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Understanding Menstrual Irregularities: Could It Be Fibroids?

fibroids surgeon in South Delhi

Menstrual irregularities are a common concern among women, often signaling underlying health issues. These irregularities can affect daily life and overall well-being, from heavy bleeding to unpredictable cycles. One of the potential culprits behind such disruptions is fibroids and, in such cases, it is highly important to consult an experienced fibroids surgeon in South Delhi. But what are fibroids, and how can they influence your menstrual health? Let us have a look.

What Are Fibroids?

Also known as uterine leiomyomas, fibroids are non-cancerous growths that develop in or around the uterus. They vary in size, shape, and location, with some being as small as a seed and others growing large enough to distort the uterus. While fibroids are generally benign, their impact on health can range from minimal to significant, depending on factors such as size, number, and location.

How Fibroids Cause Menstrual Irregularities?

One of the hallmark symptoms of fibroids is abnormal menstrual bleeding. Women with fibroids may experience:

Heavy Menstrual Bleeding (Menorrhagia): Fibroids can increase the volume and duration of menstrual flow, sometimes leading to anemia.

Prolonged Periods: Menstruation lasting longer than usual is another common sign.

Frequent or Irregular Periods: Fibroids can disrupt the regularity of the menstrual cycle, causing periods to occur more frequently or unpredictably.

Painful Periods (Dysmenorrhea): Fibroids can contribute to severe cramping and pelvic discomfort during menstruation.

The exact mechanism behind these symptoms often depends on the location of the fibroids. Submucosal fibroids, which grow beneath the uterine lining, are more likely to cause heavy bleeding, while intramural or subpetrosal fibroids may exert pressure on surrounding organs, leading to other complications.

Are Fibroids the Only Cause?

It’s important to note that not all menstrual irregularities are due to fibroids. Hormonal imbalances, polycystic ovary syndrome (PCOS), endometriosis, and thyroid disorders are other potential causes. Lifestyle factors, stress, and changes in body weight can also play a role.

When to Seek Medical Advice?

If you notice any significant changes in your menstrual cycle—such as heavy bleeding, prolonged periods, or severe pain—it’s essential to consult a healthcare professional. Early diagnosis can help identify fibroids or other conditions and ensure timely treatment.

What Are the Treatment Options for Fibroids?

Fibroid management ranges from watchful waiting to medical interventions. Mild cases may not require immediate action, while others might benefit from medications, minimally invasive procedures, or surgery. Discussing your symptoms and treatment goals with a doctor is crucial for determining the best approach.

Take Charge of Your Health

Understanding the potential link between menstrual irregularities and fibroids empowers women to prioritize their reproductive health. By staying informed and seeking medical care when needed from a good gynecologist in South Delhi, you can manage symptoms effectively and maintain a better quality of life.

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How to Talk to Your Doctor About Fibroids? Key Questions to Ask.

fibroids surgeon in South Delhi

Uterine fibroids frequently affect women, especially during their childbearing years. While they are usually benign, fibroids can cause significant discomfort and disrupt daily life. Whether you’re newly diagnosed or seeking treatment options, having a productive conversation with your fibroids surgeon in South Delhi is essential. Preparing for this discussion can help ensure you receive the best possible care. Here are key questions to ask and tips on how to approach this important dialogue.

Understanding the Diagnosis

Start by gaining clarity about your condition. Fibroids vary in size, number, and location, all of which can influence symptoms and treatment options. Here are some questions to ask:

  • What are uterine fibroids? How do they develop?
  • What type of fibroids do I have? Are they located inside, outside, or within the uterine wall?
  • How large are my fibroids, and how many are present?
  • Do my fibroids pose any risks to my overall health or fertility?

Understanding the specifics of your diagnosis can help you make informed decisions about managing your fibroids.

Evaluating Symptoms

Fibroid symptoms can range from mild to severe. Common issues include heavy menstrual bleeding, pelvic pain, and pressure on the bladder or rectum. Discuss your symptoms in detail to guide your treatment plan. Consider asking:

  • Are my symptoms typical for someone with fibroids?
  • Can my symptoms worsen over time?
  • What are the warning signs of potential complications?

