Pre-invasive Gynaecological Disease

Pre-invasive gynaecological disease refers to abnormal cell changes in the cervix, vulva, or vagina that are not cancerous, but have the potential to develop into cancer if left untreated . These changes are most commonly caused by persistent infection with the human papillomavirus (HPV).
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What is the HPV virus?
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Human Papillomavirus (HPV) is a very common virus transmitted through sexual contact. While it is sexually transmitted, HPV is not considered a typical sexually transmitted infection (STI) requiring acute treatment. In most cases, the body clears the virus naturally, but when it persists over time, it can slowly alter the cells of the lower genital tract—including the cervix, vagina, vulva and anus.
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Due to the link between HPV and cellular changes that can lead to cancer, a vaccine against the virus is now routinely offered to all school-aged children in Australia.
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Importantly, a positive HPV result on your cervical screening test does not necessarily mean you have recently been acquired the infection. The virus can remain dormant in your body for years - even decades - before becoming detectable. HPV testing was introduced in 2017 as part of routine cervical screening, after evidence showed that 99.7% of cervical cancers were caused by the HPV virus. This shift in testing allowed the screening interval to be safely extended from every 3 years to every 5 years if results are negative.
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Up to 80% of sexually active women will be exposed to HPV at some point in their lives. In around 90% of cases, the immune system clears the virus within two years. However, in about 10%, the virus can persist, increasing the risk of pre-cancerous changes in the cervical cells.
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Routine cervical screening tests (formerly called Pap smears) are designed to detect both HPV and any early abnormal changes. These changes are classified based on their location:
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• Cervical intraepithelial neoplasia (CIN)
• Vaginal intraepithelial neoplasia (VAIN)
• Vulvar intraepithelial neoplasia (VIN)
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These conditions are graded from 1 (mild) to 3 (severe). Treatment is typically recommended for grade 2 or 3 changes, which carry up to a 30% risk of progressing to cancer over 10–15 years if left untreated.
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With early detection, most pre-invasive conditions can be managed effectively, often with minor procedures. Regular screening and appropriate follow-up care are essential for protecting long-term gynaecological health and preventing cancer.

Menstrual Disorders

Menstrual disorders are among the most common reasons women seek gynaecological care. These can present in a variety of ways, including:
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• Heavy bleeding (menorrhagia)
• Painful periods (dysmenorrhoea)
• Irregular cycles
• Prolonged bleeding
• Absence of periods (amenorrhoea)
• Bleeding between periods (inter-menstrual bleeding/spotting)
• Bleeding after intercourse (post-coital bleeding)
• Bleeding after menopause

These symptoms can significantly affect your daily life, emotional wellbeing, and fertility. Underlying causes may include hormonal imbalances, polycystic ovary syndrome (PCOS), fibroids, polyps, endometriosis, adenomyosis, or structural and pre-cancerous/cancerous changes within the reproductive tract.

Assessment and Treatment
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A thorough assessment may involve:
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• A detailed medical history
• Blood tests to evaluate hormones or other contributing factors
• Pelvic ultrasound to identify structural causes

Once a diagnosis is made, your treatment plan will be tailored to your specific needs and reproductive goals.

Options may include:
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• Non-hormonal medications
• Hormonal treatments (e.g., oral contraceptives, IUDs)
• Nutritional and lifestyle support
• Surgical management when indicated
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Supportive, evidence-based care can help restore comfort, cycle regularity, and quality of life.

Pre-Menstrual Symptoms (PMS and PMDD)

Pre-menstrual symptoms - both physical and psychological - are also common and typically occur in the second half (luteal phase) of the menstrual cycle. These may include:
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• Irritability or mood swings
• Anxiety or low mood
• Fatigue or low energy
• Bloating or breast tenderness
• Heightened emotional sensitivity

In more severe cases, these symptoms may impact on daily functioning and are classified as pre-menstrual dysphoric disorder (PMDD). While distressing, these symptoms are treatable, and an effective management plan can make a significant difference.
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Menopause and Perimenopause

Menopause marks the natural end of menstrual periods, usually occurring between the ages of 45 and 55. The years leading up to this point are known as perimenopause - a transitional phase that can last anywhere from 4 to 10 years. During this time, fluctuating hormone levels may cause a variety of symptoms, including:
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• Hot flushes and night sweats
• Mood changes and irritability
• Fatigue and brain fog
• Sleep disturbances
• Vaginal dryness or discomfort during intercourse
• Urinary changes (recurrent infections, incontinence, urgency)
• Changes in libido

Every woman’s experience is different—some have only mild symptoms, while others find the transition significantly impacts their quality of life.

