Diseases and Treatments
Our Doctors

Department of Gynaecology

Overview

Gynaecology pertains to the female reproductive system and sexual health. This part of a woman’s body is subjected to change throughout her life. Hence, the need for trusted care is paramount.

World class surgeons and physicians, a highly trained support staff, state of the art infrastructure and cutting-edge technology – this is what defines the Department of Gynaecology at the Gleneagles Global Health City.

Our doctors are well versed in treating every gynaecological condition, from screening and surgery to cancer care and high-risk pregnancies. Our team has always produced excellent results and we are confident that we will continue to do so. We are dedicated towards making lives more comfortable, treatment processes as pain free as possible and recoveries quicker; it is our goal to aid in the overall improvement of women’s health.

Hand in hand with gynaecology is child care and we at Gleneagles Global Health City are well known for providing superior quality care for the mother and her new born. The mother and her child are both our responsibility and we will ensure that their trust in us is not misplaced.

Gynaecology Services

Primary Amenorrhea Clinic

Primary amenorrhea is when a girl does not get her menses by the age of 15 years but all other growth characteristics are normal. Girls around 13 years of age with absence of menses as well as other sexual growth characteristics are also said to have primary amenorrhea. Both conditions need complete examination to determine the cause and begin treatment. With treatment, the prognosis for this condition is good and menses will start.

MRKH Clinic

Mayer-Rokitansky-Küster-Hauser syndrome or MRKH in short is the underdevelopment of the female vagina and uterus. In some cases, the vagina and uterus might even be absent from birth. Women with MRKH have normal external genitalia; it is the internal genitalia that is not developed properly. Because of this, it often goes undetected initially. Only when a problem manifests (like failure in the onset of menses) is this condition diagnosed. Both surgical and non-surgical treatment options are available.

Comprehensive Well Women Master Health Check-Up

Prevention is always better than cure. Our master health check-up focuses on detecting dormant issues and addressing them before they become advanced. Women often tend to ignore their health and problems are left untreated until they become serious. Being proactive and undergoing a master health check-up will ensure early detection that will automatically translate to quick treatment and fast recovery. For conditions like cancer, early detection is vital as treatment is more effective when rendered in the starting stages of the disease.

Adolescent Clinic

Focusing on the adolescent age group, which is typically from the onset of puberty till adulthood, our adolescent clinic deals with all the problems encountered in this age bracket. Sometimes, for certain issues, treatment will be given in conjunction with other departments for all encompassing care. For example, eating disorders might require professional expertise from the nutrition and psychology department. Depending on the condition, we collaborate across departments to give our patients the best care.

Fibroid Clinic

Fibroids are fibrous tissue growths in the walls of the uterus. There may be more than one fibroid with variations in sizes as well. Fibroids usually do not develop into cancers. They might not exhibit symptoms and are usually discovered during pregnancy or during ultrasound. In some cases, fibroids might cause heavy periods, bleeding between periods and pain in the pelvic region. We treat fibroids successfully with medication and if necessary, surgery.

Menopausal Clinic

When your menstrual cycle comes to an end, typically at around 50 years of age in most women, that time period is referred to as menopause. While menopause itself requires no treatment, some women may need help with the symptoms that lead to menopause. Hot flashes, irregular periods, mood swings, night sweats, etc. are all experienced during peri (the onset of) menopause. Preventive treatment at this stage is very important and the doctor will suggest various blood tests and screening procedures depending on the patient’s unique condition and history. Vaginal bleeding after menopause definitely warrants a check-up.

Abnormal Uterine Bleeding Clinic

Any bleeding that falls under the below mentioned categories is called abnormal uterine bleeding. It includes:

Bleeding in between two periods
Periods that lasts much longer than usual
Periods that are very heavy

All these conditions need to be checked as they could be caused by various factors like fibroids, cancer, polyp, etc. Sometimes, it could even be early signs of pregnancy.

Female Sexual Dysfunction Clinic

Problems related to lack of interest in sex, pain during sex or any other issue that stresses you and damages your relationship with your partner can be treated at our female sexual dysfunction clinic. Causes may be hormonal changes or some major illness like cancer which can affect your sexual activity. Treatment might include options like hormone therapy along with changing your lifestyle for the better, counselling, etc.

PCOS Clinic

Polycystic Ovary Syndrome, PCOS in short, refers to the formation of follicles or cysts on the ovaries. Hormonal imbalance is thought to be a probable cause for this syndrome which is frequently found among many women of child bearing age. Manifesting as irregular and heavy periods, early treatment is of extreme importance as women suffering from PCOS are more prone to type 2 diabetes as well as heart diseases. Doctors also recommend healthy diet and exercise to promote weight loss among these women as it has a significant impact on PCOS.

Cosmetic Gynaecology

When the body undergoes various changes due to pregnancy and child birth, the vagina and labia might undergo changes in both functionality and appearance. Cosmetic gynaecology addresses these concerns with more and more women opting for it nowadays.

Uro-Gynaecology

Uro-gynaecologist typically treats the following conditions –

Incontinence issues
Problems with bowel movement
Urinary tract infections
Pelvic issues like pain
Heaviness of vagina and any other sensation felt in the vagina

We understand that it might be uncomfortable and embarrassing for women to come forth on issues like the above. But you can rest assured that at Gleneagles Global Hospital our medical team will do their best to ensure your comfort and treat your condition with sensitivity.

Precautions to Be Taken

Manage Stress

Everyone experiences stress. Women of today don many hats and the more responsibilities they take on, more is the stress they experience. Stress can manifest as headaches, fatigue, mood swings, anxiety and a host of other conditions. Ways to manage stress include making time for yourselves, indulging in activities you enjoy, eating healthy and if it all feels too much, never hesitating to seek professional help.

Get Regular Health Screening

Make time to get screening tests done. Lot of women delay screening tests as they feel normal. But the importance of regular screening cannot be emphasized enough. Conditions which commonly affect women like breast cancer, cervical cancer, etc. can be detected even before they manifest and treatment carried out when screening tests are done. Early treatment is key to recovery. We urge all women to undergo regular screening tests – we assure you that the benefits from these are too great to be ignored.

Vaginal Hygiene

Though a lot of women are embarrassed to talk about it or get information on it, vaginal hygiene is an important part of healthy living. Your doctor can guide you on this. What kind of soaps to use, how to maintain vaginal cleanliness, what to do when you have vaginal discharge and other pertinent issues will be discussed.

Listen to Your Signs

Women need to be aware of the changes their body is undergoing. An important factor here is to make yourself aware of factual information. You can of course read up on this from various sources but speaking to your doctor and getting expert advice would be best. Being aware will help you take charge of your health and seek medical attention as soon as a condition crops up.

Why Choose Us?

