What Are the Common Gynecological Problems?

Gynecological problems are common as almost every woman experiences one or the other issues in her lifetime. However, in most cases, the conditions are mild and easily treatable. While on the other hand, some issues are severe enough to need surgical intervention. It is always better to consult an experienced Gynecologist doctor in South Delhi to address these issues timely and get the best treatment.

In this blog, we will have a quick look at some of the commonly reported gynecological problems.

Common Gynecological Problems

There are several common gynecological problems that women may experience at some point in their lives. Some of these problems include:

Menstrual disorders: Menstrual disorders refer to a range of conditions that affect a woman’s menstrual cycle, including the length of her cycle, the amount of bleeding, and the regularity of her periods. These include irregular periods, heavy periods, painful periods, and the absence of periods.

Pelvic pain: Pelvic pain refers to discomfort or pain in the lower abdominal area, below the belly button, and between the hips. It can affect both men and women. However, women are commonly affected. This can be caused by various factors such as endometriosis, pelvic inflammatory disease, ovarian cysts, and fibroids.

Vaginal infections: These can be caused by yeast, bacteria, or viruses and may cause symptoms such as itching, discharge, and pain during intercourse.

Polycystic Ovary Syndrome (PCOS): Polycystic ovary syndrome (PCOS) is a hormonal disorder that affects women. It is characterized by the presence of multiple cysts on the ovaries, which can cause irregular periods, infertility, weight gain, and other symptoms.

Menopause and perimenopause: These are natural stages in a woman’s life when the ovaries stop producing eggs and the levels of estrogen and progesterone decline, leading to symptoms such as hot flashes, mood changes, and vaginal dryness.

Sexually Transmitted Infections (STIs): Sexually transmitted infections (STIs), also known as sexually transmitted diseases (STDs), are infections that are spread through sexual contact, including vaginal, anal, and oral sex. These infections can be caused by bacteria, viruses, or parasites and may cause symptoms such as itching, burning, discharge, and pain during intercourse.

Pelvic organ prolapse: Pelvic organ prolapse is a medical condition in which one or more organs in the pelvic region, such as the uterus, bladder, or rectum, slip or protrude into the vaginal wall or outside the vaginal opening. This condition is more common in women and is caused by weakened pelvic floor muscles or damaged connective tissues that support the pelvic organs.

It is important to seek medical attention if you experience any symptoms or have concerns about your gynecological health. Consult Dr. Ruchi Tandon, an experienced Gynecologist doctor in South Delhi.

What Are the Causes of Infertility?

Infertility could be debilitating and why not? Every couple wants a child and when it is unable to do that, the situation becomes frustrating. Well, there is no need for that as advanced medical technologies are available in the market for the diagnosis and treatment of the condition. In this blog, we will see some of the possible causes of infertility along with its diagnosis. If you are also struggling to conceive, consult an infertility specialist in Greater Kailash.

Before we move ahead, let us have a brief look at infertility.

What is Infertility?

Infertility is a medical condition characterized by the inability of a person or a couple to conceive after one year of regular, unprotected sexual intercourse. It can affect both men and women. There could be many causes of infertility including hormonal imbalances to structural problems. Infertility can be temporary or permanent. The condition can be treated with various medical, surgical, or assisted reproductive techniques.

What Are the Causes of Infertility?

There could be several reasons for infertility in males and females. Let us see:

Female Infertility

Age: As women age, their ovarian reserve and the quality of eggs decrease, leading to reduced fertility.

Hormonal imbalances: Imbalances in hormones such as estrogen, progesterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) can affect ovulation and fertility.

Structural problems: Structural problems in the reproductive system, such as blocked fallopian tubes, can prevent sperm and egg from meeting.

Endometriosis: Endometriosis is a condition in which the tissue that normally lines the uterus grows outside of it, which can cause scarring and blockages in the reproductive system.

Polycystic ovary syndrome (PCOS): PCOS is a hormonal disorder that affects ovulation and can cause irregular periods.

Lifestyle factors: Factors such as smoking, alcohol consumption, drug use, obesity, and poor nutrition can affect fertility.

Autoimmune disorders: Autoimmune disorders can cause the body to attack reproductive organs, leading to infertility.

Genetic factors: Certain genetic mutations can cause infertility or increase the risk of infertility.

Male Infertility

Abnormal sperm production: This can be due to genetic factors, hormonal imbalances, infections, radiation, chemotherapy, or certain medications.

Blockages in the sperm ducts: This can be caused by infections, injury, or prior surgeries.

Varicocele: This is a condition where the veins that drain the testicle become enlarged, leading to reduced sperm quality and quantity.

Erectile dysfunction: This can make it difficult or impossible to achieve or maintain an erection, which can affect fertility.

Retrograde ejaculation: This is the condition when the semen goes into the bladder instead of coming out during ejaculation.

Environmental factors: Exposure to certain chemicals or toxins, such as pesticides, lead, or radiation, can affect sperm production and quality.

