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Tab 1

Well Women Clinic

Well Woman Clinic is dedicated to reproductive and mental health of women. Woman health as the name suggests not only means physical and maternal health but also encompasses mental and social well being. This includes the well woman examination, hormonal evaluation, menopausal health, stress, wellness and medical weight management.

The Clinic is completely committed and designed to detect and screen common occurring disorders in women (Basic Health Check), so that they can be screened and treated at the earliest. The tests and screening includes important constituents like Pap smear to screen for cervical cancer, pelvic sonography to check for abnormalities in uterus /ovaries and clinical breast examination, thyroid status and bone health etc. Timely diagnosis and treatment are essential to prevent the disorders.

Sexual and reproductive health and contraceptive services protect women from unwanted pregnancies, thereby contributing directly to their health. Other services at the clinic are psychological counseling, nutrition counseling, physiotherapy and holistic health for antenatal and postnatal mothers.

Tab 2

Menstrual Irregularities

For most women, a normal menstrual cycle ranges from 21 to 35 days. However, 14% to 25% of women have irregular menstrual cycles, meaning the cycles are shorter or longer than normal; are heavier or lighter than normal; or are experienced with other problems, like abdominal cramps. Irregular cycles can be ovulatory, meaning that ovulation occurs, or anovulatory, meaning ovulation does not occur.

The most common menstrual irregularities include:
Amenorrhea (pronounced ey-men-uh-REE-uh) or absent menstrual periods: When a woman does not get her period by age 16, or when she stops getting her period for at least 3 months and is not pregnant.
•Oligomenorrhea (pronounced ol-i-goh-men-uh-REE-uh) or infrequent menstrual periods: Periods that occur more than 35 days apart.
•Menorrhagia (pronounced men-uh-REY-jee-uh) or heavy menstrual periods: Also called excessive bleeding. Although anovulatory bleeding and menorrhagia are sometimes grouped together, they do not have the same cause and require different diagnostic testing.
•Prolonged menstrual bleeding: Bleeding that exceeds 8 days in duration on a regular basis. •Dysmenorrhea (pronounced dis-men-uh-REE-uh): Painful periods that may include severe menstrual cramps

Additional menstrual irregularities include:
• Polymenorrhea (pronounced pol-ee-men-uh-REE-uh): Frequent menstrual periods occurring less than 21 days apart.
• Irregular menstrual periods with a cycle-to-cycle variation of more than 20 days.
• Shortened menstrual bleeding of less than 2 days in duration.
• Intermenstrual bleeding: Episodes of bleeding that occur between periods, also known as spotting.

Causes of irregular periods (generally light) include:
• Perimenopause (generally in the late 40s and early 50s)
• Primary ovarian insufficiency (POI)
• Eating disorders (anorexia nervosa or bulimia)
• Eating disorders (anorexia nervosa or bulimia)
• Excessive exercise
• Thyroid dysfunction (too much or too little thyroid hormone)
• Elevated levels of the hormone prolactin, which is made by the pituitary gland to help the body produce milk
• Uncontrolled diabetes
• Cushing's syndrome (elevated levels of the hormone cortisol, used in the body's response to stress)
• Late-onset congenital adrenal hyperplasia (problem with the adrenal gland)
• Hormonal birth control (birth control pills, injections, or implants)
• Hormone-containing intrauterine devices (IUDs)
• Scarring within the uterine cavity (Asherman's syndrome)
• Medications, such as those to treat epilepsy or mental health problems

Tab 3


Polycystic ovary syndrome (PCOS) is a hormonal disorder that is commonly seen in women of reproductive age. Women with PCOS may have occasional or extended menstrual periods or excess androgen levels. The ovaries might produce numerous little collections of liquid and fail to periodically release eggs.

The specific cause of PCOS is unexplained. Initial analysis and treatment along with weight loss might decrease the risk of long-term difficulties like type 2 diabetes and heart disease.

Symptoms of PCOS Signs of PCOS usually begin around the time of the first menstrual period during adolescence. Seldom PCOS occurs later, for example, in response to plentiful weight addition.

Signs and symptoms of PCOS differ. The examination of PCOS is done if the woman experience at least two of these signs:

Irregular periods Irregular or prolonged menstrual cycles are the most usual symptom of PCOS. For example, Women may have fewer than nine periods a year, more than 35 days between periods and abnormally huge periods.

Excess androgen High levels of androgen may result in visible signs, such as excess facial and body hair and irregularly severe acne and male-pattern baldness.

Polycystic ovaries The woman's ovaries may be expanded and include follicles that encircle the eggs. As a result, the ovaries might fail to perform normally.

PCOS signs and symptoms are typically more critical if you are overweight. Remedies can serve you to manage the symptoms of PCOS and decrease your odds of long-term health problems like diabetes and heart diseases.

The doctor should talk about what the patient's goals are so the doctor can come up with a proper treatment plan. For example, if the patient want to get pregnant and is having trouble, then the approach would mainly focus on assisting you to conceive. If the patient wants to tame PCOS-related acne, the treatment would be prepared towards skin problems

Healthy Habits The best way to deal with PCOS is to eat healthily and exercise regularly. Many of the women with PCOS are overweight. Losing only 5% to 10% of the bodyweight may reduce some symptoms and help make the periods more regular. It also might help manage problems with blood sugar levels and ovulation.

As PCOS could head to a rise in blood sugar, the doctor may want the patient to restrict sugary foods. Rather, eat foods like fruits, leafy vegetables and meals that have plenty of fiber, which raises the blood sugar level gradually.

Hormones and Medication Birth control is the most common PCOS treatment for women who do not want to get pregnant. Hormonal birth control tablets, a skin patch, the vaginal ring, shots can help the woman to restore her regular periods. These hormones also help to heal acne and unwanted hair growth also.

These birth control techniques might also lower the risk of getting endometrial cancer, in the inner wall of the uterus.

