Dr. Anu's Aastha Medicare - Maternity, Medical & Infertility Centre

Hello everyone,

I am Dr. Anu Sidana, obstetrician and Gynecologist, Aastha Medicare. Today I am going to speak about endometriosis.

What is endometriosis? it is a painful disorder in which the cyclical period it becomes painful, tissue that involves the uterine cavity there is an endometrial lining also comes outside the uterus so this is known as displaced endometrium, it involves your ovaries, fallopian tube outside of the uterus as well as the whole abdominal cavity may be affected because of endometriosis. What happens in endometriosis is that this displaced endometrium which is lying outside the uterus also undergoes cyclical changes as the uterine lining also undergoing so it thickens and it's break out and it bleeds as the patient has cyclical periods.

Under the effect of hormones, this lining which is lying outside the uterus also thickens and bleeds and it doesn't come out as there is no exit, this blood gets trapped inside the ovaries or inside the abdominal cavity in the ovaries because of collection of blood it leads to formation of endometrioma or chocolate cyst, because of this blood collection in the abdominal cavity, pelvic as well as the abdominal lining gets irritated and it leads to formation of fibrous band inside the abdominal cavity and as a result of this various organs of the pelvic cavity like you uterus tubes, ovaries as well as rectum lying behind the uterus and the bladder in front stick to each other and leads to scarring.

How does the patient present to us? the typical symptom of endometriosis is painful cyclical bleeding, normal side cramping is normal during periods but in endometriosis there is extreme pain which starts before the period, may last during the periods and after the periods also, so patient feels cyclical painful bleeding and that painful cycle leads to disturbance in her daily routine activities and affect the quality of life because of severe dysmenorrhea patient is not able to do her daily activities even they are not able to resume the work.

It also leads to pain during intercourse as well as during periods patient may feel pain during bowel movements as well as urination, this is known as hematochezia as well as patient may not have any symptoms because of endometriosis, so the severity of the pain is not related to the extent of endometriosis sometimes patient having mild endometriosis they presents with severe pain but otherwise in another patient, patient having severe endometriosis they will not feel any pain and they are diagnosed only when they are coming to us because of endometriosis the whole anatomy is distorted and patient may have difficulty in conception also. So most of the patient they present after marriage when they feel difficulty in conception. So they are mainly approaching us when they are not able to conceive after 2 to 3 years of their marriage and their diagnoses at this time due to the fact that they are suffering from endometriosis.

Now what is the theory behind it? there is no exit cause known till now which leads to endometriosis. one explanation is retrograde menstruation, the menstrual blood with endometrial cells which is coming out of the uterus every period that flows retrogradely and it lines the ovaries, fallopian tube as well as abdominal cavity which leads to endometriosis. Second theory is known as induction theory that the cells aligning the abdominal cavity as well as peritoneal cavity they undergo transformation and those peritoneal cells they convert into an endometrial cells and they respond to various hormones and lead to cyclical changes in the displaced endometrium. Third last but not the least we have seen that patient after hysterectomy or after cesarean section they develops surgical scars endometriosis that is the endometriosis cells they invade the scar tissue and that lead to formation of surgical scar endometriosis.

So what are the risk factor for endometriosis? one is late pregnancy, second is starting period at an early age and 3rd achieving menopause at an older age. Patients who are exposed to the periods at an early age and those who achieve menopause at a late age they are more prone to endometriosis, reproductive tract anomalies they also increases the risk of endometriosis as well as patient having low BMI they are also prone to endometriosis.

Now what are the various applications due to endometriosis? as I have told because of endometriosis there is alteration of anatomy that is distorted anatomy between the uterus, fallopian tubes and ovaries which leads to because of fibrosis due to lesions so it leads to inability to conceive so what are the various complications which may arise in the long run because of endometriosis. One is as we all know it leads to cyclical painful bleeding so patients they become scared of endometriosis of their periods, affects their daily quality of life during periods and irrespective of day of cycle, then second comes infertility that is difficult in conception as we all know because of endometriosis there is distortion of the anatomy between the uterus, fallopian tubes and the ovaries which leads to difficulty in conception, then because of endometriosis studies have shown that patients who are suffering from endometriosis they are at increased risk of ovarian cancer.

Now how to diagnose endometriosis? we have different diagnostic modalities by which we can diagnose the patient is having endometriosis. One is clinical symptoms that patient having cyclical painful bleeding and associated with other findings on ultrasound and MRI which are suggestive of the patient is having bilateral ovarian cyst or single cyst and the gold standard for diagnosing endometriosis is laparoscopy, with the help of laparoscopy we can visualise directly uterine-fallopian-ovarian relationship as well as we can diagnose the extent of disease and simultaneously we can treat it.

