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Cure With Care

Gynaecology

    Fibroids


    Uterine fibroids are non-cancerous (benign) tumours, commonly seen in women of childbearing age. Fibroids are composed of muscle cells and other tissues. They develop in and around the wall of the uterus or womb.


  • Treatment

    • Different methods are being used for managing uterine fibroids. Surgery is considered the best modality of treatment. The common surgeries performed for the management of fibroids include:

  • • Myomectomy or selective removal of the fibroids within the uterus

  • • Hysterectomy or removal of the uterus
    Non-surgical methods comprising of steroidal medication are also used to stabilize the oestrogen levels in the body.

    Menopause


    Every woman goes through several changes in the way her body functions, which marks different stages in her life. With puberty, starts the menstrual cycle, where certain hormones control the monthly release of the egg and preparation for pregnancy. The cessation of menstruation and the fertility of women is known as menopause, and occurs 6 months after your last menstrual period, when you are in your 40s or 50s. Some women can experience menopause before their 40s, and the condition is known as premature menopause


  • Symptoms

    • Menopause can be characterised by physical and emotional changes. Approaching the time of your menopause (perimenopause), you may experience irregular menses, dryness of the vagina, sagging of the breasts, dry skin, thinning hair, slow metabolism, weight gain, hot flushes, night sweats, problems with sleeping, and mood changes.


  • Treatment

    • Menopause itself needs no treatment, but treatment may be required to control its signs and symptoms. Your doctor will discuss the risks and benefits and may recommend any of the following, depending on your condition:


  • Hormone replacement therapy :

    • Your doctor may recommend treatment with hormones including oestrogen and/or progesterone for your hot flushes and bone loss. It may also help prevent cardiovascular problems if started within five years of menopause.


  • Vaginal oestrogen :

    • Small doses of oestrogen in the form of cream, pills, or rings can help you manage vaginal dryness, urinary symptoms and discomfort during intercourse.


  • Antidepressants :

    • Low-dose antidepressants can help you manage hot flushes when hormone replacement therapy is not advisable for you, and will also help improve your mood.


  • Medication treatment :

    • You may also be prescribed medications to reduce your bone loss and risk for fractures.

    Polycystic Ovarian Syndrome


    Polycystic ovarian syndrome (PCOS) is a common endocrinal disorder, as well as one of the common causes of infertility among women. It is characterised by an ovulation dysfunction to the normal growth and release of eggs from the ovaries. It is commonly seen in women of child bearing age. The hormonal imbalance results in enlarged ovaries containing several small cysts.


  • Treatment

    • The treatment of polycystic ovarian syndrome is based on the symptoms and individual concerns, such as infertility, irregular menstrual cycle, acne or obesity. Both medications and surgical treatment can be used for the management of PCOS.

    Infertility may be treated by fertility therapy with ovulation-inducing drugs. Clomiphene citrate, an oral anti-oestrogen, may be prescribed to patients. In some patients the doctor may add metformin to clomiphene, to help induce ovulation. In patients not responding to clomiphene and metformin, gonadotropins, namely, follicle-stimulating hormone (FSH) and luteinizing hormone (LH), can be administered by injection.

    Oral contraceptives may be prescribed for the management of irregular menstrual cycles. Oral contraceptives effectively reduce the level of the male hormone and are also effective in reducing excessive body hair growth and also minimise the risks of uterine cancer. Lifestyle modifications and anti-diabetic medications may be prescribed for the management or prevention of obesity and diabetes mellitus.

    Surgery may be recommended in patients who do not respond to medications. Laparoscopic ovarian drilling, an inpatient surgical procedure, may be used to treat the condition and induce ovulation.

    Abnormal Pap Smear & Cervical Dysplasia


    A Pap smear or Pap test is conducted as part of a woman’s routine health examination, after the age of 21 years. It is not a diagnostic test, but is a screening tool used to detect any abnormal cells in the cervix. The cervix is the lower part of the uterus that opens into the vagina.

    Pap smears help in the early detection of any serious medical conditions, such as cervical cancer. An abnormal Pap smear may indicate the presence of infection or abnormal cells called dysplasia. Cervical dysplasia is abnormal cell growth on the surface of the cervix. An abnormal Pap smear may not necessarily indicate cancer. These results highlight the requirement of further testing to identify and confirm an underlying problem.