Lifestyle factors: Certain lifestyle choices such as smoking, excessive alcohol consumption, drug use, and obesity, can also affect fertility.

Genetic disorders: Certain genetic conditions, such as Klinefelter syndrome, Y chromosome deletions, or cystic fibrosis, can affect male fertility.

For a consultation, contact Dr. Ruchi Tandon, an infertility specialist in Greater Kailash.

After Abortion Care – What You Should Know

Abortion sometimes becomes necessary considering the overall health of the expecting mother. While on the other hand, in some cases, there are personal reasons. However, abortion is not as taboo as our society thinks. Well, we will talk about some reasons for abortion in another post, here, our focus is to discuss the care one needs after abortion. The first and most important thing you need to do is find the best abortion clinic in south Delhi.

Let us now see what you should do after undergoing an abortion.

Care You Need After Abortion

After undergoing an abortion, it is important to take care of yourself both physically and emotionally. Here are some of the aftercare guidelines:

Rest and take it easy

It is normal to feel tired and emotional after an abortion. Take some time off work and enough rest.

Follow your doctor’s instructions

Your doctor will provide you with specific instructions on how to care for yourself after the abortion. Follow these instructions given carefully.

Avoid strenuous activity

Avoid any strenuous physical activity for at least a week after the abortion, and avoid lifting heavy objects.

Avoid Intercourse

You should avoid having sex for at least two weeks after the abortion, or until your doctor gives you the green light. 

Watch for signs of complications

Call your doctor if you experience heavy bleeding, fever, or severe abdominal pain.

Take care of your emotional health

It is common to experience a range of emotions after an abortion, including sadness, guilt, and anxiety. Take care of your emotional health by talking to a trusted friend or family member, seeking counseling, or joining a support group.

Remember, every woman’s experience is different, and it is important to follow your doctor’s specific instructions for aftercare.

What Are the Common Side Effects After Abortion?

After an abortion, there can be a range of physical and emotional side effects. Some of the common physical side effects of abortion include:

Bleeding

Bleeding and cramping after an abortion is normal. The bleeding may be heavy and last for several days to several weeks.

Pain

You may experience abdominal pain and cramps after an abortion. Pain medication may be prescribed to relieve the painful symptoms.

Infection

There is a risk of infection after an abortion. Signs of infection include fever, chills, and abdominal pain.

Nausea and vomiting

Some women may experience nausea and vomiting after an abortion.

Fatigue

You may feel tired and weak after an abortion.

Changes in the menstrual cycle

It is common to experience changes in your menstrual cycle after an abortion.

Emotional side effects

Many women experience emotional side effects after an abortion, such as guilt, sadness, and anxiety.

It is important to follow the instructions of your healthcare provider after an abortion to minimize the risk of complications and manage any side effects that may occur. If you experience severe or persistent symptoms contact Dr. Ruchi Tandon. She owns the best abortion clinic in south Delhi.

A Quick Guide to Uterine Fibroids

A Quick Guide to Uterine Fibroids

Abnormal growths in or on the uterus are called fibroids. They are also interchangeably called uterine fibroids. They generally don’t show any symptoms and go away on their own. However, in certain cases, they become large enough to cause symptoms. In such situations, you need to find the best fibroids surgeon in South Delhi.

In this blog, we will have a quick look at uterine fibroids along with the symptoms and treatments.

What Are Fibroids?

Fibroids are non-cancerous growth (benign) on/in the uterus. They are also known as uterine fibroids, myomas, and fibromas. Studies have found that around 20-80% of women experience uterine fibroids. Most of them do not experience any severe symptoms and do not require any treatment as well.

What Are the Types of Fibroids?

Fibroids are classifieds based on their location in/on the uterus:

Intramural Fibroids

These are the commonest types of fibroids that appear within the muscular wall of the uterus. They may grow large stretching the uterus.

Subserosal Fibroids

Fibroids that develop on the outside of the uterus (serosa) are called subserosal fibroids. These fibroids may also grow big making the uterus appear big from one side.

Pedunculated Fibroids

Sometimes, subserosal fibroids develop a stem supporting the tumor. Such fibroids are called pedunculated fibroids.

Submucosal Fibroids

Fibroids that develop in the myometrium (middle layer of the uterus) are called submucosal fibroids.

Cervical Fibroids

As the name suggests, these types of fibroids develop in the cervix.

What Are the Symptoms of Fibroids?

The location and size of uterine fibroids decide the type of symptoms they will show. If the woman has submucosal fibroids, she may experience heavy menstrual bleeding along with problems in conceiving.

Here are some of the common signs and symptoms associated with uterine fibroids:

  • Heavy bleeding that may occur between or during menstruation
  • Clots in menstrual bleeding
  • Menstruation that may last longer
  • Severe cramps during menstruation
  • Lower back pain
  • Pelvic pain
  • Painful intercourse
  • Abdominal swelling
  • Increased urination

What Causes Fibroids?