Tracking your symptoms beforehand can provide useful insights for your doctor, helping them better understand how fibroids affect your daily life.

Exploring Treatment Options

Fibroid treatment isn’t one-size-fits-all. It depends on factors such as your age, overall health, the severity of your symptoms, and whether you plan to have children. Key questions include:

  • What are my treatment options?
  • Are there non-surgical methods, such as medication or lifestyle changes, that could help?
  • What surgical treatments are available, and what are their risks and benefits?
  • Will this treatment impact my future fertility?

It’s essential to understand the pros and cons of each treatment approach and weigh them against your personal health goals.

Considering Long-Term Care

Even after treatment, fibroids can recur. Discussing long-term care and follow-up plans is vital. Ask:

  • How likely are my fibroids to return after treatment?
  • What can I do to prevent future fibroids?
  • How often should I schedule follow-up appointments?

By addressing these concerns, you can stay proactive about your health and minimize future disruptions.

Tips for a Productive Conversation

Prepare a list of questions and symptoms

Write down everything you want to discuss to avoid forgetting during the appointment.

Bring medical records

Share relevant test results or imaging reports with your doctor.

Be honest about your concerns

Whether it’s fear of surgery or worries about fertility, being open can help your doctor tailor their recommendations to your needs.

Ask for clarification

Don’t hesitate to request simpler explanations if medical jargon is confusing.

By preparing for your appointment and asking the right questions, you can take an active role in managing your fibroid health. This collaborative approach with a good gynecologist in South Delhi ensures you receive personalized care that aligns with your lifestyle and goals.

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Different Types of Uterine Fibroids. What Women Should Know?

Different Types of Uterine Fibroids. What Women Should Know?

Uterine fibroids are harmless tumors that form in the uterus. While many are small and don’t cause problems, others can lead to pain or complications. There are several different types of uterine fibroids, each with its own characteristics and potential effects. Some uterine fibroids may require the help of an experienced fibroids surgeon in South Delhi for treatment.

What Are the Types of Uterine Fibroids?

Intramural Fibroids

  • Location: These fibroids grow within the muscular wall of the uterus.
  • Symptoms: Intramural fibroids may not cause symptoms, but they can result in heavy bleeding, pelvic pain, and pressure on the bladder or rectum.
  • Treatment: The choice of treatment for intramural fibroids will be determined by how much the symptoms are affecting the patient’s quality of life.

Subserosal Fibroids

  • Location: These fibroids grow on the outside surface of the uterus.
  • Symptoms: Subserosal fibroids may cause abdominal pain, bloating, and pressure on nearby organs. If they become large enough, they can also interfere with fertility.
  • Treatment: Treatment for subserosal fibroids may include observation, medication, or surgery.

Submucosal Fibroids

  • Location: These fibroids grow beneath the inner lining of the uterus.
  • Symptoms: Submucosal fibroids are often associated with heavy bleeding, anemia, and pelvic pain. They can also interfere with fertility.
  • Treatment: Treatment for submucosal fibroids typically involves surgery, such as myomectomy or hysterectomy.

Pedunculated Fibroids

  • Location: These fibroids are attached to the uterus by a stalk or peduncle.
  • Symptoms: Pedunculated fibroids can cause pelvic pain, pressure, and heavy bleeding. They may also twist or degenerate, leading to severe complications.
  • Treatment: Treatment for pedunculated fibroids may include observation, medication, or surgery to remove the fibroid or the entire uterus.

Cervical Fibroids

  • Location: These fibroids grow in the cervix, the lower, narrow part of the uterus.
  • Symptoms: Cervical fibroids can cause abnormal bleeding, pelvic pain, and difficulty with intercourse.
  • Treatment: Treatment for cervical fibroids typically involves surgery, such as myomectomy or hysterectomy.

What Are the Factors that Affect Symptoms and Treatment?

The size, location, and number of uterine fibroids can all affect the severity of symptoms and the most appropriate treatment. Other factors that may influence treatment decisions include the patient’s age, fertility desires, and overall health.

What is the Diagnosis for Uterine Fibroids?

