Womens Health & Pregnancy

At our clinic we are privileged to have three doctors who have a Diploma in Obstetrics and Gynaecology.

Dr Patricia Civitico and Dr Graeme Edwards have pursued advanced training to provide up-to-date and detailed information for their patients.

They will help you understand your symptoms and work out diagnosis and treatment.

Problems treated here include:

• Amenorrhoea i.e. absence of menstrual periods
• Abnormal vaginal bleeding e.g. heavy bleeding
• Breast checks – see: www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Health_checks_for_women
• Post coital bleeding
• Urinary incontinence
• Infertility
• PCOS – polycystic ovary syndrome
• Abnormal discharge
• Pre-pregnancy guidance and testing
• Menopause
• Urinary tract infections (UTIs)- see: www.mydr.com.au/womens-health/urinary-tract-infection-uti
• Pap smears – see: www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/papsmear
  www.cancer.org.au/about-cancer/early-detection/early-detection-factsheets/understanding-your-pap-smear-results.html
  www.papscreen.org.au/forwomen/aboutpaptests

Gynaecology treatments are being constantly developed.

Our doctors will help you understand the latest evidence-based developments in a range of areas.

Female causes are usually related to the female’s age, issues with ovulation or issues with the pelvic anatomy, such as endometriosis or polycystic ovarian syndrome.

Following your initial consultation, you can expect that several investigations will be arranged.

These may include blood tests and a pelvic ultrasound for the female and semen analysis for the male.

Current data show that most couples will conceive within six months of trying, so best practice now suggests you seek a fertility assessment if you are not pregnant within six months.

Female age is the most significant factor affecting a couple’s chance of conceiving.

In 40% of infertile couples, the cause of infertility is attributed to a sperm factor.

In another 40% of infertile couples, the cause of infertility is found within the female reproductive system, such as ovulation failure, tubal disease or endometriosis.

One third of all infertile couples will have a combination of female and male factor infertility.

The good news is that the most common causes of male infertility are easily diagnosed and successfully bypassed with effective fertility treatments.

http://monashivf.com/preparing-for-pregnancy

http://mivf.com.au/about-fertility

To understand and treat fertility females may undergo initial testing.

Ovulation test

You’ll need a blood test to check whether or not you are ovulating or producing an egg every month.
This can be carried out at your IVFAustralia clinic during clinic hours.

Ultrasound scan

An ultrasound scan checks the lining of your womb and diagnoses any conditions that may be distorting the lining.

It allows us to check:

 • If you have any fibroids or polyps, which could affect your cycle;
 • If you have any ovarian cysts;
 • How easy it will be to collect your eggs from the ovaries;
 • The size of your ovaries and if there are many small follicles.
 • It also gives us a baseline report to compare with later in your treatment.

Ovarian Reserve (AMH test)

We usually recommend having an AMH test to measure ovarian reserve hormone called Anti Mullerian Hormone (AMH).  This simple blood test provides a very good estimate of the number of eggs that you still have in your ovaries.

Your fertility specialist can then explain whether your ovarian reserve is ‘normal’ for your age

Conceiving a healthy baby depends on a number of factors, including healthy sperm.

In fact, this can be the biggest issue after a woman’s age.

Male factor infertility affects around half of all infertile couples, so it is also important to understand how the male reproductive system works.

Booking with one of our doctors who have additional qualifications is recommended.

Dr Graeme Edwards provides fertility advice for couples and can advise you about taking the first step.

Here are 4 steps to being breast aware:

Become familiar with the normal look and feel of your breasts.
See a doctor if you notice any unusual breast changes. Have a regular breast examination with a GP at the time of your pap smear can be a good time to have your regular check. If you’re aged 50 to 74, have a mammogram every 2 years after having your breast examination with a GP. Finding breast cancer early often means that the breast cancer is small, less likely to have spread to other parts of the body and can be more effectively treated.

What is breast cancer?

