Conditions

  • Hirsutism

  • Ovarian Cysts

  • Dysmenorrhea

  • Menorrhagia

  • Endometriosis

  • Fibroids

  • Polycystic Ovarian Syndrome

  • Uterine Polyps

HIRSUTISM

Hirsutism is a condition characterized by the excessive growth of body or facial hair in women, much like hair growth patterns seen in men.

The hair grows thick and dark on the face, chest, back, upper arms, lower stomach, around the nipples and legs. Hirsutism may be related to menstrual disorders.

  • Polycystic ovary syndrome

  • Cushing’s syndrome (high levels of cortisol, a steroid hormone)

  • Congenital adrenal hyperplasia (an inherited condition characterized by abnormal levels of cortisol and androgen)

  • Tumor (tumor in adrenal gland or ovaries)

  • Certain medications

Other symptoms include:

  • Acne

  • Balding

  • Deepening voice

  • Reduced breast size

  • Enlargement of clitoris

Diagnosis of Hirsutism

Dr Alexander will collect your medical history to understand the reason behind your condition. You may be ordered blood tests to evaluate the variation in the levels of hormone.

A high level of the male hormone testosterone in the blood confirms hirsutism.

An ultrasound examination or CT scan may be ordered to examine the presence of cysts, fibroids or tumours in your ovaries. Laparoscopic examination and biopsy may be performed to diagnose cancer.

Treatments for Hirsutism

Dr Alexander may prescribe hormone therapy or oral contraceptive pills to treat hirsutism.

Surgical procedures may include the removal of fibroids, cysts or tumours.

Other cosmetic procedures, such as electrolysis (mild current targeted at hair follicles) and laser therapy (laser beam targeted over the skin to destroy hair follicles), and temporary hair removal procedures (waxing, shaving, etc.) may help to control the excessive growth of hair.

OVARIAN CYSTS

Cysts can be benign (non-cancerous) or cancerous. Depending on presentation, age of the women, time of her menstrual cycle, a cyst could be nothing but a sacs filled with fluid that develop in the ovaries. Cysts sometimes  are formed when the follicle that contains an egg fails to break and release the egg out of the ovary, resulting in accumulation of fluid and sometimes blood in the follicle.

Causes of Ovarian Cysts

Some of the risk factors for cyst formation include heredity, early menstruation, irregular menstrual cycles, excessive upper body fat distribution, and hormonal imbalance.

Symptoms of Ovarian Cysts

Ovarian Cysts usually do not cause any symptoms, but you must visit Dr Alexander if you observe swelling or bloating of the abdomen, experience pain during bowel movements, pelvic pain, severe pain leading to nausea and vomiting, and pain in the pelvis region before or after the menstrual period begins.

Treatments for of Ovarian Cysts

Some cysts will disappear by themselves and some cysts that are large will require treatment.

Treatment options include non-surgical and surgical treatment. The non-surgical treatment includes:

  • Birth control pills help to decrease formation of new cysts and prevent the formation of eggs that will become cysts.

  • Non-steroidal anti-inflammatory drugs such as ibuprofen and acetaminophen help to relieve pain.

Surgery will be recommended to remove the cyst or ovary if cysts that are 5 to 10 cm in diameter causing pain and discomfort, or if they are highly suspicious to be malignant. Laparoscopy surgery ( keyhole surgery ) to remove the cysts is usually performed, sometime laparotomy ( open abdominal cut ) is necessary.

DYSMENORRHEA

Period pain or dysmenorrhea is a condition of painful menstrual periods. Menstrual cramps or pain is felt in the abdominal areas and can occur before the menstrual cycle begins and can continue for 2 to 3 days.

Primary dysmenorrhea is the common painful condition in women with no abnormalities in the pelvic region. Women may experience severe pain before or at the onset of menstrual periods and the pain persists for 2–3 days.

Cause of Dysmenorrhea

Primary dysmenorrhea

Primary dysmenorrhea is caused by the elevated levels of the hormone prostaglandin produced by the tissues lining the uterus (womb). Prostaglandin triggers the uterine muscles to contract and push the uterine bleeding/clots out of the body through the cervix.

Conditions that may cause primary dysmenorrhea include

  • Women who have a high level of prostaglandin will experience intense pain and contractions.