Patient Experience

Patients arrive at our premises worried and unsure. We understand this. Our entire staff are well educated on handling patients’ comfort and needs. We encourage easy communication between patients and doctors. You will never find your doubts or questions brushed aside; our staff will handle every patient’s concern with empathy and care. We also maintain strict patient confidentiality and you can rest assured that your information is safe with us. Your well-being is and will always remain our priority.

Latest Technologies

Medical technology is constantly evolving and we make it a point to stay up-to-date with it. Our doctors and medical staff are ably supported by the best and the latest in technology. We spare no efforts in making sure that our patients have access to the finest in both skill and infrastructure.

Providing Quality Care

As soon as you step into our premises, you will be met with quality care from all quarters. You will notice our commitment to excellence in not just our doctors’ superb skill set but also in our nurses’ deportment and our non-medical support staff’s adherence to hygiene and safety protocols. At Gleneagles Global Hospital, we provide the best in all aspects of healthcare to take care of you.

Procedures

Laparoscopic surgeries

Laparoscopic surgeries are all keyhole surgeries that are minimally invasive with quick recovery time. The tube which is provided with a camera and inserted into the body via incisions, is called a laparoscope.

Laparoscopic Ovarian Cystectomy

A keyhole surgery for removing cysts in the ovaries, it involves minimum incisions typically made in the lower part of the abdomen. Cysts are quite common and when they do not cause any pain or discomfort, they remain undetected. When pelvic pain manifests as a result of ovarian cysts, then surgery to remove the cysts may become a necessity.

Performed under anesthesia, small cuts will be made on the abdomen to insert a laparoscope. Small surgical instruments will also be inserted through the cuts to remove the cysts. Once removed, the cuts will be closed with stitches and covered by a bandage for protection. It is important to keep the surgical area dry. Patients are advised to get as much rest as possible for a week after surgery as they might feel tired. Pain after surgery is expected and normal and may be controlled by medication.

Diagnostic Laparoscopy and Hysteroscopy for Dye Test

Primarily done to diagnose infertility issues, this procedure focuses on ruling out any blockages in the fallopian tubes. Performed as a keyhole surgery with very few small incisions, it involves injecting a dye to check for obstructions in the fallopian tubes. Under anesthesia, an incision is made near the navel for inserting a laparoscope. Another incision is made in the lower abdomen for inserting instruments when treatment is possible at the same time as diagnosis. Other conditions like cysts, endometriosis, pelvic infections, etc. can also be diagnosed through this method. Patients can often go home on the same day but sometimes a night’s hospitalization may be needed. Usually, daily activities can be resumed 3 days after the procedure.

Laparoscopic Sterilization

A minimally invasive method of birth control, the procedure involves either blocking the fallopian tubes or removing them completely. Performed laparoscopically, an incision made near the naval allows insertion of the laparoscope. Another incision made lower down on the abdomen allows for the insertion of instruments to block or remove the fallopian tubes. Blocking is done either by means of electrocoagulation or by means of a clip or band placed on the fallopian tube that act as an obstruction. In the case of fallopian tube removal, the process cannot be reversed so women are advised to be absolutely sure before undergoing the procedure. Typically, no hospitalization is needed and normal activities can be resumed after 3 days.

Laparoscopic Myomectomy

This procedure is performed to remove fibroids from the uterus. Done through small incisions through which a laparoscope and other instruments for removing the fibroids are inserted, women who want to remove fibroids but retain their uterus opt for this procedure. Usually, fibroids are left untreated and just observed when they do not cause any problems. But if they interfere with pregnancy, cause heavy bleeding or pelvic pain then they can be removed. The procedure is performed under anesthesia and typically requires hospitalization of one day. Complete recovery may take around 3 weeks.

Total Laparoscopic Hysterectomy

This is a safe procedure for the removal of the uterus and cervix. Done through small incisions on the abdomen area, the advantages of removing the uterus through laparoscopy include lesser post-operative pain and faster recovery. Performed under general anaesthesia, incisions made on the stomach allow for the insertion of a laparoscope and other instruments to remove the uterus. The uterus is cut and removed through the vagina. Women are advised to avoid heavy lifting and strenuous work while recovering.

Laparoscopic Management for Ectopic Pregnancy

Ectopic pregnancy is also known as tubal pregnancy. This is because the fertilized egg stays in the fallopian tube instead of moving to the uterus. As eggs cannot survive in the fallopian tubes, the pregnancy will have to be terminated. Damaged fallopian tubes are thought to be a probable cause for this condition. Symptoms of an ectopic pregnancy include bleeding and pain in the pelvic area. Sometimes, when detected in the early stages, medication might be sufficient to treat the condition. Other times, surgery will be required. Surgery can be done through laparoscopy and is of two kinds: saplingostomy and salpingectomy. In saplingostomy, the pregnancy alone is removed while in salpingectomy, the pregnancy and the fallopian tube both are removed. The procedure opted for will depend on the patient’s condition. Both procedures done laparoscopically with few small sized incisions are minimally invasive. However, in case of emergency, laparoscopic management will not be possible and the surgeon will have to do an open surgery.

Hysteroscopic surgeries

Hysteroscope is an instrument used for both diagnostic and treatment purposes. It is a long tube with a camera at the end which is inserted through the vagina.

Hysteroscopic Polypectomy

A polyp is a growth on the wall of the uterus. They are usually non-cancerous in nature. A hysteroscopic polypectomy is a procedure by which the polyp alone is removed and the uterus is left intact. A Hysteroscope is used for examining the uterus. Small sized polyps can be removed with the scope itself. Surgery will be done under anaesthesia and one day’s hospitalization may be necessary. After surgery, bleeding is expected and will last for around a week. Pain after surgery is also normal and your doctor may manage it with pain killers. Normal activities can be resumed in a day or two.

Hysteroscopic Myomectomy

Submucous fibroids are growths that are not cancerous in nature found in the walls of the uterus or endometrium. These growths can cause a lot of bleeding. Hysteroscopic myomectomy is a procedure to remove these fibroids without making any incisions on the abdomen. The uterus is not removed and hence this procedure is a great option for women who plan on having children. Before the advent of hysteroscopy and laparoscopy, this procedure was carried out as an open surgery. Now it is greatly simplified and carried out as an outpatient procedure not requiring hospitalization. During surgery, the surgeon will insert a hysteroscope, into the vagina. This will allow examination of the uterus for fibroids. The patient can resume normal activities in 2 days.

Hysteroscopic Septal Resection

A septate uterus is one that appears normal externally but internally it is divided into two. Women with septate uterus might be able to conceive but after conception, as the space within the uterus is limited, the pregnancy might abort. This hysteroscopic septal resection is a procedure done under anaesthesia to rectify this defect in the uterus. During the procedure, the surgeon will insert a hysteroscope through the vagina. Sometimes, the uterus will be filled with a fluid to expand it for better visualization. Loop electrical excision will be used to remove the septum in the uterus. The surgery does not involve any incisions. Hence, there is no blood loss and recovery is also quicker.

