Janene Madden, Chief Executive Officer

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1 WOMEN S HEALTHCARE

2 As a woman, I understand the importance of receiving the best in women s healthcare: to be treated as an individual with respect and sensitivity and at a time that suits you. Internationally renowned, The Portland Hospital is a hospital dedicated to the care of women. You can rest assured that you will receive the highest level of care from our experts in women s health to ensure all your needs are met. Janene Madden, Chief Executive Officer

3 DEDICATED CARE FOR WOMEN The Portland Hospital is one of the UK s leading private hospitals for the investigation and treatment of women s health issues. Many of our specialist women s health doctors also hold senior positions at London s top teaching hospitals and are considered world leaders in their field. From your very first visit you ll receive comprehensive care from our team of over 80 specialist consultants fully supported by our multidisciplinary team of expert gynaecology nurses, pain specialist nurses, physiotherapists, counsellors, theatre staff, ultrasonographers and radiologists to manage all aspects of your diagnosis, treatment and recovery. Our consultant gynaecologists are all subspecialists in their fields, ensuring that you will always be referred to the most appropriate consultant for treatment and management of your condition. At the Portland, we also understand the importance of privacy and dignity when seeking help with women s health issues. Please be assured that discretion, confidentiality and sensitivity are at the heart of our care for you, and we offer a convenient and compassionate service to help you feel at ease. Our hospital buildings are based in central London and you can choose from daytime, evening or Saturday appointments to accommodate your work or family commitments. We are fully equipped with state-of-the-art facilities to diagnose, treat and manage both common and highly complex conditions within the discrete and calming environment of our Women s Health department. Our specialist team has access to all the latest equipment and scanning techniques, including X-ray, ultrasound, MRI and fluoroscopy, to provide you with the most swift and accurate diagnosis possible. We treat a comprehensive range of minor conditions in our comfortable outpatient consulting and treatment rooms, with immediate hospital access for urgent referrals including early pregnancy concerns. Surgical procedures take place in our three state-of-the-art operating theatres with all the necessary back-up facilities. If you re staying with us as an inpatient, our 12-bed women s ward provides the highest standards of care and comfort during your stay. Women s health treatments are advancing rapidly and we specialise in the latest minimally invasive, laparoscopic techniques, which can often reduce your time spent in hospital and your recovery period. We also offer world-class expertise in urogynaecology, early pregnancy care, sexual health and colposcopy, with dedicated clinics in many of these areas, so you can be reassured that you are receiving the best possible care.

4 STATE-OF-THE-ART SCREENING Our specialist team has access to the very latest technology to investigate, diagnose, assess and treat both minor and more complex women s health issues. Smear tests are used to check the health of a woman s cervix the neck of the womb. A smear test is a simple diagnostic screening test that involves collecting a sample of cells from the surface of the cervix and checking for inflammation, infection or abnormalities that could develop into cancer. Cervical screening has proved to be extremely effective in the early detection of abnormalities and the Department of Health recommends that women between the ages of 25 to 64 years have routine cervical smears every three to five years. However, many women prefer to be screened on a more regular basis or begin screening at an earlier age. The Portland offers a nurse-led smear clinic, including HPV testing, following a self-referral directly to the outpatient clinic. Following your appointment, your results will be with you within two to three days. If your smear test returns an abnormal result, you may understandably be concerned; the nurse will discuss the results with you and answer any questions you may have. You will be advised to come in for a colposcopy with one of our experienced and accredited colposcopists, to investigate the result further, and this appointment can be arranged at your convenience.