Taking just the hormone named progestin could help the patient get her periods back on to the track. It doesn't prevent pregnancies or heal unwanted hair growth on face and acne. But it can lower the risk of uterine cancer.

Metformin lowers insulin levels in the body. It can also help with weight loss and may also prevent from getting type 2 diabetes. It may also make you more reproductive.

prevent from getting type 2 diabetes. It may also make you more reproductive. If birth control doesn't prevent hair growth later 6 months, the doctor may prescribe spironolactone. It reduces the level of a variety of sex hormones called androgens. But you should not take it if you are pregnant or planned to become pregnant, because it can cause birth defects for the child and mom also.

Tab 4


Pelvic inflammatory disease (PID) is a disorder of the female reproductive glands. It usually happens when sexually transmitted bacteria developed from your vagina to uterus, fallopian tubes.

Pelvic inflammatory disease often produces no signs or symptoms. As a result, you might not understand you have the condition and get needed treatment. The condition might be recognized later if you have trouble getting pregnant or if you grow chronic pelvic pain.

Symptoms Signs and symptoms of the pelvic inflammatory disease include:
Pain in your lower abdomen and pelvis.
Heavy vaginal discharge with an unpleasant smell.
Unusual uterine bleeding, particularly during or after sex, or between menstrual cycles.
Pain or bleeding during intercourse
Fever, sometimes with chills.
Painful or difficult urination.

PID might cause just moderate indications and symptoms or none at all. When severe PID creates fever, chills, critical lower abdominal or pelvic pain especially during a pelvic exam.

When to see a doctor Consult your doctor or seek urgent preventive care if you experience:
A severe ache in your abdomen.
Queasiness and vomiting, with a disability to keep anything down.
Fever with 101 F (38.3 C).
Nasty vaginal discharge.

If your signs and symptoms persist but are not hard, see your doctor as soon as possible. Vaginal discharge with a smell, painful urination or bleeding in between menstrual cycles can be allied with a sexually transmitted infection (STI). If these indications and symptoms occur, stop having sex and consult your doctor soon.

Cause Many kinds of bacteria can generate PID, but gonorrhea or chlamydia infections are the most popular. These bacteria are normally acquired during unprotected sex. Usually, bacteria can enter into your reproductive region anytime the common barrier created by the cervix is displaced. This happens after childbirth, abortion.

Risk factors Various factors can increase your risk of pelvic inflammatory disease, including:
Implying a sexually active woman of age younger than 25 years.
Owning multiple sexual partners.
Possessing sex without a condom.
Douching daily, which upsets the stability of good versus harmful bacteria in the vagina and might mask symptoms.
Begetting a history of pelvic inflammatory disease or a sexually transmitted infection Most experts now will agree that holding an intrauterine device (IUD) inserted does not raise the risk of pelvic inflammatory disease. Any potential risk is usually within the first three weeks after insertion.

Complications Untreated pelvic inflammatory disease might create scar tissue. You might additionally develop collections of infected fluid in your fallopian tubes, which could harm your reproductive organs. Other complications include:

Ectopic pregnancy. PID is a main cause of ectopic pregnancy. In an ectopic pregnancy, the defect tissue from PID prevents the fed egg from making its move through the fallopian tube to implant in the uterus. Ectopic pregnancies can create huge, life-threatening bleeding and require medical attention.

Infertility. Infertility. PID might damage your reproductive glands and cause unproductiveness which is known as inability to become pregnant. The more times you have had PID, the greater you have risk of infertility. Delaying treatment for PID can also dramatically increase your risk of infertility.

Chronic pelvic pain. Pelvic inflammatory disease can create pelvic pain that might continue for months or years. Stabbing in your fallopian tubes and other pelvic organs can create pain during intercourse and ovulation.

Tubo-ovarian abscess. PID might cause an abscess collection of pus to form in your uterine tube and ovaries. If you left untreated, you may develop a life-threatening infection

Prevention To subdue your risk of PID:

Practice safe sex. Use condoms each time you have sex, bound your number of partners, and also ask about a potential partner's sexual history.

Talk to your doctor about contraception. Many forms of contraception do not guard against the development of PID. Using preventive methods, such as a condom, might help to reduce your risk. Also if you take any birth control pills, it's still important to use a condom every time you have sex to protect against STIs.

Get tested. If you are at risk of STI with chlamydia bacteria, fix an appointment with your doctor for testing. Set up a regular screening with your doctor if needed. Initial treatment of an STI provides you the most useful chance of avoiding PID.

Request that your partner be tested. If you hold pelvic inflammatory disease advise your partner to be tested, and if needed treated. This can prevent the spread of STIs and possible recurrence of PID.

Don't douche. Douching upsets the balance of bacteria in your vagina.

Tab 5


Uterine fibroids are harmless tumors that arise in the uterus. It is also called as Uterine myoma.

It is something which is not known exactly why women develop uterine fibroids.
Most of the women with uterine fibroids have no symptoms at all. But, fibroids can cause several signs depending on their size, position within the uterus, and how near they are to the next pelvic organs. The most common are unusual bleeding, pain and stress.
Uterine fibroids are diagnosed by the pelvic exam and by ultrasound.
If the treatment for uterine fibroids is required, various options are available that include surgery, MRI-guided high-intensity adjusted ultrasound, and uterine artery embolization.

What are the symptoms of uterine fibroids? Do they cause any pain?

But, abnormal uterine bleeding is the most typical symptom of the fibroid. If the tumors are near the uterine wall or intervene with the blood flow to the wall, they might cause heavy, painful, prolonged periods, or spotting between the menses. Women with extreme bleeding due to fibroids may develop iron deficiency anemia. Uterine fibroids that are decreasing can seldom cause severe and localized pain.

Fibroids can also cause several symptoms depending on the size, position within the uterus, and how close they are to adjacent pelvic organs. Large fibroids can cause:

pressure in the uterus,
pelvic pain includes pain during sex,
pressure on the bladder with frequent or obstructed urination, and
pressure on the rectum with painful defecation.