Pap Smear

An important tool for cervical cancer screening, a Pap smear or Pap test involves examining the cells from the lower end of the uterus (cervix) to detect cervical cancer. A pap smear also helps in detecting changes that might lead to cervical cancer in the future. Early treatment is very important for successful treatment and hence undergoing a pap smear is very important for women in the age group of 21-65 years. The procedure is usually completed in a matter of minutes and is not painful. During the procedure, the patient will be required to lie down with legs bent at the knees. A speculum will be inserted to widen the vagina. Cervical cell samples will be taken with a soft brush and a spatula. These samples will be sent to the laboratory for testing. The patient can resume normal activities immediately. Many women shy away from undergoing a pap smear because they fear it will be painful. But pap smears are very important to detect the beginning of cervical cancer. Women are advised to talk to their gynaecologists about when and how often they need to undergo this test.

Colposcopy

If the results of a pap smear are not normal, the doctor might want to do a colposcopy for a more in-depth examination of the cervix, vagina and vulva. The instrument used for this purpose is called a colposcope. Changes that point to possible cancers of vagina, vulva or cervix can be detected with a colposcopy. Before the procedure, the use of tampons and vaginal medication should be avoided. The procedure cannot be done during menses (periods). Vaginal intercourse should also be avoided prior to the procedure. The patient can talk to the doctor and find out if any painkillers are necessary.

During the procedure, the patient will be made to lie down with knees bent. A speculum will be used to open the vagina. The doctor will use a colposcope (which will give a magnified view) near the vulva to check the vagina and the cervix. If any abnormalities are detected, a biopsy will be taken immediately. If the doctor feels the biopsy will cause pain or discomfort, a local anaesthetic will be applied. After biopsy, it is normal to feel slight pain and experience light bleeding. The doctor will advise the patient on management. The results of the biopsy will help in further treatment.

Many patients experience a lot of anxiety before a colposcopy. Music, meditation and yoga will help in controlling it. Talking to the doctor, knowing what to expect and being aware will also help control anxiety.

Hysterectomy

Open Hysterectomy

An open hysterectomy involves incisions on the abdomen to remove the uterus and cervix. When the uterus and cervix are both removed, it is called total hysterectomy. Sometimes, the ovaries and fallopian tubes might also be removed. The exact procedure will depend on the patient’s condition. The size of the incision made on the abdomen varies from 10-15 cms. A hysterectomy is done in the following cases:

Cancer in the uterus or other related organs
Fibroids which cause a lot of discomfort
Abnormal and excessive vaginal bleeding
Long term pain in the pelvis
Endometriosis
Prolapse of the uterus

The doctor will guide the patient on pre-operative procedures. The surgery itself will last 1-2 hours and will be performed under general anaesthesia. Hospitalization of 1-2 days will be needed.

Laparoscopic

Here, the removal of the uterus and related organs is done through very small incisions. Advantages over an open hysterectomy include smaller cuts, faster healing and less post-operative pain. The surgeon will be the best person to determine which type of hysterectomy will suit the patient best.

During a laparoscopic hysterectomy, a few small sized incisions are made in the abdomen. Through the incisions, a laparoscope (a tube with a light and camera) and other instruments are inserted to remove the uterus. The surgeon views the output of the laparoscope on a monitor and is guided by it during surgery. As it is minimally invasive, this mode is preferred by surgeons when it is feasible.

Vaginal

As the name implies, in this procedure, the uterus is removed through the vagina. This overcomes the need for abdominal incisions. Reduced hospitalization time and cost along with quick recovery are the advantages of this procedure. However, not all women are candidates for this procedure and some may have conditions that may require an open hysterectomy.

During the procedure, the patient will be made to lie down with knees bent. A catheter may be used to empty the bladder. The surgical site will first be cleaned. An incision will be made on the vagina to access the uterus. Instruments will be inserted to clip the uterus and remove it. In some cases, the uterus may be cut into pieces and then removed. After removing the uterus, the incision will be stitched. These stitches will be absorbed with the course of time and will not need separate removal. Two days of hospitalization is usually needed. Pain is expected and medication to deal with the same will be given. Recovery will take 3-4 weeks. The patient will need help at home and should avoid carrying heavy objects.

Diseases and Treatments

Amenorrhea

Amenorrhea Overview

Amenorrhea refers to the absence of menstrual cycle. It can be classified as primary and secondary. In primary amenorrhea, girls do not start menses till 15 years of age. Secondary amenorrhea is the absence of menses (by 3 cycles) in women who have had periods previously.

Causes and Risk Factors for Amenorrhea

Causes and Risk Factors of secondary amenorrhea

Birth control pills may lead to amenorrhea. Sometimes, even after stopping the pills, periods may not resume.
Medication used to treat cancer, blood pressure, depression and sometimes allergy can cause amenorrhea.
Polycystic ovarian syndrome often causes amenorrhea.
Growth in the pituitary, hyperthyroidism and hypothyroidism can all lead to amenorrhea.
Women who have a family history of amenorrhea are more prone to it.
High intensity exercise with lack of nutritious food can also cause it.

Complications for Amenorrhea

Inability to conceive
Miscarriage after conception
Mental stress

Diagnosis for Amenorrhea

Diagnosis includes a pelvic exam and tests to check on other normal developmental changes. The tests prescribed may include hormonal tests, pregnancy test, thyroid function and ovary function test. After getting the results of these tests, an ultrasound or MRI may be needed.

Surgery for Amenorrhea

Hormonal disorders and thyroid issues can be treated with medicines. However, a tumour may necessitate surgery.

Prevention for Amenorrhea

Following a healthy lifestyle
Eating nutritious food
Exercising
Stress reduction
Keeping track of periods and noting any irregularity

Atrophic Vaginitis

Atrophic Vaginitis Overview

A condition that mostly affects women after menopause, atrophic vaginitis causes the vagina walls to thin. Because of this, the possibility of vaginal and urinary infections increases. Women with this condition also experience pain during sexual intercourse.

Often women are embarrassed about discussing these problems and choose to remain silent. Having a frank discussion with the doctor will not only help treat the problem the right way, it will also relieve them of mental stress.

Signs and Symptoms for Atrophic Vaginitis

Pain in the vagina
Burning sensation in the vagina
Burning sensation while passing urine
Urine leakage
Urinary tract infection

Causes and Risk Factors for Atrophic Vaginitis

Decrease in estrogen is the main cause as this results in the vaginal walls becoming thin. When the walls thin, they are more susceptible to injury and infection.
Other than post-menopausal women, women who are breastfeeding and those undergoing cancer treatment may also have reduced levels of estrogen.
Smoking inhibits circulation of blood. As a result, the vagina does not get enough oxygen and the tissues become thin.
Not being sexually active can also lead to atrophic vaginitis.

