Gynaecology & Obstetrics Clinic

We provide care across five core areas of women's health. These areas are designed so that a single patient can be supported throughout different stages of her life within the same clinic.

• General women's health and gynaecological examination: Routine check-up, smear test (cervical cytology), pelvic ultrasound, vaginal discharge and infection assessment, menstrual irregularities, painful periods, and premenstrual syndrome management.
• Pregnancy monitoring and childbirth: Preconception counselling, first-trimester screening tests, advanced ultrasound examinations (anomaly scan, biophysical profile), high-risk pregnancy monitoring, vaginal delivery and caesarean section.
• Menopause and osteoporosis: Perimenopausal symptom management, hormone replacement therapy (HRT) assessment, bone density monitoring and referral.
• Infertility assessment: First-line diagnostic process — hormonal panel, hysterosalpingography (HSG), follicle tracking; referral to specialist centres where required.
• Family planning: Contraception counselling, intrauterine device (IUD/coil) fitting, oral contraceptive and injectable protocols, sexually transmitted infection screening.

On the surgical side, hysteroscopy, laparoscopic procedures and other operations within the gynaecology and obstetrics specialty are planned in coordination with the relevant hospital, based on the patient's clinical indication and overall health. Nis Clinic operates as a polyclinic; where surgery is required, patients are referred to a hospital-level facility and continuity of care is maintained throughout.

Continuity of care throughout pregnancy — with a single clinician — is important for both mother and baby. At our department, pregnancy monitoring follows a structured programme that is adapted to each patient's individual history.

First trimester (weeks 1–12): Confirmation of pregnancy, verification of foetal heartbeat, and synchronisation of gestational age with the last menstrual period. During this period the combined screening test (nuchal translucency measurement plus double biochemical test) is performed; for advanced maternal age or high-risk pregnancies, non-invasive prenatal testing (NIPT) options are discussed.

Second trimester (weeks 13–27): The detailed anomaly scan is performed at weeks 20–22. This is a critical examination in which the baby's organ development is assessed, and adequate time is allocated for it. Gestational diabetes screening (oral glucose tolerance test, OGTT) at weeks 24–28 is part of the standard programme; in patients with pre-existing risk factors it may be performed earlier.

Third trimester (weeks 28–40): The baby's growth, placental location, amniotic fluid volume and Doppler assessment are monitored at regular intervals. Weekly appointments begin from week 36; a non-stress test (NST) is performed where clinically indicated.

High-risk pregnancy: Patients with hypertension, gestational diabetes, placenta praevia, intrauterine growth restriction (IUGR), multiple pregnancy, advanced maternal age (35+) or a history of previous pregnancy complications are seen more frequently. Relevant laboratory investigations and maternal-foetal medicine centre consultations are coordinated as part of the care plan.

One advantage of pregnancy monitoring in Northern Cyprus (TRNC) is that — unlike the congested appointment queues and frequent clinician changes found in large cities — patients can build a relationship with the same doctor and maintain a consistent care plan right through to delivery. For international patients (medical tourism), part of the monitoring can take place in Northern Cyprus and part in the patient's home country; in this case records are shared and the schedule is coordinated accordingly.

The choice of delivery method is never based on a single criterion. The mother's medical condition, the baby's position and growth, placental location, previous birth history, and the mother's preference are all considered together. Clinical indication takes priority; elective caesarean section is a separate topic and is decided only after detailed discussion with the patient.

Vaginal delivery: Where the baby's position is suitable, the placenta is normally located, and the mother's health allows for labour, vaginal delivery is the preferred route. Labour is managed according to standard obstetric practice; foetal heart rate monitoring, uterine contraction assessment and cervical progression are evaluated at regular intervals.

Epidural pain relief in labour: During the active phase of labour, epidural anaesthesia may be administered subject to the patient's preference and the anaesthesia team's assessment. This approach significantly reduces labour pain while the mother remains fully conscious, and its safety profile regarding transfer to the baby is considered acceptable. It is not appropriate for every patient — patients with a history of spinal surgery, clotting disorders, local infection, or who decline the procedure are offered alternative analgesia options.

Caesarean section: A caesarean section is indicated for placenta praevia, breech presentation, unfavourable foetal positioning in twin pregnancies, two or more previous caesarean sections, foetal distress, and other obstetric indications. Anaesthesia options include:

• Spinal anaesthesia: A single-dose block administered to the lower back. The mother remains conscious, onset is rapid, and immediate skin-to-skin contact with the baby is possible. This is the preferred approach for most planned caesarean sections.
• Epidural anaesthesia: Where an epidural catheter is already in place during labour and an emergency caesarean becomes necessary, the anaesthetic dose can be increased through the existing catheter.
• General anaesthesia: Used in emergencies, where spinal or epidural anaesthesia is contraindicated, or at the patient's specific request.

The mother's birth preference: The information and decision-making process is handled in detail during the consultation. An elective caesarean decided in haste should not be a choice the patient later questions — it should be a jointly reviewed decision. Dr. Mehmetoğlu summarises her clinical approach as follows: "The choice between caesarean and vaginal delivery is made on the basis of clinical indication; the patient's wishes and expectations are listened to, but the medical rationale comes first."

A gynaecological examination differs according to a woman's stage of life. Annual routine check-ups are the foundation of women's health; waiting for symptoms before seeing a doctor allows many conditions that could have been caught early to progress undetected.

