What could possibly be the cause of your miscarriage and how to avoid it?

A miscarriage, also called a spontaneous abortion, is the spontaneous ending of a pregnancy. About 1/3 to 1/2 of all pregnancies end in miscarriage before a woman misses a menstrual period or even knows she is pregnant. About 10 to 20% of women who know they are pregnant will miscarry , mostly in the first three months.

A miscarriage is most likely to occur within the first 3 months of pregnancy, before 20 weeks gestation. Very few of miscarriages occur after 20 weeks’ gestation. These are termed late miscarriages.

What causes miscarriage?

About half of all miscarriages that occur in the first trimester are caused by chromosomal abnormalities, which might be hereditary or spontaneous , in the father’s sperm or the mother’s egg. Chromosomes are tiny structures inside the cells of the body that carry many genes, the basic units of heredity.

Genes determine all of a person’s physical attributes, such as sex, hair and eye color and blood type. Most chromosomal problems occur by chance and are not related to the mother’s or father’s health.

Miscarriages are also caused by a variety of unknown and known factors, such as:

  1. Infection
  2. Exposure to environmental and workplace hazards such as high levels of radiation or toxic agents.
  3. Hormonal irregularities.
  4. Improper inplantation of fertilized egg in the uterine lining.
  5. Maternal age.
  6. Uterine abnormalities.
  7. Incompetent cervix. (The cervix begins to widen and open too early, in the middle of pregnancy, without signs of pain or labor.)
  8. Lifestyle factors such as smoking, drinking alcohol, or using illegal drugs.
  9. Disorders of the immune system including lupus, an autoimmune disease.
  10. Severe kidney disease.
  11. Congenital heart disease.
  12. Diabetes that is not controlled.
  13. Thyroid disease.
  14. Radiation
  15. Certain medicines, such as the acne drug isotretinoin .
  16. Severe malnutrition.
  17. Infections

What are the symptoms of a miscarriage?

Symptoms of a miscarriage include:

If you are experiencing the symptoms listed above, contact your Gynecologist right away. She will tell you to come in to the office or go to the labor room.

How Is a Miscarriage Diagnosed and Treated?

Your Gynecologist will perform a pelvic exam, an ultrasound test and bloodwork to confirm a miscarriage. If the miscarriage is complete and the uterus is empty, then no further treatment is usually required. Occasionally, the uterus is not completely emptied, so a dilatation and curettage (D&C) procedure is performed. During this procedure, the cervix is dilated and any remaining fetal or placental tissue is gently removed from the uterus. As an alternative to a D&C, certain medicines can be given to cause your body to expel the contents in the uterus. This option may be more ideal in someone who wants to avoid surgery and whose condition is otherwise stable.

Blood work to determine the amount of a pregnancy hormone (hCG) is checked to monitor the progress of the miscarriage.

When the bleeding stops, usually you will be able to continue with your normal activities. If the cervix is dilated, you may be diagnosed with an incompetent cervix and a procedure to close the cervix (called cerclage) may be performed if the pregnancy is still viable. If your blood group is Rh negative, your doctor may give you a blood product called Rh immune globulin (Rhogam). This prevents you from developing antibodies that could harm your baby as well as any of your future pregnancies.

Blood tests, genetic tests, or medication may be necessary if a woman has more than two miscarriages in a row (called recurrent miscarriage). Some diagnostic procedures used to evaluate the cause of repeated miscarriage include ultrasound, hysterosalpingogram (an X-ray of the uterus and fallopian tubes), and hysteroscopy (a test in which the doctor views the inside of the uterus with a thin, telescope-like device inserted through the vagina and cervix).

Can I Get Pregnant Following a Miscarriage?

Yes. At least 85% of women who have miscarriages have subsequent normal pregnancies and births. Having a miscarriage does not necessarily mean you have a fertility problem. On the other hand, about 1%-2% of women may have repeated miscarriages (three or more). Some researchers believe this is related to an autoimmune response.

If you’ve had two miscarriages in a row, you should stop trying to conceive, use a form of birth control, and ask your Gynecologist to perform diagnostic tests to determine the cause of the miscarriages.

Dr. Ruchi Tandon, is a Gynecologist with over 13 years experience in obstetrics and Gynecology, practicing in leading hospitals in South Delhi. She is approachable, experienced and highly competent in handling all types of pregnancies.