Secondary dysmenorrhea

Secondary dysmenorrhea is the painful condition that may be caused because of other gynaecological problems. This kind of pain begins early in the menstrual cycle and lasts longer than primary dysmenorrhea.

Conditions that may cause secondary dysmenorrhea include

  • endometriosis,

  • fibroids,

  • infection,

  • ovarian cysts,

  • narrow cervix,

  • abnormal pregnancy, and

  • intrauterine device for birth control.

Symptoms of Dysmenorrhea

Some of the commonly observed symptoms are

  • back pain,

  • leg pain,

  • nausea,

  • vomiting,

  • diarrhea,

  • headache,

  • irritability,

  • weakness and

  • fainting.

Diagnosis of Dysmenorrhea

Dr Alexander will perform a pelvic examination to identify if there are any other problems associated with menstrual cramps.

Blood tests and cervical cultures will confirm if there is any sign of infection. Other diagnostic tests may be required which include MRI scan and ultrasound scan.

Non Surgical Treatment for Dysmenorrhea

If the menstrual cramps are because of the underlying medical conditions, then treating the conditions will help to relieve pain.

The conservative approach includes non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain and contraceptive pills which decrease the production of prostaglandins by preventing ovulation. However, these medicines are taken before the menstruation begins.

NSAIDs are contraindicated if you have a history of kidney and stomach problems. The other home remedies such as a heating pad to the pelvic area, regular exercises, massage to the back and abdomen, low-fat diet, and intake of calcium and thiamine tablets may help to treat period pain.

Surgical Treatments for Dysmenorrhea

Surgery is very rarely conducted for patients with dysmenorrhea. It is done only if the other conservative treatments are not successful. Obviously these procedures are reserved for women who do not wish to conceive, finished their family or certain age group. Some of the procedures carried out are

  • Mirena IUD which cause hormonal thinning of the endometrium and quite possible stop periods

  • Endometrial ablation – In this procedure, the superficial tissue layer lining the uterus is destroyed.  The extra tissue is destroyed by several ablation techniques such as laser beam, freezing, or heating. It is recommended in patients who have heavy uterine bleeding

  • Hysterectomy – It is the surgical removal of the entire uterus. It is recommended if you have fibroids, uterine prolapse, cancer in the uterus, and vaginal bleeding. This procedure will stop periods. It is not recommended for women who want to have children.

MENORRHAGIA

Menorrhagia is a condition characterized by abnormally heavy or extended menstrual bleeding. With menorrhagia, you may have an adequate blood loss and pain that disturbs your normal activities.

Symptoms of Menorrhagia

The most common symptoms of menorrhagia are:

  • Menstrual flow that soaks one or more pads per hour for several consecutive hours

  • The need to use double sanitary protection to control the flow of blood

  • Need to change your pad frequently during the night

  • Menstrual period that lasts longer than seven days

  • Menstrual flow that includes large blood clots

  • Affect the daily routine activities due to heavy menstrual flow

  • Fatigue, weakness or shortness of breath (symptoms of anemia)

Causes of Menorrhagia

The cause of menorrhagia is not known in some cases. However, several conditions that may cause menorrhagia include

  • hormonal imbalance,

  • dysfunction of the ovaries,

  • uterine fibroids (non-cancerous (benign) tumors of the uterus),

  • uterine polyps,

  • adenomyosis (where endometrial glands are found in the muscular wall of the uterus),

  • intrauterine devices (IUDs),

  • pregnancy complications,

  • cancer,

  • inherited blood disorders,

  • certain medications (anti-inflammatory medications and anticoagulants), and

  • pelvic inflammatory disease (PID),

  • thyroid problems,

  • endometriosis, and

  • liver or kidney disease.

Diagnosis of Menorrhagia

Dr Alexander will do a pelvic examination and may recommend other tests or procedures such as

  • pelvic ultrasound scan or

  • biopsy of the lining of the womb if the woman is over 40 years of age.

  • hysteroscopy

Biopsy is a technique of removing a piece of tissue from the inner lining of the uterus and examining it under a microscope. This is done to make sure that the cells are growing normally.

Dr Alexander may also recommend an examination called hysteroscopy, which involves placing a tiny tube with a light through your cervix to obtain a direct view of the lining of the womb.

Non Surgical Treatments for Menorrhagia

Treatment options will depend on the cause of menorrhagia, the severity of menorrhagia and the overall health of the patient. Some common treatments include:

  • Iron supplements may be started if your iron levels are low.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce menstrual blood flow as well as cramping.

