In adenomyosis the tissue that lines the uterus (endometrium) grows within the muscular outer walls of the uterus. This is most likely to happen from the age of 30-50.
Adenomyosis isn’t the same as endometriosis (a condition in which the uterine lining is implanted outside the uterus).
Although the cause of adenomyosis remains unknown, the disease disappears after menopause.
SIGNS AND SYMPTOMS
Excessive menstrual bleeding - heavy or prolonged.
Severe cramping pain (dysmenorrhea) during your periods.
Menstrual cramps that last throughout your period and worsen as you get older.
Pain during intercourse.
Your uterus may increase to double or triple its normal size. You may notice that your lower abdomen seems bigger or feels tender.
Endometrial hyperplasia occurs when the uterine lining (endometrium) grows too thick as a result of estrogen stimulation (or not enough progesterone).
Endometrial hyperplasia is a non-cancerous condition, however, hyperplasia with atypia (abnormal cells) is considered precancerous. It is best treated surgically with a hysterectomy.
WHO IS AT RISK
Older women experiencing menopause
Overweight
Women with polycystic ovarian disease
Never having been pregnant
Early menarche
Obesity / diabetes mellitus
WHAT ARE THE SYMPTOMS OF ENDOMETRIAL HYPERPLASIA
Abnormal uterine bleeding
Contact your doctors if you have
Heavy periods
Shorter cycles
Prolonged periods
Spotting between periods
HOW IS THIS DIAGNOSED
1. USG - Ultrasound - your doctor will ask you to get an ultrasound done to measure the thickness of the endometrium.
If the endometrium is very thick the possibility of a uterine polyp has to be considered.
2. Hysteroscopy with a Dilatation and Curettage - A hysteroscopy will allow the surgeon to actually see the lining of the uterus and thereby determine how healthy it is.
D & C - following the hysteroscopy he/she may do a curettage and the material will be sent for histopathological evaluation.
HOW IS ENDOMETRIAL HYPERPLASIA TREATED
The various treatment options depend on
The amount of vaginal bleeding
The type of hyperplasia. If the cells are abnormal or atypical.
If you are planning a pregnancy.
Discuss the various choices with your doctor.
Progesterone therapy - either orally or through an intrauterine device. This treats the hormonal in balance.
Hysterectomy may be advised if
You are post-menopausal.
If you do not respond to treatment and the bleeding is persistent and heavy.
If the hyperplasia is of an advanced type that may progress to malignancy.
If the hyperplasia worsens over a period of time. This can be found out by a repeat biopsy (hysteroscopy) often a few months of treatment.
Tubal ligation or tubal sterilization is a type of permanent birth control.
WHAT IS DONE.
During tubal ligation the fallopian tubes are cut, blocked or removed. This blocks the path of the egg which travels from the ovaries to meet the sperm.
WHY IS IT DONE.
Female sterilization is one of the most common procedures as a method of permanent family planning.
It does not protect against sexually transmitted diseases (STDs)
It may decrease the chance of ovarian cancer, more so if the fallopian tubes are removed.
WHEN IS IT DONE.
Following a normal vaginal delivery.
During a C-section
Anytime - also called an ‘Internal T.L.’
Can be done along with a MTP.
HOW IS IT DONE.
In RASHMI HOSPITAL, except during a C-section we perform a Tubal ligation through minimally invasive technique.
We perform a laparoscopic T.L.
It is done as a day care procedure under general anaesthesia. You can go home in a few hours.
Complications are rare.
WHAT CAN YOU EXPECT
It is a permanent birth control method.
Tubal Ligation reversal can be attempted but the surgery is long and not always successful.
Rarely the procedure can fail. When the procedure fails there is a risk of an ectopic pregnancy. This requires immediate treatment.
Endometriosis is an often painful disorder of the female reproductive system. The tissue that lines the inside of the uterus is called the endometrium. In endometriosis the lining grows outside the uterus, most commonly on the fallopian tubes and ovaries. Rarely it can spread beyond that onto the bladder, bowel, vagina etc.
WHAT HAPPENS IN ENDOMETRIOSIS
During your menstrual cycle, hormones signal the lining of your uterus to thicken to prepare for a possible pregnancy. If a pregnancy does not occur, the hormone levels decrease, causing the thickened lining to shed. This produces bleeding that exists through your body through the vagina-your monthly period.
When the lining of the uterus is located elsewhere it continues to act in the same way - the lining thickens, breaks down and bleeds. But it has nowhere to go or exit the body. So it get trapped.
Trapped blood may lead to the growth of cyst - CHOCOLATE CYSTS. Cysts cause scar tissue and adhesions - that binds organs together.
This causes pain and infertility.
SYMPTOMS OF ENDOMETRIOSIS 1. PAIN - before and during periods. Can be very severe and increases over time. 2. INFERTILITY 3. PAIN WITH INTERCOURSE 4. OTHERS - pain with bowel movements or urination - bloating - nausea and vomiting
Endometriosis is most likely to occur in women who haven’t had children - Some have an inherited tendency
It usually takes several years after the onset of menstruation (menarche) to develop
When menstruation ends permanently with menopause or temporarily with pregnancy, the symptoms stop.
WHEN TO SEE A DOCTOR
Severe pain during your periods or a history of infertility.
Endometriosis can be diagnosed by
ULTRASOUND - either abdominally or trans-vaginal.
LAPAROSCOPY - sometimes during a routine or a diagnostic laparoscopy the doctor can directly visualise the cysts.
WHAT ARE YOUR TREATMENT OPTIONS IF YOU HAVE ENDOMETRIOSIS
If your symptoms are mild and you are not planning a pregnancy anytime soon your doctor may recommend
Pain Medications
Hormone Therapy
LAPAROSCOPIC CONSERVATIVE SURGERY
If you are trying to get pregnant, laparoscopic surgery to remove the cysts and scar tissue will increase the chance of your success.
