Women have menstrual cycle from 11-12 years of age to about 50 years. A few episodes of bleeding during the span is normal. Continuous episodes of bleeding Increase in bleeding days, clots, and irregular periods have to be evaluated immediately.
Includes detailed history with physical examination, blood tests, ultrasound to rule out any utrine problems, thyroid test for hormonal changes.
Further evaluations include endoscopic evaluation, laproscopy etc
Treatment includes both Medical and Surgical approach depending on the cause, age, severity of bleeding, fibroids or polyps.
- Surgeries include
- Endometrial ablation
Fibroids (leiomyomas or myomas)
Fibroids are benign (not cancer) growths in the uterus. 25–50% of women have fibroids.
Symptoms: Fibroids generally are asymptomatic but in few women can cause
- Abnormal Bleeding
- Menstrual pain (dysmenorrhoea)
- Vaginal bleeding
- Pain in the abdomen or lower back
- Difficulty in urinating or frequent urination
- Constipation, rectal pain, or difficult bowel movements
- Enlarged uterus and abdomen
How do we diagnose fibroids ?
Fibroids may be diagnosed in routine USG or pelvic examination. USG is an accurate method to diagnose assess and map the fibroid as this information is needed to plan the treatment. Hysteroscopy can be used to diagnose submucous fibroids.
How do we treat Fibroids?
Hysterectomy: Removal of uterus Mymomectomy : surgical removal of fibroids while leaving the uterus in place Drugs gonadotropin-releasing hormone (GnRH) agonists for temporary relief.
In one third of infertile women population the tissue endometrium which forms the lining of the uterus is found in other parts of the body like ovaries, fallopian tubes, cul-de-sac(behind uterus), intestines, rectum, bladder. During the menstrual cycle endometrium responds to the hormonal changes and breaks down and bleeds. The bleeding inside the uterus has a passage to come out as menstrual bleeding but the tissue bleed in the other areas keeps accumulating and forma cysts (chocolate cysts) or adhesions. This can cause pain, especially before and during period.
Who is at risk ?
- Young women in the age group of 30-40 years
- Women with uterine defects like septum or bicornuate uterus
- Pelvic pain (pain in lower abdomen and back).
- Heavy Bleeding
- Pelvic examination
Severity of endometriosis determines the treatment methods. In women with problems treatment is through medications or conservative surgery techniques performed with expert precision but is not a permanent solution, symptoms may come back after treatment. Surgery is the best choice for treatment. It is performed by laparoscopy or laparotomy.
Types of CystsBenign (not cancerous) cysts: They develop due to hormonal effects . Cysst >5cms or rapidly growing require surgical treatment. Malignant (Cancerous) are more common in woman above 40 years.
- Dull or sharp ache in the abdomen constantly or intermittently
- Nausea vomiting and giddiness
- Dysmenorrhoea (painful periods)
- Larger cysts may cause torsion (twisting) of the ovary that causes pain
- Cysts that bleed or rupture (burst) may lead to serious problems requiring prompt treatment.
- Routine pelvic exam
- Ultrasound scan
- Blood tests like CA 125, CEA etc .
TreatmentTreatment depends on size and type of cyst, age, severity of symptoms, desire for future childbearing, family history of ovarian cancer. Surgical Intervention through Laproscopy, Cystectomy (removal of the abnormal tissues and saving the normal ovarian tissues) oophorectomy (removal of the complete ovary) cytoreduction is recommended if the cyst is symptomatic, growing in size, persisting for more than 6 months without change in size, very large, associated with other conditions like, ascites, cancerous or other findings.
Polycystic Ovary Syndrome (PCOS)
- Irregular or no menstrual periods
- Excess hair growth
- Inability to produce eggs (ovum) leading to childlessness
- Family history of Diabetes
- Delayed cycles
- Clinical or lab evidence of hormonal imbalance (increased androgens)
- Ultrasound picture multiple small cysts in the ovaries.