  • Oral contraceptives may be given to help reduce bleeding and make menstrual cycles more regular.

  • Oral progesterone may be given to help correct hormonal imbalance and reduce menorrhagia.

  • Mirena is a type of intrauterine device which may be used to release progestin in the womb that thins the uterine lining and reduces the blood flow.

Surgical Treatments for Menorrhagia

Surgery may be needed if medication therapy is not successful. The surgical procedures include:

  • Dilation and curettage (D&C): It is a procedure in which the cervix is dilated and the lining of the uterus is scraped to reduce menstrual bleeding. You may need additional D&C procedures if menorrhagia recurs. This procedure also allow the gynaecologist to take biopsy and check for abnormal endometrial cells.

  • Hysteroscopy: This procedure involves the use of a hysteroscope, a tiny tube with a light to view your uterine cavity and to remove abnormalities such as a polyp that may be causing heavy menstrual bleeding.

  • Endometrial ablation: It is a procedure that permanently destroys the entire lining of your uterus (endometrium) resulting in little or no menstrual flow.

  • Hysterectomy: It is a surgical removal of the uterus and the cervix that leads to infertility and the cessation of menstrual periods.

Surgical procedures such as hysterectomy, endometrial ablation, and endometrial resection are for women who decide not to be pregnant or have finished their family. Therefore, discuss with Dr Alexander about the treatment options if you plan to get pregnant in the future.

Treatment includes:

  • For amenorrhea, medroxyprogesterone will be given to check for withdrawal bleed

  • For dysmenorrhea, ibuprofen and naproxen  (NSAID) are given to relieve pain

  • For menorrhagia, iron supplements and anti-prostaglandin medications are given.  In severe cases of menorrhagia, surgeries such as thermal balloon endometrial ablation, transcervical resection of the endometrium (TCRE), and hysterectomy will be done.

  • For endometriosis, hormonal preparations can be used and/or, Laparoscopic surgery to remove the endometriosis tissue from pelvic peritoneum.

  • Fibroids, depending on their location and size can either be left alone and followed up by ultrasound or  treated by medications and /or Surgery remove the fibroids.

ENDOMETRIOSIS

Endometriosis is a common gynecological problem affecting women of reproductive age. It occurs when the tissues of the uterus start growing on surfaces of other organs in the pelvis. Endometrium may grow on ovaries, fallopian tubes, outer surface of uterus, pelvic cavity lining, vagina, cervix, vulva, bladder or rectum.

Symptoms of Endometriosis

Patients may experience

  • painful cramps in the lower abdomen, back or in the pelvis during menstruation,

  • painful sex

  • heavy menstrual bleeding,

  • painful bowel movements or urination and

  • infertility.

Causes of Endometriosis

The exact cause for the endometriosis is not known, but it is thought to be inherited through genes that run in families. A defect in the immune system, hormonal imbalance, or as a complication of other surgeries, women may develop endometriosis.

Diagnosis of Endometriosis

Dr Alexander will ask you about general health, your symptoms and perform a pelvic examination to feel for the presence of large cysts or scars.

An ultrasound scan may also be performed to look for ovarian cysts.

The ultimate diagnosis is the visually proven endometriosis that can be done by diagnostic laparoscopy or keyhole surgery.

Treatments for Endometriosis

There are several treatment options available to minimize the pain as well as control heavy bleeding.

Pain Medication

Over the counter pain relievers may be helpful for mild pain. Non steroidal anti-inflammatory medications will be prescribed by Dr Alexander in cases of severe pain.

Hormone Treatment

Hormone treatment is recommended if there is a small growth and mild pain. Hormonal preparations particularly progesterone type medications or a medication that decrease or block the production of Oestrogen can be taken in the form of pills, shots, intra-uterine device (IUD) and nasal sprays. Birth control pills help to decrease the amount of menstrual bleeding.

Surgery

Surgery is an option for women having multiple growths, severe pain, or fertility problems.

  • Laparoscopy : During this surgery, growths and scar tissue are removed or burnt. This is a minimally invasive technique and does not harm the healthy tissues around the growth.

  • Laparotomy or major abdominal surgery : This involves a larger cut in the abdomen which allows [doctor] to reach and remove the endometrial growth.