Uterine fibroids and pregnancy While fibroids do not intervene with ovulation, few studies advise that they may reduce fertility and lead to lower pregnancy outcomes. In particular, submucosal fibroids that damage the inner uterine cavity is most actively connected with reductions in infertility. Hardly, fibroids are the cause of repetitive miscarriages. If they are not removed in certain cases, the woman might not be able to sustain the pregnancy.

Risk factors There are some known risk agents for uterine fibroids, other than being a woman of reproductive age. Factors that can hold an impact on fibroid growth include:

Race. Although any woman of the reproductive age can generate fibroids, black women are extra likely to have fibroids than women of other racial groups. Besides, black women have fibroids at more adolescent ages, and they are also possible to have more or bigger fibroids, along with more severe symptoms.

Heredity. If the mother or sister had fibroids, you are at high risk of developing them.

Other factors. The onset of menstruation at an early age; overweight; vitamin D deficiency; having the diet higher in red meat and lower in the green vegetables, fruit and dairy; and drinking excess alcohol, including beer, has the chance to enhance your risk of developing fibroids.

Diagnosis Uterine fibroids are usually found accidentally during a routine pelvic exam. The doctor might feel irregularities in the shape of the uterus, advising the appearance of fibroids. If the patient has symptoms of uterine fibroids, the doctor may command these tests:

Ultrasound. If confirmation is required, the doctor might order the ultrasound. It uses sound waves to get the picture of the uterus to confirm the investigation and to map and estimate fibroids.

The doctor or technician moves the ultrasound device over the abdomen or places it inside the vagina to get images of the uterus.

Lab tests. If the woman has abnormal menstrual bleeding, the doctor might order other tests also to investigate potential causes of it. These might include the complete blood count to determine if the patient has anemia because of chronic blood loss and other blood tests to control bleeding disorders or thyroid problems also.

Recanalization Fallopian tube recanalization is the nonsurgical process to clear the blockages in fallopian tubes, part of the woman’s reproductive system. What are the fallopian tubes?

The fallopian tubes are essential for female fertility. They are the passageways for eggs to move from the ovaries to the uterus. During conception:

1. The ovary releases one egg, which will travel into the fallopian tube.
2. Sperm will go into the fallopian tubes to fertilize that perticular egg.
3. The resulting embryo is supported and moved to the uterus where the pregnancy resumes.

A common problem of female impotence is a blockage of the fallopian tubes, normally as the result of debris that has grown up. Occasionally, cutting from surgery or severe infection can lead to blockage as well.

Procedures Details Infertility is described as the inability of a couple to conceive after one year of unprotected sex. The other common cause of infertility is blocked in the fallopian tube. Till recent times this problem has required microsurgery and outcomes after the surgery was never good. Over recent times interventional radiology procedures have been increased to remove these blocks. The method is done below mild sedation and the patient is discharged after a few hours.

Fallopian tubes are fine tiny tubular structures that join the uterus to the ovary. Once the ovum is mature it travels along the fallopian tube and here that fertilization will take place. Thus the block in these tubes makes fertilization difficult.

These blocks can be secondary to an infection such as tuberculosis or mucous plug. If it is the mucous plug, then removing this block can be easily be achieved by passing the flexible soft wire through the blocked segment into it.

The procedure is usually performed on the eighth, ninth or the 10th day of a woman’s menstrual cycle. This is to allow the pregnancy to take place in the first cycle following the recanalization.

This procedure involves passing a small tube into the uterine cavity through the vagina. This may cause slight discomfort. Through the case another smaller tube is moved into the uterine cavity and the opening to the fallopian tube intubated with the help of the guidewire. A quick injection of variation is built into the opening to flush out the trash if present. If this procedure crashes then the blocked segment is gently manipulated with a guidewire and the block will be removed.

Recanalization of these tubes is successful in upto 90% of the patients who are present with corneal blocks. Blocks in the other parts of the fallopian tube are secondary to infection and cannot be cleared at all. It is also necessary to understand that fallopian tubes might have disease outer usually due to adhesions. These must be ruled out by the laparoscopy before the patient is taken up for fallopian tube recanalization.

Close to 40% of the patient’s who undergo the successful tubal recanalization conceive within the first 6 months only. However, it is important that the male partner is fully investigated and all the abnormalities are to be corrected before this procedure is taken up. Tubes that have been recanalized might close again also sometimes and then the procedure can be repeated again.

Following this procedure the patient may have light cramps and slight bleeding for a few days. But all the patients are encouraged to resume their normal activities and have a normal sexual relationship with the husband.

Tab 6

Ectopic Pregnancy

Generally Pregnancy starts by a fertilized egg. Normally, the fertilized egg connects to the wall of the uterus. An ectopic pregnancy occurs when a fertilized egg implants and develops outside the main cavity of the uterus.

An ectopic pregnancy most often transpires in a fallopian tube, which carries eggs from the ovaries to the uterus. This kind of ectopic pregnancy is also called tubal pregnancy. Sometimes, an ectopic pregnancy occurs in distinct areas of the body like in the ovary, abdominal cavity or the lower part of the uterus , which connects to the vagina.

An ectopic pregnancy can not proceed normally. The fertilized egg can not grow, and the developing tissue may cause life-threatening bleeding, if it is left untreated.

Causes The tubal pregnancy is the common type of ectopic pregnancy that happens when a fertilized egg gets attached on its way to the uterus, usually because the fallopian tube is destroyed by inflammation or is distorted. Hormonal imbalances or irregular development of the fertilized egg also might play a part.

Risk factors Fascinating Things that make you have an ectopic pregnancy are:

Inflammation or infection. Sexually transmitted germs, such as gonorrhea or chlamydia, can cause inflammation in the tubes and other nearby organs, and increase your risk of an ectopic pregnancy.

Fertility treatments. Some study recommends that women who have in vitro fertilization (IVF) or related treatments are more likely to have an ectopic pregnancy. Infertility itself may also inflate your risk.