High Risk Pregnancy – How to manage it

Any pregnancy that poses a risk to the mother or baby, or is different from normal is considered as high-risk pregnancy.

What are the risk factors for high-risk pregnancies?

Sometimes a high-risk pregnancy is the result of a medical condition or disease present before pregnancy. In other cases, a medical condition that develops during pregnancy for either you or your baby causes a pregnancy to become high risk pregnancy.

Specific factors that might contribute to a high-risk pregnancy include:

  • Advanced maternal age.Pregnancy risks are higher for mothers older than age 35 years.
  • Lifestyle choices. Smoking cigarettes, drinking alcohol and using certain drugs can put a pregnancy at risk.
  • Medical history. A history of hypertension, diabetes, heart disorders, breathing problems such as poorly controlled asthma, infections, and blood-clotting disorders such as deep vein thrombosis can increase pregnancy risks.
  • Surgical history. A history of surgery on your uterus, including  C-sections, multiple abdominal surgeries or surgery for uterine tumors (fibroids), can increase pregnancy risks.
  • Pregnancy complications. Various complications that develop during pregnancy can pose risks. Examples include an abnormal placenta position, bleeding during pregnancy, fetal growth less than the 10th percentile for gestational age (fetal growth restriction) and Rh (rhesus) sensitization — a potentially serious condition that can occur when your blood group is Rh negative and your baby’s blood group is Rh-positive.
  • Multiple pregnancy. Pregnancy risks are higher for women carrying twins or higher-order multiple fetuses.

What steps can you take to promote a healthy pregnancy?

Whether you know ahead of time that you’ll have a high-risk pregnancy or you simply want to do whatever you can to prevent a high-risk pregnancy, follow the instructions by your Gynecologist. For example:

  • Schedule a preconception appointment.If you’re thinking about becoming pregnant, consult your Gynecologist. She might counsel you to start taking a daily prenatal vitamin with folic acid and reach a healthy weight before you become pregnant. If you have a medical condition, your treatment might need to be adjusted to prepare for pregnancy. Your health care provider might also discuss your risk of having a baby with a genetic condition.
  • Seek regular prenatal care. Prenatal visits can help your health care provider monitor your health and your baby’s health. Depending on the circumstances, you might be referred to a specialist in maternal-fetal medicine, genetics, pediatrics or other areas.
  • Eat a healthy diet. During pregnancy, you’ll need more folic acid, protein, calcium and iron. A daily prenatal vitamin can help fill any gaps. Talk to your Gynecologist if you have special nutrition needs due to a health condition, such as diabetes.
  • Gain weight wisely. Gaining the right amount of weight can support your baby’s health — and make it easier to shed the extra pounds after delivery. Work with your Gynecologist to determine what’s right for you.
  • Avoid risky substances. If you smoke, quit. Alcohol and illegal drugs are off-limits, too. Get your health care provider’s OK before you start — or stop — taking any medications or supplements.

Do you need special tests?

If you have a high-risk pregnancy, you might consider various tests or procedures in addition to routine prenatal screening tests. Depending on the circumstances, your Gynecologist might recommend:

  • Specialized or targeted ultrasound.This type of fetal ultrasound, an imaging technique that uses high-frequency sound waves to produce images of a baby in the uterus  targets a suspected problem, such as abnormal development.
  • During this procedure, a sample of the fluid that surrounds and protects a baby during pregnancy (amniotic fluid) is withdrawn from the uterus. Typically done after week 14 of pregnancy, amniocentesis can identify certain genetic conditions, as well as neural tube defects — serious abnormalities of the brain or spinal cord.
  • Chorionic villus sampling (CVS).During this procedure, a sample of cells is removed from the placenta. Usually done between weeks 10 and 12 of pregnancy, CVS can identify certain genetic conditions.
  • Also known as percutaneous umbilical blood sampling, this is a diagnostic prenatal test in which a sample of the baby’s blood is removed from the umbilical cord for testing. The test can identify certain genetic disorders,  conditions and infections.
  • Ultrasound for cervical length. Your health care provider might use an ultrasound to measure the length of your cervix at prenatal appointments to determine if you are at risk of preterm labor.
  • Laboratory tests. Your health care provider will test your urine for urinary tract infections and screen you for infectious diseases such as HIV and syphilis.
  • Biophysical profile. 2This prenatal test is used to check on a baby’s well-being. It might involve only an ultrasound to evaluate fetal well-being or, depending on the results of the ultrasound, also fetal heart rate monitoring (nonstress test).

