Alak Pal is a senior Consultant Gynaecologist at the London North West University Healthcare NHS Trust with extensive experience in the management of utero-vaginal prolapse and urinary symptoms, menstrual disorders and pelvic pain, cysts in the ovary, endometriosis and fibroids. He is an accredited colposcopist, experienced in the management of abnormal cervical smears with high-risk HPV (Human papilloma virus).
HPV testing in a cervical smear is the basis of screening for cervical cancer. A cervical smear is taken by scraping superficial cells from the neck of the womb with a soft brush and then testing for high risk HPV strains. When the smear shows presence of high-risk HPV, it is deemed an abnormal smear, with an increase in the risk of cervical cancer and needs further investigations such as colposcopy.
An endometrial polyp is usually a benign (noncancerous) overgrowth of the lining of the womb, and often causes painful, heavy periods and spotting in between periods. It also increases the risk of miscarriage both after spontaneous conception and after IVF. An endometrial polyp can be removed by a surgical procedure called resection by using a hysteroscope.
Endometriosis is a condition where cells similar to the lining of the womb grow in and around the ovaries and behind the womb, causing scarring. Symptoms include pain in the lower abdomen, lower back, severe period pains and pain during sex. Treatment of mild endometriosis can be by medications, but often surgery may be required, which is usually performed as keyhole with a laparoscope.
Heavy periods or heavy menstrual bleeding (HMB) is when periods are extremely heavy or prolonged. Periods are described as heavy when the blood loss is more than average often with blood clots, the bleeding may last longer than seven days. Investigations are usually required, and treatment would depend on the underlying cause.
Menopause is when a woman stops having periods, this being a natural part of ageing. Menopausal symptoms may include hot flushes, night sweats, inability to concentrate (brain fog) and treatment is by hormone replacement therapy (HRT); however not all women need treatment. Bleeding after menopause is not normal and should always be checked by a medical specialist.
An ovarian cyst is a common growth that develops in the ovary. Most cysts are less than 4 cm, harmless, do not cause symptoms and go away without treatment. Larger fluid filled cysts, or cysts containing endometriosis and cysts with developmental tissues persist and can cause pain and bloating. These are detected on ultrasound examination and usually need surgical treatment.
Pelvic organ prolapse is when one or more of the organs in the pelvis slip down from their normal position and bulge into the vagina. It can be the womb (uterus), bowel, bladder or top of the vagina. A prolapse is not life threatening, but it can cause pain and discomfort. It can also be associated with urinary and bowel symptoms. Treatment includes pelvic floor exercises, vaginal support pessary and often surgery. Surgery involves repair of the bladder prolapse ( cystocele) or repair of the bowel prolapse ( rectocele) or repair of the prolapse of the womb.
Pain experienced in the lower abdomen and within the pelvis is called pelvic pain and may arise from female reproductive organs or from the bowel or urinary bladder. Pelvic pain can also arise from muscles and ligaments of the pelvic floor. The pain may start suddenly (acute) or be chronic for a while. Management includes identifying and treating the cause.
Uterine fibroids are benign, non-cancerous growths in the muscles and tissues of the womb. These can become quite large and cause pain in the abdomen. The most common symptoms, however, are of heavy and painful periods, and discomfort and heaviness in the lower abdomen. Fibroids are a very common occurrence, and treatment may range from medical to surgical, depending on the size of the fibroids and the symptoms. It can consist of removing the fibroids from the muscles of the uterus ( myomectomy) or shaving the fibroid from inside the cavity ( resection of fibroid) or even a hysterectomy.
Abnormal Cervical Smear
HPV testing in a cervical smear is the basis of screening for cervical cancer. A cervical smear is taken by scraping superficial cells from the neck of the womb with a soft brush and testing it in the laboratory for high risk HPV strains. When the smear shows presence of high-risk HPV, it is deemed an abnormal smear, with an increase in the risk of cervical cancer and needs further investigations such as colposcopy.