5 STATE-OF-THE-ART IMAGING Our highly experienced Imaging Services team works with the latest technology and techniques to carry out a wide range of imaging investigations, including our premier ultrasound scanning service, at the Portland. Our affiliations with London s major teaching hospitals ensure that you will receive all the benefits of recent technological advances. X-rays are used in our fluoroscopy (real-time X-ray) and angiography suite to perform a number of diagnostic tests, including hysterosalpingograms (HSGs), which look at the patency and viability of the fallopian tubes. Our consultant interventional radiologists also perform interventional procedures such as elective uterine artery embolisation. This is a minimally invasive procedure that blocks the blood flow into an oversized and painful fibroid, which will then shrink. This reduces symptoms and associated problems, such as inability to conceive, without the need for a major operation. Ultrasound scans are performed by highly qualified consultants and sonographers for the full range of women s health ultrasound services; ultrasound of the pelvic organs is useful for finding cysts in the ovaries, examining the lining of the womb, investigating causes of infertility and looking for cancers or benign tumours in the pelvic region. We understand how stressful waiting for test results can be, and our advanced technology means that all ultrasound results will be available to your consultant immediately following your scan. The consultant or sonographer will print you a copy of your report to take with you following your examination. MRI and CT scanning services are also available and are usually performed following a positive or suspected result from an ultrasound scan. This type of scanning provides a lot more detail of the area and gives doctors a much better understanding of the condition to be treated. The scans are performed by experienced senior radiographers and reported on by specialist consultant radiologists. Results from these tests are available within 24 hours of completion of the examination. Urodynamics refers to the investigations carried out to assess the function of your bladder and urethra, and are used to diagnose various types of incontinence. These studies are carried out by our specialist consultants using the very latest technology. They aim to replicate your symptoms then examine them and determine their cause during the tests, your bladder is filled and then emptied while pressure readings are taken from your bladder and abdomen. If your situation is particularly complex, your consultant may use fluoroscopy in conjunction with pressure-flow studies to glean additional diagnostic information. We also offer bone density scanning, breast ultrasound and mammography at our sister site, The Harley Street Clinic Diagnostic Centre, located just around the corner from us on Devonshire Street.

6 THE MOST ADVANCED TREATMENTS Our expert team provides compassionate and convenient assessment and treatment of a range of women s health issues, including many unique treatments for highly complex cases. Here are some examples of common assessments, diagnoses and treatments that we perform at the hospital. Colposcopy is recommended if your cervical smear test shows an abnormal result, and this procedure gives us more information about the abnormal cells. During the relatively pain-free procedure, your consultant will use a special magnifying device called a colposcope to visually examine the cervix and the vagina. This examination will determine where the abnormality is and whether a biopsy should be taken. Immediately following the procedure, your consultant will discuss their findings with you and propose a further treatment plan if necessary. Treatment for a high-grade abnormality can be performed in the outpatient clinic if required. Colposcopy at the Portland is always performed by an experienced, accredited colposcopist, and a nurse will always be present to assist and support you. Diagnostic infertility tests help couples who are having problems conceiving, including internal tests to check for blocked tubes, ovulation tests and ultrasound scans of the pelvis to check for any abnormalities. Before any testing is carried out, it is important that a detailed medical history is taken by one of our specialists. Should the need for fertility treatment arise, we work closely with the Fertility Unit at our sister hospital, The Lister Hospital, to provide seamless, high-quality care throughout your treatment. Early pregnancy care is a specialty within our Women s Health department. Miscarriage refers to the premature end of a pregnancy, and 15 to 20 per cent of pregnancies end this way. Miscarriage can occur during the first or second trimester of pregnancy (before 20 weeks). Most occur in the first 12 weeks of pregnancy and are unexplained and isolated events. Your consultant will discuss with you the best management plan to suit your situation, and please be assured that support is available for your psychological and spiritual wellbeing.