Some prenatal diagnostic tests — such as amniocentesis and chorionic villus sampling — carry a small risk of pregnancy loss. The decision to pursue prenatal testing is up to you and your partner. Discuss the risks and benefits with your Gynecologist.

Dr. Ruchi Tandon is a gynecologist specialising in high risk pregnancy, with over 14 years of clinical experience. She is currently associated with leading hospitals of South Delhi such as Max Smart Superspeciality Hospital, saket, Apollo Cradle Royale, Nehru Place and Apollo Spectra, Kailash Colony.

Post menopausal bleeding – what can it possibly be?

What is postmenopausal bleeding?

Postmenopausal bleeding is any bleeding that occurs in a woman’s vagina after she has undergone menopause. Once a woman has gone 12 months without a period, she’s considered to be menopausal.

In order to rule out serious medical problems, women with postmenopausal bleeding should always see a gynecologist.

What is vaginal bleeding?

Vaginal bleeding can have a variety of causes. These include normal menstrual cycles and postmenopausal bleeding. Other causes of vaginal bleeding include:

  • trauma or assault
  • cervical cancer
  • infections, including urinary tract infections
  • Polyps
  • Endometrial hyperplasia
  • Fibroids

If you’re experiencing vaginal bleeding and are postmenopausal, your Gynecologist will ask about the duration of the bleed, the amount of blood, any additional pain, or other symptoms that may be relevant.

Because abnormal vaginal bleeding can be a symptom of cervical, uterine, or endometrial cancer, you should get any abnormal bleeding evaluated by a gynecologist immediately .

What causes postmenopausal bleeding?

Bleeding can occur in postmenopausal women for several pathological reasons. For example, women who take hormone replacement therapy for menopause may have vaginal bleeding for a few months after starting the hormones. It’s also possible for a woman who thought she was in menopause to begin ovulating. If this occurs, bleeding may also occur.

There are a variety of other conditions that can cause postmenopausal bleeding such as polyps, endometrial hyperplasia, and endometrial atrophy.

Uterine polyps

Uterine polyps are noncancerous growths. Though benign, some polyps may eventually become cancerous. The only symptom most patients with polyps will experience is irregular bleeding.

Uterine polyps are particularly common in women who have gone through menopause. However, younger women can also get them.

Endometrial hyperplasia

Endometrial hyperplasia is the thickening of the endometrium. It is a potential cause for postmenopausal bleeding. It is often caused when there is an excess of estrogen without enough progesterone. It occurs frequently in women after menopause.

Long-term use of estrogen can lead to increased risk of endometrial hyperplasia. It can ultimately lead to cancer of the uterus if not treated.

Endometrial cancer

Endometrial cancer begins in the uterus. The endometrium is a layer of the uterus. In addition to abnormal bleeding, patients may experience pelvic pain.

This condition is often detected early. It causes abnormal bleeding, which is easily noticed. The uterus can be removed to treat cancer in many cases. Less than 10% of women who have postmenopausal bleeding have endometrial cancer.

Endometrial atrophy

This condition results in the endometrial lining becoming too thin. It can occur in postmenopausal women. As the lining thins, bleeding may occur.

Cervical cancer

Bleeding after menopause is often harmless. However, it can also be a rare sign of cervical cancer. Cervical cancer tends to progress slowly. Gynecologists can sometimes identify these cells during a regular exam.

Annual visits to the gynecologist can help with early detection and even prevention of cervical cancer. This can be done by monitoring for abnormal Pap smears.

Other symptoms of cervical cancer can include pain during sex or abnormal vaginal discharge, including in women who are postmenopausal.

Symptoms of postmenopausal bleeding

Many women who experience postmenopausal bleeding may not have other symptoms. But symptoms may be present. This can depend on the cause of bleeding.

Many symptoms that occur during menopause, like hot flashes, often begin to decrease during the postmenopausal time period. There are, however, other symptoms that postmenopausal women may experience.