If you have endometriosis that causes severe pain you may also benefit from your surgery.
LAPAROSCOPIC HYSTERECTOMY
In severe cases of endometriosis, a total laparoscopic hysterectomy and the removal of both ovaries may be the best treatment. Hysterectomy alone is also effective, but removing the ovaries ensures that endometriosis will not return.
RASHMI HOSPITAL TEAM
At Rashmi Hospitalwe evaluate each patient on an individual basis to offer you options regarding endometriosis - especially with pain management.
WHAT CAUSES ENDOMETRIOSIS
The cause is really known but some theories have been put forward.
The retrograde menstruation theory - suggests that during menstruation some of the menstrual tissue backs up through the fallopian tubes and spills in the abdomen and grows.
Endometrial Cell Transport - through the blood system or lymph system
Genetic Theory - same families have a predisposition
A myomectomy is a surgery done to remove uterine fibroids while retaining the uterus, done in a women during child bearing age.
SYMPTOMS - uterine fibroids can cause.
Heavy periods
Painful periods
Infertility
Pelvic pressure
Increase in abdominal girth
AIM - the aim of a myomectomy is to remove the fibroids, and hence relive the symptoms and improve the chances of fertility.
TECHNIQUES OF MYOMECTOMY 1. Laparoscopic myomectomy - The surgery is performed through a few small incisions made on the abdomen. The fibroid is cut into pieces (morcellation) and removed through a small incision. Sometimes the fibroid is put into a bag (endo bag) and in-bag morcellation is done.
2.HYSTEROSCOPIC MYOMECTOMY - A fibroid that protrudes into the uterine cavity is called a submucosal fibroid. This is removed (resected) through a hysteroscope inserted through the vagina and cervix.
3.ABDOMINAL MYOMECTOMY - A large open cut is made in the abdomen.
WHAT TO EXPECT
1.You will need to come in the morning of the surgery on an empty stomach.
2. You will be prepared for general anaesthesia.
3.Depending on the procedure you can go home late evening (hysteroscopic myomectomy) or stay overnight (laparoscopic myomectomy)
4. As we perform only minimally invasive surgery here at Rashmi Hospital you will have.
Less pain
Shorter hospital stay
Quicker recovery
A much smaller scar; as compared to an open procedure.
FERTILITY AND LAPAROSCOPIC MYOMECTOMY Women who have undergone a laparoscopic myomectomy have a good chance of improved fertility. Results are better in younger women with only 1 fibroid.
We advise waiting 6 months before planning a pregnancy, this gives time for the uterus to heal.
PREGNANCY RISKS AFTER A MYOMECTOMY As the uterus has been operated upon, the scar on the uterus makes that area weak, which can rupture during labor. A cesarean section may be advised around 38 weeks of pregnancy.
WILL THE FIBROIDS COME BACK Yes, they can come back especially in
Hysteroscopy is a surgical procedure where a small telescope (the size of a pencil) is used to inspect the inside of the uterus. A camera is attached to the end of the telescope and the image is viewed on a video monitor. Surgery is carried out while looking at the monitor.
DIAGNOSTIC HYSTEROSCOPY is performed with a smaller instrument. It can be combined with a D & C (Dilatation and curettage) or an endometrial sampling.
OPERATIVE HYSTEROSCOPY. When a problem is diagnosed during a diagnostic hysteroscopy it can be cleared or operated upon at the same time.
The operative hysteroscope is larger and has parts which allows the physician to insert operating tools like scissors, cautery or a laser.
PROBLEMS THAT CAN BE TREATED
Uterine polyps.
Uterine septum.
Adhesions (a scar tissue) in the uterus.
Same types of tubal block.
Uterine fibroids.
An old IUCD that is ‘lost’.
ROLE OF SIMULTANEOUS LAPAROSCOPY and HYSTEROSCOPY.
The surgeon may advise a simultaneous laparoscopy
In infertility patients to check the potency of the fallopian tubes
When a bicornuate (double) uterus is suspected.
While doing tubal cannulation in patients with blocked tubes.
To aid in the prevention of uterine perforation if excessive hysteroscopy surgery is performed.
WHAT TO EXPECT.
You will come in the morning of surgery on an empty stomach.
You should be able to go home in the evening.
In general, you will be able to return to normal activity within 1-2 days.
Complications are infrequent, may be same mild cramping.
1.I will put on weight and have an early menopause.
Mood changes, dry skin etc are a sign of menopause. Menopause occurs when both the ovaries are removed and the production of the hormones stop. In a hysterectomy only the uterus is removed. Here in Rashmi Hospital, we retain the ovaries even in post menopausal women.
2.Along recovery period with bed rest.
At Rashmi Hospital all women who undergo a laparoscopic hysterectomy are home the next day and back to work or all normal activities within a week to 10 days.
3.A hysterectomy is very painful.
As we perform only laparoscopic hysterectomy, the cuts are very small and not painful. You can walk by evening and eat normal food too.
4.I will have a huge ugly scar.
No, a laparoscopic hysterectomy is done through a few small incisions (a cuts) which heal very well.
5.Sex is not enjoyable.
On the contrary some women enjoy sex more because.
The fear of pregnancy is no longer there.
Any condition like a deep fibroid which was causing painful intercourse is eliminated.
6.I will have back pain.
This is again a sign of menopause when women do not take calcium. Since your ovaries are left intact you will not experience back pain.
WHAT HAPPENS TO ME AFTER A HYSTERECTOMY.
You will be relieved of your symptoms like heavy periods, painful periods etc.