Now coming to the treatment depending upon the age group and the presenting symptoms we treat the patient, if the patient is young and having mild symptoms of endometriosis then simple this age will work, if patient is having problem in conception then we give the treatment according to that and nowadays we have various suppressive therapies available to suppress the cyclical changes in the displaced ovarian tissue so that endometriosis doesn't grow and doesn't cause any further distortion in the anatomy of the tubes and ovaries and we advise patient to conceive as early as possible after the marriage because pregnancy has a suppressive role on endometriosis and we have seen that sometimes endometriosis gets resolved after the pregnancy and it is completely resolved once the patient achieve menopause.

Thank you

Hi,

I am Dr. Anu Sidana, Gynaecologist. Today I will talk about nausea and vomiting during pregnancy. 70% of expecting mothers are suffering from this problem. And this is most common. It usually occurs 5-8 weeks of the pregnancy. The severity of the symptoms may vary from patient to patient. This is also known as morning sickness because most of the women suffer in the morning time. The exact cause is still unknown. But studies suggest, that increased level of pregnancy hormones is responsible for this problem. Genetics and psychological factors are also responsible for this.

Who are the patients in which this is more common? This happens in the first pregnancy. Patents who are having multiple pregnancies like twins, triplet, abnormal tissue growth in the uterus also represents the symptoms. Sometimes there could be non-obstetrical causes like surgical causes, pathology in the liver, any infection or gallstones. Now, when to seek help? Mild nausea and vomiting are well tolerated by the patient. But as most of the women can't sit ideal at home with nausea and vomiting, so they need treatment for it. So, if the patient is having this problem persistently and having fever, diarrhea or there is significant weight loss, you should report tour Dr. We advice the patient dietary and lifestyle changes also to avoid the risk of nausea and vomiting. We have the patient by asking them to have small and frequent meals i.e. 6 meals a day. We always ask the patient to have parle-G or sunfeast biscuit before leaving the bed.

Then do brushing and then they will feel less nausea and vomiting. They should avoid chemical use like any odor or any species, fat-food, stuff room, noise. All these should be avoided by the patient. We always ask patients to walk for around 10-15 minutes after having a meal. We also start iron and calcium capsules. She should not take iron at bedtime because iron adds on gastritis. All these methods decrease the severity of nausea and vomiting. But if these things do not help the patient then we suggest some medications in the form of vitamin as well as other nutrition supplements. Most of the patients improve with the medications as well as dietary and lifestyle modification.

But, sometimes the condition can be more severe. The patient may have persistent vomiting throughout the day and she is having weight loss for more than 5% which is associated with dehydration. In such cases, the patient should be admitted. With the help of the treatment and a few changes, the patient improves and the condition is also treatable. Most of the patients may face mild or moderate nausea and vomiting which is treatable with diet and medicines. The patient should take the treatment in a positive way as their baby is growing well. They should consider all these things physiological and be safe, be active.

Thank You!

Hi,

I am Dr. Anu Sidana, Gynaecologist. Today I will talk about cervical cancer and its preventive measures. What is it? It arises from the mouth of the uterus i.e. cervix. Cancer is an abnormal growth of the cells. Worldwide this is the 4th most common cancer and in India, more than 72k women are dying because of cervical cancer. What are the early signs and symptoms of cervical cancer? The early patient may remain symptoms free but later on, the patient may represent with vaginal bleeding which is abnormal especially after intercourse. Then abdominal pain and pelvic pain. What are the main causes of cervical cancer? Cervical cancer is mainly caused by HPV and responsible for more than 90% of cervical cancers. All this happens because women are prone to get HPV. There are more than 15 types of HPV. Along with this, there are various receptors which may lead to cervical cancer like smoking, sexual activities ate early age, multiple sexual partners, low immune system and birth control pills.

Before the patient develops full-fledged cervical cancer, there are some precancerous lesions which over the period of 10-20 years develops cervical cancer. Here comes a roll of cervical cancer screening. What is it? It is detection as well as the treatment of precancerous lesions present on the cervix to decrease the chances of cervical cancer. There is a various method for screening which includes visual inspection of the cervix with various chemicals like acidic acid and any other ways. With the help of this, we can only screen normal and abnormal cervix. We do have a PAP test which is also known as a conventional method of testing. Next is the HPV DNA test. After testing, we send it to the lab. Along with this, we also examine the patient to rule out any other infection as well as any abnormal feature on the cervix which may suggest the patient is having a suspicios cervix. Now, when to start this screening?

Screening should be started once the patient is active for more than 3 years. If the test is negative then it has to be repeated every 3 years. If any abnormality is found then the management is done by further evaluation like colposcopy, cervical biopsy. Primary preventions are also available like vaccination. More than 15 types of viruses responsible for cervical cancer. We have vaccine only against 2 high-risk viruses. It has to be given between 9-26 years and can be given up to 45 years. They seem to be effective for 4-6 years. In the future, we are also going to get 9 cervical virus vaccination. But, it doesn't mean that you are vaccinated so, you are totally prevented because the rest of the virus still to be explored. So, even if you are vaccinated, still cervical cancer screening with the help of PAP smear is recommended every 3 years. Studies have shown that condoms have a preventive role to decrease the chances of cancer. So, the main purpose of these videos was to make you aware of cervical cancer and the various preventive measures available for it. So, be aware, be immune and be healthy.