The cause of fibroids is still under research. However, there may be certain factors that influence their development:

Hormones

The production of estrogen and progesterone may result in the regeneration of the uterine lining during each menstrual cycle while stimulating the growth of fibroids.

Family history

If you have anyone (women) in the family with a history of fibroids, you are also likely to develop the same.

Age

Women above 30 are at high risk of developing fibroids.

Obesity

Fibroids risk becomes high in women with high body weight.

What is the Treatment for Fibroids?

The age of the patient and the size & location of the fibroid will decide the type of treatment required. In moderate cases, home remedies like exercise, yoga, & massage along with acupuncture and dietary changes can help improve the condition.

Medications may be prescribed to relieve painful symptoms and control hormonal levels. If fibroids develop bigger, surgery may be required to remove them. Minimally invasive surgery is preferred by surgeons these days. Sometimes, non-invasive procedures like forced ultrasound surgery may also remove fibroids.

If you are looking for the best fibroids surgeon in South Delhi, contact Dr. Ruchi Tandon.

Common Orthopedic Problems in Pregnancy

Common Orthopedic Problems in Pregnancy

A woman experiences a lot of physical and emotional changes during pregnancy. To cope with them, it is important to consult the Best Gynecologist in Greater Kailash.

If we talk about physical changes in women during pregnancy, then orthopedic problems are common, and this is what we will be discussing here in the post.

Orthopedic Issues During Pregnancy

Lower Back Pain

Back pain is among the commonest orthopedic issues that a pregnant woman experiences. This is often because of the extra body weight. As a result of the growth and development of the fetus, the expecting mother gains weight. This puts pressure on the back muscles. Sometimes, the pain is severe. In such situations, having a strong back is important. So, maintain a strong back by doing exercises under the guidance of a skilled and experienced physiotherapist.

Osteitis Pubis

Another orthopedic condition that women may experience during pregnancy is osteitis pubis. It is an inflammatory condition that affects pubis symphysis. Bones at the front of the pelvis are called the pubic symphysis. Inflammation at this junction occurs because of the added weight and the position of the developing fetus. Pain associated with the condition can improve with the application of ice and heat and non-steroidal anti-inflammatory drugs (NSAIDs).

Heel Pain

Added body weight during pregnancy also causes heel pain. However, heel pain may occur because of plantar fasciitis. This is a condition characterized by the inflammation of a thick band of tissue present at the bottom of the foot. This band is called the plantar fascia and it connects the heel bone to the toes. Stabbing pain is what one experiences because of the condition which occurs during pregnancy. It is intense in the morning and the latter stages of pregnancy.

The application of ice and the use of shoe inserts may help improve the condition. In severe cases, the healthcare service provider may give cortisone shots.

Transient Osteoporosis of the Hip

This often occurs during late-term pregnancy. Transient hip osteoporosis is characterized by temporary bone loss around the hip joint. This makes the hip joint weak. The reason for the same is unknown but hormonal changes are believed to cause the same. Besides this, weight-bearing stress also contributes to the condition.

Knee Pain

Knee pain is very common in pregnancy and the reason for the same is simple i.e., added weight of carrying the baby. This is why rest is advised during pregnancy as it helps cope with knee pain by relieving pressure. This is especially true in the later stages of pregnancy as the fetus grows heavy.

To manage these conditions timely and ensure a healthy & happy pregnancy, consult an experienced doctor. Dr. Ruchi Tandon is an experienced gynecologist in South Delhi and also provides the best fibroids treatment in Greater Kailash.

Big and plenty of fibroids

Uterine fibroids are tumors that grow in a woman’s womb (uterus). These growths are typically not cancerous (benign)

Causes

Uterine fibroids are common. As many as one in five women may have fibroids during their childbearing years. Half of all women have fibroids by age 50.

Fibroids are rare in women under age 20. They are more common in African Americans than White, Hispanic, or Asian women.

No one knows exactly what causes fibroids. They are thought to be caused by:

• Hormones in the body
• Genes (may run in families)

Fibroids can be so tiny that you need a microscope to see them. They can also grow very large. They may fill the entire uterus and may weigh several pounds or kilograms. Although it is possible for just one fibroid to develop, most often there is more than one.

Fibroids can grow:

• In the muscle wall of the uterus (myometrial)
• Just under the surface of the uterine lining (submucosal)
• Just under the outside lining of the uterus (subserosal)
• On a long stalk on the outside the uterus or inside the uterus (pedunculated)

Symptoms

Common symptoms of uterine fibroids are:

• Bleeding between periods
• Heavy bleeding during your period, sometimes with blood clots
• Periods that may last longer than normal
• Needing to urinate more often
• Pelvic cramping or pain with periods
• Feeling fullness or pressure in your lower belly
• Pain during intercourse

Often, you can have fibroids and not have any symptoms. Your health care provider may find them during a physical exam or other test. Fibroids often shrink and cause no symptoms in women who have gone through menopause. A recent study also showed that some small fibroids shrink in premenopausal women.