Symptoms postmenopausal women may experience include:

  • vaginal dryness
  • decreased libido
  • insomnia
  • stress incontinence
  • increased urinary tract infections
  • weight gain

Why Dr. Ruchi Tandon is the best choice?

Dr. Ruchi Tandon is a gynecologist with over 13 years of experience in clinical menopause and is a trained Hysteroscopy surgeon, practicing in leading hospitals of South Delhi such as Max smart super specialty hospital, Saket, Apollo Cradle Royale, Nehru Place. She specializes in hormone replacement therapy and recommended the management of menopausal symptoms.

Ovarian cyst – laparoscopy is treatment of choice

Ovarian cysts are fluid-filled sacs or pockets in the ovary or on its surface. Women have two ovaries — each about the size and shape of an almond, 2-3cm in size— on each side of the uterus. Eggs, which develop and mature in the ovaries, are released in monthly cycles during the childbearing years.

Many women have ovarian cysts at some time. Most ovarian cysts present little or no discomfort and are harmless. The majority disappears without treatment within a few months.

However, ovarian cysts — especially those that have ruptured — can cause serious symptoms. To protect your health, get regular pelvic exams and know the symptoms that can signal a potentially serious problem.

Symptoms of ovarian cyst

Most cysts don’t cause symptoms and go away on their own spontaneously. However, a large ovarian cyst can cause:

  • Pelvic pain — a dull or sharp ache in the lower abdomen on the side of the cyst
  • Fullness or heaviness in your abdomen
  • Bloating

Complications of ovarian cyst

An ovarian cyst often causes no problems, but sometimes it can lead to complications.

  • Torsion: The stem of an ovary can become twisted if the cyst is growing on it. It can block the blood supply to the cyst and cause severe pain in the lower abdomen.
  • Burst cyst: If a cyst bursts, the patient will experience severe pain in the lower abdomen. If the cyst is infected, pain will be worse. There may also be bleeding. Symptoms may resemble those of appendicitis.
  • Cancer:less than 10 % of ovarian cysts can become malignant or cancerous.

Laparoscopy in ovarian cyst

A small incision will be made just below the navel. Next, a laparoscope will be inserted. This is a thin tube with a camera on the end. To allow the doctor to better view the organs, carbon dioxide gas will be pumped into the abdomen. The laparoscope will be used to locate the cyst. When it is found, 1 or 2 more incisions will be made. Surgical instruments will be inserted to remove the cyst. Tissue may be removed for testing. If cancer is found, both ovaries may need to be removed. After the cyst is removed, the instruments will be removed. The incision area will be closed with stitches or staples.

Immediately After Procedure

After the procedure, you will be given IV fluids and medications while recovering.

How Long Will It Take?

1-2 hours

Will It Hurt?

There will be pain after the surgery. You will be given pain medication.

Average Hospital Stay

You may stay overnight, or you may be able to leave the hospital the same day as your surgery.

Why Dr. Ruchi Tandon?

Dr. Ruchi Tandon is a trained laparoscopic Gynecological surgeon, practicing in best hospitals in South Delhi such as Max smart super speciality hospital, saket, Apollo Cradle Royale, Apollo Spectra Hospitals, Delhi. She has over 14 years of experience in the field of operative Gynecology and endoscopic procedures.

What is abortion in pregnancy?

Abortion is the removal of pregnancy tissue, products of conception or the fetus and placenta (afterbirth) from the uterine cavity. In general, the terms fetus and placenta are used after eight weeks of intrauterine pregnancy. Pregnancy tissue and products of conception refer to tissue produced by the union of sperm with the ovum.

Other terms for an abortion include elective abortion, induced abortion, MTP, termination of pregnancy and therapeutic abortion.

Preparing for abortion

Your doctor will ask about your medical history and examine you internally as well. Even if you used a home pregnancy test, another pregnancy test often is needed to confirm that you are pregnant or not. In some cases, you will need an Ultrasound, may be transvaginal, to determine how many weeks into the pregnancy you are and the size of the fetus, and to make sure the pregnancy is not ectopic /tubal.

An ectopic pregnancy is one that is growing outside of the uterus, mostly in the tubes.

