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Gynecological Problems

Fibroids, Ovarian cysts, Menstrual Cycle / Periods myths and facts, Adenomyosis, Endometriosis & Polycystic ovaries.

Some of the common Gynaecological Problems are:

  • Fibroids
  • Ovarian cysts
  • Menstrual Cycle / Periods myths and facts
  • Adenomyosis
  • Endometriosis
  • Polycystic Ovarian Disease /Syndrome (PCOD/PCOS)

A: FIBROID UTERUS

It is a very common non-cancerous growth of the smooth muscle of the wall of the uterus.

Types of fibroids :
1) Sub serous: outside the uterus wall / attached to the wall of the uterus by a pedicle.
2) Intramural: within the uterine musculature.
3) Submucous: grows into the cavity of the uterus.

 

Fibroids may be discovered incidentally on sonography done for any other reason or the fibroid may cause symptoms based on their location.
Some of the common symptoms of fibroids are as follows:
1) heavy period
2) painful periods
3) mass/lump in the lower abdomen
4) pressure symptoms due to the fibroid pressing the urinary bladder in front: frequency, the urgency of urination, or fibroid pressing the rectum posteriorly causing constipation or sense of incomplete evacuation.

The diagnosis of a fibroid uterus can be made by sonography of the pelvis. More imaging techniques like MRI & CT is rarely needed.
Treatment depends upon:
1) Age of the woman
2) Symptoms due to fibroids
3) Size and location of the fibroid
4) The desire of having children

Medical management with some medicines can be given keeping in mind the factors deciding the mode of treatment as mentioned above.

Surgery: myomectomy, removal of the fibroid only can be done. The decision to remove the fibroid alone or along with the uterus depends on the age of the woman along with her desire for future fertility. Surgery for fibroid removal can be laparoscopic.

B: OVARIAN CYST

Having a cyst in the ovary is a fairly common condition that a lot of women across all age groups experience. Most ovarian cysts are harmless but some may be a cause of concern and need evaluation. The treatment of the ovarian cyst can be both medical and surgical and depends on a lot of factors such as age, desire for child bearing, family history of certain cancers, complexity of the cyst and levels of other hormonal markers.
Most of the ovarian cysts are functional cysts due to hormonal fluctuations during a menstrual cycle, most are non cancerous.

Common symptoms of ovarian cysts:

1) Asymptomatic – Many women have no symptoms and ovarian cysts are incidentally discovered on sonography or pelvic examination.

2) Pain or pressure in the lower abdomen – Discomfort or pain during intercourse could be another symptom.

3) A mass may be felt by the lady in her abdomen if the cyst is large enough.

4) Nausea, vomiting, pressure symptoms like bladder or bowel symptoms (in case of large cysts).

5) Abnormality in the menstrual cycle.

6) Sudden onset pain – Incase the ovarian cyst get twisted / undergoes torsion.

7) Heart burn, indigestion, feeling full after eating only very little (early satiety).

8) Infertility.

Tests to diagnose ovarian cysts:
1) Pelvic examination by a gynaecologist.
2) Ultrasonography pelvis.
3) Certain hormonal markets which support the diagnosis and may be important in judging the malignant potential of the cyst, like CA-125.
4) Further imaging : like CT, MRI may be needed after a sonography.
5) Other hormonal tests: used in patients with suspected PCO (poly cystic ovaries) or infertility with ovarian cysts : like LH, FSH, Estradiol, Testosterone.

Treatment of ovarian cyst depends on a lot of factors such as :

  • Age.
  • Desire for child bearing.
  • Family history of ovarian cancers.
  • Complexity of the cyst on sonography
  • Levels of hormonal markers if done.

Most cysts are functional and resolve on their own. Some cyst require a hormonal treatment with Estrogen and Progesterone combined or Progesterone alone.
Larger cysts or complex cyst or cysts with raised markers may require surgery which can be done  laparoscopically or by laparotomy.
Women who are menopausal and have ovarian cysts require a thorough evaluation and prompt treatment keeping in mind the low chances of spontaneous resolution and the malignant potential of ovarian cysts in that age group.

