Women have menstrual cycle from 11-12 years of age to about 50 years. A few episodes of bleeding during the span is normal. Continuous episodes of bleeding Increase in bleeding days, clots, and irregular periods have to be evaluated immediately.
Includes detailed history with physical examination, blood tests, ultrasound to rule out any utrine problems, thyroid test for hormonal changes.
Further evaluations include endoscopic evaluation, laproscopy etc
Treatment includes both Medical and Surgical approach depending on the cause, age, severity of bleeding, fibroids or polyps.
- Surgeries include
- Endometrial ablation
Fibroids (leiomyomas or myomas)
Fibroids are benign (not cancer) growths in the uterus. 25–50% of women have fibroids.
Symptoms: Fibroids generally are asymptomatic but in few women can cause
- Abnormal Bleeding
- Menstrual pain (dysmenorrhoea)
- Vaginal bleeding
- Pain in the abdomen or lower back
- Difficulty in urinating or frequent urination
- Constipation, rectal pain, or difficult bowel movements
- Enlarged uterus and abdomen
How do we diagnose fibroids ?
Fibroids may be diagnosed in routine USG or pelvic examination. USG is an accurate method to diagnose assess and map the fibroid as this information is needed to plan the treatment. Hysteroscopy can be used to diagnose submucous fibroids.
How do we treat Fibroids?
Hysterectomy: Removal of uterus Mymomectomy : surgical removal of fibroids while leaving the uterus in place Drugs gonadotropin-releasing hormone (GnRH) agonists for temporary relief.
In one third of infertile women population the tissue endometrium which forms the lining of the uterus is found in other parts of the body like ovaries, fallopian tubes, cul-de-sac(behind uterus), intestines, rectum, bladder. During the menstrual cycle endometrium responds to the hormonal changes and breaks down and bleeds. The bleeding inside the uterus has a passage to come out as menstrual bleeding but the tissue bleed in the other areas keeps accumulating and forma cysts (chocolate cysts) or adhesions. This can cause pain, especially before and during period.
Who is at risk ?
- Young women in the age group of 30-40 years
- Women with uterine defects like septum or bicornuate uterus
- Pelvic pain (pain in lower abdomen and back).
- Heavy Bleeding
- Pelvic examination
Severity of endometriosis determines the treatment methods. In women with problems treatment is through medications or conservative surgery techniques performed with expert precision but is not a permanent solution, symptoms may come back after treatment. Surgery is the best choice for treatment. It is performed by laparoscopy or laparotomy.
Ovarian cyst is nothing but enlargement of ovaries due to accumilation of fluid or any other tissue.
Types of Cysts
Benign (not cancerous) cysts: They develop due to hormonal effects . Cysst >5cms or rapidly growing require surgical treatment.
Malignant (Cancerous) are more common in woman above 40 years.
- Dull or sharp ache in the abdomen constantly or intermittently
- Nausea vomiting and giddiness
- Dysmenorrhoea (painful periods)
- Larger cysts may cause torsion (twisting) of the ovary that causes pain
- Cysts that bleed or rupture (burst) may lead to serious problems requiring prompt treatment.
- Routine pelvic exam
- Ultrasound scan
- Blood tests like CA 125, CEA etc .
Treatment depends on size and type of cyst, age, severity of symptoms, desire for future childbearing, family history of ovarian cancer. Surgical Intervention through Laproscopy, Cystectomy (removal of the abnormal tissues and saving the normal ovarian tissues) oophorectomy (removal of the complete ovary) cytoreduction is recommended if the cyst is symptomatic, growing in size, persisting for more than 6 months without change in size, very large, associated with other conditions like, ascites, cancerous or other findings.
Polycystic Ovary Syndrome (PCOS)
- Irregular or no menstrual periods
- Excess hair growth
- Inability to produce eggs (ovum) leading to childlessness
- Family history of Diabetes
- Delayed cycles
- Clinical or lab evidence of hormonal imbalance (increased androgens)
- Ultrasound picture multiple small cysts in the ovaries.
Good and healthy lifestyle is the only way to combat PCOS. Healthy weight loss programs, exercise will help. Treatment is needed to help prevent endometrial cancer, diabetes, and heart disease. Medicines used to improve this condition include hormones like progesterone or birth control pills to bring on regular menstrual bleeding.
Incontinence or the involuntary leak of urine is a common condition faced by women. Urinary incontinence is broadly of three types- Stress incontinence, urge incontinence and overflow incontinence.
Stress Incontinence: occurs due to strain including lifting of heavy things or while coughing or laughing. This occurs mainly because of 2 reasons (1) urethral hypermobility (2) defect in seal mechanism or ‘intrinsic sphincter deficiency’
Urge incontinence: In this condition the bladder muscle contracts without the brains directive. . Such a bladder is termed ‘overactive’. There are abnormal sudden rises in intravesical pressures which forces urine out.
Overflow incontinence: Women with this problem leak urine exactly like a woman with stress incontinence i.e. they leak on coughing or sneezing but they have a bladder which is full all the time and overflows. They have a weak bladder which has become incapable of emptying itself and which overflows much like a jug which is full to which more water is added. This condition is much less common and usually occurs in women with long standing diabetes or altered sensorium.