  • Hysterectomy : It is a surgery that involves removal of the uterus. This procedure is done when there is severe damage to the uterus and only if patient is not willing to become pregnant.

FIBROIDS

Uterine fibroids are noncancerous (benign) tumours, commonly seen in women of childbearing age. Fibroids are composed of muscle cells and other tissues.

They develop in and around the wall of the uterus or womb. Uterine fibroids are usually round or semi-round in shape.

Types of Fibroids

Based on their location within the uterus, uterine fibroids can be classified as:

  • Subserosal fibroids: Sited beneath the serosa (the membrane covering the outer surface of the uterus)

  • Submucosal fibroids: Sited inside the uterine cavity below the inside layer of the uterus

  • Intramural fibroids: Sited within the muscular wall of the uterus

  • Intracavitary fibroids: Sited inside the uterine cavity

  • Pedunculated fibroids: Develop on a stalk attached to the outer wall of the uterus

Causes for Fibroids

The exact cause for the development of fibroids remains unknown, but some of the proposed causes include:

  • Genetic abnormalities

  • Alterations in expression of growth factor (protein involved in rate and extent of cell proliferation)

  • Abnormalities in the vascular system

  • Tissue response to injury

  • Family history of fibroids

  • Uterine infection

  • Consumption of alcohol

  • Elevated blood pressure

  • Hormonal imbalance during puberty

Symptoms of Fibroids

The majority of women with uterine fibroids may be asymptomatic. However, the basic symptoms associated with fibroids include:

  • Heavy menstrual bleeding

  • Prolonged menstrual periods

  • Pelvic pressure or pain

  • Frequent urination

  • Constipation

  • Backache or leg pain

  • Difficulty in emptying your bladder

Diagnosis of Fibroids

The diagnosis of uterine fibroids involves a pelvic examination, followed by ultrasound evaluation. Other imaging techniques such as MRI scan and CT scan may also be employed.

Treatments of Fibroids

Different methods are being used for managing uterine fibroids. Surgery is considered the best modality of treatment. The common surgeries performed for the management of fibroids include:

  • Hysterectomy or removal of the uterus

  • Myomectomy or selective removal of the fibroids within the uterus

  • Destructive techniques that involve boring holes into the fibroids with a laser or freezing probes (cryosurgery)

  • Other techniques employed are uterine artery embolisation (UAE) and uterine artery occlusion (UAO)

The last two procedures are found not to be effective, practical or widely used.

Risks during pregnancy

Some studies indicate that the presence of uterine fibroids during pregnancy, depending on their size and location, can increase the risk of complications such as first trimester bleeding, breech presentation, placental abruption, increased chance of Caesarean section and problems during labor.

POLYCYSTIC OVARIAN SYNDROME

Polycystic ovarian syndrome (PCOS) is a common endocrine disorder and one of the common causes of infertility among women.  

It is characterized by an ovulation dysfunction or impedance to the normal growth and release of eggs from the ovaries.  It is commonly seen in women of childbearing age and is rare after menopause.

The hormonal imbalance results in enlarged ovaries containing several small cysts (fluid-filled sacs).

Causes of Polycystic ovarian syndrome (PCOS)

The exact cause of polycystic ovarian syndrome is unknown. However, several factors including genetics have been implicated to play a role in the development of PCOS.

Women with a family history of polycystic ovarian syndrome are at a higher risk of developing this condition.

Researchers have also found an association between excessive insulin production and development of PCOS. Insulin hormone regulates blood sugar levels and any disorder affecting the insulin mechanism may result in excessive insulin secretion, which triggers androgen secretion from the ovaries.

Low grade inflammation, in response to ingestion of certain foods, may lead to the release of substances that can cause insulin resistance and cholesterol accumulation in the blood vessels or atherosclerosis.

Clinical studies have demonstrated the presence of low grade inflammation in women with PCOS. Excessive exposure to the male hormone during the fetal period may disrupt the function of normal genes and increase the risk of insulin resistance and low grade inflammation.

Symptoms of Polycystic ovarian syndrome (PCOS)

The symptoms of polycystic ovarian syndrome vary from person to person and depend upon the nature and severity of the condition.

Some of the symptoms of PCOS include

  • infertility,

  • absent or irregular menstrual cycle, and

  • obesity or accumulation of fat usually around the waist.

  • Abnormal facial and body hair,

  • adult acne

  • male pattern baldness or hair thinning may develop due to excessive androgen secretion.