Tubal surgery. Surgery to help in a closed or damaged fallopian tube can increase the risk of an ectopic pregnancy.

Choice of birth control. The chance of getting pregnant while using an intrauterine device (IUD) is unique. However, if you do get pregnant with an IUD in place, it's more apt to be ectopic. Tubal ligation, a continual method of birth control commonly known as "owning your tubes tied," also increases your risk, if you become pregnant after this procedure.

Smoking. Cigarette smoking before you become pregnant can grow the risk of an ectopic pregnancy. The more you smoke, then the greater will be the risk.

Complications An ectopic pregnancy can create a fallopian tube to burst open. Without the treatment, the ruptured tube can lead to life-threatening bleeding.

Prevention There is no way to block an ectopic pregnancy, but here are few ways to reduce your risk:

Restricting the number of sexual partners and utilizing a condom during sex supports to prevent sexually transferred infections and decrease the risk of pelvic inflammatory disease.
Don't smoke. If you do, stop before you strive to get pregnant.

Tab 7

Endometriosis and Adenomyosis

A disorder in which tissue that normally lines the uterus grows outside the uterus.
With endometriosis, the tissue can be found on the ovaries, fallopian tubes or the intestines.

Diagnosis To diagnose endometriosis and other conditions that can cause pelvic pain, your doctor will ask you to describe your symptoms, including the location of your pain and when it occurs.

Tests to check for physical clues of endometriosis include:

• Pelvic exam: During a pelvic exam, your doctor manually feels (palpates) areas in your pelvis for abnormalities, such as cysts on your reproductive organs or scars behind your uterus. Often it's not possible to feel small areas of endometriosis unless they've caused a cyst to form.
• Ultrasound: This test uses high-frequency sound waves to create images of the inside of your body. To capture the images, a device called a transducer is either pressed against your abdomen or inserted into your vagina (transvaginal ultrasound). Both types of ultrasound may be done to get the best view of the reproductive organs. A standard ultrasound imaging test won't definitively tell your doctor whether you have endometriosis, but it can identify cysts associated with endometriosis (endometriomas).
•Magnetic resonance imaging (MRI): An MRI is an exam that uses a magnetic field and radio waves to create detailed images of the organs and tissues within your body. For some, an MRI helps with surgical planning, giving your surgeon detailed information about the location and size of endometrial implants.
• Laparoscopy: In some cases, your doctor may refer you to a surgeon for a procedure that allows the surgeon to view inside your abdomen (laparoscopy). While you're under general anesthesia, your surgeon makes a tiny incision near your navel and inserts a slender viewing instrument (laparoscope), looking for signs of endometrial tissue outside the uterus.
A laparoscopy can provide information about the location, extent and size of the endometrial implants. Your surgeon may take a tissue sample (biopsy) for further testing. Often, with proper surgical planning, your surgeon can fully treat endometriosis during the laparoscopy so that you need only one surgery.


Adenomyosis is a condition in which the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus (the myometrium). Adenomyosis can cause menstrual cramps, lower abdominal pressure, and bloating before menstrual periods and can result in heavy periods. The condition can be located throughout the entire uterus or localized in one spot.

Though adenomyosis is considered a benign (not life-threatening) condition, the frequent pain and heavy bleeding associated with it can have a negative impact on a woman's quality of life.

What Are the Symptoms of Adenomyosis?

While some women diagnosed with adenomyosis have no symptoms, the disease can cause:
• Heavy, prolonged menstrual bleeding
• Severe menstrual cramps
• Abdominal pressure and bloating

Who Gets Adenomyosis?

Adenomyosis is a common condition. It is most often diagnosed in middle-aged women and women who have had children. Some studies also suggest that women who have had prior uterine surgery may be at risk for adenomyosis.

Though the cause of adenomyosis isn't known, studies have suggested that various hormones -- including estrogen, progesterone, prolactin, and follicle stimulating hormone -- may trigger the condition.

Diagnosing Adenomyosis

Until recently, the only definitive way to diagnose adenomyosis was to perform a hysterectomy and examine the uterine tissue under a microscope. However, imaging technology has made it possible for doctors to recognize adenomyosis without surgery. Using MRI or transvaginal ultrasound, doctors can see characteristics of the disease in the uterus.

If a doctor suspects adenomyosis, the first step is a physical exam. A pelvic exam may reveal an enlarged and tender uterus. An ultrasound can allow a doctor to see the uterus, its lining, and its muscular wall. Though ultrasound cannot definitively diagnose adenomyosis, it can help to rule out other conditions with similar symptoms.

Another technique sometimes used to help evaluate the symptoms associated with adenomyosis is sonohysterography. In sonohysterography, saline solution is injected through a tiny tube into the uterus as an ultrasound is given.

MRI -- magnetic resonance imaging -- can be used to confirm a diagnosis of adenomyosis in women with abnormal uterine bleeding.

Because the symptoms are so similar, adenomyosis is often misdiagnosed as uterine fibroids. However, the two conditions are not the same. While fibroids are benign tumors growing in or on the uterine wall, adenomyosis is less of a defined mass of cells within the uterine wall. An accurate diagnosis is key in choosing the right treatment.

How Is Adenomyosis Treated?

Treatment for adenomyosis depends in part on your symptoms, their severity, and whether you have completed childbearing. Mild symptoms may be treated with over-the-counter pain medications and the use of a heating pad to ease cramps.

Anti-inflammatory medications. Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve mild pain associated with adenomyosis. NSAIDs are usually started one to two days before the beginning of your period and continued through the first few of days of your period.

Hormone therapy. Symptoms such as heavy or painful periods can be controlled with hormonal therapies such as a levonorgestrel-releasing IUD (which is inserted into the uterus), aromatase inhibitors, and GnRH analogs.

