Gynecology & Obstetrics

Dr Ritu GuptaDr. Ritu Gupta 
(M.B.B.S, M.S)

Gynaecologist and Obstetrician
Infertility Specialist and Advanced Laparoscopic Surgeon
Ex – Senior Resident Lady Harding Medical College, Delhi

 

Obstetricians and Gynaecologists

Specialize in the Gynaecological Surgeries, General Medical Care of women, as well as care related to pregnancy and the reproductive tract.

She also specialize in the management of hormonal disorders, treatment of infections,or treat pelvic organ and urinary tract problems to include cancer of the reproductive organs.

Screening for cancer is an important part of the job of our specialist as well.

  • Endometriosis
  • Pelvic & Vaginal Pain
  • Fibroids
  • Abnormal Uterine Bleeding / Heavy Periods (Menorrhagia)
  • Hysterectomy
  • Abdominal Hysterectomy
  • PCOS and Ovarian Drilling
  • Breast Cancer
  • Mother and Child Care Hospital

Endometriosis is a common condition where tissue from the lining of the womb, grows in other areas of the body, such as ovaries, vagina, fallopian tubes, bladder, bowel, or rectum. It is a chronic condition that affects women’s all over the world.

Symptoms

The symptoms of endometriosis vary and some women may have no symptoms at all.

Most common symptoms include:

  • Painful or heavy periods
  • Pain during sex
  • Pain in the lower back, pelvis or abdomen
  • Bleeding between periods
  • Infertility problems

The experience of pain varies between women. Most women with endometriosis get pain in the area between their hips and the tops of their legs. Some women have this all the time, while others only have pain during their periods, when they have sex or when they go to the toilet.

How severe the symptoms are depends largely on where in your body the endometriosis is. A small amount of tissue can be as painful as a large amount.

Diagnosis

Endometriosis is diagnosed via an examination called a laparoscopy.

During a laparoscopy, you are given a general anaesthetic and a laparoscope (slender, tubular endoscope) is inserted through a small incision in your abdominal wall. The laparoscope has a tiny camera that transmits images to a video monitor for the Consultant to view the endometriotic tissue.

The Consultant can then perform a biopsy for laboratory testing or insert other surgical instruments to treat the endometriosis. You can usually go home the same day after you have had a laparoscopy.

Treatment

Your Consultant will discuss treatment options with you. Several factors will influence the recommended treatment options, such as

  • Your age
  • Your main symptom (pain, fertility problems)
  • If you are planning a pregnancy
  • If you have had any treatments previously
  • If you are anxious about surgery

Although there is no cure for endometriosis, the aim of treatment is to ease the symptoms so that the condition does not interfere with your daily life. Treatment can help to relieve pain, improve fertility, slow the growth of endometriosis, and prevent the disease from coming back.

Treatments for Endometriosis:

  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen act against the inflammation and help to ease pain and discomfort
  • Hormone treatments can limit or stop the production of oestrogen in your body. Removing exposure to oestrogen can reduce the endometriotic tissue and help to ease your symptoms
  • Surgery can remove or destroy the areas of endometriotic tissue. The type of surgery used will depend on where the tissue is and how extensive it is.

Surgery

  • The endometriotic tissue may be cut away, or be destroyed with heat from an electric current or a laser (endometrial ablation) or by directing a beam of helium gas to destroy the tissue. This can usually be done by a laparoscopy. The Consultant Surgeon will make small cuts in your abdomen and then use the laparoscope to view inside your pelvis and remove the tissue.
  • If endometriosis is severe and extensive, you may need laparotomy surgery. This is open surgery and a larger cut will be made in your abdomen.
  • If you have very severe symptoms, your doctor may advise you to have surgery to remove your womb, called a hysterectomy.

In many women endometriosis can come back after surgery. Your Consultant Surgeon may recommend that you take hormonal drugs after surgery to help delay the return of symptoms.

Possible causes of pelvic or vaginal pain include:

Ectopic Pregnancy

This is a life-threatening emergency that requires immediate treatment. It happens when an embryo begins growing outside of the uterus (usually in the fallopian tube). Symptoms include sharp pelvic pain or cramps, vaginal bleeding, nausea, and dizziness.

Ovarian Cysts

A follicle houses the maturing egg during the menstrual cycle and releases the egg when you ovulate. Occasionally, a follicle doesn’t open to release the egg or recloses after releasing the egg and swells with fluid, forming an ovarian cyst. This is usually harmless and goes away on its own. However, large cysts may cause pelvic pain, weight gain and frequent urination. Ovarian cysts can be identified with a pelvic examination or ultrasound.