Complications for Atrophic Vaginitis

More susceptibility to vaginal infections
Increased urination
Burning sensation while passing urine
Increased urinary tract infections
Incontinence

Diagnosis for Atrophic Vaginitis

Diagnosis will be done with the help of:

Detailed past medical history
Physical examination
Blood test
Urine analysis
Vaginal smear and acidity test

Surgery for Atrophic Vaginitis

Treatment options are non-surgical.

Lubricants to deal with dryness of vagina
Estrogen therapy
Applying moisturizers (that are meant for the vagina)
Stretching the muscles of the vagina using dilators

Prevention for Atrophic Vaginitis

Wearing comfortable underwear, preferably in cotton
Staying sexually active improves blood flow and keeps tissues healthy

Bacterial Vaginosis

Bacterial Vaginosis Overview

This condition is caused by an imbalance of vaginal bacteria. It does not lead to any other health issues but it may hinder pregnancy.

Signs and Symptoms for Bacterial Vaginosis

Many women remain asymptomatic. When symptoms do manifest, they may take the following forms:

Vaginal discharge that may be white, grey or green. The discharge itself will be thin.
Itching in the vagina
Fishy odour from the vagina
Burning sensation while passing urine

Causes and Risk Factors for Bacterial Vaginosis

The vaginal environment is slightly acidic, so normally bacteria will not grow. This acidity is due to the presence of a bacteria called lactobacillus and when this lactobacillus level drops, bad bacteria may enter the vagina causing bacterial vaginosis.

Risk factors include:

Douching the vagina
Smoking
Being sexually active
Having multiple partners for sex – homosexual women are more at risk
Using IUD (intra uterine birth control device)

Complications for Bacterial Vaginosis

Increased risk of pelvic inflammatory disease
Trouble with pregnancy
If pregnancy does proceed, chance of the new born having low birth weight is increased
Higher risk of contracting sexually transmitted diseases

Diagnosis for Bacterial Vaginosis

Diagnosis involves the following:

A complete physical examination
Medical history
Test to check vaginal acidity
Analysis of vaginal discharge to check for presence of bad bacteria

Surgery/Treatment for Bacterial Vaginosis

Antibiotics in the form of tablets, cream or gel
Finishing the whole course of antibiotics even if the condition seems to have resolved

Prevention for Bacterial Vaginosis

Avoiding douching
Not having many sexual partners
Using a condom during sexual activity
Avoiding scented soaps, vaginal deodorants
Wiping the vagina from the front towards the back

Cervical Cancer

Cervical Cancer Overview

The lower portion of the uterus that is connected to the vagina is called the cervix. When cancer affects this part, it is termed cervical cancer. The human papilloma virus, HPV in short, is a major cause of cervical cancer. Normally the defence mechanism of the body will protect the body from HPV, but in some cases, HPV causes the cells of the cervix to change into cancer cells.

Signs and Symptoms for Cervical Cancer

Symptomless when it begins, advanced cases might manifest the following symptoms:

Pain during sexual intercourse
Blood after intercourse
Blood from the vagina in-between periods/after menopause
Vaginal discharge that has blood and a bad odour

Causes and Risk Factors for Cervical Cancer

HPV is in most cases responsible for cervical cancer
Bad lifestyle choices play a role as well
Having many sexual partners
Becoming sexually active very early
Having other sexually transmitted diseases
A weak immune mechanism
Smoking plays a huge role

Complications for Cervical Cancer

Kidney failure
Formation of blood clots
Pain
Bleeding/discharge from the vagina

Diagnosis for Cervical Cancer

The doctor will conduct a cervical examination with a colposcope and may take samples for further analysis.
If cancer is confirmed, the stage the cancer is at will have to be determined. For this, x-ray, CT scan, MRI and PET scan may be needed.

Surgery for Cervical Cancer

When the cancer is in the beginning stages, surgery is recommended. Surgical options include removing the affected portion of the cervix, total removal of the cervix or removing the uterus and the cervix. The extent of spread will decide which surgery is best.

Other treatment options include chemotherapy, radiation, immunotherapy and palliative care.

Prevention for Cervical Cancer

HPV vaccines are available. Patients can discuss with their doctors and get vaccinated.
Undergoing regular screening tests like pap smear.
Practicing safe sex.
Not smoking

Early Menopause

Early Menopause Overview

Menopause refers to the end of the menstrual cycle. This usually occurs in women aged 45 -55 years. If women less than 45 years of age undergo menopause, it is called early menopause.

When the production of eggs by the ovaries stops, there is a fall in the hormone estrogen. This estrogen is responsible for the female reproductive cycle. A fall in estrogen leads to menopause. Additionally, when the ovaries are removed (for other medical conditions like cancer) it can lead to menopause.

Signs and Symptoms for Early Menopause

Irregular periods
Periods lasting longer or shorter than usual
Spotting between periods
Increased bleeding during periods
Moodiness
Lack of sleep
Sweating at night
Dryness in vagina
Hot flashes
Incontinence

Causes and Risk Factors for Early Menopause

Smoking
Bad lifestyle habits – lack of exercise, nutritious food and sun exposure
Autoimmune diseases like rheumatoid arthritis
Epilepsy
Turner’s syndrome
Genetic predisposition – if the mother attained early menopause, chances of daughter attaining early menopause is greater

Complications for Early Menopause

Loss of estrogen very early does increase a patient’s risk of heart disease, osteoporosis, dementia and premature death.

Diagnosis: Menopause doesn’t usually require any diagnostic tests. But if early menopause is suspected, the doctor may suggest some hormonal tests for diagnosis.

Surgery/Treatment for Early Menopause

There are no surgical interventions for early menopause. The condition itself does not require any treatment either. However, if the symptoms are causing a lot of discomfort, then there are some treatment options that can be tried. The treatment will depend on the symptoms the patient is feeling and the doctor will guide the patient on this.

Prevention for Early Menopause

There are no known ways of preventing early menopause but the following have been shown to be effective:

Stopping smoking
Maintaining a healthy weight
Exercising regularly
Making the right food choices

Endometrial Cancer

Endometrial Cancer Overview

The lining of the uterus is called the endometrium. Cancer of this endometrium is called endometrial cancer, also sometimes known as uterine cancer. While other types of cancers in the uterus can also happen, endometrial cancer is more common.

Signs and Symptoms for Endometrial Cancer

Because this cancer causes bleeding in the vagina, it can be detected early. Signs include:

Bleeding after attaining menopause
Bleeding in between cycles of periods
Pain in the pelvic area

Causes and Risk Factors for Endometrial Cancer

Normally the cells in the body have a life cycle – they grow, multiply and die. However, cancer cells are cells that have mutated. They grow very fast and do not die. As a result, they form tumours. The exact cause for cells becoming cancer cells is not known. A few risk factors however, have been identified.

Any health condition that leads to hormonal imbalance
Early set in of menstrual cycle
Late menopause
Old age
Being overweight
Being treated with hormones for other conditions
Lynch syndrome

Complications for Endometrial Cancer

Endometrial cancer can cause anaemia. Anaemia will manifest as dizziness, fatigue, headache, pain in the chest, palpitations and breathlessness.