Treatment of incontinence
A clear understanding of the cause of urinary incontinence is essential to treatment. Urge incontinence requires medication to calm down the bladder. Anticholinergic agents with smooth muscle relaxant properties are used in treatment. Overflow incontinence is treated by giving the bladder a period of rest by passing a catheter.
Stress incontinence needs treatment of both the pelvic muscle weakness and at the defective water ‘seal’ mechanism. Pelvic muscle weakness can be improved by Kegel’s exercise. Extreame cases require surgical intervention. Surgery involves sling operations which elevates the bladder neck to improve pressure transmission to this area at the time of straining.Slings that are used can be synthetic tapes or autologous slings created by the patients own rectus fascia.v
Difficulty in controlling stools is not uncommon after delivery. This is especially likely to happen if the labor was difficult or if a perineal tear complication occurred. Fecal incontinence can be distressing and embarrassing for a woman. Most women can be treated by perineal surgery with reconstruction of the anal sphincter (the control muscle for stools).
In some women, the uterus descends which is termed as Prolapsed Uterus.
Symptoms include constipation, difficulty in passing urine or motions, stress incontinence Treatment: Surgery is the only option. Anterior colorrhaphy, posterior colprrhaphy, vaginal hysterectomy, sacrospinous fixation, colpocleisis.
Menopause is defined as the state of an absence of menstrual periods for 12 months. The menopausal transition starts with varying menstrual cycle length and ends with the final menstrual period. In this phase the function of the ovaries ceases (reproductive organs) Menopause is the time in a woman’s life when.
Women experience mental and physical health problems like Hot flashes, Mood swings, irregular vaginal bleeding, urinary tract infection, weight gain due to hormonal changes in the body. Some women can develop osteoporosis due to decrease in bone density, cardiac diseases etc.
Menopause is part of life and not a disease. Therefore, gynecologists generally prescribe conservative treatment methods like hormonal therapy like estrogen and progesterone and lifestyle changes.
Women with menopause have had good treatment experiences at Apollo Hospitals. Book an appointment today for a checkup with our Gynecologists
Painful Bladder Syndrome
Interstitial cystitis or Painful bladder syndrome is a pain associated with the bladder, pelvic pain, urinary frequency and vaginal pain or vaginismus in women.
Diagnosis involves urodynamics, imaging and cystoscopy with bladder distension and evaluation of bladder wall changes. A biopsy may also be taken from the bladder.
Treatment involves a combination approach of oral medication, hydrodistension of the bladder under anesthesia and periodic instillation of medication into the bladder. For patients who fail to respond to these therapies, botulinum toxin injections into the bladder or surgical treatment may be required.
Surgeries / Procedures
Hysteroscopy, Dilatation and Curettage (D and C)
Dilatation and curettage or D&C is a daycare procedure at Apollo Hospitals and patients can comfortably go home on the same day.
We use state of the art equipment a 3-chip Stryker camera, a large flat panel high definition medical monitor and endoscopes from Richard Wolf and Karl Storz. Procedure is done under short general anesthesia for maximum patient comfort.
Hysteroscopy and Hysteroscopic surgery
Hysteroscopy is the endoscopic visualization of the uterine cavity from within. In contrast to just a dilatation and curretage, the advantage of performing a hysteroscopy is that one can carry out the entire procedure under vision. This enables us to take directed biopsies from areas that look suspicious thus reduce the chances of missing a diagnosis.
We use state of the art equipment for such procedures with a 3-chip Stryker camera, a large flat panel high definition medical monitor and endoscopes from Richard Wolf and Karl Storz. Procedure is done under short general anesthesia for maximum patient comfort.
We are performing all forms of hysteroscopic surgery such as hysteroscopicseptal resection, removal of displaced intrauterine devices, hysteroscopic removal of polyps and removal of submucosal fibroids. Many of these are day-care procedures and patients can go home the same day post-surgery.
The gynecologists at Apollo hospitals , Hyderabad treat all Urogynecology problems including urinary incontinence, pelvic organ prolapse, pelvic pain, painful bladder syndrome (PBS-IC) urinary tract fistulae, urinary tract infection and dyspareunia (painful intercourse)..
For pelvic organ prolapse surgical anterior Colporrhaphy, posterior Colpoperineorrhaphy, vaginal hysterectomy.
Vault prolapse ( Extrusion of vagina after a hysterectomy) is corrected with surgery which is often done vaginally like sacrospinous fixation and colpocleisis. Abdominal scarocolpopexy is also offered.
Fecal incontinence can be treated by perineal surgery with reconstruction of the anal sphincter (the control muscle for stools).
For Stress incontinence placement of a synthetic tape by a minimally invasive approach either through the lower part of the abdomen (retropubic tapes such as TVT or Sparc) or from below (by a transobturator approach). Or an autologous rectus fascia sling fashioned out of the woman’s own tissues. This may be preferable in women with very poor urethral function or those with prior failed procedures with an unhealthy vagina.