  • Treatment

    • Following an abnormal Pap smear, the next step is further testing to confirm the cause of the abnormal cells. A repeat Pap smear or test for human papilloma virus (HPV), a major risk factor for cervical cancer, may also be recommended. Depending on the age of the patient and the type of abnormal cells, the doctor may recommend the following treatment options:


  • • Cryosurgery/Cauterization

  • • Cone biopsy or LEEP procedure:

    • In this procedure, a small segment of cervical tissue including abnormal cells is removed by specially designed instruments for evaluation.

    Post-menopausal bleeding


    Bleeding after menopause, also known as post-menopausal bleeding (PMB), is a condition characterised by vaginal bleeding after 12 months of menopause.

    In most cases, PMB is harmless, but sometimes it may be secondary to an underlying medical disorder. Therefore, bleeding after menopause should be carefully investigated.

  • Causes

    • The common causes of post-menopausal bleeding include:


  • • Thinning of the tissues lining the uterus (endometrial atrophy) or vagina (vaginal atrophy)

  • • Cervical and endometrial polyps

  • • Infection and inflammation of the uterine lining (endometritis)

  • • Endometrial hyperplasia (thickening)

  • • Medications such as hormone replacement therapy

  • • Cancer of the uterus, including endometrial cancer and uterine sarcoma

  • • Cancer of the cervix or vagina

  • • Non-gynaecological causes, such as pelvic trauma or bleeding disorder

  • • Bleeding from the urinary tract or rectum


  • Determining the cause of postmenopausal bleeding

    • The common causes of post-menopausal bleeding include:


  • • Transvaginal ultrasound: A specially designed imaging device is inserted through the vagina to view the pelvic organs and to identify any abnormalities.

  • • Endometrial biopsy: This procedure involves insertion of a thin tube inside the uterus for withdrawing the samples of uterine lining, for laboratory analysis.

  • • Hysteroscopy: This procedure involves examination of the uterus through an instrument with a small camera and a light source.

  • • D&C (dilation and curettage): This procedure involves removal of tissues from the uterine lining, which are sent for laboratory analysis.


  • Treatment

    • Treatment of the PMB depends on the underlying cause of bleeding.


  • • Polyps: They are surgically removed

  • • Endometrial atrophy: Treated with medications

  • • Endometrial hyperplasia: Treated with medications and/or thickened areas of the endometrium are surgically removed.

  • • Endometrial cancer: Treatment involves total hysterectomy i.e. surgical removal of the uterus, cervix and ovaries. In some cases, nearby lymph nodes, and part of the vagina may also be removed.


    • The treatment of advanced endometrial cancer may include hormone therapy, chemotherapy, and radiation therapy. Early detection and treatment of the cancer can result in full recovery.

    Uterovaginal Prolapse


    A prolapse is a medical condition where an organ or tissue falls down or slips from its normal position. A pelvic organ prolapse is a condition that occurs when the structures, such as the uterus, rectum, bladder, urethra, small bowel, or the vagina itself, falls out from their normal position.

    Utero-vaginal prolapse is a downward movement of the uterus and/or vagina. The main cause of the prolapse is weakness in the supporting tissues of the uterus and vagina. The common factors, such as frequent lifting of heavy objects, chronic cough, severe constipation, menopause, childbirth, and pregnancy may increase your risk of developing a utero-vaginal prolapse.

  • Treatment

    • If the symptoms are mild, non-surgical treatment options, such as medications, pelvic floor exercises, vaginal pessary (a device that is inserted into the vagina to support the pelvic floor), oestrogen containing vaginal cream, and lifestyle changes, may be helpful.

    Surgery can be considered in patients with severe symptoms of utero-vaginal prolapse. There are different types of procedures to address the prolapse, such as hysterectomy (removal of the uterus), hitching up the bladder or vagina, or repair and ‘tightening’ of the vagina.