Evaluating Uterine Fibroid Size for Removal

Women with large or symptom-producing fibroids may need to have an imaging study done to evaluate uterine fibroid size to determine whether it needs to be removed. The risk of not getting treatment is that fibroids sometimes grow to a size that often leads to significant symptoms, eventually requiring removal.

Larger fibroids or those that continue to grow may lead to complications.

• If submucosal fibroids are found on the inside of the uterus and are large enough to misshape the uterine lining, they should be removed to prevent reproductive problems. (iii)
• If fibroids are larger than a 12- to 14-week pregnancy (about the size of a large grapefruit), the risk of complications during surgery, such as injury to the ureter or bladder, increases. (i)
• Left untreated, very large fibroids can begin to degenerate or burst, even if they aren’t causing any symptoms. (i) Degeneration occurs when the growing fibroid outgrows its blood supply, causing the cells of the fibroid to die. This typically causes abrupt, severe pain and tenderness.
• When fibroids reach the size of a grapefruit (4 – 6 inches), there is a rare association with blood clots in the lungs, which can be deadly. (i)
• Rapidly growing large fibroids may be a sign of a rare cancerous form of fibroid, called a leiomyosarcoma. This type of tumor can’t be differentiated from a non-cancerous (benign) fibroid using ultrasound, MRI, or other imaging studies. However, this type of fibroid only occurs in less than 1percent of uterine fibroids, and these cancerous tumors are not believed to grow from a benign fibroid. (ii)

Treatment Options for Uterine Fibroids

There are several uterine fibroid treatment options:

• Uterine fibroid embolization (UFE) uses tiny particles about the size of sugar crystals that are injected into the blood vessels that lead to the uterus. The particles block the flow of blood to the fibroid, causing it to shrink and die. This minimally invasive procedure can be performed by an interventional radiologist on an outpatient basis. It doesn’t require open surgery and offers relief of symptoms with fewer risks, less pain, and a faster recovery compared to surgical procedures.
• Magnetic resonance imaging-guided (MRI) ultrasound surgery uses ultrasound waves to destroy fibroids. Waves are directed at the fibroids through the skin with the help of magnetic resonance imaging.
• Endometrial ablation destroys the lining of the uterus. This procedure is best for small fibroids that are less than 3 centimeters in diameter. (v)
• Hysterectomy is the surgical removal of the uterus. Because this surgery removes the fibroids along with the uterus, there is no chance of becoming pregnant after undergoing a hysterectomy.
• Myomectomy is another surgical option to remove all types of fibroids. There are three approaches to performing a myomectomy: hysteroscopy, laparotomy, and laparoscopy.

How large do uterine fibroids need to be before being surgically removed?

The normal uterine size is the size of a lemon or 8 cm. There isn’t a definitive size of a fibroid that would automatically mandate removal. Your healthcare provider will determine the symptoms that are causing the problem. Fibroids the size of a marble for instance, if located within the uterine cavity, may be associated with profound bleeding. Fibroids the size of a grapefruit or larger may cause you to experience pelvic pressure, as well as make you look pregnant and see increased abdominal growth that can make the abdomen enlarged.

It’s important for the healthcare provider and patient to discuss symptoms which might require surgical intervention.

Dr. Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 14 years of experience in handling all kinds of Gynecological conditions including Fibroids. She is one of the best fibroids surgeon in south delhi.

Fibroids – Do’s and don’ts

What Are Fibroids?

Fibroids, or leiomyomata (myomas), are common noncancerous growths that usually occur in or on the muscle walls of the uterus. One cell divides repeatedly and grows into a firm, rubbery mass separate from the rest of the uterine wall. Almost half of women older than 50 have these growths. They’re more common in African American women than in Caucasian women. They can grow as a single mass or more often as a number of masses of different sizes.

What Causes Fibroids?

The cause isn’t clear. Several factors probably work together to produce fibroids. These factors may be hormones such as estrogen, genetics (runs in families), and environmental. Being overweight, never having had a child, and getting periods before age 10 also may have an effect. The fibroids usually, but not always, shrink after menopause (change of life).

What Are the Symptoms of Fibroids?

Most fibroids (30% to 50%) cause no symptoms. Problems, when they occur, are related to the size and location of the fibroids. Fibroids may grow to be quite large so that a woman may look pregnant and have symptoms of pregnancy: pressure in the pelvic area (lower belly), heaviness, and need to go to the bathroom often to urinate. Fibroids in the uterine wall or in the cavity of the uterus may cause bleeding between periods or heavier and more painful periods. Constipation, backache, pain during sex, and lower belly pains may occur. Rarely, fibroids cause sudden pain or bleeding.

How Are Fibroids Diagnosed?

The health care provider will do an examination of the pelvic area. Ultrasound or x-rays may be used but aren’t always needed for diagnosis. The doctor may do a special procedure (hysteroscopy) for women with bleeding symptoms. This simple procedure lets the doctor look into the uterus to find the cause of the bleeding or to plan or carry out therapy.