7 An ectopic pregnancy is a pregnancy that grows outside the womb, and can occur when the fallopian tube is not functioning normally and the pregnancy grows within the tube (20 to 25 per cent of cases). However, in rare cases, it may occur on the cervix, in the abdomen or on an ovary. An ectopic pregnancy cannot survive as only the womb can support the growth of a foetus. If an ectopic pregnancy bursts inside a fallopian tube, it is a life-threatening medical emergency and we are fully equipped to perform the urgent surgery that this requires. Endometriosis is a chronic yet very common condition where the endometrial tissue usually only found inside the womb develops outside the womb, commonly on organs in the abdomen and pelvis. This tissue responds to hormones as it would in the womb; the tissue swells, breaks down and bleeds, and is unable to pass from the body during menstruation. Instead, the surrounding tissue becomes inflamed and causes pain, often causing scarring. Around ten percent of women will have endometriosis, although not all will experience symptoms. The best way to diagnose endometriosis is through a laparoscopic (keyhole) examination at the Portland this procedure will be performed under a general anaesthetic as a daycase procedure by a specialist consultant gynaecologist using the latest technology. If endometriosis is confirmed, your consultant may treat this at the same time, with your prior consent, using laparoscopic techniques. Fibroids are benign (non-cancerous) growths that form in the womb, made up of muscle fibre. The size of fibroids can vary widely, from the size of a pea to as large as a melon. Fibroids are most common in women in their 30s and 40s almost half of all women will develop fibroids by the age of 50 and they tend to shrink after the menopause. Our specialist Imaging Services team will use advanced ultrasound techniques to diagnose fibroids, and your consultant gynaecologist will offer the most appropriate treatment depending on your symptoms.

8 Myomectomy is the surgical removal of fibroids, and is the procedure of choice for women with symptomatic fibroids who do not wish to have a hysterectomy. Our specialist consultants are experienced in removing fibroids using advanced keyhole surgery techniques, which offer many advantages over the traditional open abdominal approach including enhanced recovery, a shorter hospital stay and reduced scarring. Hysteroscopic resection is a procedure for removing fibroids that grow inside the womb. Also known as transcervical resection of fibroids (TCRF), this procedure is performed using an instrument known as a hysteroscope a fine telescope which is passed through the vagina and cervix to look inside the womb. A loop carried on the telescope shaves off the fibroid by passing an electrical current through it. Your consultant can perform this procedure on a daycase basis, allowing you to return to your normal activities as soon as possible. Fluoroscopy and interventional radiology uses X-rays and a contrast agent to allow our specialist consultants to examine the internal structures of the body in real time. This means your consultant can watch the examination as they are performing it, and then review a recorded version at a later time. Our team will often use fluoroscopy to examine the bowel and urinary tract, administer medication or fluids, treat fibroids and also varicose veins. Menorrhagia, also known as heavy periods, is a very common condition that nearly 50 per cent of women will experience, which interferes with their quality of life. This is often due to fibroids, endometriosis, polyps, polycystic ovaries or changes prior to the menopause. Your consultant will suggest a personalised diagnostic plan to determine the cause in your particular case, which may include blood tests, an ultrasound scan, an endometrial biopsy and/or hysteroscopy (using a camera to examine the uterus, under local or general anaesthesia). If surgical treatment is required, your consultant gynaecologist will be able to perform this using the latest keyhole surgery techniques to enable a swift recovery and minimal scarring. Urinary tract infections (UTIs) are caused by bacteria that invade the urinary system, most commonly in the urethra (the tube that carries urine out of the body), and multiply. Cystitis is a common infection of the bladder the part of the urinary tract system that collects urine from the kidneys it can cause pain, discomfort and urinary frequency. Normally there are no bacteria in this tract, however, bacteria or yeast from the lower gastrointestinal tract or rectal area can enter the urinary tract.

9 The bacteria can multiply and infect the urethra, and can also travel up and infect the bladder. Your consultant can treat cystitis quickly and effectively with a course of antibiotics. Pelvic inflammatory disease (PID) is a serious yet common infection of the female reproductive organs including the womb, ovaries and fallopian tubes. PID is commonly caused by a sexually transmitted infection (STI). It can affect the vagina and the cervix, and also spread into the womb, the fallopian tubes and ovaries. PID can cause scar tissue to form in the pelvis and fallopian tubes, which can cause blocked tubes and result in infertility or an ectopic pregnancy. The most common symptoms for PID are abnormal vaginal discharge and chronic pelvic pain. Your consultant will perform a series of tests, which can include vaginal swabs, an ultrasound scan of the pelvis and a biopsy of the lining of the womb. Laparoscopic examination under a light general anaesthetic may also be performed. Your consultant gynaecologist will be able to offer you the best treatment according to your symptoms. Human papilloma virus (HPV, or wart virus) is a very common virus, transmitted through genital or sexual contact, that 70 to 80 per cent of women will contract at some stage in life. It usually produces no symptoms and many women will not even be aware that they have had the virus indeed, most women (95 per cent) will clear it through their natural immunity but in some cases it may not clear and can cause abnormal smears. HPV can lead to genital warts or, very rarely, cervical cancer, however regular smear tests every three years and HPV testing would detect any abnormalities before this develops. A vaccine for HPV is now available at the Portland. This offers excellent protection and your consultant will be able to advise you appropriately.