  • Prevention

    • Although utero-vaginal prolapse is not always preventable, there are certain measures that can be taken to help reduce the risk of developing utero-vaginal prolapse or prevent it from getting worse. These include:



  • • Perform Kegel exercises to strengthen your pelvic floor muscles, especially during pregnancy and after childbirth

  • • Do not bear down when giving birth until your cervix is completely dilated

  • • Take hormone replacement therapy after the menopause

  • • Avoid constipation and straining with bowel movements, after delivery

  • • Avoid heavy lifting, prolonged standing, and chronic coughing

  • • Perform pelvic floor exercises on a regular basis

    Contraception


    Contraception, also known as birth control practice, is prevention of pregnancy by interfering with the whole process of conception and implantation. In the current scenario, numerous methods of contraception are in practice and include barrier or hormonal method, withdrawal, natural family planning, abstinence, and sterilisation (surgery). Some of these methods are confined for women and others for men and some of the methods are reversible and some are permanent methods.

    Menorrhagia


    Menorrhagia is a condition characterised by abnormally heavy or prolonged menstrual bleeding, which may be disruptive to your normal activities. Treatment options will depend on the cause of menorrhagia, the severity of menorrhagia and the overall health of the patient. Some common treatments include:


  • • Iron supplements may be started if your iron levels are low.

  • • Non-steroidal anti-inflammatory drugs (NSAIDs) may help reduce menstrual blood flow as well as cramping.

  • • Oral contraceptives may be given to help reduce bleeding and make menstrual cycles more regular.

  • • Oral progesterone may be given to help correct hormonal imbalance and reduce menorrhagia.

  • • Mirena, a type of intrauterine device which releases progesterone in the womb that thins the uterine lining and reduces the blood flow may be used.

    • Surgery may be needed if medication therapy is not successful. The surgical procedures include :

  • • Endometrial ablation: Is a procedure that permanently destroys the entire lining of your uterus (endometrium) resulting in little or no menstrual flow.

  • • Dilation and curettage (D&C): Is a procedure in which the cervix is dilated and the lining of the uterus is scraped to reduce menstrual bleeding. You may need additional D&C procedures if menorrhagia recurs.

  • • Hysteroscopy: This procedure involves the use of a telescope to view your uterine cavity and to remove abnormalities, such as a polyp, that may be causing heavy menstrual bleeding.

  • • Endometrial Resection: Is a surgical procedure that uses an electrosurgical wire loop to remove the lining of the uterus.

  • • Hysterectomy: Is surgical removal of the uterus.

    • Surgical procedures should generally be deferred until your family is complete. Therefore, discuss with your doctor about the treatment options if you plan to become pregnant in the future.

    Endometriosis


    Endometriosis is a common gynaecological problem affecting women of reproductive age. It occurs when the tissues of the uterus start growing on surfaces of other organs in the pelvis. Endometrium may grow on ovaries, fallopian tubes, outer surface of uterus, pelvic cavity lining, vagina, cervix, vulva, bladder or rectum.

    Patients may experience painful cramps in the lower abdomen, back or in the pelvis during menstruation, heavy menstrual bleeding, painful bowel movements or urination and infertility.

    There are several treatment options available to minimise the pain, as well as control heavy bleeding.


  • Pain Medication

    • Over the counter pain relievers may be helpful for mild pain. Non-steroidal anti-inflammatory medications will be prescribed by your doctor in cases of severe pain.



  • Hormone Treatment

    • Hormone treatment is recommended if there is a small growth and mild pain.



  • Surgery

    • Surgery is an option for women having multiple lesions, severe pain, or fertility problems.

  • • Laparoscopy: During this surgery, lesions and scar tissue are removed or burnt. This is a minimally invasive technique and does not harm the healthy tissue around the lesion.

  • • Laparotomy or major abdominal surgery: This involves a larger cut in the abdomen which allows the doctor to reach and remove the endometrial lesion.

  • • Hysterectomy: It is a surgery that involves removal of the uterus. This procedure is done when there is severe damage to the uterus and only if the patient has completed her family.

    Pelvic Inflammatory Disease


    Pelvic inflammatory disease (PID) is characterised by infection of the female reproductive organs, such as the uterus, fallopian tubes, and ovaries. It is mostly acquired through unsafe sexual practices and is one of the most serious consequences of sexually transmitted diseases (STD). PID can cause permanent damage to the female reproductive system, and is one of the leading causes of infertility.

