Facts About Hysterectomy

What is Hysterectomy operation?
Hysterectomy means removal of the uterus
What is uterus and what is its function?
Uterus is also called the womb, where the child grows within the woman's body.
What are the common reasons for removing the uterus (Hysterectomy) ?
1. Tumour of the uterus (called Fibroid).
2. Heavy bleeding during menses.
3. Ovarian cyst in patients whose family is complete.
4. Uterine prolapse (where uterus comes down in elderly women)
What happens after Hysterectomy operation?
1. The woman will not have any menses, and
2. She will not be able to bear any more children.
What are the different types of hysterectomy?
1. Abdominal hysterectomy (open operation)
2. Vaginal hysterectomy (performed from below)
3. Laparoscopic hysterectomy (there are different types)
Is removal of uterus equal to menopause?
No, removal of uterus is not menopause. Please read the leaflet on 'MENOPAUSE'.
Are ovaries always removed during hysterectomy operation?
No, the ovaries need not be removed in all cases of hysterectomy operation.
What are the advantages and disadvantages of keeping or removing the ovaries during hysterectomy ?
Please see later.

What is Nondescend Vaginal Hysterectomy (NDVH)?
It is removal of womb without any descend (without coming down in the vagina-called prolapse) entirely through birth passage (Vaginal Route).

When can it be done?
Almost any womb, without associated large ovarious tumours may be removed entirely through the birth passage (Only vaginal route).

Has it any advantage over other forms of hysterectomy?
Yes, there is No cut mark on the abdomen. Not even the port marks of the Laparoscopic operation.Complications usually less than other types of hysterectomy. Shorter hospital stay (48 hrs. may be even 24 hrs ). May have food within Six Hours of operation.

Can any gynaecologist do it?
It is more difficult. Only technically skilled surgeons who have experience on this art usually do it.

Keeping Or Removing Ovary

What are ovaries ? 
Ovaries are female organs, which are like testes in the males. There are two ovaries, right and left.
What are the functions of the ovaries ?
Ovaries produce eggs and female hormones till 46 to 50 years of age. At this age, all eggs are finished and no more female hormones are produced. This results in menopause. The woman stops having menses even if she has an intact uterus. This is called 'natural' menopause.
What is surgical menopause ?
When both ovaries are removed during hysterectomy the women goes into surgical menopause.
Is removal of uterus equal to menopause ?
There will not be any menses after removal of uterus but this is not equal to menopause. The woman will still continue to have female hormones from her ovaries if they have not been removed.
Are ovaries always removed during hysterectomy operation ?
No, the ovaries need not be removed in all cases of hysterectomy operation.
What are the advantages of keeping the ovaries during hysterectomy ?
If the ovaries are preserved, the woman does not go into menopause immediately. Many women, however, go into menopause within 2 - 3 years after hystrerectomy. The exact cause is not known.
What are the disadvantage of keeping the ovaries ?
Ovaries, if kept, may form cysts in 20% cases. Very rarely, they can develop cancer, but not in all cases. Ovarian cysts that form after hysterectomy are difficult to remove in some cases.
Do women go into immediate menopause after hysterectomy ?
No. Surgical menopause occurs only when ovaries are removed surgically. However, many women go into menopause within 2 - 3 years of hysterectomy even if ovaries are not removed during hysterectomy.

Facts About Menopause

What is Menopause ?
Menopause is the permanent stoppage of menses in a woman when the function of the ovaries stop.
What are the different types of menopause ?
1. Natural Menopause: When the ovaries stop producing female hormones due to natural ageing. It occurs around 46 - 50 years of age.
2. Surgical Menopause: When the ovaries are removed surgically at any age.
What are ovaries ? 
Ovaries are female organs, which are like testes in the males. There are two ovaries, right and left.
What are the functions of the ovaries ?
Ovaries produce eggs and female hormones, which are required for normal menses till 46 to 50 years of age. At this age, all eggs are finished and no more female hormones are produced. This results in menopause. The woman stops having menses even if she has an intact uterus.
Is removal of uterus equal to menopause ?
There will not be any menses after removal of uterus but this is not equal to menopause. Menopause occurs due to stoppage of ovarian hormone production.
Do women go into immediate menopause after hysterectomy ?
No. Surgical menopause occurs only when ovaries are removed surgically. However, many women go into menopause within 2 - 3 years of hysterectomy even if ovaries are not removed during hysterectomy. The exact cause is not known.
What is HRT ?
HRT is Hormone Replacement Treatment. Women take this when there are no female hormones in the body. This can be prescribed after natural menopause or after surgical menopause.
What are the advantages of HRT ? 
HRT reduces the hot flushes, night sweats, irritability and mood swings associated with menopause. It also reduces the risk of fracture among women after menopause.
What are the disadvantages of HRT ?
On prolonged use of high dose HRT for more than 5 years, a minimal increase in breast cancer (1 in 1000) has been reported. So nowadays, low dose HRT are prescribed for shorter duration, and regular follow-up with periodic mammography every 2-3 years are recommended.