Uterine artery embolization. In this minimally invasive procedure, which is commonly used to help shrink fibroids, tiny particles are used to block the blood vessels that provide blood flow to the adenomyosis. The particles are guided through a tiny tube inserted by the radiologist into the patient’s femoral artery. With blood supply cut off, the adenomyosis shrinks.

Endometrial ablation. This minimally invasive procedure destroys the lining of the uterus. Endometrial ablation has been found to be effective in relieving symptoms in some patients when adenomyosis hasn't penetrated deeply into the muscle wall of the uterus.

Does Adenomyosis Cause Infertility?

Because many women who have adenomyosis also have endometriosis, it is difficult to tell precisely what role adenomyosis may play in fertility problems. However, some studies have shown that adenomyosis may contribute to infertility.

Can Adenomyosis Be Cured?

The only definitive cure for adenomyosis is a hysterectomy, or the removal of the uterus. This is often the treatment of choice for women with significant symptoms.

Tab 8


Laparoscopically 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). (A different procedure, called a laparoscopic hysterectomy, is entirely performed using a laparoscope and other instruments inserted through tiny abdominal incisions, and the uterus, Fallopian tubes etc. are removed in tiny portions.)

Not all hysterectomies can or should be done by LAVH. In certain situations, a laparoscopic hysterectomy (see above) may be sufficient. In other cases, an abdominal hysterectomy or a vaginal hysterectomy (without laparoscopy) is indicated. The surgeon determines the appropriate procedure for each individual case based upon the reason for the hysterectomy and the medical history and condition of the patient.

This is a minimally invasive surgical procedure using a laparoscope to remove the uterus and/or fallopian tubes and ovaries through the vagina. A laparoscope is a thin tube with an attached telescope and a light source, which is used to light up and view the inside of the pelvic structure and the abdomen.

It allows the doctor to examine the insides clearly and find the cause of symptoms such as abdominal pain, pelvic pain, or swelling of the abdomen or pelvic region.

Depending on the patient’s condition, the surgery can take anywhere from 60 minutes to 90 minutes.

How is LAVH performed?

During LAVH, several small incisions (cuts) are made in the abdominal wall through which slender metal tubes known as "trocars" are inserted to provide passage for a laparoscope and other microsurgical tools. The laparoscope acts as a tiny telescope. A camera attached to it provides a continuous image that is magnified and projected onto a television screen for viewing.

In the course of LAVH, the uterus is detached from the ligaments that attach it to other structures in the pelvis using the laparoscopic tools. If the Fallopian tubes and ovaries are to be removed, they are also detached from their ligaments and blood supply. The organs and tissue are then removed through an incision made in the vagina.

What are the disadvantages of LAVH?

The incisions in an LAVH are relatively small. The scars, pain, and recovery time from LAVH are usually significantly less than with an abdominal hysterectomy, which requires both a vaginal incision and a 4-6 inch (10-15 cm) long incision in the abdomen). LAVH is similarly less physically traumatic than a routine vaginal hysterectomy. When LAVH is feasible, it has distinct advantages.It can allow for a vaginal hysterectomy in patients who have not had children.

What are the advantages of LAVH?

The incisions in an LAVH are relatively small. The scars, pain, and recovery time from LAVH are usually significantly less than with an abdominal hysterectomy, which requires both a vaginal incision and a 4-6 inch (10-15 cm) long incision in the abdomen). LAVH is similarly less physically traumatic than a routine vaginal hysterectomy. When LAVH is feasible, it has distinct advantages.It can allow for a vaginal hysterectomy in patients who have not had children.

Tab 9

Vaginal Hysterectomy

Vaginal hysterectomy is a surgical procedure to remove the uterus through the vagina.

During a vaginal hysterectomy, the surgeon detaches the uterus from the ovaries, fallopian tubes and upper vagina, as well as from the blood vessels and connective tissue that support it, before removing the uterus.

Vaginal hysterectomy involves a shorter time in the hospital, lower cost and faster recovery than an abdominal hysterectomy, which requires an incision in your lower abdomen. However, depending on the size and shape of your uterus or the reason for the surgery, vaginal hysterectomy might not be possible. Your doctor will talk to you about other surgical options, such as an abdominal hysterectomy.

Hysterectomy often includes removal of the cervix as well as the uterus. When the surgeon also removes one or both ovaries and fallopian tubes, it's called a total hysterectomy with salpingo-oophorectomy (sal-ping-go-o-of-uh-REK-tuh-me). All of these organs are part of your reproductive system and are situated in your pelvis.

KLFC's approach
Why it's done

Vaginal hysterectomy treats various gynecological problems, including:

Fibroids. Many hysterectomies are done to permanently treat these benign tumors in your uterus that can cause persistent bleeding, anemia, pelvic pain, pain during intercourse and bladder pressure. For large fibroids, you might need surgery that removes your uterus through an incision in your lower abdomen (abdominal hysterectomy).

Endometriosis. This occurs when the tissue lining your uterus (endometrium) grows outside the uterus, involving the ovaries, fallopian tubes or other organs. Most women with endometriosis have a laparoscopic or robotic hysterectomy or abdominal hysterectomy, but sometimes a vaginal hysterectomy is possible.

Adenomyosis. This occurs when the tissue that normally lines the uterus grows into the uterine wall. An enlarged uterus and painful, heavy periods result.

Gynecological cancer. If you have cancer of the uterus, cervix, endometrium or ovaries, or precancerous changes, your doctor might recommend a hysterectomy. Most often, treatment for ovarian cancer involves an abdominal hysterectomy, but sometimes vaginal hysterectomy is appropriate for women with cervical or endometrial cancer.

Uterine prolapse. When pelvic supporting tissues and ligaments weaken or stretch out, the uterus can sag into the vagina, causing urine leakage, pelvic pressure or difficulty with bowel movements. Removing the uterus and repairing supportive tissues might relieve those symptoms

Abnormal uterine bleeding. When medication or a less invasive surgical procedure doesn't control irregular, heavy or very long periods, hysterectomy may be needed.