Diagnosis for Endometrial Cancer

Complete pelvic examination
Transvaginal ultrasound
Hysteroscopy to examine the uterus
Biopsy of endometrium
Dilation and curettage

Surgery/Treatment for Endometrial Cancer

Treatment depends on how far the cancer has progressed. To determine this, a chest x-ray, CT scan and PET scan may be done. The results will help the doctor classify the stage of cancer and begin appropriate treatment.

Surgical removal of uterus and associated organs – this will make pregnancy impossible. The doctor will discuss the implications of surgery in detail before deciding on it. During surgery, sometimes the lymph node may be removed for further testing to determine the cancer spread.
Chemotherapy – using chemicals to kill cancer cells
Radiation therapy – using radiation to kill cancer cells
Immunotherapy – boosting the body’s immune system to kill cancer cells
Palliative care for pain relief
Hormone therapy – to reduce the hormones the cancer cells rely on for growth

Prevention for Endometrial Cancer

Patients on hormone therapy can discuss alternative treatment options with their doctor. The pros and cons of hormone therapy need to be weighed.
Tablets for birth control are thought to possibly prevent endometrial cancer.
Maintaining ideal weight helps reduce endometrial cancer risk.

Female Infertility

Female Infertility Overview

Infertility is the inability to get pregnant even after a year of trying. If the woman is over 35 years of age, the duration is reduced from a year to 6 months.

Signs and Symptoms for Female Infertility

Irregular periods
Very long or very short interval between periods

Causes and Risk Factors for Female Infertility

Malformed uterus
Injury to fallopian tubes
Polyps and fibroids in the uterus
Problems with the cervical canal
Excess prolactin production by pituitary gland
Poly cystic ovarian syndrome – most common cause of infertility
Premature ovarian failure – ovaries stop producing eggs in women below 40 years
Hypothalamus not producing follicle stimulating hormone and luteinizing hormone in the right quantities
Endometriosis
Women over 30 years who produce fewer eggs
Smoking damages the cervix and fallopian tubes. It is also responsible for ectopic pregnancies and miscarriages.
Being obese or underweight both cause infertility
Having sexually transmitted diseases

Diagnosis for Female Infertility

Checking for the hormones produced before and after ovulation to make sure the ovulation process is happening
A hysterosalpingography to check for any blockage in the fallopian tubes
Biopsy of the endometrium
Testing the quality of eggs produced
A sonohysterogram which is more advanced than an ultrasound and helps in checking the uterus
Laparoscopy may be done to check the inside of the uterus for any abnormalities

Surgery/Treatment for Female Infertility

The treatment depends on the problem.

Fertility Medication – They work like natural hormones and help in starting ovulation. There are many medications available for this. However, fertility medicines have some risks which have to be discussed before starting.
Laparoscopy/Hysteroscopy – Once the abnormality is diagnosed, surgery can be carried out to fix it. This can range from correcting the shape of the uterus to removing polyps and fibroids.
Tubal surgeries to correct blocked fallopian tubes

Prevention for Female Infertility

Maintaining healthy weight. Exercise in moderation as high intensity exercises have been shown to decrease eggs production.
Quitting smoking. Smoking will also affect foetal development in pregnant women.
Stopping alcohol.
Reduction in caffeine intake.
Adopting ways to combat stress.
Undergoing infertility treatment is stressful. Do not hesitate to reach out for help. Talking to friends and family might help.Professional help is also always available to guide patients through what can be very difficult times.

Female Sexual Dysfunction

Female Sexual Dysfunction Overview

When women experience problems like pain during sex, absence of desire or orgasm or if they are unable to respond sexually, it is called female sexual dysfunction. It can affect all age groups. Lifestyle, environmental factors, past experiences, etc. all play a role.

Signs and Symptoms for Female Sexual Dysfunction

Lack of interest in sex
Unwillingness to enter into any sexual activity
Inability to feel any arousal
Not reaching orgasm
Pain during sex

Causes and Risk Factors for Female Sexual Dysfunction

Hormonal changes after giving birth or after menopause
Major diseases like cancer, Parkinson’s, etc.
Drugs to combat depression, hypertension drugs, chemotherapy, allergy medication, etc.
Reduction in estrogen levels
Mental disorders like anxiety
Chronic stress
Differences with partner

Complications for Female Sexual Dysfunction

Might cause relationship issues with partner
May affect women mentally

Diagnosis for Female Sexual Dysfunction

The doctor will take into account the patient’s medical history. The patient is encouraged to be honest with the doctor while answering questions.
A pelvic examination to rule out any physical changes that might be causing sexual dysfunction.
Blood tests to pinpoint other conditions which might indirectly lead to sexual dysfunction.

Treatment/Surgery for Female Sexual Dysfunction

Treatment depends on the cause of the issue.

Estrogen/androgen therapy
Medication to stimulate desire – side effects should be discussed beforehand
Open conversation with partner is encouraged
Vaginal lubricant can be tried
Stop drinking – alcohol has been shown to limit sexual response
Exercising is a known mood elevator
Adopt various stress reduction techniques
Counselling

Prevention for Female Sexual Dysfunction

Exercising regularly
Eating nutritious food
Quitting alcohol and smoking
Refraining from illegal/recreational drug consumption
If any prescription medication is suspected of causing dysfunction, alternatives can be discussed with the doctor.

Gonorrhoea

Gonorrhoea Overview

Gonorrhoea is a condition that affects both men and women. Caused by bacteria that is transmitted through sexual contact, the parts affected are urethra, rectum, throat and cervix (for women).

Signs and Symptoms for Gonorrhoea

Symptomless majority of the time, when they do manifest, the symptoms include the following.

In men:

Pain during urination
Discharge (pus) from the penis
Inflammation in testicle

In women:

Pain during urination
Pain in pelvic region
More than usual discharge from vagina
Bleeding in-between period cycles
Bleeding after sexual intercourse

Causes and Risk Factors for Gonorrhoea

Caused by the bacteria Neisseria gonorrhoeae, the most common cause of gonorrhoea is sexual transmission from one person to another.

Risk factors include:

Women below 25 years being sexually active
Homosexual contact between men
Having many partners for sex
History of gonorrhoea or other sexually transmitted disease

Complications for Gonorrhoea

Gonorrhoea can affect the uterus in women leading to infertility.
Gonorrhoea can cause inflammation in the testicles leading to infertility among men.
Patients with gonorrhoea are more susceptible to infection by HIV.
Babies born to mothers with gonorrhoea could be blind and have scalp infection.
Gonorrhoea can also spread to other parts causing fever, rashes, etc.

Diagnosis for Gonorrhoea

Urine test to check for the bacteria in urine sample
Swab to get sample cells of the affected part – throat, vagina, etc. The samples are then analysed in the laboratory to confirm gonorrhoea.

