Dr. Rahul Manchanda

Good evening, I am Dr Rahul Manchanda, and I’m consultant gynaecological endoscopic surgeon. I have spoken to you on this platform before, and I’m based at A 32, New Friends Colony, which is my OPT, Manchanda Endoscopic Center, and I perform all surgeries at Pushpawati Singhania Research Institute Hospital.

Now let us discuss on ovarian cysts in women. Ovarian cysts are important because these are a collection of fluid in the ovary, or they can be tumours in the ovary, but not to worry about this issue. The situation can become worst in case of ovarian cancer. And unfortunately, the ovary is notorious for having cancer which is detected very late, because they increase at such a huge pace that by the time the symptoms appear, it’s very late. And these are normally detected in the last stages where nothing very much can be done. So it’s important not to take it lightly. At every stage of a woman’s life, whether it is in before she gets her menses, or when she’s menstruating, or after the menses finish, there is various range of awareness that can occur. One should go for a regular gyno checkup, or go for a regular medical check-up and get an ultrasound in various stages, and see if everything is alright. If there is a cyst, it would catch, and that needs to be investigated, and you need to see your gynaecologist. The cysts can be normal and can be physiological, but they need to be investigated.

Nowadays of course we have minimal invasive surgery, so they can be tackled very easily. We can make a diagnosis and there is no requirement of making the large cut but the cyst can be removed through small holes. And we advice the patient to go home the next day. With the diagnosis, and of course, with satisfaction that it is nothing sinister.

So please look after yourselves. Go to a gynaecologist, go to a doctor.

If you need to consult us you can get us through Lybrate platform, or of course the OPT either at Pushpawati Singhania Research Institute in the mornings or in the evenings at New Friends Colony.

This is Dr Rahul Manchanda. Thank you very much.

A breast lump is an enlargement, swell, protuberance or a bump that is different than the breast tissue surrounding it. Breast lumps can appear in men as well as women and they can be benign or malignant. Causes of benign breast lumps are as follows:

1. Fibroadenosis: Also known as Fibro-cystic breast disease, it is a benign condition that affects the breast. It may affect either of the breasts or both. One of the major symptoms of Fibroadenosis is a breast lump. Usually, the lumpiness disappears after the menstrual cycle is over. Fibroadenosis occurs because the breast tissue doesn’t respond well to the hormonal changes during the menstrual cycle.
2. Fibroadenomas: Fibroadenomas occur because of abnormal response to the hormone oestrogen. The lumps are usually well formed and round, around the milk ducts of the breast. Breast lumps due to Fibroadenomas are called breast mice, because they move around the breast. In some cases, they disappear and in some, they tend enlarge during pregnancy.

Other benign causes of breast lumps are breast abscesses, breast cysts, lipoma (lump of fat), mastitis (infection in the breast tissues), fat necrosis (another name for breast lumps) and intraductal papilloma (benign tumour of the milk ducts in the breast). A breast lump that is firm, well defined and doesn’t move around, i.e. it doesn’t disappear after your period or pregnancy, may be a result of breast cancer.

Treatment of breast lumps
The treatment of a breast lump depends on its cause. Benign breast lumps usually disappear over time. Otherwise following treatments can be considered as per the doctor’s discretion-

1. Medication: If the breast lumps are painful or increase over time, it is advisable to take medication.
   • Non-steroidal anti-inflammatory drugs (NSAIDs) and other painkillers like paracetamol
   • Danazol, Tamoxifen or Bromocriptine are administered to treat breast pain as well
   • Antibiotics which are administered to cure breast abscesses that are caused due bacterial infections
2. Limiting the amount of fat in the diet or wearing well fitting bras also reduces the amount of pain due to breast lumps.
3. Certain types of breast lumps are filled with fluid or pus. This fluid can be drained through a procedure called aspiration or drainage.
4. A radical way to treat a breast lump is surgery. Many a times, these lumps get bigger and painful and the most effective way to deal with it is to remove it. If you wish to discuss about any specific problem, you can consult a gynaecologist.

PCOS or polycystic ovary syndrome is an endocrine disorder in women, in which the female hormones, progesterone and estrogen, are imbalanced. This imbalance leads to the formation of cysts (benign masses) in the ovaries. PCOS tends to affect your heart functions, fertility, menstrual cycle and appearance.

