition is important when considering appropriate management. An early diagnosis allows for early intervention, which will favour promising outcomes. The Alana Physiotherapists are trained to identify the cause of your hand and wrist pain, and to assist each woman throughout her recovery. An appointment can be made with the reception staff and does not require a doctor’s referral.

Physiotherapy

Do I need a referral to see a physiotherapist at Alana Healthcare?

If you are attending an appointment with our specialist physiotherapist you may be eligible to claim a Medicare rebate if you are referred from a GP under a GP Management Plan (GPMP). Not everyone is eligible and you will need to speak to your GP to find out. You can find more information about eligibility criteria on the Human Services website. If you are not eligible to claim your physiotherapy visit through Medicare, you may be able to claim through your private health insurance, subject to your level of cover.

Is my pelvic floor assessment covered by Medicare or Health Insurance?

Most insurance policies include some cover for physiotherapy services, however you would have to check this directly with your health fund. Medicare may cover part of the cost of a physiotherapy appointment, but you must be referred under a GP Management Plan to be eligible. Please contact our friendly staff for more information.

When should I have my postnatal follow up assessment?

It is normal to experience some bleeding similar to a period for up to 6 weeks post-birth, we therefore suggest a follow up appointment for an assessment of your pelvic floor muscles at approximately 6-8 weeks post-partum (when your bleeding has ceased). This enables the earliest commencement of your pelvic floor recovery whilst also minimising any chance of infection. For your convenience, we can schedule this assessment alongside your postnatal appointment with your Alana Obstetrician.

When should I have my antenatal pelvic floor assessment

The best time is when you are between 20 and 26 weeks gestation, and we will always do our best to schedule your assessment alongside one of your antenatal appointments with your Alana Obstetrician. If you are not seeing an Alana Obstetrician for your pregnancy, you can still come in and see an Alana Physiotherapist for pelvic floor assessment at any stage after the first trimester.

What do I do if I am experiencing hand/wrist pain during my pregnancy or after the birth?

Correct diagnosis of a hand or wrist condition is important when considering appropriate management. An early diagnosis allows for early intervention, which will favour promising outcomes. The Alana Physiotherapists are trained to identify the cause of your hand and wrist pain, and to assist each woman throughout her recovery. An appointment can be made with the reception staff and does not require a doctor’s referral.

Can I have physiotherapy for pelvic floor issues including urinary issues or pelvic pain?

Our specialised physiotherapy team offer services for women with problems related to pelvic floor function. This may be issues related to bladder or bowel problems (leakage or needing to toilet frequently) and problems associated with pelvic pain. Our team work together to formulate a plan specifically for you.

Recovering from Gynaecological Surgery

How soon can I go back to work following hysterectomy?

Recovery following hysterectomy is variable and depends on the type of hysterectomy and the patient. The usual range would be 1-4 weeks for vaginal or laparoscopic hysterectomy and 4-8 weeks for abdominal hysterectomy. You can resume intercourse once there is no further bleeding and the pain has settled. This will usually be between 2-4 weeks.

Is bleeding normal after a hysterectomy?

For the first 6 weeks it is not uncommon to have vaginal bleeding. This is because the top of the vagina is healing. As the stitches dissolve with time, you may sometimes experience bleeding when there has been none previously. You should contact Alana Healthcare if your bleeding is very heavy or there is an offensive odour to the blood that is coming away. If you have had a subtotal hysterectomy where the cervix is left in place, then you may have a small amount of spotting on a monthly basis.

Will a hysterectomy affect my sex life?

Studies have shown that overall there is no change in sexual life or pleasure after a hysterectomy. Individual women may notice some changes, with some reporting diminished sexual response whilst others report improved sex following their surgery. There is no way of predicting if there will be any change – good or bad.

Treatment for Chronic Pelvic Pain

Are there alternatives to injections?

Yes, usually you will be recommended to have physiotherapy first, after you have been assessed and the diagnosis made. If there are other problems that are noted then it may be suggested that these be treated first. If physiotherapy is not successful (it is for 40% of women without the need for injection), then injections may be helpful.

Can I have repeat injections?

If your treatment is successful, but the effect of the injection wears off (as it often does), then you may be able to have further injections. The usual time before re-injections are performed is 6 months, but may be a little shorter or much longer.

Will the effect always be the same?

Usually if you have responded to an initial injection, then you will respond in a similar manner to subsequent injections. If you have had no relief in your symptoms but the muscles are relaxed by the injection, then other treatments may be required. It may be that due to development of new problems (such as endometriosis or other pelvic problems) that the injections are not as effective as previously. If this is the case, then it may be suggested that further investigations or tests are performed.

What if I have side effects?

These will usually be temporary and managed individually. You should let your Alana doctor know as soon as possible if a side effect has occurred and get advice regarding how to proceed.

Will injections affect my fertility?

No. Studies have shown that there is no adverse effect on fertility or the ability to have a normal vaginal delivery. It is not recommended that you have injections through your pregnancy and you should not try and become pregnant for 6 months after an injection.

Can injections make my pain worse?

In rare cases, yes, it is possible that the pain may be worse. Worsening of symptoms has been reported by only 2 women to date (risk <1%) both of whom had multiple surgeries in the area of the perineum (pelvic floor). It is thought that abnormal muscle/nerve connections may be responsible for this. This is a very rare event and careful consideration should be given if you have had more than one surgical procedure to the area to be injected.

What are the costs?

The medication is not reimbursed by the PBS and the cost of between $500-650 will be your responsibility. Some health funds may cover the cost of the medication. You will need to discuss this directly with your health fund. The remainder of the costs will be estimated depending on the procedure and indication. You can contact the staff at Alana Healthcare to obtain a quote after you have had an assessment with your doctor.

Can I have physiotherapy for pelvic floor issues including urinary issues or pelvic pain?

Our specialised physiotherapy team offer services for women with problems related to pelvic floor function. This may be issues related to bladder or bowel problems (leakage or needing to toilet frequently) and problems associated with pelvic pain. Our team work together to formulate a plan specifically for you.