Breast cancer occurs when abnormal cells in the breast grow in an uncontrolled way. Breasts are made up of lobules and ducts surrounded by fatty and connective tissue. Lobules produce breast milk and ducts carry milk to the nipple.

What are the symptoms of breast cancer?

The symptoms of breast cancer depend on where the tumour is in the breast, the size of the tumour and how quickly it is growing.

Breast changes that may indicate breast cancer include:

 • a new lump or lumpiness, especially if it’s only in one breast
 • a change in the size or shape of the breast
 • a change to the nipple, such as crusting, ulcer, redness or inversion
 • a nipple discharge that occurs without squeezing
 • a change in the skin of the breast such as redness or dimpling
 • an unusual pain that doesn’t go away.
There are a number of conditions that may cause these symptoms, not just breast cancer.

If any of these symptoms are experienced, it is important that they are discussed with a doctor.

What are the risk factors for breast cancer?

There are different types of risk factors, some of which can be modified and some which cannot.

It should be noted that having one or more risk factors does not mean a person will develop breast cancer.

Many people have at least one risk factor but will never develop breast cancer, while others with breast cancer may have had no known risk factors.

While the causes of breast cancer are not fully understood, there are a number of factors associated with the risk of developing the disease.

Some of the risk factors for breast cancer include:

 • being a woman (although men can also develop breast cancer)
 • increasing age
 • having a strong family history of breast cancer.
 • having a breast condition such as a personal history of breast cancer, DCIS or LCIS
 • a number of hormonal factors, child-bearing history, personal and lifestyle factors

Diagnosis of breast cancer involves the triple test. This includes:

 • a clinical breast examination
 • imaging tests – which may include a mammogram and/or ultrasound
 • taking a sample of tissue (biopsy) from the breast for examination under a microscope.

http://canceraustralia.gov.au/affected-cancer/cancer-types/breast-cancer

Talk to one of our GPs here at our clinic to have regular checks and a better understanding of breast cancer prevention.

When your next pap smear is due, you will have a HPV test instead.  This is the preferred test, as it picks up the risks much faster and is a more accurate test.

A HPV test is taken in the same way a pap smear was taken.

At the time of having your HPV test you may also have an STI check and a breast check. Ask your doctor here during your consult.

What are the symptoms of cervical cancer?

In the early stages of cervical cancer, there are usually no symptoms. The only way to detect your risk factors is to have the HPV test.

If you have any abnormal vaginal bleeding (such as intermittent bleeding, bleeding after sex or after menopause), abnormal or persistent vaginal discharge (bloody or offensive), or pelvic pain, you should see your general practitioner without delay.

What is the link between HPV and cervical cancer?

In a small number of women, the HPV stays in the cells of the cervix.  When the infection is not cleared, there is an increased risk of developing abnormalities. In some cases, these abnormalities of the cervix can progress to cancer.

Results

We will usually receive your HPV result approx 1 week later. We ask that you ring for a result message and speak with our nurse or practice assistant for the doctor’s written result for you.

If followup is needed we will provide you with an explanation and a plan.

We also use a recall system for reminders and followup to give maximal health treatment.

What if I am told I have an unsatisfactory sample?

Sometimes the report will indicate that the sample was unsatisfactory. This may happen because cells may be obscured by blood, inflammation or mucous.
In this case you will be asked to have another HPV test in 6-12 weeks. This allows time for the cells of the cervix to renew, so there are enough for another sample.

What if my result identifies a strain of the HPV?

Inflammation

Sometimes a cervical screen test will show signs of inflammation. This means that the cells of the cervix are slightly irritated.

This irritation may be due to an infection, even though you may not be aware of any symptoms. It might be a bacterial infection or thrush.  This can be very well treated with a prescription from the doctor.

Genital warts

There are over 100 different types of HPV, including some that cause genitals warts. Genital wart HPV is similar to the virus which causes warts on other parts of the body.

