Preventive gynaecology

Nadezhda Hospital provides female healthcare through a wide range of specialized screening and diagnostic tests. At its core, however, it is each woman’s responsible approach to her own health – once a year a woman should have an appointment with a mammologist for an ultrasound or a mammogram, and a gynaecologist for a prophylactic Pap smear and examination.

At the gynaecologist’s discretion, further tests may be carried out, if cervical disease is suspected.

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Prevention of women's health

Pap smear test is a cervical cancer prevention test that every woman aged between 21 and 65 years is advised to take once a year, and if an increased risk is detected – every 6 months. This is a painless procedure in which the obstetrician-gynaecologist uses a fine brush to take two cytology samples – from the vaginal part of the cervix and from the cervical canal. The samples contain surface cells from the cervix, which are then examined under a microscope to detect any changes.. Conventional Pap smears and the so-called liquid-based Pap smears are performed at Nadezhda Hospital. For the conventional smear, the cytological material is ‘smeared’ onto a slide, after which the brush is discarded, with about 80% of the cellular material discarded with it. This is also the main disadvantage of the conventional method – the likelihood that cells with precancerous changes will not end up on the slide, but will be discarded with the brush is high, and this leads to false negative results and missed diagnoses of precancerous changes to the cervix. For the liquid-based cytology, the brush is „shaken off“ in a liquid environment, where 100% of the cells go and are subsequently analyzed.

Pap smear results are produced within 10 working days. They may be printed out from your personal patient profile, or on-site, at the Registry Office of Nadezhda Hospital. The results produced need to be presented to the attending physician for comment and, if necessary, to discuss management.

Colposcopic examination is a specialized examination that is routine in modern gynaecological practice, and it forms an integral part of adequate diagnosis of cervical diseases. In this examination, the cervix is viewed with a special microscope (colposcope). The procedure is quick, painless, and performed in an outpatient setting without anaesthetic. If necessary, a biopsy (tissue sample) is collected for histological examination.

The purpose of this test is to screen for cervical cancer or the presence of infection with high-risk types of human papillomavirus that are associated with a high risk of developing cervical cancer. The test is performed in the gynaecologist’s consulting room, and the test may be performed at the same time as the Pap smear – using the same cell sample or a second sample from the cervical canal.

Most often the ultrasound examination is vaginal and aims to find out the condition of the uterus and ovaries. After the examination, you will be given detailed information about your condition and recommendations for management.

Ovarian reserve assessment

Some tests exist, which can be used to infer the state of ovarian reserve. Unfortunately, these are not included in a routine obstetrics and gynecology prophylaxis. Normally such examinations are appointed only in the consulting room of a reproductive specialist after a patient has asked for assistance due to a problematic pregnancy. Thus, most women, who otherwise regularly monitor their health, would not know if there is a deviation in their ovarian reserve, especially since its depletion happens quietly and asymptomatically.

Any woman who has plans for a future pregnancy can take matters into her own hands and have tests for ovarian reserve assessment, especially if she is affected by any of the factors that put her at risk of premature depletion.

A comprehensive panel, as informative as possible, includes blood tests for certain hormones and an ultrasound examination with a specialist in reproductive medicine:

Hormonal blood tests

It is tested on the second or third day of a woman’s monthly period and provides important information about the state of the ovarian reserve. This is a hormone that is produced by the pituitary gland, tasked with “waking up” the follicles in the ovary each month for a mature ovum to develop. As we age and the ovarian reserve deteriorates, the follicles need an increasingly high concentrations of FSH to develop. FSH values may vary from month to month, but while high levels – measured even once – are an alarm signal of diminished ovarian reserve, low values do not always guarantee a good state of ovarian reserve. To properly interpret FSH values, it is usually tested at the same time as two other hormones, LH (Luteinizing Hormone) and E2 (Estradiol).

Produced by the granulosa cells of the early developing antral follicles. The hormone is measured on any day of a woman’s menstrual cycle and indicates the number of egg cells remaining. Low AMH values are an indicator of reduced or depleted ovarian reserve. It is secreted by the accessory cells responsible for follicle preparation, and its levels decrease in direct proportion to the decrease in future egg cells. AMH is accepted by specialists as the most accurate and adequate marker for assessing ovarian reserve. A word of caution: if you get a disturbing AMH result, you may want to repeat the test – AMH is one of the “fickle” lab tests, and it is possible that results in different labs may show a difference.

Formed in the pituitary gland and stimulates the final maturation of follicles, their rupture, and ovulation. LH testing at the beginning of the period (second or third day) supports the correct interpretation of FSH measurement results, as the ratio between the values of the two hormones is an important guide for specialists.

The primary female gender hormone, which plays a main role in the functioning of the ovary. Estradiol is secreted by the growing follicle, and a rise in its concentration as ovulation approaches is a sign for the pituitary to reduce FSH production. However, sometimes this may happen earlier than usual, at the beginning of the menstrual cycle. This premature rise in estradiol causes FSH levels to fall artificially, and so an otherwise impaired ovarian reserve may appear apparently normal. Therefore, the estradiol value is needed to indicate whether the FSH measurement result should be taken as indicative or whether the test should be repeated within another menstrual cycle.

Ultrasound examination

Determination of ovarian diameter and number of antral follicles– it determines the number of antral follicles in the ovary and complements the information obtained from the hormonal examinations. This provides the reproductive specialist with a basis for a definitive opinion on the state of the ovarian reserve. Although it varies from cycle to cycle, it is a quick and easy method for a “snapshot” of ovarian reserve.

It is important to note that the correct interpretation of blood test results can only be made by the reproductive specialist, and only after an ultrasound examination.

It is possible that in different individual cases, specialists may recommend additional tests, depending on your personal medical history and the presence of risk factors. 

See also

Operative gynaecology
Medical abortion
Aesthetic gynaecology
Fertility preservation