Surgery/Treatment for Gonorrhoea

Gonorrhoea in adults and babies (who have got it from their mothers) can be treated with antibiotics. It is essential that the person’s partner also be treated with antibiotics even if they are asymptomatic.

Prevention for Gonorrhoea

Having only one partner for sex
Using condom during sex
Undergoing regular screening when there is more than one sex partner

Menopause

Menopause Overview

Menopause is the natural termination of the menstrual cycle – when women do not get their periods for a year. Women between 45-55 years of age undergo menopause though a slight variation in the age bracket is normal.

Menopause between 40-45 years is called early menopause. While menopause is before 40, it is called premature menopause.

Signs and Symptoms of Menopause

Increasing duration between periods
Very long or very short periods
Hot flashes
Sweating at night
Headaches
Inability to sleep
Mental issues like depression, anxiety
Mood swings
Tenderness in breasts
Loss of hair
Pain in the joints
Increase in weight
Lack of interest in sex

Causes and Risk Factors of Menopause

Menopause is normal. As the production of the reproductive hormones in women’s bodies reduces with age, menopause results. However, in some cases menopause can be brought about by:

Removing the ovaries surgically
Chemotherapy and radiation therapy for cancer treatment

Complications of Menopause

Increase in weight
Increased risk of cardiovascular disease
Women are more prone to osteoporosis after menopause
Inability to contain urine (incontinence)

Diagnosis of Menopause

The symptoms are usually enough to diagnose menopause. But hormone tests are also available for diagnosis. They involve checking the level of the follicle stimulating hormone and estrogen. As hypothyroidism can also present symptoms similar to menopause, the thyroid stimulating hormone level can also be checked to rule out hypothyroidism.

Surgery of Menopause

There is no surgical treatment for menopause. However, the symptoms of menopause can be treated to provide some relief to the patient. The exact treatment depends on what the patient is experiencing and can involve one or more of the following:

Estrogen therapy
Vaginal estrogen (applied directly to vagina)
Anti-depressants in low doses
Vitamin D to prevent osteoporotic changes

Prevention of Menopause

There is no preventing menopause but making good lifestyle choices, eating nutritious food, exercising, practicing relaxation techniques and getting adequate sleep will make dealing with menopause easier.

Menorrhagia

Menorrhagia Overview

Very heavy blood flow during periods is called menorrhagia. Lots of women experience what they think is heavy blood flow, but in menorrhagia the blood flow is so heavy that even daily activities become difficult and there is a feeling of extreme tiredness.

Signs and Symptoms of Menorrhagia

Blood flow during periods requires frequent change of sanitary pad – one every hour for a number of hours together.
Requiring change of pad in the night
Use of two sanitary pads at a time to manage blood flow
Inability to carry on with routine activities
Anaemia, tiredness and breathlessness
Blood clots during periods are bigger than usual

Causes and Risk Factors of Menorrhagia

Hormonal imbalance due to various conditions like PCOS, thyroid dysfunction, obesity, etc.
Non-production of eggs by ovaries
Fibroids/polyps in uterus walls
Birth control devices like IUD
Uterine/cervical cancer
Other problems with endometrium like adenomyosis

Complications of Menorrhagia

The heavy bleeding may be accompanied by painful cramps in the abdomen
Patients may become anaemic due to loss of blood

Diagnosis of Menorrhagia

Detailed medical history of periods
Blood tests
Pap smear
Biopsy of endometrium
Ultrasound of abdomen
Hysteroscopy

Surgery of Menorrhagia

Initially the doctor will treat the condition with medicines – NSAIDs, birth control pills, etc. The medicine will depend on the patient’s unique condition.

Surgical procedures include:

laparoscopic myomectomy
Endometrial Ablation (using LASERs on the endometrium)
Endometrial Resection (instead of LASER, an electrosurgical wire loop is used to remove the endometrium)
Hysterectomy – removal of uterus and cervix

Prevention of Menorrhagia

Menorrhagia can be prevented by eating healthy food – especially food rich in iron and vitamins. Regular exercise also goes a long way toward prevention.

Menstrual Cramps

Menstrual Cramps Overview

This refers to the lower abdominal pain felt during periods. The pain varies from mild to severe and sometimes gets better with passing years. For many women, the pain stops after delivering the first baby.

Signs and Symptoms of Menstrual Cramps

Lower abdominal pain of varying intensity
Pain could also be felt in the thighs, hips and lower back
Pain could be accompanied by vomiting/diarrhoea

Causes and Risk Factors of Menstrual Cramps

Endometriosis – growth of endometrium outside the uterus
Adenomyosis – endometrium growing onto adjacent muscle
Pelvic Inflammatory Disease – a bacterial infection of uterus
Cervical stenosis – narrowing of cervix
Fibroids in uterus
Smoking
Genetic predisposition towards heavy periods

Complications of Menstrual Cramps

Though they are painful and can interfere with daily activities, they do not cause any complications.

Diagnosis of Menstrual Cramps

Ultrasound
CT scan
MRI
Laparoscopy

Surgery of Menstrual Cramps

Treatment is first started with medication – painkillers and birth control tablets.

If there is a condition causing cramps like fibroids, endometriosis, etc., the appropriate surgical procedure to treat that condition will be performed.

Prevention of Menstrual Cramps

Exercising regularly
Vitamin tablets
Practicing techniques to reduce stress

Ovarian Cancer

Ovarian Cancer Overview

Cancer of the ovaries is called ovarian cancer. Ovaries are present on either side of the uterus. They are responsible for the production of eggs and the hormones estrogen and progesterone. Cancer starting in the ovaries might spread to other parts of the uterus.

Signs and Symptoms for Ovarian Cancer

Early detection is crucial to contain the spread. Signs include:

Stomach feeling bloated
Hunger satisfied after eating less
Constipation
Loss of weight
Pelvic discomfort
Need to pass urine frequently

Causes and Risk Factors for Ovarian Cancer

The exact cause is not known but the following groups have a higher risk:

Women in the age group of 50-60
Genes BRCA 1 & 2 increase the risk of ovarian as well as breast cancer
History of ovarian cancer in the family
Starting menstrual cycle early and late menopause
Estrogen therapy given in high doses for long durations

Diagnosis for Ovarian Cancer

A pelvic examination to check the vagina and cervix
An ultrasound or CT scan
Blood test for tumour markers

Surgery for Ovarian Cancer

If the cancer is limited to one ovary, surgical removal of that ovary and fallopian tube will be done.
If the cancer has spread to other organs, removal of the uterus and associated organs will be needed. In such a case, it will not be possible to have children in the future.
If cancer has spread over the body, surgery might be followed by chemotherapy to control it.

Prevention for Ovarian Cancer

Birth control pills might help. They have side effects, so a thorough discussion with the doctor is necessary.
A family history of ovarian cancer may need genetic testing. If risk is very high, ovaries could be removed as a preventive measure.