What ia a PAP TEST? 
The Pap test, or Pap smear, is a screening test for cervical cancer. The test can detect changes in the cells on the cervix (the opening to the uterus, or womb, at the top of the vagina). These changes may be cancerous, pre-cancerous, or caused by inflammation. During the pelvic exam, the doctor will insert a speculum into your vagina and gently open it so the cervix can be seen. A thin brush and a wooden or plastic spatula are used to collect a sample of cells from the cervix. These cells are sent to the lab to be viewed and read by a cytotechnologist.


What is HPV?
Human PapillomaVirus is a very common infection that can be spread through sexual contact.  Studies suggest that three of every four people who have sex will get a genital HPV infection at some point in their lives. Sexually transmitted HPV can be spread through vaginal, anal, and oral sex. Some types of HPV can cause cancer of the cervix, vulva, vagina, and penis.Genital warts are not usually linked with cancer. To lower your risk of developing HPV, limit your number of sexual partners and use condoms. If you are between the ages of 9-26, you should have the HPV vaccine to help protect you from infection. Regular pap tests are the best way to prevent precancer and cancer of the cervix.


What is Cervical Dysplasia?
Cervical dysplasia is a term used to describe the appearance of abnormal cells on the surface of the cervix, the lowest part of the uterus. These changes in cervical tissue are classified as mild, moderate, or severe. While dysplasia itself does not cause health problems, it is considered to be a precancerous condition. Left untreated, dysplasia sometimes progresses to an early form of cancer known as cervical carcinoma in situ, and eventually to invasive cervical cancer. Mild dysplasia is the most common form, and up to 70% of these cases regress on their own (i.e., the cervical tissue returns to normal without treatment). Moderate and severe dysplasia are less likely to self-resolve and have a higher rate of progression to cancer. The greater the abnormality, the higher the risk for developing cervical cancer.Cervical dysplasia does not cause symptoms; therefore, regular screening and early diagnosis are important. Detecting and treating dysplasia early is essential to prevent cancer. For this reason, most physicians quickly remove suspicious cervical lesions and require frequent Pap smears to monitor for recurrences.


What is a COLPOSCOPY?
A colposcopy is the painless viewing of the cervix and the vagina through a high-powered microscope called a colposcope. The colposcope looks like a pair of binoculars attached to a stand. It does not enter the vagina. Direct examination through the colposcope allows the detection of abnormalities on the cervix that can not be seen with the naked eye.
You will lie on the examining table with your feet in the stirrups, just like a regular pelvic exam. The provider will use a speculum to separate the walls of the vagina, just like during a normal Pap test. The speculum will remain in the vagina throughout the procedure, causing you to feel a little pressure. A vinegar solution (called acetic acid) will be applied to the cervix to remove mucous and debris. The colposcope will be placed near the vaginal opening. The provider will be able to see your vagina and cervix under magnification. Any areas showing abnormal cells will be biopsied. In a biopsy, a tiny sample of tissue will be removed from the area with a tweezers-like instrument. An endocervical scraping from the os (the opening in the middle of the cervix) may be taken as this is often where abnormal cells begin. You may feel a pinch or cramping when the tissue samples are taken. The samples will be sent to a pathology lab to be examined.
If a biopsy was taken, you may have slight bleeding or spotting for a few days following the procedure. If a tampon is inserted, please remove it in 4-6 hours. Do not reinsert another tampon. Use only pads until the bleeding stops. Additionally, you may notice a coffee ground or mustard-like discharge. This is normal. Do not resume intercourse for one week or until bleeding stops—whichever is greater. If bleeding occurs that is heavier than a period, please call the office. If you have any cramping after the procedure, you may continue the Ibuprofen or Naproxen Sodium for relief. You may resume normal activities including showers and tub baths as desired. 


