Centre for Women Health

Hysterectomy is a procedure to surgically remove the uterus (womb). In many cases, the cervix is also removed along with the uterus. Depending on the reason for the hysterectomy, surrounding tissues like fallopian tubes and ovaries are extracted. Following a hysterectomy, you will lose the ability to become pregnant and menstruate. There are multiple reasons why a hysterectomy is performed, including fibroids and cancer. Due to advanced surgical technology, recovery after a hysterectomy usually takes four to six weeks. Alternate name Abdominal hysterectomy Body location Pelvic region How is the surgery performed? After evaluating your medical records, your doctor will decide the type of hysterectomy procedure you need and the best technique. You will need to change into the hospital gown, and an IV line will be placed in a vein in your arm. An anesthesiologist will give you regional or general anaesthesia. After that, the surgeon will perform the hysterectomy using one of the following surgical techniques: Vaginal hysterectomy: In this type of hysterectomy, your doctor makes an incision in the upper wall of the vagina to remove the uterus. This technique does not have an external incision, and dissolvable stitches are placed. You can go home on the same day of the procedure. A vaginal hysterectomy is used for uterine prolapse and non-malignant uterine conditions. Laparoscopic hysterectomy: A laparoscope is a thin tube with a camera at its tip. This laparoscope is inserted through a small incision below your belly button into the abdomen. The uterus can be removed in parts. You can return home the same day of the procedure or after a night at the hospital. Laparoscopic hysterectomy has shorter recovery times than abdominal hysterectomy. Abdominal hysterectomy: In this type of hysterectomy, the uterus is removed through a 6- to 8-inch-long abdominal incision. This incision goes from your belly button to your pubic bone or across the pubic hairline. This technique is used in advanced cases of uterine cancer and requires a more extended hospital stay. Recovery time is longer with this technique. A typical hysterectomy takes between one to three hours, depending on the size of the uterus, the presence of scar tissue from earlier surgery and if any other organs need to be removed. Preparation  If you need a hysterectomy, your doctor will discuss the procedure and how it is performed. You will also know what to expect after the procedure and the time for healing. Preparatory steps before the hysterectomy include: Stopping your blood thinning medications like aspirin, ibuprofen, and warfarin. Evaluating your medical history and the medications you are taking with the doctor. They will inform you if you must stop taking any medications or nutritional supplements before surgery. Quitting smoking before the procedure to ensure normal healing. Undergo a few blood and urine investigations.  You will need to stay in the hospital for a few days. Be sure to make the necessary arrangements and ask a friend or family member to accompany you for your surgery. Procedure type Minimally-invasive surgical procedure. Follow up After your hysterectomy, you will usually require a few hours in the recovery room. Your healthcare team will monitor your health and signs of pain. You will receive medicines for pain and infection. You are encouraged to walk soon after surgery once the pain is bearable.  You may require one to two days of hospital stay after your hysterectomy, depending on the type of procedure. You may notice bleeding or discharge for a few days to weeks after a hysterectomy. However, inform your doctor if you have heavy menstrual bleeding. Your abdominal incision will heal in a few weeks to a month, but the scar may be visible. Risks  Any surgery comes with some amount of risk. A few common risk factors of hysterectomy are: Allergy to medications used Bleeding Infection Blood clots Injury to the bladder or the uterus Pain during sexual intercourse Decreased interest in sex Increased risk of heart disease if one or both ovaries are removed before menopause Recovery A hysterectomy procedure is major surgery and will require a few days of hospital stay. You will need six to eight weeks to recover completely. However, recovery times can vary from person to person and also depend on the type and extent of surgery. After your hysterectomy, you must get as much rest as possible. Avoid picking up heavy items like shopping bags or suitcases. Since the incision is made through your abdominal muscles, you must allow them to heal before returning to your regular workout routine. Your doctor will inform you about recovering at home.

