Obstetrics, IVF, Gynec and Gynec-Onco

Common Gynec Issues

PCOS
PCOS or Polycystic Ovarian Syndrome occurs when ovaries produce abnormal amounts (higher than normal levels) of estrogen and androgen hormones in females. Some women may also develop cysts in their ovaries. Almost 20%-30% of Indian women are affected by PCOS.
- The common symptoms of PCOS are:
- Delayed or Irregular periods
- Low flow during periods
- Thinning hair from forehead and crown
- Maybe absolutely painless periods
- Weight gain that is resistant to weight loss measures
- Excessive dark or coarse hair on the face, chest, or back
- Dark skin on underarms or intimate areas

The common diagnosis and tests to identify PCOS are:

Ultrasound
Hormone Tests
Clinical Examination

The Treatment usually involves:

Lifestyle Measures
Fertility Treatment or contraceptive pills
Screening for Diabetes
Supplements and PCOS Treatment medications

In case, you notice such symptoms, consulting the gynecologist is advisable.

Endometriosis
Endometriosis is a medical condition where the uterine lining develops outside the uterus, leading to pelvic pain and potential fertility issues. It can affect women from any age group.
- The common symptoms of endometriosis are
- Painful periods
- Pain in the lower part of the belly (pelvis), during intercourse, or while urinating or passing the bowels
- Heavy bleeding during periods with clots
- Bloating
- Nausea
- Fatigue

The Diagnosis includes:

Clinical Examination
Sonography
MRI
Diagnostic Laparoscopy is also done in some cases

The treatment includes:

Painkillers
Hormonal suppression
Fertility treatment
Surgery to remove the endometriotic lining

While the exact cause of endometriosis remains unidentified, symptom management is possible through medication or, in certain instances, surgical intervention.

It is advisable to consult your gynecologist if you have any symptoms.

Fibroids
Fibroids are benign lesion that forms inside the uterus. They often vary in size. They are common among Indian women. The chances of fibroids turning cancerous are less than 1%. The common types of fibroids are :
Intramural fibroids:
can be found in the muscle wall of the uterus and can often grow larger
Submucosal fibroids:
develop in the middle muscle layer (myometrium) of the uterus and aren’t very common
Subserosal fibroids:
form outside the uterus.
Though these are not life-threatening, they can significantly affect one’s quality of life.

The common symptoms include::

Heavy bleeding during periods
Longer periods
Excessive menstrual cramps
Pressure or a feeling of fullness in the lower abdomen
Frequent urination
Pain during intercourse
Fertility problems

Commonly diagnosed by:

Clinical Examination
Routine Sonography
Pelvic Sonography
Pelvic CT Scan or MRI

Frequent sonographies are recommended even in the reproductive age groups to detect fibroids and monitor if they are growing in size. So for any irregular periods, heavy or light, a consultation from a Gynaecologist is highly recommended.

Common Gynec issues after Marriage
a. Painful Sex Most commonly reported among women after marriage, and can be treated in 90% of them with gel-based solutions
- b. Vaginal infections
- These are very common and usually occur where there is an imbalance in the vaginal microbiome.
- Causes of infection:
- Bacterial
- Fungal
- Viral
- Trichomoniasis
- Chlamydia
- Sometimes swab is taken and the treatment is given based on the diagnosis.
- c. Contraception
- Some methods of contraception include condoms, copper or hormonal Intrauterine devices (IUDs), injections, and combined hormonal or progesterone-only pills.
- It is always advisable to take your gynecologist’s advice before taking contraceptive pills.
- Contraception should be tailor-made as per a woman’s medical details and her wishes.

Hysterectomy
This is a surgery for uterus removal. It is done due to fibroids and sometimes is recommended for endometriosis or cancers. In addition to traditional open surgeries, the uterus can be removed through small incisions in the abdomen using minimally invasive procedures like laparoscopic or robotic hysterectomy. Robotic surgery has significant benefits like less pain and less blood loss, shorter recovery time, fewer operative complications, and quicker return to normal activities.

Menopause
The natural decline in reproductive hormones in a woman who is in her 40s, leading to irregular periods is called perimenopause. The cessation of periods for 12 months is menopause. The first sign could be early, delayed, heavy, light, or any irregularity in periods. If one has heavy or prolonged or painful periods, then it is strongly recommended to consult a gynecologist.