Thank You!

Hi,

I am Dr. Anu Sidana, Gynaecologist. Today I will talk about pregnancy included hypertension. It is affecting 1 pregnant woman out of 14 in India. It happens because of high blood pressure. It is also associated with swelling of face and feet. Presence of protein in the urine may or may not be there. What causes hyperglycemia or pregnancy-induced hypertension? It is a multi factorial disease. It is due to defective placentation. Placenta is connection between the mother and the baby. Now who are at risk of pregnancy-induced hypertension? It is most common during first pregnancy, age for than 40 and it also comes genetically. It happens in overweight patient, twin pregnancy and in diabetic patient. Its symptoms are rapid weight gain, high BP, swelling of feet and face. What are the complication of it? It may leads to vomiting, headache, blurring of eye, stomach pain. It may also leads to growth restriction in the baby, preterm labor pain. Its sudden rise in BP then it may lead to seizures and fit to the mother which is life-threatening.

We advice the patient to take appropriate bed rest. Stress, high salt intake to be avoided. If the patient is having any of the symptoms, she should approach to the Dr immediately. We give safer medicines to the patient for management of blood pressure. Our main is to control the blood pressure and have safe mother and baby till 37 weeks which is preterm period and after this, we should deliver the baby. Once the placenta will be out, severity of BP will also come down. We ask the patient to do daily fetal count. If the patient is not recovering well, in such cases we have to terminate the pregnancy. Otherwise, our main aim is to keep the patient on conservative management. If patient is going for labour then it is OK otherwise we induce the patient to deliver the baby as it is best for the patient. What are the main preventive measures? Maintain your weight prior to the pregnancy. Preconception is must to rule out the problems. If patient has high BP record then we can start with another medicines. Be safe and have a safe pregnancy.

Thank You

Hello friends,

I am Dr. Anu Sidana, Gynaecologist. Today I am going to make you aware about polycystic ovarian syndrome. What is polycystic ovarian syndrome? Basically it is affecting all, it is a hormonal disorder which affects all the women starting from adolescent till the menopause. What is the difference between PCOD and polycystic ovarian syndrome? Basically PCOD is an ultrasound finding and when the hormonal disturbances are present in the body it present clinically in the patient then we label the patient as polycystic ovarian syndrome.

What is the main cause behind polycystic ovarian syndrome? It is not exactly known till now but most common is the sedentary lifestyle, secondly it could be because of stress and in 1-3% of the patient it is mainly because of the genetics that it that it runs in families. So how we diagnose the patient? Patient come to us with clinical symptoms as delayed cycle, periods coming at the gap of more than 35 days or patient is having less than 9 periods in a year. Then secondly weight gain. Third it may lead to acne or hair growth. Patient may present with all the symptoms altogether or may present with one symptom only. Then on the ultrasound we get the findings of polycystic ovaries, we diagnose the patient as polycystic ovarian syndrome on the help with the help of clinical as well as biochemical tests. Now, what is the main pathology behind polycystic ovary syndrome? It is basically eggs are being formed in the ovary but none of them is getting mature enough to get ruptured so it leads to formation of water-filled cysts within the ovary leading to polycystic appearance.

So, what happens if patient ignore the symptoms? If patient doesn't treat if we don't treat the patient in time in the long run as the ovulation is not effective patient may have difficulty in conception and it leads to infertility and because of the hormonal imbalance because of polycystic ovaries what happens it leads to rise in male type of hormones and decrease in female type of hormones. As a result there is metabolic changes which leads to changes in the lipid profile and patient becomes at a risk of diabetes as well as cardiac problem and in the long run abnormal uterine bleeding and patient also has an increased risk of uterine cancer. So, how to treat the patient? Before starting the treatment foremost thing to be done is the counselling of the patient regarding lifestyle modification which includes exercise. Any kind of exercise for at least 30-45 minutes either it is brisk walking, yoga, dance whatever suits the patient to be started.

Second is the weight management. Weight should be maintained according to the BMI so if there is less content of the fat in the body, lesser changes because of the polycystic ovaries and lesser complications because of the PCOS. Then what kind of treatment we have available? We have only two kind of treatment either we stress the ovaries or either we stimulate, always stimulate the ovary. Why? If patient want to conceive, we stimulate the ovaries so that effective eggs are being formed, there is ovulation and patient conceives and if patient doesn't want to conceive as she is unmarried then we stress the ovaries with the help of contraceptive pills and we have various hormonal therapies to regularise her cycle and according to her symptoms like hair growth and acne we treat the patient accordingly. So take home message is maintain a healthy diet, maintain your weight as well as be active to avoid the complications of polycystic ovarian syndrome.

Thank you.