Ovarian Cysts

Ovarian Cysts Overview

When fluid filled sacs develop on the surface of the ovary, they are called ovarian cysts. Mostly symptomless, many women do not realise they have cysts. If the cyst ruptures, then it could cause problems.

Signs and Symptoms for Ovarian Cysts

Stomach might have a bloated/full feeling
Pain in the abdomen on the side of the cyst

Causes and Risk Factors for Ovarian Cysts

Use of drug clomiphene that is used to trigger ovulation
Lining of uterus growing outside uterus – endometriosis
A pelvic infection that affects the ovaries
History of ovarian cysts

Complications for Ovarian Cysts

Cysts that develop after menopause could be malignant
Large cysts can move the ovary – this can be very painful
Rupture of cysts is also painful

Diagnosis for Ovarian Cysts

Pelvic examination
Ultrasound to diagnose the cyst, its location and whether it is solid or liquid filled
Laparoscopy done under anaesthesia to diagnose and remove cysts
A blood test called CA 125 to find out increased levels of protein of the same name

Surgery for Ovarian Cysts

If the cyst is large and increasing in size, surgery will be recommended.

Surgery to remove only cyst
Surgery to remove cyst along with the ovary
If cancer is confirmed, removal of uterus and associated organs might also be suggested.

The surgery done depends on the patient’s condition.

Prevention for Ovarian Cysts

Regular pelvic examinations aid in early diagnosis and treatment.

Pelvic Inflammatory Disease

Pelvic Inflammatory Disease Overview

A disease caused by sexually transmitted bacteria that affects the uterus and other female reproductive organs , it may not produce any symptoms and may be diagnosed only when there is an inability to get pregnant or when long term pelvic pain develops.

Signs and Symptoms of Pelvic Inflammatory Disease

Pelvic and abdominal pain
More than usual vaginal discharge that has a bad odour
Bleeding after sexual intercourse
Irregular bleeding (in-between periods)
Intercourse is painful
Fever
Difficulty in passing urine

Causes and Risk Factors of Pelvic Inflammatory Disease

Bacteria that get transmitted while having unprotected sex is the main cause of PID.
Bacteria can also enter the reproductive system during periods and after miscarriage, pregnancy and abortion.
Sometimes the bacteria enter via an intra-uterine birth control device (IUD).

Risk factors include having sex before 25 years of age, unprotected sex and having more than one sex partner.

Complications of Pelvic Inflammatory Disease

Untreated, PID can cause enough damage to make pregnancy difficult. Long term pelvic pain and formation of abscess in the reproductive tract are other complications.

Diagnosis of Pelvic Inflammatory Disease

Detailed medical history
Pelvic examination
Blood tests
Ultrasound
Biopsy of endometrium
Laparoscopy

Surgery of Pelvic Inflammatory Disease

PID responds well to antibiotics in the initial stages. If it doesn’t respond, hospitalization may be needed for more intense treatment. Bursting of an abscess may need surgical intervention.

Prevention of Pelvic Inflammatory Disease

Use a condom
Asking the doctor about screening methods
Partners should also be checked for sexually transmitted infections

Chronic Pelvic Pain

Chronic Pelvic Pain Overview

Pain in the lower abdomen or in the hips that lasts for longer than six months is called chronic pelvic pain.

Signs and Symptoms for Chronic Pelvic Pain

Long term pain
Pain is intermittent
Sometimes, the pain is severe; other times it is a dull nagging pain
Cramps in the abdomen
Heaviness in pelvis
Pain during sexual intercourse
Being seated for long periods contributes to pain
Any kind of bowel movement causes pain

Causes and Risk Factors for Chronic Pelvic Pain

Pelvic pain has many causes and sometimes a combination of causes might be resulting in the pain.
Pelvic inflammatory disease might affect pelvic organs causing pain.
When uterus, fallopian tubes and ovaries are removed for other conditions, sometimes a part of the ovaries may be left which can develop into cysts causing pain.
Some conditions that affect the musculoskeletal system can cause pelvic pain.
Fibroids when they degenerate can cause pelvic pain.
Endometriosis – A condition in which the endometrium grows outside the uterus
Bladder conditions like interstitial cystitis.

Complications for Chronic Pelvic Pain

Chronic pelvic pain can have serious effects on the mental well-being of women.

Diagnosis for Chronic Pelvic Pain

Medical history
Blood tests including tests for sexually transmitted infections
CT scan, ultrasound, MRI
Laparoscopic examination which will help diagnose endometriosis

Surgery/Treatment for Chronic Pelvic Pain

Treatment involves medication to handle pain. Sometimes, women may find that the pain is more during certain parts of their menstrual cycle. In such cases, hormonal medications might help. Antidepressants can also be given as they have pain relieving properties.

Surgical intervention can be in the form of:

Laparoscopy: Endometriosis can be diagnoses and treated with laparoscopy
Hysterectomy: Though it is rare, removal of uterus and associated organs can be advised for certain conditions

Prevention for Chronic Pelvic Pain

Managing the pain will help. Since the pain is long-term it can lead to depression. Practicing ways to reduce anxiety and depression (like meditation) can help.

Poly Cystic Ovary Syndrome (PCOS) Overview

In women with poly cystic ovaries, fluid filled sacs called follicles develop on the ovaries. This condition is diagnosed in women as they approach reproductive age. These follicles can affect the normal functioning of the ovary.

Signs and Symptoms for Poly Cystic Ovary Syndrome (PCOS)

Irregular periods cycle
More than 35 days in-between two cycles
Periods are heavy when they do come
Facial hair
Bad acne
Pattern of baldness usually seen in men
Some women may experience headaches

Causes and Risk Factors for Poly Cystic Ovary Syndrome (PCOS)

Though the exact cause remains elusive, the following may have an effect:

Genetically linked
Increased levels of androgen

Risk factors include:

Insulin resistance
Obesity

Complications for Poly Cystic Ovary Syndrome (PCOS)

Difficulty in getting pregnant
Hypertension
Diabetes
High LDL or bad cholesterol
Heart problems
Risk of endometrial cancer increases
Sleep apnea

Diagnosis for Poly Cystic Ovary Syndrome (PCOS)

Medical history of menstrual cycle
Pelvic examination
Blood tests for androgen levels
Ultrasound of the abdomen to confirm poly cystic ovaries

Surgery for Poly Cystic Ovary Syndrome (PCOS)

Lifestyle changes benefit women with PCOS immensely. A healthy diet which focuses on fruits and vegetables are best. Exercise has been seen to have a major beneficial effect. Both diet and exercise together are recommended to tackle complications like insulin resistance, diabetes and weight loss.
Medicines (like metformin and birth control pills) are also available to treat PCOS.
When other options do not work, surgery (ovarian drilling) can be done to re-establish normal ovulation.