Physical symptoms include:
Urinary incontinence
Weight gain
Disinterest in intercourse
Deteriorating bone health
Vasomotor flushes, which are a form of temperature dysfunction that result in sudden hot or cold flushes
Bloating
If one notices any such symptoms, it’s time to consult the gynecologist.
The common diagnosis includes:
Sonography of full abdomen with pelvis
Hormonal blood investigations
Mammography and Pap-smear tests are advisable after the age of 40
It is essential to get a consultation from an expert. Regular tests are recommended annually. The intensity and frequency of symptoms increase after one has crossed a certain age and hit menopause.

Pregnancy
These 9 months in a lady’s life are of huge significance. Carrying a child or conceiving is very special. Having said that there is an enormous change in the female’s body plus one goes through a lot of psychological changes as well. Here the family plays a major role in keeping the bond alive and also gives strength to the lady who’s pregnant. Plus, the gynecologist also plays a pivotal role in this special journey and keeps you well informed and updated with the whole progress.

The common impact during pregnancy is:
Nausea
Morning sickness
Frequent urination
Fatigue
Disliking certain foods
Sense of pelvic heaviness
Tender swollen breasts
Abdomen stretch
Mood swings
These are common experiences but not necessarily everyone faces the same as every individual is different and so is their body. But listening to your gynecologist will surely help. This can be divided into three trimesters.

First Trimester (1 to 12 Weeks):

During this phase, one may feel weak, or have mood swings, and reduced appetite (like PMS). As your body changes during pregnancy, you might need to adjust your daily routine, like going to bed earlier or eating smaller, more frequent meals. Many of these discomforts usually improve as the pregnancy progresses, and some women may not experience any discomfort symptoms at all.
Getting an early sonography is crucial to check for ectopic pregnancy (pregnancy in the tube) after which another sonogram is done to confirm the heartbeat.
At 11-13 weeks, an important sonography called the “NT scan” or level I scan is conducted to assess any genetic risks. Blood tests for genetic screenings are also typically performed alongside this scan.

Second Trimester (13 to 28 Weeks)

Life becomes relatively better at this stage as the discomfort reduces to some extent. It is important to stay active and do prenatal exercises.
What to expect?
- Abdomen expands
- Improved appetite and cravings
- Stretch marks
- Body weight
- Body aches
- Numbness or tingling hands
- Pregnancy masks like dark patches
- Itching on the abdomen
- Swelling of the ankles, fingers or face
- Facial glow
Nutrition becomes important starting this trimester. One can travel during this trimester if one wishes to.

Third Trimester (29 to 38 or 40 Weeks)

One is reaching the end goal. The worries often reduce, and some experiences of the second trimester continue during this time as well along with a few additional ones.
One may want to use a pregnancy pillow for comfortable sleep.
What to expect?
- Breathing difficulty in lying down flat
- Frequent urination
- Heartburn
- Swelling at various body parts
- Braxton-Hicks Contractions (mild infrequent period-like cramps)
- Tender breasts
- The baby moving toward the lower abdomen
Your gynecologist will check the progress and will keep advising you all through.

IVF
In Vitro Fertilization (IVF) means a series of procedures to conceive. This method can be used if fertility treatments have failed, one has blocked tubes or a very low egg or sperm count, or after at least a year of trying for conception or pregnancy for a couple. It starts with the second day of the menstrual cycle where hormone injections are given to the would-be mother. This is approximately given for 10-12 days and ovum formulation is being observed. The sonography and hormone reports will disclose the status of the ovum formulation. If this process is successful, then all the eggs will be aspirated under the general anesthesia. Further, this fluid will be transferred to the test tube in the embryology lab. The eggs will be assessed under the microscope. After the assessment of eggs, the fertilization process will be done with the help of sperm. This process is known as Intra-Cytoplasmic Sperm Injection (ICSI). After this, the sperm and eggs are placed in an incubator. Subsequently based on the condition of the embryo, the assessment is done and a further process, where the embryos are placed back in the womb with or without anaesthesia.
At Zydus, there is a huge team of IVF specialists and the senior most is a pioneer in North Gujarat. They as a team have handled endless patients and given this beautiful gift of parenthood to thousands of patients. People from across the world come to Zydus for IVF and have gone back with shining smiles.

Cervical Cancer
Among the various types of gynecological cancers, Cervical cancer stands out as one of the most prevalent in India and is caused by the human papillomavirus (HPV). It develops in a woman’s cervix and can spread to other parts of the body as it progresses to advanced stages. Fortunately, prevention is possible through HPV vaccination. It is ideally administered between the ages of 9 to 14 years, and this vaccine provides crucial protection. Cervical cancer is spread with skin-to-skin contact during intercourse or by one’s finger, tampon, menstrual cup, or vibrator. However, it is curable if diagnosed at early stages.
The symptoms might not be very clear at the early stage but an annual Pap smear test is advisable in women after a certain age to diagnose pre-cancer changes even before the cancer has occured.