A blood test will determine your blood type and whether you are ABO Rh positive or negative. The Rh protein is made by the red blood cells of most women. These blood cells are considered Rh-positive. Some women have red blood cells that do not produce Rh protein; these blood cells are considered Rh-negative.

Pregnant women who have Rh-negative blood are at risk of reacting against fetal blood that is Rh-positive. Because a reaction can harm future pregnancies, Rh-negative women usually receive an injection of Rh immunoglobulin (RhIG) to prevent Rh-related problems after miscarriage or abortion.

How it is done

Doctors can use medicines, surgery or a combination of both to end a pregnancy. The method depends on how far along in the pregnancy you are, your medical history and your individual preference.

Abortions during early pregnancy, before 49 days, can be done safely with medications. Abortions between 6 and 14 weeks usually are done surgically, although medications may be used to help soften and open the cervix.

After 14 weeks, abortions can be done using labor-inducing medications that cause uterine contractions or by using these medicines in combination with surgery.

Medical abortion
Abortions completed with medication, called medical abortions, can be performed within 49  days of gestation. Days of gestation are the number of days beginning on the first day of your last menstrual period.

Most often doctors use a combination of mifepristone and misoprostol.

Surgical abortion

Suction or aspiration abortion

Sometimes called a suction D & E (for dilation and evacuation), this procedure can be done up to 14 weeks after the first day of the last menstrual period. Suction D & E is the procedure most commonly used to end a pregnancy. One dose of antibiotics is recommended prior to the procedure to prevent infection. The cervix is dilated (widened) and a rigid hollow tube is inserted into the uterus. An electric pump sucks out the contents of the uterus. The process takes about 15 minutes. Local anesthesia is usually applied to the cervix to minimize the pain of dilating the cervix. Medication given intravenously (into a vein) may help to decrease anxiety and relieve pain.

Why Dr. Ruchi Tandon is the best choice for your abortion?

Dr. Ruchi Tandon, is a gynecologist, based in South Delhi, practicing Obstetrics and Gynecology for over 14 years. She is proficient in all kinds of medical, surgical and high-risk abortions. She is available at her clinic in greater Kailash part 2, max smart super specialty hospital, Saket and Apollo Cradle Royale, Nehru Place, Delhi.

Menopause in Indian women – An enigma

Menopause is the process through which a woman ceases to be fertile or menstruate completely. It is a normal part of life and is not considered a disease or a medical condition.

Symptoms may occur years before a woman’s final period also called as Perimenopause. Some women may experience symptoms for months or years afterward or before actual menopause.

In India, the average age for menopause is 47 years.

Despite being a natural process in the body of any woman, menopause can cause drastic changes that trigger a variety of symptoms.

While menopause is not a disease or disorder, it does trigger some profound changes in a woman’s body.

A diagnosis of menopause is confirmed when a woman has not had a menstrual period for one continuous year. However, the symptoms of menopause generally appear before the end of that one-year period.

Signs and symptoms

Irregular periods

Changes to the menstrual pattern are the first noticeable symptoms of menopause. Some women may experience a period every 2 to 3 weeks. Others will not menstruate for months at a time.

Lower fertility

Perimenopause is the 3-to-5-year period before menopause.

During the perimenopausal stage, a woman’s estrogen levels will drop significantly. This reduces her chances of becoming pregnant.

Vaginal dryness

Dryness, itching, and discomfort of the vagina tend to occur during perimenopause.

As a result, some women may experience Dysparenuia , or pain during sex. Women experience this pain due to lowering estrogen levels. These lower levels cause vaginal atrophy.

Vaginal atrophy is an inflammation of the vagina that happens as a result of the thinning and shrinking of the tissues, as well as decreased lubrication.

Hot flashes

A hot flash is a sudden sensation of heat in the upper body. It may start in the face, neck, or chest, and progress upward or downward.

The skin may become red and patchy, and a woman will typically start to sweat. Her heart rate may suddenly increase, strengthen, or become irregular. Hot flashes generally occur during the first year after a woman’s final period.

Night sweats

Hot flashes that occur during the sleep cycle are called night sweats. Most women say their hot flashes do not last more than a few minutes.

However, studies have confirmed that moderate-to-severe night sweats and hot flashes may pose a problem for 6-8 years before actual menopause.