Uterine fibroids are typically diagnosed through a physical examination, pelvic ultrasound, or MRI scan. In some cases, a hysteroscopy or laparoscopy may be necessary to confirm the diagnosis or evaluate the extent of the fibroids.

What Are the Treatment Options for Uterine Fibroids?

The treatment options available for uterine fibroids include:

  • Observation: If the fibroids are small and asymptomatic, they may be monitored without treatment.
  • Medication: Hormonal medications can be effective in regulating menstrual cycles and reducing excessive bleeding.
  • Myomectomy: The surgery removes fibroids without affecting the uterus.
  • Hysterectomy: This surgical procedure involves removing the uterus, often along with the ovaries.

The choice of treatment will depend on the individual patient’s circumstances and preferences. Before making a decision, it’s crucial to talk to a fibroids surgeon in South Delhi about the potential advantages and drawbacks of each option.

Living with Uterine Fibroids

Many women with uterine fibroids can live normal, healthy lives. If you have been diagnosed with uterine fibroids, it is important to manage your symptoms and seek appropriate treatment. By working closely with a good gynecologist in South Delhi, you can develop a personalized treatment plan that meets your specific needs.

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Fibroids After Menopause – A Quick Guide

Fibroids After Menopause - A Quick Guide

Fibroids are non-cancerous growths. These growths occur in the uterine wall. While they are most common during the reproductive years, some women may continue to experience them after menopause. Understanding the causes, symptoms, and treatment options for fibroids after menopause can help you manage any discomfort or concerns. If the condition becomes severe, you need to consult an experienced fibroids surgeon in South Delhi.

What Are the Causes of Fibroids After Menopause?

  • Hormonal Changes: Although estrogen levels decrease significantly after menopause, some women may still produce small amounts. This residual estrogen can contribute to the growth of fibroids.
  • Genetics: A family history of fibroids can increase your risk.
  • Age: While fibroids are more common during the reproductive years, some women may develop them later in life.

What Are the Symptoms of Fibroids After Menopause?

  • Heavy Bleeding: Even after menopause, you may experience irregular bleeding or spotting.
  • Pelvic Pressure or Pain: Fibroids can put pressure on your bladder or rectum, causing discomfort.
  • Urinary Frequency or Incontinence: Fibroids can affect your bladder, leading to increased urination or difficulty controlling your bladder.
  • Constipation: If fibroids are large enough, they can put pressure on your intestines, causing constipation.
  • Infertility: While rare, fibroids after menopause can sometimes interfere with fertility if you’re considering having a child later in life.

What is the Diagnosis of Fibroids After Menopause?

If you’re experiencing any of these symptoms, it’s important to see a healthcare provider for an evaluation. They may use the following tests to diagnose fibroids:

  • Pelvic Exam: Your doctor will perform a physical exam to check for any abnormalities in your abdomen or uterus.
  • Ultrasound: An ultrasound uses sound waves to create images of your uterus and ovaries.
  • MRI: Magnetic resonance imaging can provide more detailed images of your fibroids.

What Treatment Options Are Available for Fibroids After Menopause?

The best treatment for fibroids after menopause will depend on your symptoms and the size and location of the fibroids. Some women may not require any treatment, while others may benefit from the following options:

  • Observation: If your fibroids are small and causing no symptoms, your doctor may recommend monitoring them over time.
  • Medication: In some cases, hormonal therapy can help shrink fibroids.
  • Surgery: If your fibroids are causing significant symptoms or interfering with your quality of life, surgery may be necessary. Surgical options include:
  • Myomectomy: This procedure involves removing the fibroids while preserving the uterus.
  • Hysterectomy: If you’re no longer interested in having children, a hysterectomy may be recommended. This includes removing the uterus. In some cases, ovaries may also be removed.

Living with Fibroids After Menopause

While fibroids can be uncomfortable, it’s important to remember that they are generally benign and do not increase your risk of developing cancer. By understanding the causes, symptoms, and treatment options, you can manage your condition and maintain a good quality of life.