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Laparoscopic fibroid removal (laparoscopic myomectomy) is a minimally invasive procedure to remove uterine fibroids. Fibroids are small growths in the uterus. Since most fibroids are not cancerous, removing them surgically is based on several factors. You may require a laparoscopic fibroid removal if you have the following: Heavy menstrual bleeding Bleeding between periods Frequent urination Pain or pressure in lower abdomen  Difficulty emptying your bladder If you are having difficulty getting pregnant (some fibroids increase the risk of miscarriage or pregnancy complications) Alternate name Laparoscopic myomectomy Body location The uterus lies in the pelvic region of the female body.   How is it performed? A laparoscopic myomectomy is performed under general anaesthesia. During the surgery, the surgeon will make small incisions (about half an inch long) in the lower abdomen, typically near the belly button. The surgeon will pass a tube through one of the incisions to fill the abdomen with carbon dioxide gas, allowing them to see all organs clearly. Through another incision, a laparoscope is inserted. A laparoscope is a thin tube with a light bulb and a camera on its tip. Through a third incision, the surgeon inserts the surgical instruments required to remove the fibroids. After removing the fibroids, the surgeon removes all the instruments, releases the gas from the abdomen and closes the incisions. Preparation for the procedure  If you are set to undergo laparoscopic fibroid removal, a few things you will need to do in the preparatory phase are: Routine blood tests: You will require a standard blood test before surgery. Your doctor may also perform routine transvaginal sonography to study the uterine lining. Fasting: Stop eating and drinking fluids at least 10 to 12 hours before the surgery Discontinue medications: If you take any medications, your doctor may review them and ask you to stop them before surgery. This is particularly common with blood thinners. Hospital stay: Though your fibroid removal occurs laparoscopically, you will be required to stay in the hospital for at least two or three days. Procedure type Surgical procedure Follow up  After your surgery, you will be required to stay at the hospital until your surgeon feels you are fit to go home. Painkillers and antibiotics will be prescribed to enable comfortable healing. Your doctor will inform you how to take care of your incision wound and what kind of diet to follow. You may notice vaginal bleeding and spotting for a few days after your procedure.  You will be required to visit your surgeon for follow-up visits, during which they will evaluate your overall health and healing. If you plan to conceive, your doctor will inform you about the next steps. Risks Though laparoscopic fibroid removal surgery is common and safe, it does carry a few risks. Some of the risks associated with this procedure include the following: Excessive bleeding: Women with a larger uterus or excessive fibroids are at risk of developing heavy menstrual bleeding, resulting in low blood count and anaemia. Risk during pregnancy: Women who had a deep incision in the uterus during laparoscopic fibroid removal may be advised to get a caesarean delivery. Hysterectomy: If the surgeon finds other uterine abnormalities along with fibroids, they may decide to remove the entire uterus. Adhesions: Scarring and adhesions are common after fibroid removal. When adhesions form inside the uterus, there are chances of light menstrual periods and difficulty in getting pregnant. The risk of adhesions is higher in the case of  open fibroid removal. Recovery The recovery time after laparoscopic fibroid removal is shorter and more comfortable than conventional open surgery. Your doctor will prescribe a few medications to help relieve your pain. You must avoid lifting anything heavy or participating in intense exercise or activity until your incision is fully healed. You may be required to wait at least six to eight weeks before having sex. Women who plan to conceive after surgery must wait at least three to six months to allow complete healing of the uterus. The first few weeks after your surgery are meant for complete rest. You will be allowed to take short, light walks that increase circulation to the uterus and accelerate healing.