Contents of a routine annual examination:

• General gynaecological assessment (speculum examination, bimanual examination)
• Pelvic ultrasound (transabdominal or transvaginal)
• Smear test (cervical cytology) — for cervical cancer screening
• Breast review and referral for breast imaging where indicated
• Vaginal swab culture, hormonal panel where symptoms are present

Smear test frequency and HPV screening: A smear test is initiated after the age of 21 or after the start of sexual activity. Where results are normal, the recommended interval is generally every three years; when performed together with an HPV test, this can extend to every five years. An abnormal smear result leads to further investigation with colposcopy (detailed cervical assessment under magnification) and, where indicated, cervical biopsy.

Endometrial biopsy: A sample of the endometrium is taken in patients with postmenopausal bleeding, irregular or prolonged periods, or increased endometrial thickness. The procedure can be performed in the clinic under local anaesthesia; the sample is sent to the pathology laboratory.

HSG (hysterosalpingography): Part of the infertility diagnostic process. The uterine cavity and fallopian tube patency are assessed by contrast X-ray. It is performed in the early follicular phase following the end of menstruation.

Colposcopy: Detailed examination of the cervical surface using a magnifying optical instrument where cervical lesions are suspected. Aceto-acetic acid and Lugol's solution staining identify suspicious areas; biopsy can be taken in the same session if required.

The frequency of each screening test is personalised according to the patient's age, family history, previous results and risk factors. Rather than a one-size-fits-all annual rule, we recommend an individualised monitoring programme.

Menopause is not a single event — it is a transition period averaging 4–8 years (perimenopause). During this time, periods become irregular, and symptoms such as hot flushes, night sweats, sleep disturbance, mood changes and vaginal dryness may develop. Not every woman experiences the same intensity; for some, quality of life is significantly affected, while for others the transition passes quietly.

Our clinical approach:

• Diagnosis: Menopause is generally diagnosed on the basis of clinical features and menstrual history. Ancillary tests (FSH, oestradiol) are not usually required in typical presentations; however, they are requested where early menopause is suspected (under 40) or in atypical cases.
• Hormone replacement therapy (HRT): HRT is considered as an option in patients significantly affected by hot flushes, night sweats and genitourinary symptoms. Indication, contraindications (history of breast cancer, thromboembolic event, uncontrolled hypertension, liver disease) and the risk profile are discussed in detail. Where a decision is made to proceed, the lowest effective dose is prescribed for the shortest appropriate duration.
• Local vaginal treatment: For genitourinary syndrome of menopause (vaginal dryness, painful intercourse, urinary symptoms), local oestrogen therapy is a separate option from systemic HRT and carries a lower general risk profile.
• Lifestyle and alternative approaches: Regular exercise, calcium and vitamin D, soya-based diet, reduction of caffeine and alcohol, and sleep hygiene have a meaningful effect during this period. These are the first-line approach for patients who decline HRT or for whom it is contraindicated.

Osteoporosis monitoring: Bone loss accelerates after menopause. Bone mineral density measurement (DEXA scan) is recommended for all women aged 65 and over, and earlier for those with risk factors (early menopause, family history of hip fracture, prolonged corticosteroid use, BMI below 20). Treatment decisions are made in coordination with endocrinology or internal medicine.

The menopausal period is not the point at which women's health "ends" — it is the beginning of a new phase of monitoring. Cardiovascular health, bone density, and breast and cervical screening all continue without interruption during this stage.

Definition of infertility: Failure to achieve pregnancy after one year of unprotected, regular intercourse in women under 35, or after six months in women aged 35 and over. There is no need for alarm before these periods have elapsed; however, earlier assessment is warranted where specific risk factors are present (previous pelvic infection, history of endometriosis, irregular periods, known anatomical problem).

First-line assessment — which tests?

• Detailed history and physical examination (both partners)
• Hormonal panel: FSH, LH, oestradiol, AMH (ovarian reserve marker), TSH, prolactin
• Ovarian reserve assessment: AMH plus transvaginal ultrasound with antral follicle count
• HSG (hysterosalpingography) — tubal patency assessment
• Semen analysis for the partner

The majority of these tests can be arranged within the clinic. Once results are collated, the pathway forward is determined according to the couple's specific situation. In some cases the problem is straightforward and lifestyle changes or a short course of ovulation induction are sufficient; in others, referral to a specialist reproductive medicine centre (IVF/ICSI) is required. First-line assessment is carried out at Nis Clinic; in vitro fertilisation (IVF) programmes are not conducted here. Referral to a specialist centre, once the diagnostic process is complete, is discussed openly.

Family planning — contraception options:

• Intrauterine device (IUD / coil): Hormonal (levonorgestrel) and copper options available. Effective for 5–10 years, fully reversible, high reliability. Fitted at the clinic within the first week after menstruation; position is confirmed by ultrasound 4–6 weeks later.
• Combined oral contraceptive pill, vaginal ring, transdermal patch: Daily, weekly or monthly options. Selected according to the patient's age, smoking status, migraine history and cardiovascular risk profile.
• Three-monthly injectable contraceptive: An option for patients who find daily pill-taking difficult or who are breastfeeding.
• Barrier methods: Condom; provides protection against sexually transmitted infections as well as pregnancy.
• Natural methods: Calendar method, basal body temperature tracking, cervical mucus monitoring. Lower efficacy; patient education is essential.
• Permanent methods: Tubal ligation; considered for couples who have definitively completed their family; coordinated with the relevant surgical centre.

Sexually transmitted infections: Screening for chlamydia, gonorrhoea, HPV, herpes and syphilis is offered to patients with risk factors or at the patient's request. HPV vaccination (Gardasil 9) is ideally administered between ages 9 and 14, and up to age 26 later (up to 45 in some countries); the vaccination window and its efficacy are discussed in detail during the consultation.