In some patients black or dark brown patches are seen around the skin of the neck, arm, breasts or thighs. Patients often experience anxiety or depression and breathlessness during sleep.

Diagnosis of Polycystic ovarian syndrome (PCOS)

The diagnosis of polycystic ovarian syndrome is based on the medical history along with a physical and pelvic examination to evaluate the condition of the patient and help identify the underlying cause.

Test conducted could include:

  • blood tests are conducted to determine the level of various hormones.

  • glucose tolerance test and

  • evaluation of blood cholesterol may also be conducted.

  • pelvic ultrasound is performed to evaluate the appearance of the ovaries and the uterine lining.

Treatments for Polycystic ovarian syndrome (PCOS)

The treatment of polycystic ovarian syndrome is based on the symptoms and individual concerns such as infertility, irregular menstrual cycle, acne or obesity.

Both medications and surgical treatment can be used for the management of PCOS. Infertility may be treated by fertility therapy with ovulation-inducing drugs.

Drug Therapy: Clomiphene citrate, an oral anti-estrogen, may be prescribed to patients. In some patients, [doctor] may add metformin to clomiphene to help induce ovulation. In patients not responding to clomiphene and metformin, gonadotropins, namely, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) can be administered by injection.

Oral contraceptives: may be prescribed for the management of irregular menstrual cycles. Oral contraceptives effectively reduce the level of male hormone and are also effective in reducing excessive body hair growth and also minimize the risks of uterine cancer.

Lifestyle modifications and anti-diabetic medications may be prescribed for the management or prevention of obesity and diabetes mellitus.

Surgery may be recommended in patients who do not respond to medications. Laparoscopic ovarian drilling, an outpatient surgical procedure, may be used to treat the condition and induce ovulation.

PCOS and other associated conditions

Patients with polycystic ovarian syndrome frequently develop other serious medical conditions such as

  • diabetes mellitus,

  • cardiovascular diseases,

  • pregnancy induced high blood pressure,

  • miscarriage or premature delivery.

These patients are also at risk of uterine cancer, anxiety or depression.

be recommended to provide relief.

UTERINE POLYPS

Uterine polyps are noncancerous tissue overgrowths of endometrium, a tissue in the inner lining of the uterus, that extend into the uterus cavity.

Causes of Uterine Polyps

Uterine Polyps may occur spontaneously or because of high levels of oestrogen hormone, although it is not known what actually causes it. Polyps grow faster during pregnancy and while using oral contraceptives or oestrogen replacement therapy.

Although most of the polyps are noncancerous, the polyps that developed in women during or after menopause may turn out to be cancerous.

Uterine polyps are more common in women aged between 40 and 50 years. However, occasionally may be seen in younger women of 20 years or less. Obesity, uncontrolled hypertension and certain drugs used to treat breast cancer may increase the risk of uterine polyps.

Symptoms of Uterine Polyps

Most common symptom of uterine polyps is irregular menstrual periods.  Menorrhagia or abnormal heavy menstrual bleeding, prolonged periods, bleeding between periods and bleeding even after menopause or during sexual intercourse are some of the other symptoms of uterine polyps. Infertility may also be an indication of the presence of uterine polyps.

Diagnosis of Uterine Polyps

Uterine polyps are diagnosed based on the medical history and symptoms. Also, other diagnostic tests such as transvaginal ultrasound, sonohysterography, hysteroscopy, biopsy and curettage may be performed.

Treatments for Uterine Polyps

Smaller polyps that do not cause any problem need not be removed but should be assessed every 6 months to check their progression. However, if uterine polyps cause pelvic pain, heavy menstrual bleeding, or infertility or if there is previous history of miscarriage, then removal of uterine polyps (polypectomy) may be considered.

Usually, polypectomy may be performed at Dr Alexander’s office using hysteroscopy during which a long, thin rod with a video camera and light (hysteroscope) is inserted through the vagina and cervical opening. Then the polyp is held and cut with a small pair of scissors.

Larger polyps need to be operated in a hospital set-up under general anaesthesia. In order to remove the uterine polyp, laparoscopy may be performed along with a hysteroscopy. Laparoscopy involves use of laparoscope, a long rigid tube with a video camera and light which is inserted through a small incision made in the belly button. Through the laparoscope, special surgical instruments can be inserted that assist in removal of the polyp.