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Ovarian cysts develop as fluid pockets in the ovaries or on their surface. Women have two ovaries on either side of the uterus that release eggs every month. The released eggs go to the uterus through the fallopian tubes. Most ovarian cysts disappear naturally on their own and are not noticeable. However, some cysts burst, and this could lead to serious health problems. Associated Anatomy Ovarian cysts could form in one or both ovaries present on either side of the uterus. Types of Ovarian Cysts There are different types of ovarian cysts. 1. Functional Cysts These cysts usually form over the ordinary course of a woman's menstrual cycle. 2. Endometriotic Cysts These cysts form when endometrial tissue attaches to the ovaries and forms cysts. 3. Malignant Cysts Most cysts are benign. However, a few may turn malignant or cancerous. The existence of malignant cysts indicates ovarian cancer. Regular pelvic tests or biopsies can help identify malignant cysts quickly and start treatment. 4. Benign Neoplastic Cysts Although rare, these cysts grow abnormally. Rather than a follicle, neoplastic cysts form out of germ cells. These cysts do not disappear on their own and need external intervention to being removed. Ovarian Cyst Causes There are no known exact causes for ovarian cysts. However, the formation of cysts can be attributed to these reasons: Hormonal Problems - Hormone imbalances can be caused by drugs or medicines that help women ovulate. Pregnancy - Cysts may form during early pregnancy to help support the pregnancy to term. They may disappear naturally during the curse of pregnancy or will need to be removed after delivery. Endometriosis - For women with endometriosis, an endometriosis tissue might attach to the ovaries, and a cyst called endometrioma could form. Pelvic Infections - Severe infections in any part of the pelvis could spread to the ovaries and cause the formation of cysts. Cancer - Ovarian cancer may also cause cysts in the ovaries. Ovarian Cyst Symptoms Small ovarian cysts generally do not have any symptoms since they usually dissolve by themselves. However, if ovarian cysts do not dissolve, they may cause the following symptoms: Pelvic pain before and during periods. Pain in the lower back Breast tenderness Nausea Pain during intercourse Pain during bowel movements Painful cramps during periods Bloated feeling Clotted blood during periods Stages of Ovarian Cysts There are no specific stages for ovarian cysts. An ovarian cyst forms naturally as a regular part of the menstruation cycle and disappears naturally during the cycle. However, sometimes, cysts do not dissolve but become bigger. The bigger cysts cause discomfort to the affected women. However, the cysts can be treated accordingly with proper diagnosis and treatment. Ovarian Cysts Diagnosis Doctors, typically gynaecologists, need to perform multiple tests to analyze the symptoms and diagnose ovarian cysts. The tests used to conclude the affliction are: Pregnancy Test: A positive pregnancy test without actual pregnancy can indicate cysts - usually corpus luteum cysts. Pelvic Ultrasound: Pelvic ultrasounds use sonic waves to get a clear picture of the ovaries and the uterus. Cysts can be seen clearly in the ultrasound. They can help doctors determine the cysts' shape, size, and consistency for proper treatment. Blood Tests: In the case of solid or semi-solid cysts, there may be the presence of a protein called CA 125. It is a cancer antigen and is present in the case of cancerous cells. Therefore, blood tests can help doctors identify cancer and begin treatment accordingly. Ovarian Cyst Treatment Most small cysts usually go away on their own. However, doctors may prescribe birth control pills to stop ovulation for 2-3 cycles. This prevents further cysts from forming, and slowly existing cysts reduce and disappear. However, cysts do not disappear on their own and need external help in some cases. Subsequently, the surgery type also depends on the size of the cysts and how they appear in the ultrasound scans. Laparoscopy If the cysts are smaller, doctors would recommend laparoscopy. First, through a small cut near the belly button, a tool with a camera is inserted for doctors to view the cyst. Then, another small tool is used to remove the cyst. The procedure is not overly complicated, and the patient might be discharged on the same day. Laparotomy If cysts are huge or are cancerous, doctors might suggest laparotomy. Here, the doctor makes a more significant cut on the abdomen. Then, a biopsy is done to determine if the cysts are cancerous. IF it is cancerous, a hysterectomy is performed to remove the affected ovaries and, if needed, the entire uterus. Risk Factors for Ovarian Cysts Ovarian cysts can form at any age. However, they are more common during peak reproductive years. Risk factors for ovarian cysts include: Treatment for Infertility - Infertility treatments involve the introduction of many hormones to create the ovulation cycle in the body. Hyperstimulation of eggs in the ovaries could cause cysts to form. Pregnancy - Before the formation of the umbilical cord, a woman's body might form cysts in the ovaries to help support early pregnancy. Tubal Ligation - Tubal ligation is the