If you have any concerns about fibroids or are experiencing symptoms, don’t hesitate to consult with your healthcare provider. They can provide personalized guidance and recommend the best course of action for you.

Dr. Ruchi Tandon is a renowned fibroids surgeon and PCOS doctor in South Delhi.

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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.

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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.

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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.

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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.

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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.

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Fibroids in the time of covid pandemic

What are fibroids?

Fibroids are abnormal growths that develop in or on a woman’s uterus. Sometimes these tumors become quite large and cause severe abdominal pain and heavy periods. In other cases, they cause no signs or symptoms at all. The growths are typically benign, or noncancerous. The cause of fibroids is unknown.

Fibroids are also known by the following names:

  • leiomyomas
  • myomas
  • uterine myomas
  • fibromas
What are the different types of fibroids?

The type of fibroid a woman develops depends on its location in or on the uterus.

Intramural fibroids

Intramural fibroids are the most common type of fibroid. These types appear within the muscular wall of the uterus. Intramural fibroids may grow larger and can stretch your womb.

Subserosal fibroids

Subserosal fibroids form on the outside of your uterus, which is called the serosa. They may grow large enough to make your womb appear bigger on one side.

Pedunculated fibroids

Subserosal tumors can develop a stem, a slender base that supports the tumor. When they do, they’re known as pedunculated fibroids.

Submucosal fibroids

These types of tumors develop in the middle muscle layer, or myometrium, of your uterus. Submucosal tumors aren’t as common as the other types.

What causes fibroids?

It’s unclear why fibroids develop, but several factors may influence their formation.

Hormones

Estrogen and progesterone are the hormones produced by the ovaries. They cause the uterine lining to regenerate during each menstrual cycle and may stimulate the growth of fibroids.

Family history

Fibroids may run in the family. If your mother, sister, or grandmother has a history of this condition, you may develop it as well.

Pregnancy

Pregnancy increases the production of estrogen and progesterone in your body. Fibroids may develop and grow rapidly while you’re Pregnant..

Who gets fibroids?

Fibroids are common, with around 1 in 3 women developing them at some point in their life. They most often occur in women aged 30 to 50.

Fibroids are thought to develop more frequently in women of African-Caribbean origin.

It’s also thought they occur more often in overweight or obese women because being overweight increases the level of oestrogen in the body.

Women who have had children have a lower risk of developing fibroids, and the risk decreases further the more children you have.

What are the symptoms of uterine fibroids?

Most women with fibroids will experience no symptoms at all. However, large or numerous fibroids can cause the following symptoms:  

  • Heavy or prolonged periods
  • Bleeding between periods
  • Pelvic pain and pressure
  • Frequent urination
  • Low back pain
  • Pain during intercourse
  • Difficulty getting pregnant
How are uterine fibroids diagnosed?

Fibroids are most often found during a physical exam. Your health care provider may feel a firm, irregular (often painless) lump during an abdominal or pelvic exam.

Scans can confirm a diagnosis. These tests are the two main options:

  • Ultrasound: Ultrasound is the most commonly used scan for fibroids. It uses sound waves to diagnose fibroids and involves frequencies (pitch) much higher than what you can hear. A doctor or technician places an ultrasound probe on the abdomen or inside the vagina to help scan the uterus and ovaries. It is quick, simple and generally accurate. However, it relies on the experience and skill of the doctor or technician to produce good results.  Other tests such as MRI may be better for other conditions, such as adenomyosis.
  • MRI: This imaging test uses magnets and radio waves to produce images. It allows your provider to gain a road map of the size, number and location of the fibroids. We can also distinguish between fibroids and adenomyosis, which sometimes gets misdiagnosed. We use MRI to confirm a diagnosis and help determine which treatments are best for you. MRI may also provide a better option for related conditions such as adenomyosis.

 How to manage fibroids in covid pandemic times?

Laparoscopy and open myomectomy are both options in covid pandemic depending on the extent of symptoms and position of the fibroid.

Dr. Ruchi Tandon is a Gynecologist, practicing in leading hospitals of South Delhi , max smart superspeciality hospital and Apollo Cradle Royale , with over 14 years experience in handling all kinds of fibroids and complications.