How Are Fibroids Treated?

Most fibroids need no treatment and only regular checks to be sure that they’re not growing too large or causing problems. Medicines including hormones and drugs that act against hormones can be tried. If fibroids continue to be a problem, hysterectomy (surgery to remove the uterus) is an option. Sometimes, fibroids alone may be surgically removed (myomectomy), which saves the uterus if children are wanted. Another newer method is uterine artery embolization. In this method, arteries to the uterus are blocked so they don’t feed the fibroids. Myolysis (electric current destroys fibroids and shrinks blood vessels feeding them) and cryomyolysis (liquid nitrogen is used instead of electric current) are other methods. However, fibroids can return and mean more surgery later. Newer medicines may shrink fibroids, but this change is only temporary.

DOs and DON’Ts in Managing Fibroids:

• DO get regular health care provider checkups.
• DO tell your health care provider your concerns and describe your symptoms.
• DON’T delay having children just because you have fibroids. They usually won’t get in the way of pregnancy. If you do need treatment for fibroids, some treatments can temporarily or permanently prevent you from becoming pregnant.
• DON’T worry about getting cancer from fibroids. Typical fibroids are not cancerous.

Surgery for uterine fibroids

Medication to treat fibroid symptoms usually only works while you are taking it. Many women who have severe pain and heavy menstrual bleeding end up considering surgery as an option. There are a number of different types of surgical treatments, each with its own pros and cons.

• Surgery is done in the hope that it can permanently stop the symptoms of uterine fibroids. Some women do, in fact, experience long-term relief. But surgery always carries risks too. Whether or not surgery is an option – and, if so, what kind of surgery – will depend on how the woman feels about the different advantages and disadvantages. The size, number and location of the fibroids will also influence the choice of treatment. Not all types of surgery are suitable for women who still want to have children.

Your doctor may recommend taking hormones such as GnRH analogues several weeks before having surgery. These kinds of artificial hormones are used to shrink the fibroids. Doctors can then make smaller cuts during surgery, allowing the womb (uterus) to recover more quickly. The drug ulipristal acetate is sometimes used for this purpose too.

• But removing individual fibroids isn’t a good idea if it might cause too much scarring in the womb, or if the risk of bleeding during or after surgery is too high. Plus, it isn’t always absolutely certain that the symptoms will improve after surgery. Hysterectomy (surgical removal of the womb) is then an option – or possibly another non-surgical treatment approach such as uterine artery embolization (UAE, sometimes also called uterine artery embolization, or UFE). Uterine artery embolization cuts off the blood supply to the fibroid.

Dr.Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 14 years experience in handling all kinds of Gynecological conditions including Fibroids.

Fibroids surgery -laparoscopy / key hole surgery versus open myomectomy

Uterine fibroids are noncancerous growths that grow in the wall of the uterus. When fibroids cause heavy bleeding or painful symptoms, and other treatments are ineffective, a doctor may recommend surgery.

Fibroids are common, but it is challenging for doctors to determine what percentage of people have them, as not everyone experiences symptoms. According to various estimates, fibroids may affect between 20% and 80% of the female population under the age of 50 years.

Although fibroids can sometimes grow to the size of a grapefruit or even larger, they are often very small. Many people with fibroids are unaware that they have them. People with asymptomatic fibroids do not require surgery or other treatments.

However, other people experience abdominal pain, pressure, bloating, pain during sex, frequent urination, and heavy or painful periods. These individuals may require surgery.

In this article, learn more about surgery for fibroids, including the types, risks, and what to expect.

There are several different surgical approaches to treating fibroids. The types of surgery that a person can have will depend on the location of the fibroid.

A doctor will usually recommend more conservative options, such as medication, before considering surgery.

In cases where medication and other treatments do not work, surgical options include the following:

Myomectomy

Myomectomy is a surgical procedure that removes fibroids. Depending on the location of these growths, a surgeon may also have to remove other tissue in the process. Surgeons offer different myomectomy techniques.

The traditional technique is quite invasive as it uses a relatively large cut. This incision may go from the bellybutton to the bikini line or run horizontally along the bikini line. Some surgeons also perform laparoscopic surgeries, which use smaller incisions but require more skill.

Although a myomectomy preserves the uterus, women who wish to become pregnant should speak to a doctor about the possible complications. Those with very large or deeply embedded fibroids may only be able to have cesarean deliveries after this procedure.

New fibroids may develop after a myomectomy, which means that it is not a permanent solution for everyone.

Radiofrequency ablation procedure

Radiofrequency ablation destroys fibroids using either an electric current, a laser, cold therapy, or ultrasound. It requires only a small incision.

However, it can cause dangerous pregnancy complications, such as scarring and infection, so doctors do not recommend it for those who are planning future pregnancies.

Radiofrequency ablation may be a good option for people considering a hysterectomy who want a less invasive procedure.

Endometrial ablation

Endometrial ablation does not remove fibroids, but it can help relieve heavy bleeding.