procedure of tying up the fallopian tubes. It essentially means female sterilization. The process permanently prevents pregnancy in women. The procedure might cause cysts to form in the ovaries. Hypothyroidism - Hypothyroidism is thyroid imbalance that causes changes in hormone levels in the body. These hormones could cause cysts to form in the ovaries. PCOS - It is a condition that causes lots of small cyst to develop in ovaries as a result of altered hormonal levels. Ovarian Cyst Prevention Primary Prevention Ovarian cysts occur naturally. There is no clear, identifiable way to prevent cysts. The only way to prevent the rapid progression of growth of cysts is to have regular pelvic examinations. Another simple way to identify ovarian cysts is to pay attention to your periods. Any changes in menstruation or sudden increase in painful cramps need to be communicated to the doctors immediately. Secondary Prevention There are no secondary ways to prevent ovarian cysts. Possible Complication of Ovarian Cyst Ovarian Torsion: Ovarian torsion happens when cysts grow bigger and move, which causes the ovaries to twist. The torsion can cause sudden pain, nausea, and even lightheadedness. Ovarian Cyst Rupture: It commonly occurs in corpus luteal cyst. Outcome is evaluated based on associated symptoms. Few Specific Conditions Torsion of Ovary: Ovarian torsion can be easily managed laparoscopically Dermoid: Dermoid cyst contains multiple types of tissue, it can be easily performed laparoscopically and most of the ovarian tissue can be preserved. Although most cysts are harmless and go away on their own, an early diagnosis and careful track of any cyst is required so that it doesn't grow and cause complications. Epidemiology of Ovarian Cysts Most ovarian cysts resolve naturally on their own, even before being detected. However, globally, it is theorized that at least 7% of the female population has had ovarian cysts in their lifetime. Expected Prognosis of Ovarian Cysts Functional cysts that form during a woman's menstrual cycle resolve independently. Other cysts or benign tumors can be removed surgically with laparoscopy or laparotomy. Usually, ovarian cysts do not cause long-term complications for affected women. Natural Progression of Ovarian Cysts Ovarian cysts form due to fluid buildup in the follicles. If they do not dissolve on their own, they grow and remain in the follicles. The growth of the cysts causes pain to the affected women and may affect the ability to conceive. Pathophysiology of Ovarian Cysts Ovarian cysts affect the ovaries and, consequently, the reproductive organs in a woman's body. Cysts form in the ovaries due to fluid buildup in follicles. If they do not reduce on their own, they may grow and cause issues during menstruation. Related Blogs PCOS: No More Silent Struggle! Understanding Infertility and its Treatment Treating Endometriosis: Pain, Cure and Medications When Should You See a Gynecologist? A Guide for Women at Every Age

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Uterine fibroids are non-cancerous lumps that form in the uterus of females. They mostly occur during the childbearing age, contributing to infertility or delayed pregnancy. Many women with uterine fibroids have reported their genes and obesity to be the cause of the condition. Associated Anatomy The Uterus or the womb Alternate Name of Uterine Fibroids Uterine fibroids are clinically called leiomyomas or myomas. Uterine Fibroids Causes Genes/Family history: Any disease of the uterus or the breast can be genetic. So, if your mother or sister or second-degree relative had the condition, it is likely that you may also get it. Genetic changes: The food we eat and the pollutants around us may bring about changes in the genes and their functioning. These changes may give way to the development of fibroids. Hormones: A woman goes through a roller coaster of hormones, especially during her childbearing ages. Any alteration or disturbance in the hormonal signalling pathway may contribute to the development of fibroids. Uterine Fibroids Symptoms Signs and symptoms that women with uterine fibroids experience differ with age and body type. No two women with the condition have the same set of symptoms, and no two symptoms occur together for different women. However, some of the common symptoms are: Heavy menstrual bleeding Menstruation that lasts more than 7 days Pelvic pain Spotting or bleeding between periods Frequent urination Difficulty emptying the bladder Uterine Fibroids Diagnosis Ultrasound: If you experience any symptoms of uterine fibroids, you may be asked to undergo an ultrasound for confirmation. In an ultrasound scan, sound waves are used to detect the presence of lumps in the uterus. Hysteroscopy: A small lighted telescope is inserted into the uterus through the cervix and saline is released to expand the uterine cavity and obtain clear images of the uterus. MRI: It is useful for mapping of fibroid for planning of surgery. Uterine Fibroids Treatment Medical management GnRH agonists: The first line of treatment for uterine fibroids is medication, which includes GnRH agonists (drugs that mimic Gonadotropin Releasing Hormone). These drugs stop menstrual bleeding, thereby enabling the fibroids to shrink. Oral Contraceptives: There