10 Menopause refers to the time in your life when menstruation ceases and the ovaries permanently stop releasing eggs. You are likely to experience menopause at any time between the ages of 40 and 58 (the average age is 51) and it is considered complete when you have been without a period for a full year. A natural menopause is a gradual process but you may experience a range of symptoms that vary in severity, including hot flushes, night sweats and irritability. This can be treated with medication such as hormone replacement therapy (HRT). There are various preparations of HRT; your consultant will recommend the preparation that would best suit your needs. Ovarian cysts are fluid-filled cysts within the ovaries that can vary dramatically in size. They are very common most women will have them at some stage of their life and will often be unaware but some women may experience pain. The Portland s premier ultrasound service is used to diagnose ovarian cysts and your consultant will propose the best treatment plan for your specific situation. Not all ovarian cysts need to be removed but if you do require surgery, your consultant gynaecologist will use the latest keyhole techniques to minimize scarring and recovery time, helping you return to your normal routine as quickly as possible. Minimal-access surgery (MAS, or keyhole surgery) uses a laparoscope to allow surgeons to look inside your body using a thin telescope. The laparoscope carries a light into your abdomen and magnifies the structures, allowing your surgeon to operate without making a large cut into the abdomen. The telescope is inserted through a small cut in the skin and can be used to find the cause of pelvic pain or look at endometriosis or ovarian cysts. Our specialist consultants regularly use keyhole surgery for ectopic pregnancy, hysterectomy and endometriosis, or to carry out sterilisations and biopsies. These advanced techniques are normally carried out under general anaesthetic, requiring just a short stay in the hospital and minimizing any subsequent scarring and recovery time. Polycystic ovary syndrome (PCOS) is a condition where the normal function of the ovaries has changed. There are three key symptoms of the condition: your ovaries have many (more than 12) tiny cysts, your hormones are out of balance and you don t ovulate every month. Using the Portland s premier ultrasound techniques, your consultant will diagnose PCOS if you exhibit two of the three main symptoms. There is no way of reversing the formation of these cysts, but if you ve received a diagnosis of PCOS, it is important that you get treatment to control your symptoms particularly if the symptoms are severe and cause a lot of worry, or if infertility becomes an issue. Complementary therapies and nutritional advice can be a big help, and the Portland s multidisciplinary team will support you with a tailored plan to suit your needs.

11 Prolapse of the womb occurs when the muscles, tissues and ligaments supporting the pelvic organs weaken enough that the womb slips down from its normal position. This is a common condition among women who have had children or have gone through the menopause, and you may also be at risk if you are overweight, have a persistent cough or experience long-term constipation. Your prolapse may not require treatment but if surgery is necessary, your specialist consultant will have access to the latest equipment and techniques to ensure the fastest possible recovery. Our team of expert consultants at the Portland offers a sexual health service dedicated to helping you and your partner take care of your sexual health. Seeing a specialist assures expert treatment and confidential advice, and gives you the confidence to discuss even the most intimate concerns. Many women like to ensure they enjoy the best of health by having regular health checks. If there is any indication there may be any problems, they are picked up at the earliest opportunity and investigated to offer you peace of mind. The Portland offers a Well Woman Check service as an essential part of pro-active healthcare management, which includes the following elements: Consultation with a leading consultant gynaecologist Full gynaecological history and pelvic examination Blood pressure and BMI (Body Mass Index) assessment Cervical smear and HPV testing Contraception and sexual health review Explanation of results and appropriate management plan discussed Detailed written report ed or posted to you and your GP Our urogynaecology services offer discrete diagnosis and the latest treatment for women who suffer from incontinence problems. Urinary incontinence is the loss of bladder control leading to the leakage of urine, and it can be a temporary or chronic condition. Incontinence is a symptom, not a condition in itself, and may have several different causes. Our specialist team will undertake a detailed assessment to determine the most appropriate treatment for your particular circumstances. A large number of other surgical and non-surgical procedures are undertaken at the Portland, depending on your personal diagnosis. We are fully equipped to care for complex conditions, using the very latest treatments and techniques. To find out more, please visit our website or call our dedicated Women s Health enquiry line on +44 (0)