    Infertility


    The inability of women to conceive after a year of having unprotected sex either primarily or secondarily, i.e. after previous pregnancies.


  • When to get help?

    • You may have reason to be concerned if you have been trying to get pregnant for at least one year and:


  • • You are in your late 30s and have been trying to get pregnant for six months or longer

  • • Your menstrual cycles are either irregular or absent

  • • You have painful periods and pain at intercourse

  • • You have a known history of fertility problems

  • • You have a history of pelvic inflammatory disease or endometriosis

  • • You have had multiple miscarriages

  • • You have been treated for cancer with drugs and radiation


  • What are the causes?

    • Some of the causes may include:


  • • Problems with ovulation: Certain conditions, like polycystic ovarian syndrome (ovaries secrete excessive amounts of male hormone testosterone) and hyperprolactinemia (produce high amounts of prolactin, a hormone that induces the production of breast milk), can prevent your ovaries from releasing eggs.

  • • Damaged fallopian tubes: Fallopian tubes carry the eggs from the ovaries to the uterus. Any damage to them can affect the fertilization of the egg by the sperm. Pelvic surgeries and infections can cause formation of scar tissue that can damage your fallopian tubes.

  • • Abnormalities of the cervix and uterus: Abnormal mucus production in the cervix, problems with the cervical opening, abnormal shape and presence of benign growths in the uterus can all contribute to infertility.

  • • Premature menopause: Mostly caused by a condition known as primary ovarian insufficiency, premature menopause occurs when menstruation stops before the age of 40. The exact cause of this condition is unknown, though various treatments for cancer and abnormalities with the immune system have been known to contribute to it.

  • • Adhesions: Bands of scar tissue can form in the pelvis after an infection or surgery.

  • • Other medical conditions: Diabetes, endometriosis, thyroid disorders, sickle cell disease or kidney diseases can affect the fertility of a woman.

  • • Medications: Certain medications have been known to cause temporary infertility. Stoppage of those medications can restore fertility in most of the cases.


    • Your fertility decreases with age. You are at a greater risk if you smoke, consume excess alcohol, or are overweight, obese, or underweight.


  • Diagnosis

    • Female infertility can be confirmed with the following tests:



  • • Blood tests measure your hormone levels and determine if you are ovulating.

  • • Biopsies may be obtained to evaluate the inner lining of your uterus.

  • • Ovarian reserve testing may be performed in order to determine the number and quality of eggs ready for ovulation.

  • • Imaging studies such as a pelvic ultrasound or hysterosonography may be performed to obtain a detailed view of your fallopian tubes and uterus.

  • • Hysterosalpingography involves obtaining an x-ray image after injecting a contrast material into your cervix which travels up to your fallopian tubes. This can help identify any blockages in your fallopian tubes.

  • • Laparoscopic evaluation involves inserting a thin tube fitted with a camera through an incision in your abdomen, in order to detect any abnormalities in your reproductive organs, such as the ovaries, uterus, and fallopian tubes.


  • How is infertility treated?

    • Your doctor will suggest a treatment suitable for your problem. Fertility drugs may be recommended to stimulate and regulate ovulation, in women who are infertile due to ovarian disorders. You could also be chosen for assisted insemination, where your husband’s sperm is collected, concentrated, and placed directly into your uterus, when your ovary releases eggs to be fertilised. This procedure is also known as intrauterine insemination (IUI), and can be in tandem with your normal menstrual cycle or fertility drugs. Apart from these, problems with your uterus, such as intrauterine polyps or scar tissue, can be treated with surgery.

    In vitro fertilisation (IVF) is a type of assisted reproductive technique, which involves collecting multiple mature eggs from a woman and fertilising them with sperm outside the body, in the lab. Once fertilised, the embryos are implanted into the uterus within three to five days.

    Some of the other techniques used in IVF include intracytoplasmic sperm injection (a single healthy sperm cell is directly injected into a mature egg), assisted hatching (the outer covering of the embryo is removed to facilitate embryo implantation into the uterus), and using donor eggs or sperm. Gestational surrogates may also be considered for women for whom pregnancy poses high health risks, or for those who have a non-functional or absent uterus



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