Pelvic Inflammatory Disease (PID)

This infection can cause permanent damage to the uterus, ovaries and fallopian tubes. It is the leading preventable cause of infertility in women. Symptoms include abdominal pain, fever, abnormal vaginal discharge, and pain during sex or urination. PID is treated with antibiotics or surgery in severe cases.

PMS

As well as triggering mood swings and food cravings, PMS (premenstrual syndrome) can also cause abdominal cramps, low back pain, headaches, tender breasts, and acne. Hormonal changes may be to blame. Stress, lack of exercise and some vitamin deficiencies may make the symptoms worse. Lifestyle changes and medication can often help.

Fibroids are benign tumours that develop within the uterus. About 1 in 5 women develop fibroids during their childbearing years and half of all women will have fibroids before they are 50.

Symptoms

  • Heavy menstrual bleeding (menorrhagia)
  • Bleeding between periods
  • Periods lasting longer than normal
  • Pelvic cramping or pain with periods
  • Sensation of fullness or pressure in lower abdomen
  • Needing to urinate more often
  • Pain during intercourse

Diagnosis

Fibroids often do not cause symptoms and are usually discovered during a routine gynaecological examination, diagnostic test or scan. To confirm diagnosis you may be asked to undergo:

  • Ultrasound scan
  • Transvaginal ultrasound
  • Hysteroscopy
  • Laparoscopy
  • Biopsy

Treatment

Treatments vary depending on your age, general health, the type of fibroids, and if you are pregnant or planning to get pregnant in the future. Some women may just need pelvic exams or ultrasounds every once in a while to monitor the fibroid growth.

Treatment for the symptoms of Fibroids:

  • Birth control pills (oral contraceptives) help control heavy periods
  • Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for pain
  • Intrauterine devices (IUDs) release the hormones to reduce heavy bleeding and pain
  • Iron supplements treat anemia caused by heavy periods
  • Short-term hormone therapy injections help to shrink the fibroids

Surgery options for treating fibroids:

  • Hysteroscopy
  • Uterine artery Embolisation
  • Myomectomy
  • Hysterectomy

Your period could be defined as heavy if you:

  • Pass large blood clots
  • Require frequent changes of tampons or sanitary towels
  • Require double sanitary protection (tampons and sanitary towels)
  • Bleed through to clothes or bedding

Heavy periods that recur each month, and interfere with your quality of life, are known as menorrhagia. Menorrhagia accounts for 30% of all Gynecological outpatient attendances. 25% of women feel that their menstrual loss is excessive and up to 10% take time off work.

Causes

In 40-60% of cases the cause of heavy bleeding is not known. This is called dysfunctional uterine bleeding. With dysfunctional uterine bleeding, the womb and ovaries are normal, it is not a hormonal problem, and periods may be regular. This condition is more common in patients approaching the menopause or who have only started their periods recently (in these cases periods are likely to be irregular in addition to being heavy).

Other, less common causes of heavy bleeding include:

  • Fibroids, which are non-cancerous tumours that grow in the muscle of the uterus
  • Endometriosis, where cells from the uterus lining grow in other parts of the body
  • Pelvic infection (e.g. STIs)
  • Polyps, masses in the inner lining of the uterus
  • Endometrial cancer (very rare cause)
  • Hormonal problems
  • Polycystic ovary syndrome
  • Anticoagulant medication such as warfarin

Diagnosis

To diagnose the cause of heavy periods, tests may include vaginal examination of the cervix (neck of the womb) and examination of the size and shape of the uterus (womb). If the vaginal examination is normal and the patient is under 40 year old, the diagnosis is generally dysfunctional uterine bleeding. If the uterus is found to be large or abnormal, and/or they are over 45 years old, further diagnostic tests may be required. Further tests will also be required if other symptoms, such as irregular bleeding or pain during sex, are also present. These may include:

  • Ultrasound, which can detect fibroids, polyps or structural changes in the uterus
  • Internal swabs to check for infection
  • Hysteroscopy (a thin telescope is passed into the uterus)
  • Endometrial sampling (biopsy of the uterine lining) to check for abnormalities

Most patients are given a blood test to check for anemia, due to the heavy blood loss. Approximately 60% of women with menorrhagia (recurrent heavy periods) will develop anaemia.