Disturbed sleep

It can be difficult for women to fall asleep and stay asleep as they progress through menopause.

In some cases, night sweats can lead to discomfort during the night and difficulty sleeping. Sleep disturbance may also be caused by insomnia or anxiety.

Urinary problems

Menopause can disrupt a woman’s urinary cycle.

Women tend to be more susceptible to Urinary tract infections (UTIs) during menopause, such as cystitis. They may also find that they also need to visit the toilet more often.

Emotional changes

Women can experience depression and low mood during menopause.

Hormonal changes can often trigger depressed feelings and mood swings. In many cases, these emotional symptoms also go hand-in-hand with sleep disturbance.

Women may also experience low libido, or sex drive, as a result of these emotional changes.

Problems focusing and learning

Menopause can affect cognitive functions, such as concentration.

Some women may also experience short-term memory problems and difficulty focusing for long periods.

Other effects

Other symptoms of menopause include:

  • a buildup of fat in the abdomen, sometimes leading to overweight and Obesity.
  • Hair loss and thinning hair
  • breast shrinkage

Without treatment, symptoms usually taper off over a period of 2 to 5 years. However, symptoms can persist for longer. In some cases, vaginal dryness, itching, and discomfort can become chronic and eventually get worse without treatment.

Complications

Menopause can lead to the development of complications, including:

  • Cardiovascular disease: A drop in estrogen levels has been associated with an increased risk of cardiovascular disease.
  • Osteoporosis: A woman may lose bone density rapidly during the first few years after menopause. Low bone density leads to a higher risk of developing Osteoporosis.
  • Urinary incontinence: Menopause causes the tissues of the vagina and urethra to lose their elasticity. This can result in frequent, sudden, and overwhelming urges to urinate. These urges can be followed by an involuntary loss of urine. Women may involuntarily urinate after coughing, sneezing, laughing, or lifting during menopause.
  • Breast cancer: Women face a higher risk of breast cancer following menopause. Regular exercise can significantly reduce the risk.

Menopausal remedies at South Delhi

Dr. Ruchi Tandon is an exceptional  Gynecologist specializing in disorders such as menopause. She has over 14 years of experience in pregnancy, fibroids, fibroids, excessive bleeding, and hot flashes. She is a new generation doctor with a holistic approach towards her Perimenopausal and menopausal patients. She specializes in providing the best treatments for all patients.

Why you should choose a specialized Laparoscopic Surgeon and Cosmetic Gynecologist?

Laparoscopy is a skilled profession that demands a high level of expertise and well-versed training. Gynecological Laparoscopy involves procedures such as

  • Laparoscopic Myomectomy
  • Laparoscopic hysterectomy
  • Laparoscopic Ovarian Cystectomy
  • Laparoscopic tubal evaluation and repairs
  • Laparoscopy and Hysteroscopy for Infertility
  • Hysteroscopic Polypectomy
  • Hysteroscopic septal resection
  • Hysteroscopic D&C

Gynecological expertise is of paramount importance in all of these procedures.

Reasons for gynecologic laparoscopy

Laparoscopy can be used for diagnosis, treatment, or both of them. A diagnostic procedure can sometimes very commonly turn into a treatment.

Some reasons for diagnostic laparoscopy are:

  • unexplained pelvic pain
  • unexplained infertility history of pelvic infection

Conditions that might be diagnosed using laparoscopy include:

  • Endometriosis
  • Uterine fibroids
  • Ovarian cysts or tumors
  • Ectopic pregnancy
  • Pelvic adhesions
  • Pelvic inflammatory disease

Some types of laparoscopic treatment include:

  • Hysterectomy or removal of the uterus
  • Removal of ovaries
  • removal of ovarian cysts
  • removal of fibroids
  • blocking blood flow to fibroids
  • adhesion removal
  • reversal of a contraceptive surgery called tubal ligation
  • Burch procedure for incontinence
  • vault suspension to treat a prolapsed uterus

Preparing for gynecologic laparoscopy

Preparation depends on the type of surgery. You may need imaging tests, or your doctor might order fasting or an enema.

Tell your doctor about any medication you take. This includes over-the-counter drugs and supplements. You may need to stop them before the procedure.