Prevention for Poly Cystic Ovary Syndrome (PCOS)

Eating a healthy diet
Exercising regularly
Maintaining body weight

Uterine Fibroids

Uterine Fibroids Overview

Uterine fibroids, also known as myomas, are growths on the uterus that are mostly non-cancerous in nature. The fibroids may vary in number from single to many with variation in sizes as well.

Signs and Symptoms of Uterine Fibroids

Heavy periods
Periods that last longer than normal
Pain in the pelvic region
Need to urinate frequently
Constipation
Pain in the lower back and leg

Causes and Risk Factors of Uterine Fibroids

Genetic modification in cells
Estrogen and progesterone seem to aid fibroid growth
Family history of fibroids
Alcohol consumption
Being overweight
Diet that is low in fruits and vegetables
Vitamin D deficiency

Complications of Uterine Fibroids

Fatigue
Anaemia that might lead to a need for blood transfusion

Diagnosis of Uterine Fibroids

Pelvic examination during which the doctor may find the uterus shape to be abnormal leading to the possible presence of fibroids.
Blood tests for anaemia and thyroid dysfunction
Abdomen ultrasound
MRI
Hysteroscopy

Surgery/Treatment of Uterine Fibroids

Medication to restore normal periods cycle are available. If the patient is not troubled by the fibroids, it is best to wait and watch. Fibroids mostly shrink after menopause.
Ultrasounds to heat and destroy fibroids. This is done inside an MRI machine and guided by the MRI images. However, this is a new technology.
Cutting off blood supply to the fibroids thus shrinking them.
Minimally invasive laparoscopy to remove fibroids.
Abdominal myomectomy which is an open surgery to remove the fibroids.
Hysterectomy to remove the uterus.

Prevention of Uterine Fibroids

Eating healthy food rich in fruits and vegetables
Making good lifestyle choices

Uterine Polyps

Uterine Polyps Overview

The inner lining of the uterus is called the endometrium. Growths on this endometrium are called endometrial polyps or quite simply, polyps. Though usually benign, there is a possibility of these polyps becoming cancerous. Polyps may vary in both number and size.

Signs and Symptoms for Uterine Polyps

Irregular periods – duration of a period cycle as well as time interval between two cycles is unpredictable
Heavy periods
Post-menopausal bleeding
Inability to conceive

Causes and Risk Factors for Uterine Polyps

Hormonal changes
Women just before and after menopause are more at risk
Obesity
Hypertension
Tamoxifen, a drug used in the treatment of breast cancer, can cause polyps

Complications for Uterine Polyps

Women with polyps have difficulty in conception. Removing the polyps might help with pregnancy.

Diagnosis for Uterine Polyps

Ultrasound and hysterosonography to diagnose polyps
Hysteroscopy
Biopsy of the endometrium, but in some cases the biopsy could miss the polyp cells

Surgery/Treatment for Uterine Polyps

If the polyp does not cause any problems, it would be best to wait and watch.

Certain hormonal medication can be used to treat polyps. However, there is always a chance for the recurrence of the condition.

Hysteroscopy can be done to remove the polyps. After removal, the polyps are sent for biopsy.

Prevention for Uterine Polyps

Undergoing regular check-ups
Keeping blood pressure under check
Maintaining ideal weight

Poor Ovarian Reserve

Poor Ovarian Reserve Overview

Ovarian reserve refers to the quality and quantity of eggs produced by the ovary. When this is lower than what is normal for a particular age, it is called poor ovarian reserve.

Signs and Symptoms for Poor Ovarian Reserve

Women find it difficult to become pregnant
Even if they do get pregnant, they are more prone to miscarriage
Irregular periods
Heavy bleeding during periods

Causes and Risk Factors for Poor Ovarian Reserve

Cancer treatments like chemotherapy and radiation
Women with autoimmune disorders
Smoking
Infections of the pelvis
Mumps
Endometriosis
Genetic problems

Complications for Poor Ovarian Reserve

Difficulty in getting pregnant and retaining the pregnancy.

Diagnosis for Poor Ovarian Reserve

Blood test for ascertaining the level of follicle stimulating hormone (FSH) and anti-Mullerian hormone (AMH). These levels should then be referenced against what is normal for that age group. Typically for those having poor ovarian reserve, FSH will be high and AMH will be low.

Surgery/Treatment for Poor Ovarian Reserve

Women with poor ovarian reserve can get pregnant but early detection and treatment is important. Treatment with dehydroepiandrosterone (DHEA) has proved successful. Sometimes, in-vitro fertilization is recommended.

Prevention for Poor Ovarian Reserve

Eating a vitamin rich diet
Quitting smoking
Manage stress
Maintain weight

Chocolate Cyst/ Endometriotic Cyst

Chocolate Cyst/ Endometriotic Cyst Overview

Chocolate cysts are cysts filled with old menstrual blood that form deep inside the ovaries. Being filled with blood gives them a chocolate brown colour and hence the name. They are also seen as another more advanced form of endometriosis. They may be found in one or both the ovaries in varying sizes and numbers.

Signs and Symptoms for Chocolate Cyst/ Endometriotic Cyst

The size of the cyst does not seem to have an effect on the symptoms. The symptoms, when they do manifest, can be seen as:

Irregular periods
Stomach cramps
Inability to conceive
Painful sexual intercourse

Causes and Risk Factors for Chocolate Cyst/ Endometriotic Cyst

A chocolate cyst may be formed because of endometriosis.

Complications for Chocolate Cyst/ Endometriotic Cyst

A rupture of a chocolate cyst will cause severe pain. It needs emergency treatment.
Chocolate cysts may affect a woman’s ability to get pregnant.
Lower number of eggs may be produced by the ovary.
The eggs that are formed may not be well developed.
Elevated levels of follicle stimulating hormone which point to problems with the ovary.

However, it is to be noted that with treatment, it is possible for women with chocolate cyst to get pregnant.

Diagnosis for Chocolate Cyst/ Endometriotic Cyst

Physical pelvic examination
Ultrasound abdomen
Once an ultrasound confirms a cyst, a biopsy of the cyst will be needed to diagnose a chocolate cyst.

Surgery/Treatment for Chocolate Cyst/ Endometriotic Cyst

Treatment will depend on the patient’s condition – age, presence of cyst in one or two ovaries, desire to have children, etc.

If the cyst does not cause any problem, it is best to just observe it.
Birth control pills can be prescribed to stop cyst growth and help with pain management.
Surgery is recommended when the cyst size exceeds 4 cm and is causing a lot of problems. If cancer is suspected, it is best to remove the cysts.
Laparoscopic surgery which is minimally invasive can be done to remove the cysts.

Prevention for Chocolate Cyst/ Endometriotic Cyst

Regular and sufficient exercise
Avoiding alcohol
Reducing caffeine consumption (as it increases estrogen level)

Our Doctors

Dr Padmapriya Vivek

MBBS, MD(OBG), Diploma in Reproductive Medicine(Germany)

Head of the Department - Obstetrics, Gynaecology & Fertility Medicine

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