Chronic pelvic pain. If your pain is clearly caused by a uterine condition, hysterectomy might help, but only as a last resort. Chronic pelvic pain can have several causes, so an accurate diagnosis of the cause is critical before having a hysterectomy.

For most of these conditions — with the possible exception of cancer — hysterectomy is just one of several treatment options. You might not need to consider hysterectomy if medications or less invasive gynecological procedures manage your symptoms.

You cannot become pregnant after a hysterectomy. If you're not sure that you're ready to give up your fertility, explore other treatments.

Although vaginal hysterectomy is generally safe, any surgery has risks. Risks of vaginal hysterectomy include:

Heavy bleeding
Blood clots in the legs or lungs
Damage to surrounding organs
Adverse reaction to anesthetic
Severe endometriosis or scar tissue (pelvic adhesions) might force your surgeon to switch from vaginal hysterectomy to laparoscopic or abdominal hysterectomy during the surgery

How you prepare
As with any surgery, it's normal to feel nervous about having a hysterectomy. Here's what you can do to prepare:

Gather information. Before the surgery, get all the information you need to feel confident about it. Ask your doctor and surgeon questions.

Follow your doctor's instructions about medication. Find out whether you should take your usual medications in the days before your hysterectomy. Be sure to tell your doctor about over-the-counter medications, dietary supplements or herbal preparations that you take.

Discuss anesthesia. You might prefer general anesthesia, which makes you unconscious during surgery, but regional anesthesia — also called spinal block or epidural block — might be an option. During a vaginal hysterectomy, regional anesthesia will block the feelings in the lower half of your body. With general anesthesia, you'll be asleep.

Arrange for help. Although you're likely to recover sooner after a vaginal hysterectomy than after an abdominal one, it still takes time. Ask someone to help you out at home for the first week or so. What you can expect

Talk with your doctor about what to expect during and after a vaginal hysterectomy, including physical and emotional effects.

During the procedure
You'll lie on your back, in a position similar to the one you're in for a Pap test. You might have a urinary catheter inserted to empty your bladder. A member of your surgical team will clean the surgical area with a sterile solution before surgery.

To perform the hysterectomy:
Your surgeon makes an incision inside your vagina to get to the uterus Using long instruments, your surgeon clamps the uterine blood vessels and separates your uterus from the connective tissue, ovaries and fallopian tubes

Your uterus is removed through the vaginal opening, and absorbable stitches are used to control any bleeding inside the pelvis

Except in cases of suspected uterine cancer, the surgeon might cut an enlarged uterus into smaller pieces and remove it in sections (morcellation).

Laparoscopic or robotic hysterectomy You might be a candidate for a laparoscopically assisted vaginal hysterectomy (LAVH) or robotic hysterectomy. Both procedures allow your surgeon to remove the uterus vaginally while being able to see your pelvic organs through a slender viewing instrument called a laparoscope.

Your surgeon performs most of the procedure through small abdominal incisions aided by long, thin surgical instruments inserted through the incisions. Your surgeon then removes the uterus through an incision made in your vagina.

Your surgeon might recommend LAVH or robotic hysterectomy if you have scar tissue on your pelvic organs from prior surgeries or from endometriosis.

After the procedure After surgery, you'll be in a recovery room for one to two hours and in the hospital overnight. Some women are able to go home the day of the surgery.

You'll take medication for pain. Your health care team will encourage you to get up and move as soon as you're able.

It's normal to have bloody vaginal discharge for several days to weeks after a hysterectomy, so you'll need to wear sanitary pads.

How you'll feel physically Recovery after vaginal hysterectomy is shorter and less painful than it is after an abdominal hysterectomy. A full recovery might take three to four weeks.

Even if you feel recovered, don't lift anything heavy — more than 20 pounds (9.1 kilograms) — or have vaginal intercourse until six weeks after surgery.

Contact your doctor if pain worsens or if you develop nausea, vomiting or bleeding that's heavier than a menstrual period.

How you'll feel emotionally After a hysterectomy, you might feel relief because you no longer have heavy bleeding or pelvic pain.

For most women, there's no change in sexual function after hysterectomy. But for some women, heightened sexual satisfaction occurs after hysterectomy — perhaps because they no longer have pain during intercourse.

You might feel a sense of loss and grief after hysterectomy, which is normal. Or you might have depression related to the loss of your fertility, especially if you're young and hoped for a future pregnancy. If sadness or negative feelings interfere with your enjoyment of everyday life, talk to your doctor.


After a hysterectomy, you'll no longer have periods or be able to get pregnant.

If you had your ovaries removed but hadn't reached menopause, you'll begin menopause immediately after surgery. You might have symptoms such as vaginal dryness, hot flashes and night sweats. Your doctor can recommend medications for these symptoms. He or she might recommend hormone replacement even if you don't have symptoms.

If your ovaries weren't removed during surgery — and you still had periods before your surgery — your ovaries continue producing hormones and eggs until you reach natural menopause.

Tab 10

Non Descent Vaginal Hysterectomy(NDVH)

NDVH or non-descent vaginal hysterectomy means the removal of the uterus from the woman’s body through the vagina instead of the abdomen.

Which conditions require NDVH surgery?

Your gynecologist may suggest the NDVH surgery procedure in case of
• Heavy bleeding
• Endometriosis
• Fibroids
• Dysfunctional uterine bleeding

“A non-descent vaginal hysterectomy (NDVH) requires skill, expertise and practice to remove the uterus through the natural hole in the vagina.”

Advantages of NDVH surgery

NDVH in gynaecology is a common procedure that is nearly painless and smoother than a laparoscopy. The benefits of NDVH are:

• No stitches/scars, meaning it is a scarless surgery
• Few complications
• Short hospital stay and fast recovery
• Less pain after surgery
• Less expensive than other hysterectomies

How long does it take to recover after NDVH?

You will need to stay in the hospital for 2 to 3 days. After your hospital stay, you will be able to go back home without requiring support.