Ask a friend to come to pick you up after the surgery or schedule a car service. You will not be allowed to drive yourself.

Cosmetic Gynaecology

Cosmetic Gynaecology is one of the emerging areas of Gynecology and includes :

  • Non-surgical vaginal tightening
  • Surgical vaginoplasty
  • Hymenoplasty or restoration of virginity
  • Ovarian rejuvenation
  • Reversing menopause
  • Labiaplasty
  • Non-surgical treatments for painful intercourse

Dr. Ruchi Tandon, is a specialized gynecologist practicing in Greater Kailash, South Delhi with over 13 years of experience in operative laparoscopy, cosmetic Gynecology, and high-risk pregnancy cases.

What do you mean by Laparoscopy?

Laparoscopy also called as keyhole surgery, is a specialized kind of surgery, using very fine instruments and through small incisions (0.3-1.2 cm). Originally started in Germany, it has evolved rapidly over the last 3 decades, superseding convention surgery and ultimately is the preferred mode of operation for all types of Gynecological procedures and surgeries. The various advantages of Gynecological laparoscopic procedures include less hospitalization duration, quicker patient recovery, lesser scaring, overall less operative time reducing

complications.  

Procedures done by Laparoscopy /Hysteroscopy:

  • Laparoscopic Myomectomy
  • Laparoscopic hysterectomy
  • Laparoscopic Ovarian Cystectomy
  • Laparoscopic tubal evaluation and repairs
  • Laparoscopy & Hysteroscopy for Infertility
  • Laparoscopic Adhesiolysis
  • Hysteroscopic Polypectomy
  • Hysteroscopic Myomectomy
  • Hysteroscopic septal resection
  • Hysteroscopic D&C

Advantages of laparoscopic surgery:

  • Faster healing
  • Lesser scarring
  • Better recovery
  • Lesser hospital stay
  • Lesser intra operative complications

Complications of laparoscopy:

Same as of any other conventional open surgery.

The use of energy devices has risk of thermal injury to visceral organs, namely bowel injury and ureter injuries.

What all you need to know before your laparoscopy?

It is important to understand the benefits and risks of your procedure before undergoing any surgery.

In cases of difficulty, Laparoscopy may need to be converted into open laparotomy. Huge fibroids, adhesions and difficultly in visualisation can make laparoscopy a challenge for operating surgeon.

Laparoscopy Treatment:

Laparoscopy is being done in all the leading hospitals in South Delhi. Dr Ruchi Tandon has received extensive training in laparoscopy from best hospitals in Delhi and Mumbai, such as moolchand hospital, leelavati hospital. Dr Ruchi Tandon is one of the best gynecologists, based in greater Kailash and doing all sorts of daycare and operative laparoscopic procedures. Infertility surgeries, Myomectomy, hysterectomy, Hysteroscopy are some of the procedures to name a few.

She is doing these procedures at Max smart super specialty hospital, Saket, Apollo Cradle Royale and Apollo Spectra. In lieu of her experience and contribution to this field, she was conferred with the “best budding endoscopic surgeon “(National) award by the Economic Times at a grand event on 4th October, recently in Delhi.

Management of abnormal uterine bleeding

abnormal uterine bleeding

Abnormal uterine bleeding may be acute or chronic, and is defined as bleeding from the uterus that is abnormal in regularity, volume, frequency, or duration and occurs in the absence of pregnancy. Acute AUB refers to an episode of heavy bleeding that is of sufficient quantity to require immediate intervention to prevent further blood loss. Acute AUB may occur spontaneously or in association with chronic AUB. Initial screening for an underlying disorder of hemostasis in patients with excessive menstrual bleeding should be structured by the medical history.

Basic workup of abnormal bleeding includes CBC (complete blood count), blood group, Thyroid function tests(TSH), UPT( Urine pregnancy test), coagulation parameters(PT,PTT,INR) and LFT( liver function test). Hormonal management is considered the first line of medical therapy for patients with acute AUB without suspected bleeding disorders.

Antifibrinolytic drugs, such as tranexamic acid, work by preventing fibrin degradation and are effective treatment for patients with recurrent AUB. Surgical options include dilation and curettage, endometrial ablation, uterine artery embolization, and hysterectomy.