  • Hysterectomy (removal of the uterus) is often used in order to treat fibroids, this is not an option for patients wishing to maintain their fertility and organs, and hence a myomectomy is performed.
  • Hysterectomy may be total (removing the body, fundus, and cervix of the uterus; often called “complete”) or partial (removal of the uterine body while leaving the cervix intact; also called “supracervical”). It is the most commonly performed gynecological surgical procedure.
  • Hysterectomy may cause an increased risk of the relatively rare renal cell carcinoma. The increased risk is particularly pronounced for young women, the risk was lower after vaginally performed hysterectomies. Hormonal effects or injury of the ureter were considered as possible explanations. In some cases the renal cell carcinoma may be a manifestation of an undiagnosed hereditary leiomyomatosis and renal cell cancer syndrome.

What is Laproscopically Assisted Vaginal Hysterectomy (LAVH)?

Laproscopically assisted vaginal hysterectomy (LAVH) is a surgical procedure using a laparoscope to guide the removal of the uterus and/or Fallopian tubes and ovaries through the vagina (birth canal). The ovaries and other organs may also be removed. The uterus is removed through the vagina. It is done:

  • When uterine fibroids are small to moderate in size.
  • When the uterus is slightly larger than normal.
  • To remove endometriosis and scar tissue (adhesions) confined to the uterus, fallopian tubes, and ovaries.
  • To assess or remove ovaries at the same time as a vaginal hysterectomy.

 Patient Recovery

Hospital stay is 3 to 5 days or more for the abdominal procedure and between 1 and 2 days but possibly longer for vaginal or laproscopically assisted (LAVH) vaginal procedures.

Advantages of Laparoscopic-Assisted Vaginal Hysterectomy (LAVH)

  • Low risk of complication
  • Less blood loss
  • Short inpatient treatment duration Possible even with larger uterus and after previous surgery
  • Combination with reduction operations are possible
  • Shortest operation time
  • Short recovery period

An abdominal hysterectomy is a surgical procedure that removes your uterus through an incision in your lower abdomen. A partial hysterectomy removes just the uterus, leaving the cervix intact. A total hysterectomy removes the uterus and the cervix.

Recovery

Recovery after a hysterectomy takes time. Immediately after a hysterectomy, you will stay in the hospital from 1 to 4 days for post surgery care.

At home, you may resume your normal diet, and bathe or shower normally.  The incision should be kept clean with soap and water, but it is not necessary to keep it bandaged.  You may use lotion on the skin around the incision to relieve itching.

Advantages of Abdominal Hysterectomy:

  • No limitation by the size of the uterus
  • Combination with reduction and incontinence surgery possible
  • The advantages of an abdominal hysterectomy are that the uterus can be removed even if a woman has internal scarring (adhesions) from previous surgery or her fibroids are large. The surgeon has a good view of the abdominal cavity and more room to work. Also, surgeons have the most experience with this type of hysterectomy. However, the abdominal incision is more painful than with vaginal hysterectomy and the recovery period is longer.

If you have been diagnosed with polycystic ovary syndrome (PCOS), you are probably no stranger to fertility problems. You may have tried to lose weight or take different fertility drugs to help you conceive. But if these PCOS fertility treatments did not work for you, you may wonder if there is another option.

Laparoscopic ovarian drilling is a surgical treatment that can trigger ovulation in women who have polycystic ovary syndrome (PCOS). Electrocautery or a laser is used to destroy parts of the ovaries.

What To Expect After Surgery

If you have a laparoscopy procedure, you will likely go home the same day and can do your normal activities within 24 hours. Your return to normal activities will depend on how quickly you recover from surgery, which may take a few days or as long as 2 to 4 weeks.

Breast Cancer starts when cells in the breast begin to grow out of control. These cells usually form a tumor that can often be seen on an x-ray or felt as a lump. The tumor is malignant (cancerous) if the cells can grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body.

Advanced treatment options include two types of surgery that go beyond non-invasive options to treat lymphedema, a common side effect of breast cancer.

A small number of cancers start in other tissues in the breast. These cancers are called sarcomas and lymphomas and are not really thought of as breast cancers. breast tissue

What are the risk factors for breast cancer?

The main risk factors for breast cancer are things you cannot change: being a woman, getting older, and having certain gene changes. These make your risk of breast cancer higher But having a risk factor, or even many, does not mean that you are sure to get the disease. breast cancer details