“You can resume your daily chores, walk or climb stairs as usual.”

As a non-descent vaginal hysterectomy is a surgery like any other surgery, it involves risks like bleeding or infection.

“In the hands of an experienced gynecologist, you should have no reason to worry.”

How do You prepare for NDVH?

• Take medicine as advised by your surgeon and anesthesiologist
• Avoid milk or food 8 hours prior to the scheduled time of surgery/procedure. You may drink water till 3 hours prior to the surgery/procedure.
• Contact your doctor immediately if you have a cough, cold, nasal congestion, fever, vomiting, and/or any other discomfort before admission.
• Ensure you bathe with soap and water, and wash your hair with shampoo before admission. Cut your finger and toe nails.
• On the day of the surgery, avoid wearing any jewellery/make up like nail paint, eye liner
• Bring the necessary documents as recommended by hospital staff.

Tab 11

Laparoscopic Tubectomy

What is tubectomy? Tubectomy, also known as tubal sterilization, is a continual method of contraception in women. It is a healing process that blocks the fallopian tubes, through preventing the egg released by the ovary from reaching the uterus.

Implications for Tubectomy Tubectomy is shown when a woman who doesn’t wish to imagine in the future voluntarily requests this strong method of sterilization.

A woman counting permanent sterilization through the tubectomy ought to consider the following points: .Ideas for wanting to opt for permanent sterilization
.Whether tubal ligation is the most suitable option for her
.Side effects, dangers and difficulties associated with the system.
.Whether other methods of contraception might be further suitable

Technique Tubectomy is a main surgical method in which the fallopian tubes are cut open and trimmed or tied up to prevent the portion of the egg into the uterus.

Procedure Several small surgeries are made around the belly button. A telescopic tool known as a laparoscope is implanted through one of the cuts. There is a petite camera at the top of the laparoscope which broadcasts images to a screen, presenting the surgeon with a view of the interior organs. Guided by the images and going through the tiny holes, the surgeon injects special instruments to seal the devices by making parts of them or by checking them using clips.

Different methods Bipolar coagulation- Electric current is utilized to harden parts of the fallopian tubes.
Monopolar coagulation- The tubes are hardened using electric current. A radiating course is also used to further damage them.
Tubal clip- The fallopian tunnels are blocked by permanently cutting them or joining them together.
Tubal Ring- The tube is tied utilizing a band.
Fimbriectomy- In this method, a part of the fallopian tube is separated from the ovary. This forms a gap, impeding the capacity of the tube to take eggs and transport them to the uterus.

Recovery Patients will be discharged on the same day after the tubectomy.
However, after experiencing the surgery, one may expect:
Pain and illness in the first four to eight hours
Abdominal pain and cramps Fatigue Dizziness

Stitches are taken out regularly after a week or ten days. It is also important to understand the surgeon for a follow-up check-up after six weeks.

Care to be taken after tubectomy It is important to follow the surgeon’s opinion about keeping post-surgery. Some suggestions include:
Strenuous exercise should be evaded for about a week.
Work may be returned within a few days.
Abstain from sex for a week after the tubectomy.
Pain medicine can help manage pain.
Make sure to consult the doctor if you endure high fever, bleeding from the cut, fainting spells, etc.

Tubectomy is a significant surgery that’s constant and not without its set of risks. Hence it is necessary to receive aid and support the surgery of under-qualified doctors only at trusted gynecology hospitals.

Tab 12

Ovarian Cyst

Ovaries are the part of the female reproductive system which is located in the lower abdomen of the female body on both sides of the uterus. Women have two ovaries that produce eggs as well as the hormones known as estrogen and progesterone.

Sometimes we observe a fluid-filled sac known as a cyst that will develop on any one of the ovaries. Most of the women will develop at least one cyst during their lifetime. These cysts stay painless and have no indications.

Types of ovarian cysts

Follicle cyst During the women's menstrual cycle, at least one egg grows in a sac called a follicle. This is located inside the ovaries. In most of the cases, this follicle or sac breaks its shell or opens up to release an egg. But if the follicle does not break open, the fluid which presents inside the follicle can form a cyst on any of its ovary.

Corpus luteum cysts A follicle sac typically dissolves or melts after releasing its egg. But if the sac does not dissolve and then the opening of the follicle seals, then it this point additional fluid can develop inside the sac and this leads to accumulation of fluid which causes a corpus luteum cyst. Other types of ovarian cysts include:

Dermoid cysts: sac grows on the ovaries that can also contain hair, fat, and other tissues. Cystadenomas: noncancerous growths that can also develop on the outer surface of the ovaries Endometriomas: tissues that grow normally inside the uterus can also develop outside the uterus and attach to the ovaries which results in the formation of a cyst Some women can also suffer from a condition called polycystic ovary syndrome. This condition refers to ovaries that contain a large number of small cysts. It can cause the ovaries to enlarge from its initial size. If it is not treated at the beginning stage then those polycystic ovaries can cause infertility.

Ovarian cysts do not show any symptoms. But symptoms can appear when cyst starts growing. Those symptoms may include:
· abdominal bloating or swelling
· painful bowel movements
· pelvic pain throughout the menstrual cycle
· painful intercourse
· pain in the lower thighs
· breast tenderness
· nausea and vomiting
Intractable symptoms of an ovarian cyst that need immediate medical attention include:
· severe or sharp pelvic pain
· fever
· faintness or dizziness
· rapid breathing

Ovarian cyst complications Most of the ovarian cysts are naturally go away on their own without any treatment. But in a rare case, your doctor may detect some cancerous cystic ovarian mass during its routine examination.

Ovarian torsion is another rare complication of an ovarian cyst. This is when a large cyst creates an ovary to twist or leave from its original position. Blood supply to the ovary glands is cut off, and it can cause damage or death to ovarian tissue. Although the uncommon, the ovarian torsion accounts for almost 3 percent of emergency gynecologic surgeries. Ruptured cysts are also rare, which can cause intense pain and internal bleeding. This complication increases your risk of an infection and can be life-threatening if it is not treated well.