The etiologies of acute AUB should be classified based on the PALM–COEIN system: Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia, Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, and Not otherwise classified.

Dr. Ruchi Tandon is a famous gynecologist who specializes in cases of AUB (Abnormal uterine bleeding).She has performed about 1000 hystroscopies and procedures related to AUB.

Endometriosis and its controversies

Endometriosis is defined as the presence of endometrial tissue at any area other than the normal situation; if it is seen in myometrial tissue it leads to a condition called as adenomyosis.

Endometriosis  commonly involves your ovaries, fallopian tubes and the tissue lining of pelvis. Rarely, endometrial tissue may spread beyond pelvic organs like intestines,liver and retroperitoneal spaces.

With endometriosis, displaced endometrial tissue continues to act as it normal tissue , it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit your body, it becomes trapped and bleeds monthly. When endometriosis involves the ovaries, cysts called endometriomas or chocolate cysts may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions ,abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other.

Endometriosis can cause pain , sometimes severe —,especially during  periods. Fertility problems also may develop in younger females. Fortunately, effective treatments are available for both.

Symptoms

The primary symptom of endometriosis is pelvic pain associated with  menstrual period.

Common signs and symptoms of endometriosis may include:

  • Painful periods (dysmenorrhea).Pelvic pain and cramping may begin before  period and extend several days into the period.
  • Pain with intercourse.Pain during or after sex is common with endometriosis.
  • Pain with bowel movements or urination. most likely to experience these symptoms during  
  • Excessive bleeding. occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).
  • Endometriosis is first diagnosed in  women who are seeking treatment for infertility.
  • Other symptoms. may also experience fatigue, diarrhea, constipation, bloating or nausea, especially during the menstrual periods.

The severity of  pain isn’t necessarily a reliable indicator of the extent of the condition.  Women with mild endometriosis have intense pain, while others with advanced endometriosis may have little pain or even no pain at all.

Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts or appendicitis. It may be confused with irritable bowel syndrome (IBS), a condition that causes alternate bouts of diarrhea, constipation and abdominal cramping.

When to see a doctor

See your doctor if you have signs and symptoms that may indicate endometriosis.

Endometriosis can be a challenging condition to manage. An early diagnosis, a multidisciplinary medical team and an understanding of your diagnosis may result in better management of your symptoms.

Causes

Although the exact cause of endometriosis is not certain, possible explanations include:

  • Retrograde menstruation.In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
  • Transformation of peritoneal cells.In what’s known as the “induction theory,” experts propose that hormones or immune factors promote transformation of peritoneal cells — cells that line the inner side of your abdomen — into endometrial cells.
  • Embryonic cell transformation.Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial cell implants during puberty.
  • Surgical scar implantation.After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
  • Endometrial cells transport.The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
  • Immune system disorder.It’s possible that a problem with the immune system may make the body unable to recognize and destroy endometrial tissue that’s growing outside the uterus.

Risk factors

Several factors place you at greater risk of developing endometriosis, such as:

  • Never giving birth
  • Starting your period at an early age
  • Going through menopause at an older age
  • Short menstrual cycles — for instance, less than 27 days
  • Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen your body produces
  • Low body mass index
  • Alcohol consumption
  • One or more relatives (mother, aunt or sister) with endometriosis
  • Any medical condition that prevents the normal passage of menstrual flow out of the body
  • Uterine abnormalities

Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis end temporarily with pregnancy and end permanently with menopause, unless you’re taking estrogen.

Complications

Fertilization and implantation

Infertility

The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant.

For pregnancy to occur, an egg must be released from an ovary, travel through the neighboring fallopian tube, become fertilized by a sperm cell and attach itself to the uterine wall to begin development. Endometriosis may obstruct the tube and keep the egg and sperm from uniting. But the condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.

Even so, many women with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Doctors sometimes advise women with endometriosis not to delay having children because the condition may worsen with time.

Ovarian cancer

Ovarian cancer does occur at higher than expected rates in women with endometriosis. But the overall lifetime risk of ovarian cancer is low to begin with. Some studies suggest that endometriosis increases that risk, but it’s still relatively low. Although rare, another type of cancer — endometriosis-associated adenocarcinoma — can develop later in life in women who have had endometriosis.