There are certain symptoms, which can be indicative of PCOS; these symptoms tend to begin as a woman's menstrual cycle starts. In certain cases, however, PCOS may also affect a woman in her mid age. PCOS can also cause excessive hair growth in unwanted places like above the upper lip,chin,arms and chest like a male.

The symptoms are:

• Increase in the production of male hormone, leads to development of male characteristics
• The size of the breasts may reduce
• The tone and the texture of the voice may change and become similar to a man's voice
• Hair may start to fall
• You may suffer from acne and pimple breakouts on your face
• It can lead to sudden weight gain
• It may affect a woman's fertility
• It may lead to pain in the pelvis

Other symptoms: Apart from these symptoms, a woman may also experience other health complications such as high levels of bad cholesterol, high blood pressure and diabetes.

Causes: The causes of PCOS are not well known, however, the likely causes are genetics and hormonal complications. If someone in the family has PCOS, then the risk of being affected by PCOS rises significantly. The other likely cause is the overproduction of the male hormone androgen in the female body. Although androgen is a male hormone, the female body also produces it in trace amounts. However, in some cases, when it is overproduced, it might impair the ovulation process.

Diagnosis and Treatment: Once the condition is diagnosed, there are certain treatments, which are recommended for the patient. The condition in itself does not have a cure, but the symptoms can only be controlled. Medications to control the androgen levels in the female body may be administered if you have androgen hormone complication. A balanced diet and an exercise regimen can be chalked out to control body weight and regulate blood sugar levels. If PCOS leads to ovulation problems, then medications to facilitate ovulation may be advised. If you wish to discuss about any specific problem, you can consult a gynaecologist.

Pregnancy is considered to be one of the most challenging and important phases in the life of a woman.

Pregnancy Complications are health problems that occur during pregnancy. They can involve the mother’s health, the baby’s health, or both. Some women have health problems before they become pregnant that could lead to complications. Other problems arise during the pregnancy. Keep in mind that whether a complication is common or rare, there are ways to manage problems that come up during pregnancy.

Some complications that might occur during pregnancy are discussed below:

1. Severe Nausea and Vomiting: It is common for nausea and vomiting to occur during a pregnancy. In order to avoid this condition, one should consume several small meals throughout the day and completely avoid spicy and fatty foods.
2. A persistent abdominal pain, severe headache, swelling and visual disturbances during the third trimester: This can be a fatal condition and often is a sign of high blood preeclampsia (pregnancy complication involving high blood pressure as well as damage to another organ system). It can be diagnosed early using good prenatal care which essentially comprises of frequent check-ups with the doctor and all the necessary treatment during pregnancy.
3. Flu Symptoms: It is recommended that flu vaccine should be administered to pregnant women as they usually tend to develop the disease during their pregnancy.
4. Gestational Diabetes: Gestational diabetes can increase the chance of a larger baby at birth and create delivery complications, increase your risk for high blood pressure and cause the baby to have blood sugar problems after birth. If you are diagnosed, it’s important to consult your gynecologist to control your blood sugar level, which can often be done through diet and exercise.
5. Baby’s activity level significantly declines: Sometimes, the activity of a previously active baby might decline. This can be felt by reducing the number of the kicks by the baby. The doctor has specific equipment that aids in identifying and resolving the problem.
6. Bleeding: Heavy bleeding accompanied by abdominal pain and menstrual-type cramps during the first trimester might indicate an ectopic pregnancy (embryo is implanted outside one’s uterus) or a miscarriage while occurrence in the third semester indicates placental abruption (characterized by the placenta separating from the womb’s walls). Any form of bleeding warrants the immediate attention of the doctor. Steps to avoid bleeding include bed rest, avoiding heavy work, and keeping yourself hydrated.

A Healthy Pregnancy-

The best way to ensure a healthy pregnancy is to focus on the things you can control and don’t obsess about what could happen. Take good care of yourself and your developing baby and talk with a healthcare provider when you have concerns.

Hello, this is Rahul Manchanda. I am a part of Manchanda's endoscopic centre. And I am a gynaecology endoscopic surgeon. We do Minimal Invasive Surgery for women's diseases. This includes surgery for Infertility, for which I want to talk about today.