The common symptoms of PCOS are:
Vaginal discharge that is watery, bloody, or foul-smelling
Irregular bleeding in between periods or after menopause
Bleeding after intercourse
Vaginal discomfort
Weight loss
Fatigue
Loss of appetite
Persistent pain in the back, legs or pelvis
Swelling in legs
Gynec-onco specialist will ensure a proper diagnosis and will guide the patient if surgery or radiotherapy or chemotherapy is advisable.

Uterine Cancer
Uterine cancer has two types Endometrial cancer and Uterine sarcoma (very rare). Endometrial cancer begins in the uterus lining and are seen in >90% of the cases.

There are two strong symptoms of Endometrial cancer:
Post-Menopausal Bleeding: Any amount of bleeding after menopause is abnormal.
Heavy, frequent, and irregular menstruation during the cycle
Pelvic pain
The common diagnosis includes:
Sonography
Endometrial Biopsy
The usual treatment is surgery which can be open, minimally invasive laparoscopically, or robotics. The gynecologist decides whether chemotherapy or radiation is required, and its extent.

Ovarian Cancer
Ovarian cancer doesn’t get detected quickly and does not have any early signs. It often shows very late symptoms. It’s a very nonspecific kind of cancer and is more known as a silent disease. It is a growth of cells that form in the ovaries.
Diagnosis can be done by imaging (screening ultrasound followed by MRI or CT Scan). Tumor markers like CA-125 are blood tests that help in screening for ovarian cysts or masses and help determine the risk for ovarian cancer.
The main treatment is surgery and chemotherapy. If there is stage 3 or more, chemotherapy is advised before surgery to control the disease burden first. If the disease burden is not so high, surgery can be offered before.
There is also advanced treatment available for the same known as HIPEC (Hyperthermic Intraperitoneal Chemotherapy). This is chemotherapy in the abdomen to eliminate the cancer cells. This helps to delay the recurrence of cancer.

The usual symptoms include:
Loss of appetite
Felling full after even a small meal
Loss of weight
Abdominal heaviness or discomfort
Pelvic pain
Menstrual irregularities

Vulvar Cancer
It’s a cancer that starts in the tissue of the vulva. It commonly forms a lump on the vulva which often causes itching.

The common symptoms include:
Bleeding
Itching in the vulvar area
Change in the skin color going white or red
Breaches in the skin
Ulcers
The treatment includes Surgery, Radiotherapy or Chemotherapy.

Trophoblastic Tumour
It is group of rare disease where the trophoblast cells grow in the uterus after pregnancy or abortion. It’s a specialized branch and can be treated with chemotherapy and is curable. Mostly surgeries are also not required for the same. And can be treated with special care.

Breast Cancer
1 in every 20 women suffers from breast cancer and almost 2000 women are diagnosed with breast cancer every day which translates into 1 woman suffering from breast cancer every 4 minutes and unfortunately we end up losing 1 life to this cancer every 13 minutes. These are the hard facts of Breast cancer in India. It is rapidly increasing but it can be controlled with early diagnosis. Mostly women consult the specialists at later stage.

The symptoms are:
Painless lump in the breast or underarm, not causing any discomfort
Changing in the skin of the breast
Irritation or dimpling of breast skin
Recent size or change in the breast
Thickening or partial swelling
Red coloured Nipple discharge
Pain in the nipple area
Redness of skin in the nipple area or breast
The Diagnosis can be done with simple Mammography and needle biopsy, if required. Self-Examination is important and annual mammography tests after the age of 40 is recommended.
The treatment includes
Radiation
Chemotherapy
Immunotherapy
Targeted Therapy
Surgery

Fibroadenoma
It is a common lump in the breast. It generally affects into the age of 15 to 35 years. It is a painless lump moving in the breast, also known as breast mouse. It is advisable to show it your gynecologist/Breast Surgeon where they do a simple needle biopsy which is scarless or painless 15 minutes’ procedure. And the disease is diagnosed. If the lump is hard, painful and more than 3 cm, it is usually excised. If there is a family history of breast cancer, then also a consultation from breast cancer specialist is required.

Cosmetic Gynaecology Procedures:
This series of procedures can be done depending on patient’s symptoms and wishes. We use lasers and non-surgical techniques along with surgery. Lasers can also be used for functional purposes as well like urine incontinence after menopause or infection control for recurrent vaginal infections.