'Let's Talk About Menopause'

Tickets for our 'Let's Talk About Menopause' event on 15 June sold out so quickly that we have decided to hold a second session on Monday 5 July, from 5.30pm at The Piano, 156 Armagh St, Christchurch. To register, visit our website oxfordwomenshealth.co.nz or go straight to www.eventfinda.co.nz

Speakers at the hour-long presentation will include gynaecologist Richard Dover, endocrinologist Anna Fenton, physiotherapist Julee Binns, and dietitian Sara Widdowson.
 

If you are looking for information about menopause, we also recommend visiting menopause.org.au and imsociety.org

Queenstown Clinics

Oxford Women’s Health is now holding Queenstown clinics at the Wakatipu Medical Centre, Lower Shotover, rather than the Skin Institute.

Gynaecologists Janene Brown and Ben Sharp are working regularly from the Centre and welcome a referral from your GP, or you can give us a call to make an appointment on (03) 379 0555.
 

Breast cancer –
reducing the risk

Breast cancer is the most common cancer for Kiwi women and the third most common cancer for New Zealanders overall. Style magazine recently sat down with our oncoplastic breast surgeon Josie Todd to discuss what women can do to help identify breast cancer and get treatment as early as possible.

What is the correct way to do a self-examination? 
When undertaking a self-examination, raise one arm and with the opposite hand very gently examine the entire breast, including the nipple, using the flat part of your fingers. This can be done while lying down or standing in the shower. It is important not to squeeze or pinch the breast tissue during the examination. For pre-menopausal women, it is sufficient to check once a month, just after completing your period cycle. For post-menopausal women, and younger women on hormonal treatment who do not have a period, checking once a month is also recommended. Younger women with lumpy breasts should also be encouraged to examine regularly to get used to what is normal for them and report any change to their GP.

Why is it important women attend regular breast screening?
Breast Screen Aotearoa (BSA) offer a free two-yearly mammogram, provided by the Ministry of Health, for all women aged between 45 and 69. The purpose of breast screening is to help identify early cancer or precancerous change, as the outcome is much better for women if cancer is detected early. Women over the age of 69, who wish to have mammograms, should discuss this with their GP. However, these are not funded.

What breast reconstruction options are available?  
Some women with a new breast cancer diagnosis may need a mastectomy as part of treatment. Some of these women may be suitable for breast reconstruction depending on the type of cancer, background medical condition, or the need for additional treatment. There are many breast reconstruction options for women requiring a mastectomy. This can involve implants or autologous flaps, which use the patient’s own tissue to recreate a new breast shape. Patients should discuss treatment options with their oncoplastic breast surgeon or the plastic surgeon undertaking the reconstruction.

Post-mastectomy breast reconstruction can be done as an immediate reconstruction or as a delayed reconstruction.

Oncoplastic breast surgeon Josie Todd

Historically, removal of the breasts (simple mastectomy) meant women were left with a flat scar and used an external prosthesis to fit inside the bra. Surgeons are now able to offer immediate breast reconstructions to more women who need a mastectomy.

Breast reconstruction is a complex process and it is important all women with a new breast cancer be encouraged to explore reconstruction options and have a detailed discussion with their treating surgeon.

Are breast implants common and is there anything that can go wrong?
Breast implants have been used for many years for cosmetic augmentation and as part of reconstruction following mastectomy. Technical advances in implants and improved surgical expertise have helped improve the cosmetic outcomes for many women over the last five decades. More recently, a rare lymphoma, Anaplastic Large Cell Lymphoma (ALCL), related to silicone breast implants, has been identified. The message for women is that implants on the whole are safe and there is ongoing research into this rare condition.

What should women look for when doing self-examinations
All women should be encouraged to regularly examine their breasts. When performing a self-examination, there are a few “red flags” to consider. These include:
1. A breast lump which is persistent. In younger women, this is a lump that persists even after the period cycle. For post-menopausal women, any new lump is always a concern, and you should see your GP to have it checked.
2. Changes in the nipple, such as inversion (where the nipple gets pulled inwards) or a blood-stained discharge.
3. Persistent change in the shape of the breast.
4. New skin changes in the breast, such as redness or skin thickening.
5. Ongoing breast pain. Seek early medical attention and visit your GP to have your symptoms checked thoroughly.