Infertility despite our country has large population has rampant here. Many couples want babies of course and are unable to have them. So infertility is a  science in medicines that deal with this problem. And as an infertility specialist, we would like to help those people who are troubled with this. Endoscopic surgery is a large part of this.

You must have heard In Vitro Fertilization, ICSI i.e, Intracytoplasmic Sperm Injection methods to those who do not have babies and can not conceive. But you don't really need an IVF unless it is indicated and that needs to be diagnosed by the Endoscopic surgeon. You have procedures like looking into the uterus to see whether there is a problem and those problems can be corrected. And many people don't need IVF, once this works up and go through the endoscopic surgery. Tubes that are blocked can be open up with the very simple procedures in which you don't need to stay in a Hospital for very long and you do not have many cuts on the body, the cost is less, the trauma to the body is much less, you can go back to the work faster and of course you avoid the Infertility procedures. So, yes we do this surgery.

We are based at New Friends Colony and also Pushpawati Singhania Research Institute Hospital. Facebook page is also available where you can put your queries on that. Also, you can contact me through Lybrate.

Not only this, we do other types of surgeries also which we will talk to you about. But in case of Infertility, these surgeries are used. So if you have a problem, let us diagnose it, let us help to treat you and put a smile on your face.

Thank you. Regards.

Although most women experience menopause between the age of 45 and 55, but when women experience the menopause before they reach 40, it is termed a premature or early menopause. It is also known as premature ovarian failure.
This may be due to primary ovarian insufficiency in which there is decreased activity in ovaries and the periods spontaneously stops. It may be result of chemotherapy treatment for cancer or it can be surgically induced menopause when the ovaries are removed. Premature menopause can also be caused by treatments for cancer or other conditions that involve chemotherapy or radiation therapy for the pelvis. These treatments can damage the ovaries and result in ovarian failure. The chances of premature menopause depend on the type and amount of chemotherapy as well as the age of the patient

Removal of both ovaries by surgery causes menopause right away. Menstruation stops after this surgery, but the hormones of women facing such condition drop quickly. They experience strong menopausal symptoms such as hot flashes and diminished sexual desire

Chromosome defects like Turner’s syndrome can lead to premature menopause. In this condition, the female is partly or completely missing an X chromosome due to which the ovaries does not form normally leading to early menopause. Women with a family history of premature menopause are more likely to have the same themselves. Autoimmune diseases like Thyroid disease and rheumatoid arthritis that attack the body's immune system may mistakenly effect the ovaries thus preventing them from making hormones.

One should visit a gynaecologist, if the period stops or changes before the age of 40. Menopause is confirmed when a woman does not have her period for 12 months in a row. Blood tests for measurement of oestrogen and related hormones, like follicle-stimulating hormone determines if one has reached premature menopause

Women have premature menopause can be observed as physical problems, emotional disturbances or problems associated with sexual functioning. Women experience sudden waves of mild or intense body heat commonly known as hot flashes and can also experience profuse sweating called as night sweats and have difficulty in sleeping. They experience vaginal dryness and the sexual drive or the libido also decreases. The bone density decreases leading to osteoporosis and fractures. In addition to physical symptoms, there are emotional symptoms like anxiety, mood swings, loss of focus and difficulty in concentration. Women who want to conceive and go through premature menopause may feel extremely upset. The sexual symptoms include dryness and thinning of walls of vagina, thus causing pain or discomfort during sexual intercourse.

Infertility refers to being able to get pregnant after one year of trying. Women who can get pregnant but are unable to stay pregnant are also termed as infertile. Ovulatory disorders are one of the most common reasons why women are unable to conceive and is presen in 30% of women suffering from infertility.

1. Hormonal problems: Ovulation is linked with a complex balance of hormones and any disruption in the process can hinder ovulation. The disruption includes the fact that the ovaries are not producing normal follicles in which the eggs can mature. Ovulation is rare if the eggs are immature and there are no chances of fertilization. Polycystic ovary syndrome is the most common disorder responsible for infertility. Malfunction of the hypothalamus leading to failure in triggering hormonal stimulus to ovaries for egg maturation leading to immature eggs and ovarian failure. Malfunction of the pituitary gland leading to imbalance in hormonal secretion thus causing disturbance in ovulation. This can occur due to physical injury, a tumour or a chemical imbalance in the pituitary.