How did I get HPV?

HPV is spread through genital skin contact during sexual activity. As viruses are microscopic, HPV can pass through tiny breaks in the skin. HPV is not spread in blood or other body fluids.

While condoms are an important barrier to many sexually transmitted infections, they offer limited protection against HPV as they do not cover all of the genital skin.

Because the virus can be hidden in a person’s cells for months or years, having a diagnosis of HPV does not necessarily mean that you or your partner has been unfaithful. For most people it is probably impossible to determine when and from whom HPV was contracted.

HPV Vaccines at our clinic

For young people who may not have had the full course of HPV vaccines (e.g. 3 vaccines such as Gardasil), you can have this provided at our clinic.

Please enquire about having the HPV vaccine – by phone 9650 4218 or by email: manager@cpmc.com.au

For more information on the HPV vaccine, please visit the Immunise Australia Program website.

See also:
www.hpvvaccine.org.au/

www.nps.org.au/medicines/immune-system/vaccines-and-immunisation/for-individuals/vaccines-a-z/human-papillomavirus-hsmearpv

Contraception: long-term options for women

Several medicines and devices are available to provide long-term, reversible contraception for women. These options offer from 1 month to 5 years of contraceptive protection, depending on which one is selected.

Oral contraception is highly effective in preventing an unplanned pregnancy, when used correctly.

The two types available in Australia are the combined pill, known as ‘the Pill’, and the mini pill.
The hormones in oral contraception prevent ovulation and thicken cervical mucus to prevent sperm from getting through.

A doctor can advise you on the risks and benefits of using oral contraception, as well as on the alternative methods available.

Long-term contraceptives can only be obtained through a doctor here at our Clinic.

Selecting the most appropriate long-term contraceptive for your needs will depend on your individual preferences and circumstances — for example, when and if you plan to have a pregnancy in the future — as well as your previous and current general and reproductive health.

Implant

The contraceptive implant is a tiny rod which is inserted under the skin of the inner, upper arm to provide 3 years of contraceptive protection.

The implant is made of plastic containing a progestogen, and is 2 mm wide and 4 cm long — similar in shape and size to a match stick.

Your doctor will remove the implant after it has been in place for 3 years, or at any time prior to this if the contraceptive effect is no longer required. Fertility returns soon after removal of the implant.

To continue contraception, a new implant must be inserted at the time of removal of the previous one.

We have four doctors at at our clinic who are trained to insert and remove an Implanon.

Please enquire when booking.

Please let Reception know at the time of booking what your needs are e.g. Initial discussion or Implant procedure.

If you are new to this type of contraception you will be offered an initial consultation with one of our doctors so you can make an informed choice.

Hormone-releasing intrauterine device

A small, T-shaped device made of impregnated plastic that is placed inside the uterus (womb). From here it releases a progestogen called levonorgestrel, which provides continuous contraceptive protection for 5 years.

It has a small string attached that passes out through the cervix — feeling the string high up in the vagina lets you know that the device is still in place.

The device is removed by your doctor after 5 years, or earlier if contraception is no longer required.

If further contraception is needed, a new device is inserted at the same time as removal of the previous IUD.

Insertions are performed by a Gynaecologist so our doctors here will be able to do the referral for your procedure but not the insertion.

For removals, our doctors can do this here at our clinic (provided the string is visible). Please discuss at the time of booking.

This type of contraceptive has also been found to reduce problems with heavy periods. It is recommended you find out more about this type of contraception.

Depot injection

A depot injection for long-term contraception usually involves an injection into the muscle of your buttock, or your upper arm, to provide protection from pregnancy for 3 months.

If contraception is needed beyond this time the injection is repeated every 3 months, for as long as needed.

How it works

These injections contain the medicine medroxyprogesterone acetate (sometimes shortened to ‘MPA’).