C: MENSTRUAL CYCLE / PERIODS MYTHS & FACTS

Do this, don’t touch that – the advice never ends, especially when you’re on your period (or awaiting it). Here are some myths and facts about periods:

  • Myth: You must have your period every 30 days and it must last for seven days, otherwise something is wrong with you.
  • Fact: The timing of every woman’s period is a little different – the number of days of bleeding and the interval at which it arrives. The normal range is 21 to 35 days and bleeding can last anywhere between two and seven days. The interval between periods is longer for teenagers and girls who have just started menstruating. This is because during the initial few years the ovaries don’t release an egg regularly. Periods also tend to become irregular with varied duration of bleeding around menopause. However, older women who are nearing menopause sometimes have an increased risk of uterine cancer or a pre-cancerous change related to irregular periods and bleeding. 
  •  Myth: You should not wash your hair during your period.
  •  Fact: There’s absolutely no medical evidence to support this myth, and it can be categorised as a false belief. Washing your hair is a perfectly normal way to maintain good hygiene both during and between periods. 
  •  Myth: Missing a period must signal pregnancy.
  •  Fact: Missing a period doesn’t always mean that you’re pregnant. There are several medical conditions (thyroid disorders, excessive weight loss and pelvic infections) that can cause hormonal changes during your cycle and lead to a missed or delayed period. 
  •  Myth: You should not exercise when you’re on your period.
  •  Fact: You can exercise while you’re on your period. Depending on how comfortable you are, it’s up to you to take a call on the intensity and type of exercise in which you engage. 
  •  Myth: If you drink cold beverages when you’re on your period, you will catch a cold.
  •  Fact: Drinking cold liquids when you’re on your period has absolutely nothing to do with catching a cold. A cold or flu is caused by a virus and you won’t catch a cold simply by drinking cold beverages when you’re on your period. However, it is true that many women feel more comfortable sipping on hot beverages while menstruating. 
  •  Myth: It is “safe” to have intercourse during your period.
  •  Fact: While the possibility of pregnancy is almost nil, it is not 100% safe, because ovulation may occur irregularly. 
  •  Myth: If you get your period after it is delayed (by more than a week), then there’s no chance of pregnancy at all.
  •  Fact: What might look like a delayed period can actually be a sign of an early pregnancy. The ‘bleeding’ may be because of implantation or a miscarriage.

D: ADENOMYOSIS

Adenomyosis usually affects women of reproductive age during the later half of their reproductive life (40-50years). The exact cause of this condition is not known.

Some of the common symptoms are: 

  • Heavy bleeding during periods.
  • Moderate to severe cramping pain during periods.
  • Blood clots during periods due to heavy bleeding.
  • Pressure / heaviness in lower abdomen due to an enlarged uterus 
  • Pain during inter-course.

Other conditions like fibroids, endometriosis can mimic the symptoms of adenomyosis.
An examination by a gynaecologist and further on a sonography can help to suspect adenomyosis.
However the definitive diagnosis of adenomyosis can be made only after the uterus is removed (hysterectomy) and examined by a pathologist.
Adenomyosis is an estrogen dependent condition and goes away once the woman attains menopause.
The definitive treatment of adenomyosis is removal of the uterus (hysterectomy).
Some women may have milder symptoms and may attain menopause without requiring any surgical intervention. They may do well with certain medications only.

Some common medicines given to relieve the symptoms are : pain killers, anti inflammatory drugs, oral contraceptives.

Removal of the uterus is best done laparoscopically if there are no contraindications to do laparoscopy.

E: ENDOMETRIOSIS

This is a fairly common painful disorder in which the endometrium ( which lines the uterine cavity ) grows outside the uterus.

The most common sites of endometriotic implants are the ovaries , Fallopian tubes and the peritoneum .

Endometrial implants bleed and the area becomes thickened and surrounding areas may develop adhesions . In the ovary, a cyst may form (endometrioma / chocolate cyst) .