Spotting and Endometrial polyp
An endometrial polyp is usually a benign (noncancerous) overgrowth of the lining of the womb, and often causes painful, heavy periods and spotting in between periods. It also increases the risk of miscarriage both after spontaneous conception and after IVF. An endometrial polyp can be removed by a surgical procedure called resection by using a hysteroscope.
Pain and Endometriosis
Endometriosis is a condition where cells similar to the lining of the womb grow in and around the ovaries and behind the womb, causing scarring. Symptoms include pain in the lower abdomen, lower back, severe period pains and pain during sex. Treatment of mild endometriosis can be by medications, but often surgery may be required, which is usually performed with a laparoscope.
Heavy and Prolonged Periods
Heavy periods or heavy menstrual bleeding (HMB) is when periods are extremely heavy or prolonged. Periods are described as heavy when you lose more blood than is typical and may have to change sanitary protection very frequently, may pass blood clots and the bleeding lasting longer than seven days. Investigations are usually required, and treatment would depend on the underlying cause.
Menopause
Menopause is when a woman stops having periods and is a natural part of ageing. Symptoms may include hot flushes, night sweats, inability to concentrate (brain fog) and treatment is by hormone replacement therapy (HRT); however not all women need treatment. Bleeding after menopause is not normal and should always be checked by a medical specialist.
Cyst in the Ovary
An ovarian cyst is a common growth that develops in the ovary. Most cysts are less than 4 cm, harmless, do not cause symptoms and go away without treatment. Larger fluid filled cysts, or cysts containing endometriosis and cysts with developmental tissues persist and can cause pain and bloating. These are detected on ultrasound examination and usually need surgical treatment.
Prolapse
Pelvic organ prolapse is when one or more of the organs in the pelvis slip down from their normal position and bulge into the vagina. It can be the womb (uterus), bowel, bladder or top of the vagina. A prolapse is not life threatening, but it can cause pain and discomfort. It can also be associated with urinary and bowel symptoms. Treatment includes pelvic floor exercises, vaginal pessaries and often surgery. Surgery involves repair of the bladder prolapse ( cystocele) or repair of the bowel prolapse ( rectocele) or repair of the prolapse of the womb.
Pelvic Pain
Pain experienced in the lower abdomen and within the pelvis is called pelvic pain and may arise from female reproductive organs or from the bowel or urinary bladder. Pelvic pain can also arise from muscles and ligaments of the pelvic floor. The pain may start suddenly (acute) or be chronic for a while. Management includes identifying and treating the cause.
Fibroids
Uterine fibroids, also called leiomyoma, are benign, non-cancerous growths in the muscles and tissues of the womb. These can become quite large and cause pain in the abdomen. The most common symptoms, however, are of heavy and painful periods, and discomfort and heaviness in the lower abdomen. Fibroids are a very common occurrence, and treatment may range from medical to surgical, depending on the size of the fibroids and the symptoms. It can consist of removing the fibroids from the muscles of the uterus ( myomectomy) or shaving the fibroid from inside the cavity ( resection of fibroid) or even a hysterectomy.
Mr Alak Pal MD, FRCOG is a senior Consultant Gynaecologist at the London North West University Healthcare NHS Trust, with extensive experience in the management of uterovaginal prolapse and urinary symptoms, menstrual disorders and pelvic pain, cysts in the ovary, endometriosis and fibroids. He is an accredited colposcopist, experienced in the management of abnormal cervical smears with high-risk HPV (Human Papilloma Virus).
Mr Alak Pal is committed to delivering high quality and safe gynaecology service to his patients. He provides a wide range of general gynaecology, urogynaecology and cervical screening services in West London, Windsor and South Buckinghamshire, including colposcopy, screening for gynaecological cancers and both surgical and non-surgical management of benign gynaecological disorders.