Treatment and Support
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The good news is there are a range of safe and effective treatment options available. These may include:
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• Lifestyle modifications
• Non-hormonal therapies
• Menopausal Hormonal Therapy (MHT) – which can reduce symptom severity by up to 87% and also supports bone density and cardiovascular health.
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A Personalised Approach
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With a tailored, evidence-based management plan, you can:
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• Alleviate disruptive symptoms
• Protect long-term health (including bone and heart health)
• Feel empowered and supported through midlife and beyond

Menopause is a natural stage of life - and with the right care, it can be a healthy and fulfilling one.

Vulval Conditions

The vulva—the external part of the female genital area—can be affected by a range of skin and soft tissue conditions.

These may present with symptoms such as:
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• Itching or burning
• Pain during intercourse
• Sensitivity or discomfort
• Skin changes (such as discolouration, thickening, or thinning)

Common vulval conditions include:
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• Infections (bacterial, fungal, or viral)
• Dermatitis or allergic reactions
• Lichen sclerosus
• Lichen planus
• Vulvodynia (chronic vulval pain without an identifiable cause)
• Pre-cancerous changes, such as vulval intraepithelial neoplasia (VIN)

These conditions are often under-recognised or misdiagnosed, which can lead to prolonged symptoms and unnecessary distress.

Assessment and Management
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A careful and respectful examination will be performed, and may include:
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• Swabs to test for infection
• Skin biopsies for diagnosis
• Pelvic imaging if needed

Treatment is personalised and may include:
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• Topical or oral medications
• Lifestyle modifications or symptom tracking
• Minor surgical procedures
• Long-term monitoring and follow-up care
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The aim is always to relieve discomfort, restore function, and improve your quality of life.

Pelvic Pain

Pelvic pain is a common concern, affecting up to one in four women in Australia. It may be constant or intermittent and can have a profound impact on your physical, emotional, and sexual wellbeing.
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What Causes Pelvic Pain?
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Pelvic pain is often complex and multi-factorial.
Common causes include:
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• Endometriosis
• Adenomyosis
• Fibroids
• Ovarian cysts
• Pelvic infections
• Bladder or bowel disorders
• Pelvic floor muscle dysfunction

In some cases, no obvious physical cause is found—however, this does not make the pain any less real or valid. Chronic pelvic pain is a recognised medical condition and deserves thorough care and support.
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Assessment and Treatment
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A comprehensive approach is key to understanding and managing pelvic pain. Your assessment may include:
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• A detailed medical history
• A pelvic examination
• Imaging such as a transvaginal ultrasound or MRI
• Diagnostic laparoscopy (keyhole surgery) if needed

Treatment is individualised and may involve:
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• Pain management strategies and multidisciplinary care
• Medication (hormonal or non-hormonal)
• Pelvic physiotherapy
• Surgical intervention
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The goal is to identify the cause, relieve your symptoms, and improve your quality of life. You’ll be supported with a clear plan and ongoing care tailored to your needs and goals.

Pelvic Floor and Urogenital Disorders

The pelvic floor is a group of muscles and connective tissues that support the bladder, uterus, and bowel. When these muscles become weak, tight, or poorly coordinated, it can lead to a range of symptoms, including:
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• Urinary incontinence
• Pelvic organ prolapse
• Constipation or difficulty emptying
• Pelvic pressure or pain
• Discomfort during intercourse
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What Causes Pelvic Floor Dysfunction?
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This condition is common and may arise due to:
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• Pregnancy and childbirth
• Ageing and menopause
• Obesity
• Chronic constipation or straining
• Pelvic surgery
• High-impact exercise or heavy lifting

Although these issues can be distressing, they are highly treatable—and many women experience significant improvement with the right care.
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Assessment and Treatment
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Treatment is tailored to your individual symptoms and needs, and may include:
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• Pelvic floor physiotherapy (the first-line treatment)
• Lifestyle modifications (such as bladder training or weight management)
• Pessaries for prolapse support
• Medications
• Surgical options if conservative measures aren’t effective
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With proper diagnosis, support, and treatment, most women can regain pelvic function, control, and confidence.

Gynaecology.

Pre-invasive Gynaecological Disease

Menstrual Disorders

Menopause and Perimenopause

Vulval Conditions

Pelvic Pain

Pelvic Floor and Urogenital Disorders

Compassionate, holistic gynaecological care - because every woman deserves to feel heard, understood and empowered through their health journey.

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