During endometrial ablation, a surgeon uses a range of techniques — which may include heat, electric current, freezing, lasers, or wire — to destroy the lining of the uterus. These techniques reduce or stop heavy bleeding.

This procedure is less invasive than some other surgical options. Sometimes, doctors can even perform it on an outpatient basis in their office.

This procedure may prevent women from being able to get pregnant in the future, so it is not a good option for those who would still like to have children.

Hysterectomy

A hysterectomy is a surgery to remove the uterus and, sometimes, the ovaries. A hysterectomy permanently eliminates uterine fibroids.

This procedure is not an option for anyone planning a future pregnancy, as it removes the womb. Some people opt to leave the ovaries in place so that they continue producing estrogen.

A surgeon may be able to perform a laparoscopic hysterectomy, which uses several small incisions and a tiny camera to help the surgeon see inside the abdomen. An open hysterectomy requires a large incision between the bellybutton and the bikini line.

Another option is a vaginal hysterectomy, which is the approach that most people prefer. In this procedure, a surgeon will remove the uterus through the vagina.

A vaginal hysterectomy may not be possible if the uterus or fibroid is too large to fit through the vagina.

Individuals who undergo an open hysterectomy may have a longer recovery time. Doctors usually recommend a hysterectomy only for those whose fibroids are very large or significantly interfere with their quality of life.
People who have other reproductive health issues, such as endometriosis, may find that a hysterectomy provides significant relief from fibroids and other symptoms.

Morcellation

Morcellation is a procedure that reduces the size of fibroids so that a surgeon can remove them through a tiny incision in the abdomen. A doctor may use morcellation during a myomectomy, hysterectomy, or other surgery.
However, the Food and Drug Administration (FDA) caution that morcellation carries significant risks.

While fibroids are not cancerous, uterine cancer is more common in people having fibroid surgery than experts previously thought.

It can also be difficult to tell the difference between a fibroid and a type of cancer that looks the same. According to the FDA, morcellation may inadvertently spread cancer that resembles a fibroid.

Benefits

The benefits of surgery depend on the type of surgery and can vary from person to person. For example, there is no chance that the fibroids will grow back after a hysterectomy. However, they may regrow following other procedures.

Some potential benefits include:

• reduced bleeding
• relief from pain or pressure
• removal of fibroids
• the potential that fibroids will either not grow as large or not regrow at all

Dr. Ruchi Tandon is a reputed Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 13 years experience in handling all kinds of fibroids.

Fibroids- Laparoscopic surgery in the COVID times

The incidence of fibroids ranges from 30% to 70% in women of reproductive age, with the peak incidence occurring between 35 and 49 years of age. Risk factors for fibroids include nulliparity, obesity, black ethnicity, family history, polycystic ovarian syndrome, diabetes, and hypertension. Fibroids are present in 5–10% of the patients presenting with infertility. Laparoscopic myomectomy is preferred over abdominal myomectomy because several small incisions are used rather than one larger incision. Related to the small incisions, recuperation is usually associated with minimal discomfort. Women with infertility and fibroids become pregnant after myomectomy in approximately 50% of cases. The pregnancy rate in patients undergoing hysteroscopic and laparoscopic/abdominal myomectomy is 45–49%. Laparoscopic myomectomy is a technically challenging procedure with surgeon-specific limitations. Preoperative treatments with gonadotropin-releasing hormone have been shown to reduce blood loss and shorten operative time. The consensus states that the maximal size must be 8–10 cm and the total number of fibroids should not exceed four. It is important not to perform laparoscopic myomectomies with more than 5–7 large fibroids because in these cases, the procedure is excessively time-consuming and gives the surgeon opportunities to miss the smaller fibroids after the uterus has been incised and repaired in too many places. The role of vasoconstrictors such as vasopressin, epinephrine, and ornipressin help with the control of bleeding from the incised sites. Temporary clipping of the uterine artery is an effective procedure in reducing hemoglobin loss during laparoscopic myomectomy.

Do you need surgery?

Uterine fibroids are growths in your uterus. Because they’re typically not cancerous, you can decide whether or not you want to have them removed.
You may not need surgery if your fibroids don’t bother you. However, you might consider surgery if your fibroids cause:

• heavy menstrual bleeding
• bleeding between periods
• pain or pressure in your lower belly
• frequent urination
• trouble emptying your bladder
Surgery might also be an option if you want to get pregnant in the future. Sometimes fibroids can increase your risk of having a miscarriage or complications during your pregnancy.

If you decide to have fibroid surgery, you have two options:
• myomectomy
• hysterectomy

Surgery can relieve your fibroid symptoms, but it does come with risks. Your doctor will talk you through your options. Together, you can decide whether to have a procedure and, if so, which one to have.

Types of fibroid surgery

There are two types of fibroid procedures. Which one you have depends on:
• the size of your fibroids
• the number of fibroids you have
• where in your uterus they’re located
• whether you want to have children

Myomectomy

Myomectomy removes your fibroids and can relieve bleeding and other symptoms. This surgery is an option if you’d like to have children in the future, or if you want to keep your uterus for another reason.