Can cancer cervix be prevented?
Yes,

• Routine Pap smear. It detects changes in the lower part of the womb (cervix) which occurs before actually cancer develops and can be cured easily.
• Vaccine for HPV virus. It should be taken between ages of 12 and 20 years. It prevents caner cervix in over 95% of cases.
  
  

Why should I perform a monthly breast exam?
Every year more than 200,000 women in the United States are diagnosed with breast cancer. Nearly 90% of breast lumps are found by the woman herself. Only by doing this task every month will you become familiar with your breasts and make it more likely to notice any changes. And, changes are what you are looking for. If you find any lump, hard knot or thickening you should contact your doctor or midwife immediately. If you are still having periods, you should do the exam seven days after your period begins. Your breasts are least likely to be tender and swollen at this time. If you no longer have periods, choose a day each month for the exam, such as the first of the month.


What ia Premenstrual Syndrome (PMS)?
Premenstrual syndrome (PMS) is a term used to describe the abnormal symptoms many women experience one to two weeks before the beginning of their period. Physical symptoms, accompanied by mood swings and depression, are the classic signs. PMS symptoms can occur any time after ovulation, approximately two weeks after the beginning of your period. Ways to decrease incidence of PMS symptoms include: decrease caffeine, avoid salt, avoid sugar, stop smoking, decrease alcohol intake, increase calcium, increase exercise, increase magnesium.  All PMS symptoms should disappear rapidly once menstruation begins.


What is Polycystic Overian Syndrome?
Polycystic Ovarian Syndrome (PCOS) is one of the leading causes of female infertility and is associated with long-term health risks of heart disease and diabetes. Three features of PCOS are 1) enlarged ovaries containing multiple, small cysts; 2) excess androgens (male hormone); and 3) chronic amenorrhea (missed periods).Symptoms include: hirsuitism, irregular/lack of ovulation, obesity, acne/oily skin, infertility, ovarian cysts, insulin resistance, and hair loss.The diagnosis is made through a careful history of symptoms along with physical findings, blood work and ultrasound testing. There is no cure for PCOS. The treatment of PCOS is generally symptomatic and centers on life-style modifications and medication.
What is Insulin Resistance?
Insulin resistance (IR) is a condition in which the cells of the body become resistant to the effects of insulin. As a result, higher levels of insulin are needed. Reproductive abnormalities include difficulty with ovulation and conception (infertility), irregular menses, or a cessation of menses. Once insulin resistance is diagnosed, it is controlled by medication and lifestyle changes.


WHAT IS ENDOMETRIOSIS?
Normally, during the menstrual cycle tissue builds up and breaks down within the uterus. In endometriosis, endometrial tissue (tissue from the lining of the uterus) is found outside the uterus. During the menstrual cycle this tissue builds up and breaks down in the same way but there is no way for it to leave the body. Women with endometriosis have symptoms ranging from mild to severe, although some women have no symptoms at all. Symptoms can include menstrual cramps, pain during sex, low back pain, constipation, pain with bowel movements, and infertility. Some women have chronic pelvic pain. Symptoms are usually at their peak just prior to and with the menstrual period.When your medical history and exam suggest endometriosis as a possibility, a laparoscopy may be offered to diagnose endometriosis.  Endometriosis is usually treated with medications first and if that is unsuccessful possible surgery.


What are FIBROIDS?
Fibroids are benign growths that develop from the cells that make up the muscle of the uterus. The size and location of fibroids can vary greatly. They may appear inside the uterus, on its outer surface, or within its wall.The two most common symptoms are abnormal uterine bleeding and pelvic pressure. Menstrual periods with fibroids may be very long and very heavy. There may be pressure in the pelvic region from the enlarged uterine size caused by the fibroids. However, many women with fibroids never have any symptoms at all.If you have uterine fibroids you should be checked by your doctor on a regular basis. Getting regular checkups and being alert to warning signs will help you be aware of changes that may require treatment.


What is MENORRHAGIA?
Menorrhagia is excessive menstrual bleeding commonly referred to as heavy bleeding. If your bleeding lasts seven or more days per cycle, or is so excessive that you need to change protection nearly every hour, you may have menorrhagia. Treatment options include drug therapy including use of oral contraceptives, D&C, or possibly endometrial ablation.