Diagnosing the ovarian cyst The doctor can detect an ovarian cyst during their routine pelvic examination. They may publish like a swelling one of your ovaries and order an ultrasound test to authenticate the presence of a cyst. An ultrasound test is an imaging test that uses a high-frequency sound wave to produce an image of your internal organs. Ultrasound tests help you to determine the size, location, shape, and composition of a cyst.

Imaging machines used to diagnose ovarian cysts include: CT scan: a body imaging device which is used to create cross-sectional images of internal organs
MRI: a test which uses magnetic fields to produce in-depth images of internal organs
Ultrasound device: an imaging device which is used to visualize the ovary

Treatment for an ovarian cyst Your doctor may recommend you for treatment to shrink or remove the cyst if it does not feed away on its own or if it grows larger.
· Birth control pills
· Laparoscopy
· Laparotomy

Ovarian cyst prevention Ovarian cysts cannot be prevented. However, routine gynecologic examinations can detect or determine ovarian cysts early.

Tab 13

Carrier Screening

What is carrier screening?
Carrier screening is a type of genetic test that can tell you whether you carry a gene for certain genetic disorders. When it is done before or during pregnancy, it allows you to find out your chances of having a child with a genetic disorder.

What is a carrier?
For some genetic disorders, it takes two genes for a person to have the disorder. A carrier is a person who has only one gene for a disorder. Carriers usually do not have symptoms or have only mild symptoms. They often do not know that they have a gene for a disorder.

what are the chances of having a child with a genetic disorder?
If both parents are carriers of a recessive gene for a disorder, there is a 25% (1-in-4) chance that their child will get the gene from each parent and will have the disorder. There is a 50% (1-in-2) chance that the child will be a carrier of the disorder—just like the carrier parents. If only one parent is a carrier, there is a 50% (1-in-2) chance that the child will be a carrier of the disorder.

How is carrier screening done?
Carrier screening involves testing a sample of blood, saliva, or tissue from the inside of the cheek. Test results can be negative (you do not have the gene) or positive (you do have the gene). Typically, the partner who is most likely to be a carrier is tested first. If test results show that the first partner is not a carrier, then no additional testing is needed. If test results show that the first partner is a carrier, the other partner is tested. Once you have had a carrier screening test for a specific disorder, you do not need to be tested again for that disorder.

When can carrier screening be done?
Some people decide to have carrier screening before having children. Carrier screening also can be done during pregnancy. Getting tested before pregnancy gives you a greater range of options and more time to make decisions.

Do I have to have carrier screening?
Carrier screening is a voluntary decision. You can choose to have carrier screening, or you can choose not to. There is no right or wrong choice.

What carrier screening tests are available?
Carrier screening is available for a limited number of diseases, including cystic fibrosis, fragile X syndrome, sickle cell disease, and Tay–Sachs disease. Some of these disorders occur more often in certain races or ethnic groups. For example, sickle cell disease occurs most frequently in African Americans. Tay–Sachs disease is most common in people of Eastern or Central European Jewish, French Canadian, and Cajun descent. But anyone can have one of these disorders. They are not restricted to these groups.

Who should have carrier screening?
All women who are thinking about becoming pregnant or who are already pregnant are offered carrier screening for cystic fibrosis, hemoglobinopathies, and spinal muscular atrophy (SMA). You can have screening for additional disorders as well.
There are two approaches to carrier screening for additional disorders:
1) targeted screening and
2) expanded carrier screening.

What is targeted carrier screening?
In targeted carrier screening, you are tested for disorders based on your ethnicity or family history. If you belong to an ethnic group or race that has a high rate of carriers for a specific genetic disorder, carrier screening for these disorders may be recommended. This also is called ethnic-based carrier screening. If you have a family history of a specific disorder, screening for that disorder may be recommended, regardless of your race or ethnicity.

What is expanded carrier screening?
In expanded carrier screening, many disorders are screened using a single sample. This type of screening is done without regard to race or ethnicity. Companies that offer expanded carrier screening create their own lists of disorders that they test for. This list is called a screening panel. Some panels test for more than 100 different disorders. Screening panels usually focus on severe disorders that affect a person’s quality of life from an early age.

Is one approach better than the other?
Before testing, you and your obstetrician–gynecologist (ob-gyn) or other health care professional can discuss the benefits and limitations of each carrier screening approach. In some cases, both approaches can be used to tailor screening to your individual situation.

What choices do I have if my partner and I are carriers of a genetic disorder?
If you have carrier screening before you become pregnant, you have several options. You can become pregnant and have prenatal diagnostic tests to see if the fetus has the disorder. You can choose to use in vitro fertilization (IVF) with donor eggs or sperm to become pregnant. With this option, the embryo can be tested before it is transferred to the uterus. You also may choose not to become pregnant. If you have carrier screening after you become pregnant, your options are more limited. In either case, a genetic counselor, your ob-gyn, or other health care professional can explain your risks of having a child with the disorder.

How accurate is carrier screening?
No test is perfect. In a small number of cases, test results can be wrong. A negative test result when you have a gene for the disorder tested is called a false-negative result. A positive test result when you do not have a gene for a disorder is called a false-positive result.

Are results of carrier screening confidential?
The Genetic Information Nondiscrimination Act of 2008 (GINA) makes it illegal for most health insurers to require genetic testing results or use results to make decisions about coverage, rates, or preexisting conditions. GINA also makes it illegal for employers to discriminate against employees or applicants because of genetic information. GINA does not apply to life insurance, long-term care insurance, or disability insurance.

If you find out that you are a carrier of a gene for a genetic disorder, you may want to tell other family members. They may be at risk of being carriers themselves. There is no law that states that you have to do so. If you choose to tell family members, your ob-gyn or genetic counselor can advise you about the best way to do this. It cannot be done without your consent.