About 80 to 90 percent of women who have a myomectomy get relief from their symptoms or see their symptoms reduced. The fibroids won’t grow back after surgery, but you may develop new fibroids. Up to 33 percent of women who have this surgery will need a repeat procedure within 5 years because they grow new fibroids.

This surgery can be done in one of three ways, depending on the number, size, and location of your fibroids. You’ll be under general anesthesia for all of these procedures.

Hysteroscopy

This procedure is more effective for women with smaller and fewer fibroids. Hysteroscopy can also remove fibroids that have grown into the inside of your uterus.

During the procedure, the doctor inserts a long, thin, lighted telescope through your vagina and cervix into your uterus. Fluid is injected into your uterus to expand it and help your doctor see your fibroids.

Then, the surgeon uses a device to cut or destroy your fibroids. The fibroid pieces wash out with the fluid that was used to fill your uterus.
With hysteroscopy you may go home the same day as your surgery.

Abdominal myomectomy

This procedure, also known as a laparotomy, is better for large fibroids, but it leaves a bigger scar than the other two types of myomectomy. For this procedure, your surgeon makes a cut in your lower belly and removes your fibroids.
After abdominal myomectomy, you’ll stay in the hospital for one to three days. Complete recovery takes 2 to 6 weeks.

Laparoscopy

Laparoscopy is used for women who have smaller and fewer fibroids. During laparoscopy, your surgeon makes two small cuts in your belly. A telescope is inserted into one of the openings to help your doctor see inside your pelvis and around your uterus. A tool is inserted into the other opening to remove your fibroids.

Your surgeon may cut your fibroids into small pieces before removing them. In robotic laparoscopy, your surgeon uses robotic arms to perform the procedure.

Laparoscopic procedures may require an overnight hospital stay but have a faster recovery than abdominal myomectomy.

Hysterectomy

Hysterectomy removes part or all of your uterus. This procedure may be an option if you have a lot of fibroids, they’re large, and you’re not planning to have children.

The surgeon can remove your uterus in a few different ways:

• Laparotomy or abdominal hysterectomy. Your surgeon makes a cut in the lower abdomen and removes your uterus.
• Vaginal hysterectomy. The surgeon removes your uterus through your vagina. This approach may not work for very large fibroids.
• Laparoscopic hysterectomy. The surgeon inserts the instruments and removes the uterus through small incisions. This procedure can be done robotically.

The surgeon may leave your ovaries and cervix in place. Then you will continue to produce female hormones.

Complete recovery from an abdominal hysterectomy takes 6 to 8 weeks. Recovery from laparoscopic and vaginal hysterectomy is quicker.

Hysterectomy is the only surgery that cures uterine fibroids and fully relieves their symptoms. However, you will no longer be able to have children.
Recommendations of Laparoscopic surgery in COVID era
Even if it is still unknown whether SARS-CoV-2 shares the properties of other viruses that can be found in laparoscopic surgical smoke, many scientific societies have published online their recommendations on laparoscopy during this pandemic. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGE) recommends stopping elective surgeries. In urgent or necessary surgeries, since laparoscopy could potentially release viruses, SAGE states that the use of devices to filter released CO2 for aerosolized particles, the reduction of medical staff to the minimum inside the operating room, and the use of personal protective equipment (PPE) should be strongly considered .

The European Society for Gynecological Endoscopy (ESGE) has also suggested postponing elective surgery for benign conditions until the pandemic ends. The screening of patients for coronavirus infection before planned surgical treatment or the postponement of surgery on suspected or documented SARS-CoV-2-positive patients until their full recovery, if there is no immediate life-threatening situation, is strongly recommended. If this is not possible, surgery must be performed with full PPE for the entire theater staff. Surgery for gynecological cancer should continue unless alternative interim options are possible after the end of the outbreak. The ESGE also provides suggestions to reduce CO2 release: (a) closing the port taps before insertion, (b) attaching a CO2 filter to one of the ports for smoke evacuation if needed, (c) not opening the tap of any ports unless they are attached to a CO2 filter or being used to deliver the gas, (d) reducing the introduction and removal of instruments through the ports, (e) deflating the abdomen with a suction device before removing the specimen bag from the abdomen, (f) deflating the abdomen with a suction device and via the port with a CO2 filter at the end of the procedure, and (g) minimizing the use of cauterization .

The Royal College of Obstetrics and Gynecology (RCOG) together with the British Society for Gynecological Endoscopy (BSGE) provides similar advice on CO2 evacuation and prevention of aerosol transmission and in addition suggests performing laparotomies or deferring operations that have a risk of bowel involvement due to an increased theoretical risk in such cases .The American Association of Gynecologic Laparoscopists (AAGL), along with many other surgical and women’s health professional societies, supports suspension of non-essential surgical care during the immediate phases of the coronavirus disease 2019 (COVID-19) pandemic .In addition to suggestions to reduce aerosol diffusion during and immediately after laparoscopy, the AAGL provides similar advice on screening patients before surgery and suggests additional imaging evaluation (chest computed tomography) prior to any surgical procedure, based on published data on its high predictive ability for early disease.

