Bombay Hospital & Medical Research Centre

Menorrhagia is heavy or prolonged menstrual bleeding. Many women have this type of abnormal uterine bleeding. It can be related to a number of conditions including problems with the uterus, hormone problems, or other conditions.

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I am Dr. Neelima Mantri, masters in obstetrics and gynaecology. I am a consultant and laparoscopic surgeon at Bombay hospital and medical research centre and Nanavati hospital. I have done a fellowship in minimally invasive surgery at Eva Women's University in South Korea. I am going to discuss today the topic of laparoscopic hysterectomy. Women today are faced with multiple gynaecological problems some of the common ones are uterine fibroids, slipping down of the uterus into the vagina commonly called as prolapse, heavy menstrual bleeding, ovarian tumour and sometimes cancers. Women do not pay attention to their basic problems and thus it results in their accumulating and things get advanced. Many a time these problems cannot be resolved completely with medicines and require removal of the uterus which is called as hysterectomy. In olden days, the surgery of uterus removal was performed by taking big cuts around 15-20 cms on the abdomen but now the advances in the technology these surgeries of uterus removal can be completed by taking small incisions on the abdomen, the procedure called as laparoscopy.

What is laparoscopy? Laparoscopy is a procedure where 3-4 small cuts around half to one cm are taken on the abdomen and specialized instruments are passed through them. Through one of the incisions the telescope and camera are passed and the procedure is visualized on the screen. Now the procedure is carried out in this way and the uterus is separated from its attachments and removed. What are the advantages of laparoscopy? First of all, the small cuts are taken on the abdomen so pain is remarkably less as compared to the conventional method. The use of magnified high definition camera makes the object and makes the organ visible, it is more powerful than the human eyes and so the technique is advanced as compared to the open surgery. The blood loss is less as compared to the conventional surgery so patient does not lose much blood and patient remains healthy. Next is that the recovery time is quicker and there is mobilization of the patient on the same day, so the patient is very much satisfied with the procedure, gets discharged in 2-3 days.

For a woman, the entire family is dependent on her, so a patient which in bedridden for many days is not acceptable, so with this laparoscopy procedure, the women are really satisfied because they can join their activities quickly and job also can be resumed quite earlier as compared to the other method. Now, lastly, the cuts are very small so the healing is faster and it is cosmetically very appealing scar as compared to a bigger scar which would have been otherwise. Now one must remember that it is a skill-full surgery, so a skilled surgeon is required so this procedure should be carried out with a gynaecologist who is skilled in this latest advances. Secondly, this procedure requires updated technology so one should opt for hospitals or centers which have this updated technology and latest instruments. So to conclude, I would like to say that women should not neglect their symptoms moreover should be aware that the option of laparoscopy is available to them which will make their life back to normal in a shorter period of time as compared to other options. Thank you so much for watching the video.

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Hi,

I am Dr. Neelima Mantri, Gynaecologist. Today I will talk about PCOS. It is a very common problem. Many girls and young women are suffering from PCOS. How does it present? The common symptom is an irregular cycle. The cycles are delayed for 1-2 months or even more. And when they are there, they are heavy. Patient passes clots. They may be painful or painless. And it gradually keeps on increasing. Another symptom is seen, the patient may develop acne. The patient may have facial hair. Hair is around the chin, upper lips and near the breast, buttocks. These are the symptoms which would be seen. The common symptom is infertility. Pregnancy really becomes an issue and the patient needs assistance from a gynecologist. In the later stage, diabetes could be seen. Sometimes endometrial cancers are also seen. So, it is not a disease which can be treated and got rid off. It is a disease which sticks to the woman through her entire productive life and with medications it can be controlled. But not treated. So, let's see how it happens.

It happens because of female internal hormone produces like male hormones. That is the reason she is not able to have an egg to rupture. The 2nd cause of PCOS is insulin resistance which is also seen in patients with diabetes. The body is not able to respond to the insulin and that is the reason patient puts on weight. Obesity is very common in PCOS. Now how does one can get diagnosed? It can be diagnosed with one out of 3 factors. One factor is clinical like acne, obesity, androgenic hair type, irregular cycles. 2nd is with sonography. Sonography will show ovaries which are increased in size and has cysts which are PCOS. And a 3rd part is with blood tests. So, blood tests show male type hormonal pattern. And the female pattern will not be seen. Now, what is the treatment? Apart from medicines, the backbone of treatment is exercise and weight loss means diet modification. So, basically, lifestyle modification is very important in the treatment of PCOS. The patient really needs to cut down on her weight, calories and if this is achieved, the patent may not need medicines to maintain cycles and get her infertility cured.

Yes, medications are also available like hormonal pills, contraceptive pills which can take care of this disease. Also, sometimes insulin sensitizers are used for this. But if exercise and diet are not taken care of or not controlled, these medicines do not work 100%. And after stopping medicines, symptoms may come back. So, lifestyle modification is very important in the management of PCOS. When exercises and lifestyle are not being followed, the patient may need surgery by laparoscopy which takes care of this cyst. So, friends, stay fit, eat healthy and workout regularly. This is the message which PCOS Dr would like to give so that you can stay away from PCOS.

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Hi,

I am Dr. Neelima Mantri, Gynaecologist and today I will talk about endometriosis. It is a very common problem affecting many women. It occurs because of growing uterine lining outside the uterine cavity. The symptoms seen are painful menses. The pain is such that the patient may have to take leave from the school, office, and patient may also have to take pills regularly. Another set of the patient may have infertility. They may not be able to conceive after repeated intercourse. Now another thing could be like painful intercourse and later on as the disease advances the pain will be all throughout. It may not be restricted until the time the menses are going. Now how is this occur? Inside the uterine wall, there is a light pink lining which is the normal lining of endometrium. During your menses, the line sheds through the vagina. In women with endometriosis, their body has the tendency, some part of menses travel through the tubes and it is been thrown inside the abdominal cavity.

Now, this lining is active so in the presence of hormones, it starts growing there in pieces in the abdomen. Now wherever it gets attached to, it causes sticking of the organs to each other. This is the reason for the pain. Because when the organs want to move, their morbidity is restricted because of the organ getting stuck due to this blood and lining. Sometimes, this lining collects on the ovaries and it causes big cyst in the ovary called endometrium or commonly known as a chocolate cyst. These are the very painful condition and they affect the ovarian function. Now the diagnosis of this disease, any test is difficult because tests are not conclusive. The sonography may also not be conclusive if ovarian leisures are not safe. Endometriosis can be diagnosed by laparoscopy. But it is not easy to put each and every patient in painful menses under laparoscopy. So, medications can be tried like birth control pills or any hormonal medications.

But they may not be 100% effective. Cysts are removed. Any area which is active in taking care of by burning them without causing harm to others. But the surgery is very skillful surgery. The disease is a progressive disease that means after surgery patient can be given relief for a few years but in a few years, the disease can restart again. Such people need additional medications beyond surgery so that the disease gets postponed. Sometimes medicines are given to release the menses so that disease can be burnt out. And the patient's life is improved. So, whenever you have painful menses, do not neglect them. Consult your gynecologist and go for a check-up because if it is not treated early you may lose up with your fertility and this disease has further implications as this disease progresses, the complexity increases. So, do check yourself with regular health visits and take care of yourself.

Thank You!