He consults at the following hospitals:
Clementine Churchill Hospital, Harrow
The Syon Clinic, Brentford
Portland Hospital, London.
Spire Thames Valley Hospital, Wexham
Princess Margaret Hospital, Windsor
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He has been the lead for colposcopy and for local cervical screening service at Ealing Hospital for 5 years and was then appointed as lead for local gynaecological cancer services for 7 years.
He now leads the service for urogynaecology which involves management of women with prolapse and urinary issues.
With his long involvement in different aspects of gynaecology, he has a wide range of general gynaecological and specialist skills which he seamlessly brings to his patient care.
Click here to read Dr Alak Pal’s Bupa profile
Mr Alak Pal provides advice and treatment of various gynaecological problems including heavy periods, pelvic pain, urinary urgency and incontinence, uterovaginal prolapse, abnormal cervical smears, uterine fibroid and ovarian cyst. Mr Alak Pal understands how busy life can be and that it may be difficult to make an appointment with the GP for a gynaecology related problem.
You do not need a GP’s referral to book an appointment with Mr Alak Pal. You can self -fund or use your private health insurance. Women intending to use their private health insurance should obtain a pre-authorisation for the appointment. Mr Alak Pal is ‘fee-assured’ for all health insurance providers.
Routine checks
Individuals with a family history of breast, uterine or ovarian cancer may request more regular check-ups, while others may opt for an annual gynaecological check-up for reassurance which would include a cervical (PAP) smear. Mr Alak Pal can provide annual check-ups on a regular basis.
Pelvic pain
Pelvic or lower abdominal pain may be debilitating and can interfere with normal life. Management may include investigations, especially pelvic ultrasound, blood tests and some individuals may need laparoscopy to find and treat the cause of pain. Pain may be caused by endometriosis, ovarian cysts, fibroids or adhesions. Mr Alak Pal will discuss the individual symptoms, shortlist possible causes and treat the cause.
Heavy periods and irregular bleeding
Many women, at some point in their lifetime, may be troubled by heavy periods or irregular, unscheduled bleeding. Management may include medical treatment, blood tests, ultrasound, hysteroscopy and occasionally surgical treatment. Mr Alak Pal will go through the individual history, identify possible causes, arrange for investigations and plan treatment.
Urinary problems
Women of all ages suffer from various types of urinary problems, which vary as to cause and contributing factors.
A very common problem is urinary frequency when you have to go to the toilet more frequently than normal. This could be due to drinking more fluids and conditions such as diabetes, or instability of the bladder muscles ( overactive bladder). It could also be due to bladder infection (cystitis).
Urinary tract infection
Infection affecting the bladder (cystitis) is a common problem in women of all age groups. Cystitis may be aggravated by holding urine for long periods, low fluid intake, sexual intercourse and ageing. Symptoms are of lower abdominal discomfort, pain during passing urine, passing only small amounts of urine and often dark and blood-stained urine. Treatment is by antibiotics.
Also common, are problems with bladder control such as:
However, you must see a doctor immediately if you can not pass urine or empty your bladder, see blood in urine, or have symptoms of bladder infection.
Prolapse
Utero-vaginal prolapse affects many and may be associated with back pain and bladder and bowel difficulties. It can affect women at any age although more common in those in their fifties or above. Mr Alak Pal will discuss the symptoms, identify the severity of prolapse and discuss management options.
Menopause
Symptoms of menopause can be very troublesome, and may start a few years before periods actually stop. Mr Alak Pal will discuss management options, and some may wish to start Hormone Replacement Therapy (HRT) which he will prescribe. Any bleeding or spotting after menopause is not normal and needs immediate attention.
Mr Alak Pal is a senior Consultant Gynaecologist at the London North West University Healthcare NHS Trust with extensive experience in the management of utero-vaginal prolapse and urinary symptoms, menstrual disorders and pelvic pain, cysts in the ovary, endometriosis and fibroids. Read more…