Dr. Ruchi Tandon is a reputed Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals, doing Laparoscopy for fibroids , by latest techniques and recommendations.

Vaginal infections – how to diagnose and treat

Vaginitis describes a few conditions that can cause infection or inflammation of your vagina. vulvovaginitis describes inflammation of both your vagina and your vulva. Your vulva is the external part of your genitals.

Read on to learn more about what causes different types of vaginal infections and what you can do about it.

What should I look for with a vaginal infection?

Some vaginal infections may not produce any symptoms. If you do develop symptoms, the most common are:

  • Vaginal itching
  • a change in the amount of discharge from your vagina
  • a change in the colour of your vaginal discharge
  • Pain or burning during mictutition
  • Pain during intercourse
  • Vaginal bleeding or spotting

The symptoms of vaginal infections will also vary based on the cause of your infection:

  • Bacterial infections typically cause grayish-white or yellow discharge. This discharge may have a fish-like odor that’s easily noticed after sex.
  • Yeast infections typically produce itching. If discharge is present, it may be thick and white and look like cottage cheese.
  • Trichomoniasis is a condition that can produce vaginal itching and odor. Discharge from this infection is typically greenish-yellow and may be frothy.

Vaginal infections aren’t life-threatening conditions. However, you should make an appointment to see your doctor if you:

  • have never had a vaginal infection before
  • have had a vaginal infection but are experiencing new symptoms
  • have had different or new sexual partners
  • develop a fever
  • believe you may be pregnant
  • have symptoms that return after treatment

If you experience vaginal irritation and have been diagnosed with yeast infections in the past, you may not need to see your doctor.

Yeast infections can be treated at home with over-the-counter vaginal antifungal medications. However, if you’re not sure that you have a yeast infection, it’s always wise to check with your doctor.

What causes vaginal infections?

Vaginal infections can have several causes. If you develop a vaginal infection, your doctor will diagnose and treat your infection based on its cause.

Common causes of vaginal infections include:

  • Bacterial infections. Certain bacteria are commonly found in your vagina. An overgrowth of these bacteria can cause bacterial vaginosis.
  • Yeast infections. Yeast infections are usually caused by a fungus called Candida albicans. Many things, including antibiotics, can reduce the number of antifungal bacteria in your vagina. This reduction can lead to an overgrowth of fungi and cause an infection.
  • Trichomoniasis. This vaginal infection is caused by a protozoan parasite that can be contracted through sexual intercourse.
  • Vaginal atrophy. This condition commonly occurs after menopause. It can also develop during other times in your life when your estrogen levels decline, such as while breastfeeding. Reduced hormone levels can cause vaginal thinning and dryness. These can lead to vaginal inflammation.
  • Irritants. Soaps, body washes, perfumes, and vaginal contraceptives can all irritate your vagina. This can cause inflammation. Tight-fitting clothes may also cause heat rashes that irritate your vagina.

In some cases, your doctor may not be able to determine the cause of your vaginal infection. This condition is known as nonspecific vulvovaginitis. It can occur in women of any age, but it’s more common in young girls that haven’t entered .

How are vaginal infections diagnosed?

To diagnose a vaginal infection, your doctor will ask you about your health history. They’ll also typically ask about your sexual health such as your current number of sexual partners and your history of past vaginal infections sexually transmitted infections ( STD).

Your doctor may also perform a pelvic exam. During this exam, your doctor may collect a sample of vaginal discharge. They’ll send this sample to a laboratory for analysis. This can help your doctor learn what’s causing your infection.

How are vaginal infections treated?

Treatment for vaginal infections will depend on what’s causing your infection. For example:

  • Metronidazole tablets, cream, or gel, or clindamycin cream or gel may be prescribed for a bacterial infection.
  • Antifungal creams or suppositories may be prescribed for a yeast infection.
  • Metronidazole or tinidazole tablets may be prescribed for trichomoniasis.
  • Estrogen creams or tablets may be prescribed for vaginal atrophy.

If your infection is caused by an irritant, such as soap, your doctor will recommend a different product to reduce irritation.

How can you prevent vaginal infections?

Not all vaginal infections can be prevented. Using a condom during sexual intercourse will help prevent the spread of STIs. It will also lower your risk of contracting them.

Proper hygiene can also help prevent some vaginal infections.

When possible, you should wear cotton underwear and pantyhose with a cotton crotch. This can lower your risk of developing vaginal inflammation and irritation. Some women develop inflammation and irritation from wearing less breathable fabrics.

Dr. Ruchi Tandon is a Gynecologist practicing in South Delhi , in leading hospitals , Max Smart superspeciality hospital and Apollo hospitals. She has experience of over 13 years in treatment of vaginal infections.