are other oral contraceptives that help in preventing menstruation and shrinking the fibroids. Progesterone releasing Intra uterine devices: It provides symptomatic relief in reducing heavy menses. It doesn't shrink the fibroid or make it disappear. Tranexamic acid: It is a non hormonal medication to ease heavy periods. It's taken only on heavy bleeding days. Medication for uterine fibroids can cause undesirable side effects like hot flashes, depression, mood swings, etc. So, it is often advised to opt for surgery and get the lumps removed. Non Invasive Procedure MRI-guided focused ultrasound surgery (FUS): This is a non-invasive procedure that restores maximum healthy uterus tissues. Minimally Invasive Procedures Uterine artery embolisation: Blood supply to the fibroids is blocked by inserting small particles in this minimally-invasive procedure. Radiofrequency ablation: Radiofrequency waves are used to ablate fibroids and stop blood flow to the fibroids. Definitive Management Open / Laparoscopic/ Hysteroscopic/Robotic Myomectomy: To remove fibroids leaving the uterus in place for fertility preservation. Hysteroscopic myomectomy is ideal for the submucosal fibroid ( in the cavity of the uterus). Most of the time Laparoscopic surgery is possible even for large or multiple fibroids. Maximum number of fibroids removed during myomectomy in BLK MAX is 106. Hysterectomy: Removing the uterus is only a solution if you do not wish to get pregnant anymore. However, this is the only proven permanent solution for uterine fibroids. Hysterectomy can be done via Lap/ Robotic/ Open techniques. Uterine Fibroids Preventions Primary Prevention There are no proven methods to prevent the occurrence of uterine fibroids, but a healthy diet with less sugar, gluten, and processed items, and an active lifestyle can reduce the chances. Secondary Prevention Uterine fibroids may keep reoccurring, depending on your age and the severity of your condition. There are certain ways through which you can prevent fibroids from reoccurring: Keeping your blood sugar level and blood pressure in check Eating non-inflammatory food free from sugar, gluten, etc. Maintaining an active lifestyle Risk Factors of Uterine Fibroids There are certain factors or conditions that may or may not increase your chance of contracting uterine fibroids. Age - older women are at a higher risk of contracting the disease than younger women. Family history of uterine fibroids - if your first-degree or second-degree relatives had this condition, there is a possibility that you may also get it. Obesity - women who are obese are more likely to get uterine fibroids than women with a healthy BMI. Blood pressure - women with hypertension are at a risk of contracting uterine fibroids. No history of pregnancy Deficiency of Vitamin D Possible Complication One of the most common complications of uterine fibroids is anaemia. There is a heavy blood loss associated with uterine fibroids, and it results in anaemia. When left untreated, uterine fibroids may give way to uterine polyps, which are slightly difficult to treat and remove. So, a timely diagnosis and taking proper measures to treat the condition is paramount. Epidemiology Uterine fibroids are more commonly seen in women of African origin than in white women. As seen earlier, women in their reproductive age and older women are at a higher risk of contracting uterine fibroids. Expected Prognosis Uterine fibroids are generally one of the reasons for infertility or delayed pregnancy. Anaemia is the immediate effect observed in women with uterine fibroids. They do not manifest any symptoms for several years after developing. However, in some women, symptoms like heavy menstrual bleeding and prolonged menstruation may progress sooner, causing anaemia. Natural Progression Uterine fibroids may take many years to present symptoms and progress. However, once they grow, there are high chances of them recurring. Pathophysiology Uterine fibroids are benign lumps that can grow on the uterus, extending into the underlying muscular layer (submuscular leiomyoma) or into the uterine cavity (subserosal). Natural hormonal response mechanisms get enhanced, leading to the rapid growth of the uterine lining leading to endometrial thickening. This results in pelvic pain and heavy menstrual bleeding. Frequently Asked Questions 1. Are fibroids cancer? Fibroids are non-cancerous growths that develop in the uterus. 2. Do fibroids make your stomach big? Yes, large fibroids can cause the abdomen to appear swollen or enlarged, leading to a larger stomach. 3. Do fibroids make you tired? Yes, fibroids can sometimes cause fatigue and tiredness, especially if they are large or cause heavy menstrual bleeding. The loss of blood and associated symptoms can contribute to feelings of tiredness. 4. Will fibroids go away on their own? Fibroids typically do not go away on their own, but their growth can vary. Some fibroids may shrink after menopause when hormone levels decrease, but it's best to consult a doctor for proper evaluation and management. 5. Can I conceive if I have uterine fibroids? It is possible to get pregnant if you have uterine fibroids, but their size and location can impact fertility and pregnancy. 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