MPA is a progestogen, which is a synthetic substance that mimics the action of the natural hormone progesterone. MPA works by stopping the release of an egg from the ovary (‘ovulation’) each month.
If no egg is present for fertilisation by sperm, then a pregnancy cannot occur.

After your initial visit with a doctor your repeat depot injection can be done by a nurse here, reducing your ongoing costs.

www.mydr.com.au/babies-pregnancy/contraception-long-term-options-for-women

Pregnancy Testing

All our doctors are able to assist with pregnancy testing. We have a Pathology lab next door that will report your result within one day.

The process is that you have the blood test and then ring us for a result message at an agreed time.

The contraceptive implant is a tiny rod which is inserted under the skin of the inner, upper arm to provide 3 years of contraceptive protection. The implant is made of plastic containing a progestogen, and is 2 mm wide and 4 cm long — similar in shape and size to a match stick.

Your doctor will remove the implant after it has been in place for 3 years, or at any time prior to this if the contraceptive effect is no longer required. Fertility returns soon after removal of the implant.

To continue contraception, a new implant must be inserted at the time of removal of the previous one.

We have 4 GPs at at our clinic who are trained to insert and remove implanon.

Please let reception know at the time of booking what your needs are e.g. Initial discussion or Implant procedure.

If you are new to this type of contraception you will be offered an initial consultation with one of our GPs so you can make an informed choice.

You will also need a prescription to purchase the implant and bring the packet with your for your procedure appointment, if you choose to go ahead.

This type of contraception is low in costs as the one implant lasts 3 years.

The doctor will decide in consultation with you the most suitable time for insertion.

This depends on your personal situation (e.g. on the birth control method that you are currently using).

Unless you are switching from another hormonal contraceptive method, insertion should be done on day 1-5 of your normal menstrual bleeding to rule out pregnancy.

Your GP here will advise you when to insert the implant in your initial consult.

With our doctors: Dr Patricia Civitico & Dr Graeme Edwards

What is Shared Maternity Care?

Shared Maternity Care means that during your pregnancy you can see the same general practitioner for most of your pregnancy visits with some visits at the hospital.

Together, the hospital and your chosen GP will ‘share your care’.

The birth of your baby is at the hospital e.g. Royal Women’s Hospital.

Why choose shared care?

Shared Care is a popular choice for women who are healthy with a normal pregnancy.

In choosing Shared Care you:

  •  have most of your care close to your home or work
  •  see the same doctor who gets to know you and your baby
  •  build a relationship with your doctor and continue to see them after your baby is born
  •  have fewer hospital visits

Shared Care doctors here charge the normal consultation fee. They are highly experienced in pregnancy management, and their advice and recommendations give you the best care.

How shared care works?

You attend to see the GP here who will explain the Shared Care process. They will order your first set of blood tests so that you and the hospital are fully informed.

A good time to see the GP here is in your first 8 weeks. This ensures that you are fully informed and that you are successfully booked with the hospital.

Public Shared Care

Our doctors are registered to do shared care with a wide range of public hospitals in Melbourne including the Royal Women’s Hospital, the Mercy, Monash, Sunshine, Sandringham and more.

If you are not privately insured, this is an ideal option. You are able to access the expertise of our shared care GPs and have your delivery booked with a hospital that you will get to know prior to baby being born.

Private Shared Care

One of our GPs here, Dr Graeme Edwards, has a successful relationship with two private obstetricians who deliver at Frances Perry House (the private section of the Women’s Hospital).

The delivery and half of your pregnancy appointments are with the private obstetrician.

Those with private health insurance may find this an ideal option, as they have access to two doctors (the GP and private obstetrician) for their care and advice.

NOTE: You can download more information on Shared Care at The Womens Hospital HERE

Acknowledged Source: www.thewomens.org.au/SharedMaternityCareAtTheRoyalWomensHospital

Some wonderful resources are found here:

https://www.pregnancybirthbaby.org.au/

Other languages: http://about.healthdirect.gov.au/multi-language-health-resources