Tsunami of change after having a baby

Welcoming a baby is a time of joy, but it can be a big adjustment. Oxford Women’s Health gynaecologist Richard Dover recently spoke to Woman Magazine about the impacts of motherhood.

While antenatal classes prepare parents for the physical arrival of a baby, there’s a tsunami of unexpected changes that come for women after their first child is born.

“Your priorities shift to the baby, to the point that this new person becomes more important than yourself or your partner,” Richard says. “There is a lot of re-evaluation of relationships.”

Friends and family also need to adopt a new mindset and understand that for you, the needs of your new baby come before anything else.

But you also need to take some time to focus on your own wellbeing. From a health point of view, every woman’s pelvic floor is affected by pregnancy, even if you have a Caesarean. “You have nine months of extra weight pressing on your pelvic area. Whatever way you give birth, things aren’t going to be quite the same as they were.”

Pelvic floor exercises are very helpful and are highly recommended. “Any improvement you can make to your pelvic floor muscles will help, especially if you are planning on having more babies.”

But, Richard adds, “it’s not the time for crash diets”.

If you are trying to get pregnant again, eating well, being active, getting a good night’s sleep and making sure you have the right vitamins and minerals on board will make it easier to conceive.

While the impact of pregnancy on a woman’s body is typically seen in the light of varicose veins and stomachs that aren’t as taut as they once were, there are other changes after having a baby. For example, while periods are often heavier, they are generally much less painful. Breastfeeding helps protect against breast and ovarian cancers later in life.

Other issues that are commonly linked to pregnancy and childbirth, such as prolapse and stretch marks, are often influenced by other factors, including genetics. If you’re having a health problem you think is related to childbirth, you should always seek help. For example, painful sex is not a normal consequence of having a baby and the cause needs to be investigated.

The support of family and friends is also important after having a baby. “It’s really good to have someone come in and give you a rest so you can feel like a normal human being. The chance to do something simple like drink a coffee while it’s still warm or go for a walk around the park can really revive you. Even an undisturbed shower or soak in the bath can be a real luxury.”

Cervical Screening Gives Peace of Mind

Canterbury woman Sarah says she has an even greater respect for cervical screening, after she was found to have pre-cancerous cells, following a recent smear test.

At just 36 years of age and describing herself as super healthy, Sarah says without screening she never would have known that anything was wrong. “Thankfully my doctor found the cells early and my life has carried on as normal.”

In late 2020, Sarah visited her General Practitioner for her three-yearly smear test, something she had always done without fail. “I had never had an unusual smear before, so I was expecting everything to be OK. It came as a bit of a surprise when abnormal changes were discovered.”

It was recommended Sarah have a colposcopy - a procedure that closely checks the cervix for abnormal areas, including cervical cancer. Because she had private health insurance and had been to Oxford Women’s Health in the past, she called the clinic and an appointment was arranged with gynaecologist Janene Brown. A colposcopy at the clinic revealed a high-grade abnormality - C1N3 pre-cancerous cells on her cervix.

The next step was to have another procedure to remove the cells and have them tested to see if any of them were cancerous. 

“By this point, I thought there’s nothing I can do about it. I just need to go through the process and see what comes next,” Sarah says.
 

Sarah underwent a Large Loop Excision of the Transformation Zone procedure, known as a LLETZ biopsy.

This relatively common treatment removes abnormal cells from the cervix, which are then sent away for further examination.

“The thought of someone looking at your lady bits is scary but if you need to have a colposcopy or LLETZ, you just need to get it done. In the end it wasn’t hard and I had a lovely bunch of ladies looking after me.”

When the results came back, Sarah was told the C1N3 changes were benign but had the potential to turn into cancer if they hadn’t been removed. During the LLETZ procedure, Janene Brown had also performed a diathermy, which uses heat to destroy abnormal cervical cells. No further treatment was required and a follow-up smear revealed all was well.

Now, Sarah just needs to have a smear every 12 months, rather than three yearly to check all is well. “It was a good result,” she says. “I have no history of cervical cancer, no family history of cancer, and I have a very healthy and active life, so it just shows that cancer doesn’t care who you are, or how well you are. You just have to look after yourself.”

She says, cervical screening appointments give her peace of mind. “Everyone needs to keep on top of their regular smear tests and check-ups. It’s so simple.”