Some of the common symptoms of endometriosis are :

A) painful periods : dysmenorrhea
B) heavier than usual periods
C) pain during intercourse
D) infertility / inability to conceive naturally
E) Pelvic / lower abdominal pain
F) no symptoms
E) painful bowel movements and painful urination , which are experienced during menstruation .
G) other symptoms like nausea , bloating , constipation , fatigue during periods/menses.

There are certain risk factors which increase the chances of developing endometriosis:

  • early age at starting your periods
  • never given birth
  • late age at menopause
  • Short menstrual cycles — for instance, less than 27 days
  • Low body mass index
  • Alcohol consumption
  • Family history of endometriosis
  • Uterine abnormalities

DIAGNOSIS

Clinical examination : pelvic examination may reveal a ovarian cyst or painful tender nodules

Ultrasonography : can pick up ovarian endometriomas. Peritoneal implants are not picked up by sonography

MRI : can be done before planning out a surgery

Diagnostic Laparoscopy : This is one of the most accurate ways of diagnosing endometriosis . The endometrial implants can be seen during laparoscopy and can be biopsied if needed .

TREATMENT

Treatment will depend on your symptoms and also your desire of fertility .

Few of the options are
1) pain killers
2) hormonal treatment : oral contraceptives, progesterone, Gonadotropins .
3) surgical removal of the endometrioma , removing /breaking the lesions caused due to fibrosis /adhesions .

Women with endometriosis are in a lot of pain physically , as well as emotionally they feel drained out due to sub/infertility .
Women should be encouraged to join support groups so they can discuss their symptoms /disease state with other women facing similar complaints due to endometriosis .

If you feel you may be having endometriosis ( based on the symptoms mentioned above ) please do get in touch with us and fix an appointment soon!

F: POLYCYSTIC OVARIAN DISEASE / SYNDROME (PCOD/PCOS)

Polycystic ovarian disease /syndrome is a very common hormonal imbalance disorder in women of reproductive age group .

The exact cause of PCOS is unknown . There are many genetic factors, environmental factors , insulin resistance , which have shown to increase the risk of developing this metabolic disorder .

PCOS often seen to run in families . However , it is not necessary that a woman will develop PCOS if her mother , sisters or aunt have it . She however needs to be more careful .

Early diagnosis of PCOS is important as if the problem is not diagnosed and treated well on time , this metabolic hormonal disorder can lead to other disease such as diabetes /insulin resistance , raises lipids and triglycerides ( which are a cardiovascular risk ), endometrial ( uterine ) cancer .

Some of the most common symptoms of PCOS are
1) Irregular periods
Scanty or prolonged interval between menstrual cycles
The length of the cycle is irregular .
When the woman gets her period , it is heavier than normal .

2) Hair loss : excessive hair loss leading to baldness and receding hair line .

3) Acne : over the face , jaw line , upper chest , upper back .

4) Fatigue , lethargy , mood swings

5) Hirsutism : thick hair ( male pattern hair ) : increase in facial as well as body hair , in areas such upper lip , under the chin , between eyebrows .
Coarse hair appearing in a woman who previously had female pattern hair is a sign of increased androgens .

Other tests done to diagnose PCOS :

Along with the important clinical features mentioned above , the blood androgen levels are elevated ( testosterone , DHEA) , serum insulin levels are raised . Ultrasonography May show Polycystic appearance of the ovaries .

Adolescent PCOS however is diagnosed with slightly different parameters . Ultrasonography May show Polycystic pattern of which is not always abnormal in adolescents.

Women with PCOS are usually overweight but there are a few percentage of women who have PCOS but are slim ( they are the thin PCOS )

PCOS is also a very common cause of infertility . Due to the basic hormonal imbalance /insulin resistance the ovarian follicles do not nature and there is no ovulation .

There are various treatment options available which can be given as per the age of the lady , her desire to have children or not , whether the hormonal markers are elevated or not .

The first and most important treatment for PCOS is lifestyle modification : dietary changes , increasing physical activity, managing stress better.

If you think you maybe having PCOS , then please get a consultation with our doctor soon .

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