12 COMPLEX CONGENITAL GYNAECOLOGICAL ANOMALIES Our specialist team at the Portland is highly experienced in diagnosing and managing complex congenital abnormalities of the reproductive organs, and we are the only UK private hospital to specialise in this field. Patients from all over the world visit us to receive expert treatment and care in our discreet and comfortable environment. Patients with these complex conditions are generally diagnosed at one of two key moments in their life: 1. At birth. If your baby s genitalia appear ambiguous, your child will be cared for by our specialist paediatric endocrinologists and paediatric urologists, and then usually referred to one of our consultant gynaecologists when they reach puberty. 2. In adolescence. Diagnosis may occur at this age if a young woman s periods don t start as expected, they develop more masculine features (such as an enlarged clitoris) or they may have abdominal pain from obstructed menstruation. If your daughter is diagnosed in adolescence, she will be cared for by specialist consultant gynaecologists within our Women s Health team. There are a variety of investigations and treatments that may be necessary at either stage to provide a full diagnosis, and these require a team approach with different skills. Our multidisciplinary team draws on specialist expertise in all areas to offer the full range of diagnostic procedures, specialist imaging and the latest treatments, including laparoscopic gonadectomy, vaginoplasty (open and laparoscopic), clitoral reduction, vaginal dilation and resection of the septum. In addition to surgical treatment, we strongly believe in taking a holistic approach to promote your child s successful recovery. Our multidisciplinary team at the Portland offers expert psychological care unique within the private sector to fully support your child s wellbeing.

13 COMPLEMENTARY SERVICES The Portland Hospital offers a wide range of therapies to support our women s health services on an inpatient and outpatient basis. Many gynaecological problems can be treated and symptoms managed with the appropriate therapy programme; complementing medical management and sometimes reducing the need for medications or surgery. Our dynamic and enthusiastic team of therapists have chosen to specialise in the assessment and treatment of women. We work closely with your consultant or GP to ensure that the care that you receive is coordinated and centred on your needs, including the following services: Therapy and nutritional advice to ease symptoms associated with the menopause such as Bowen Therapy, acupuncture and reflexology Manual Lymphatic Drainage (MLD) massage for lymphoedema following breast or other surgery Advice regarding diet, activities of daily living, sport and exercise Counselling for anxiety, depression and body image disorders For further information, please contact our department on +44 (0) or by at therapies@hcahealthcare.co.uk Manual therapy to treat musculoskeletal back and pelvic pain Pelvic floor assessment and re-education for continence problems, pelvic floor pain or sexual dysfunction Advice and treatment to support recovery following a hysterectomy, and other gynaecological surgery

14 LOCATED IN CENTRAL LONDON The Portland Hospital lies at the heart of the private healthcare district in London at the top of the famous Great Portland Street. Our address is: The Portland Hospital for Women and Children Great Portland Street London W1W 5AH We also have outpatient consulting rooms at: 212 Great Portland Street London W1N 5HG Women s Health enquiry line: +44 (0) Hospital switchboard: +44 (0) Fax: +44 (0) Getting here by car There are two car parks near the hospital: NCP in Carburton Street Union Car Parks in Devonshire Row Mews You will also find meter parking bays in the surrounding streets. Getting here by tube Great Portland Street Station (2 minutes walk) Circle, Hammersmith & City and Metropolitan Lines Regents Park Station (5 minutes walk) Bakerloo Line Copyright 2014: This publication may not be reproduced in whole or part by any means without the prior consent of HCA International. Whilst every effort has been made to ensure accuracy of the content at the time of publication, the publishers shall not be held responsible in any way for any inaccuracies or omissions.

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