2. Scarred ovaries: Ovulation failure can also be due to a physical damage to the ovaries. Invasive surgeries involving ovarian cysts leads to damaging or scarring of capsule of the ovary to become due to which follicles cannot mature leading to disruption of ovulation.

3. Premature menopause: Early menopause or premature menopause before the normal age means that the natural supply of eggs has been depleted. This is most common in extremely athletic women with a history of low body weight and extensive exercise.

4. Follicle problems: Infertility is also caused due to non-ruptured follicle syndrome in which women who produce a normal follicle, with an egg inside of it, every month but the follicle fails to rupture. This leads to disruption of ovulation as the egg remains inside the ovary.

5. Others: Treating female infertility by chemotherapy is next to premature ovarian failure by loss of primordial follicles. Sexually transmitted infections are a leading cause of infertility. Tobacco smoking is detrimental to the ovaries and the amount of damage is dependent upon the amount and length of time of exposure of smoke in the environment. Nicotine in cigarettes interfere with the body’s ability to create oestrogen, a hormone that regulates ovulation. In addition, blocked fallopian tubes due to pelvic inflammatory disease or surgery for an ectopic pregnancy also causes infertility. Infertility can also be due to physical problems with the uterus or fibroids of uterus where non-cancerous clumps of tissue and muscle on the walls of the uterus. If you wish to discuss about any specific problem, you can consult a gynaecologist.

Epithelial Ovarian Cancer is a condition in which malignant tumor emerges from the tissue lining in the outer surface of the ovary. Epithelial tumors are usually benign, but this form of malignancy has been found to be the most common type of ovarian cancer. Moreover, it cannot be diagnosed until in its advanced stage. Medical research shows that factors such as multiple pregnancies, delayed childbirth and early menarche seem to raise the risk of ovarian cancer, while dietary and environmental factors also play a significant role in it.

Symptoms
1. A majority of the patients have been observed to have extensive intra-abdominal growth.
2. They may experience discomfort or swelling of the abdominal region.
3. The feeling of being bloated, lack of appetite, unnatural weight alteration, dyspepsia, malaise, and urinary problems are frequently reported symptoms.
4. Patients also experience constipation and other gastrointestinal problems.

Treatment
The first step towards treatment of ovarian cancer is to diagnose the condition. A thorough pelvic examination (consisting of an examination of the vagina, uterus, ovaries, fallopian tubes, and cervix) will help to pin point any abnormality of the ovary. If the doctor notes nodularity, firmness or lack of tenderness during the examination, these can be taken as symptoms of malignancy of epithelial ovarian tumors. Ultrasound examination of the abdominal region will also help to locate abnormality in the tissues on the outer surface of the ovary. The next logical step towards treatment is getting a biopsy. During this procedure potentially malignant cells are removed and then diagnosed by a pathologist to conclude if the cells are cancerous or not. The process of removal is known as laparotomy.

Apart from a handful of stage one patients, most women with epithelial ovarian cancer receive chemotherapy. The standard treatment for this type of ovarian cancer is the surgical elimination of tumor. This includes total abdominal hysterectomy, a surgery in which the uterus and cervix is removed through an incision in the abdomen. Post surgical treatment consists of taxane-platinum chemotherapy. Patients with minimal residual cancer undergo external radiation therapy or intraperitoneal chemotherapy (radioactive liquid is channelled into the abdomen with the help of a catheter).

A lot of research has been done in this field and a variety of clinical trials are available for a patient, if he/she wishes to be a part of it. Leading methods are immunotherapy and targeted therapy are also available. Immunotherapy uses the immune system of the patient to battle cancer. Bodily substances or substances created in the lab are used to restore and boost the body’s natural defence mechanisms against cancer. Targeted therapy, on the other hand, uses substances to identify the cancer and attack the malignant cells without jeopardizing non-cancerous cells.

Menstrual problems and their impact on female health

Good evening my name is Dr. Rahul Manchanda and I'm a gynecologist obstetrician. I do specialize in gynecological endoscopy which is a subspecialty of obstetrics and gynecology in which we look at women's diseases through small cuts. We treat them and manage them. Women's diseases that we look through this method or anything from people who can't conceive who have difficulty in conceiving to menstrual problems pain during the periods right up to cancer and women as we know are the pivot of society and the family in general and they need to look after their health. Whether you have heavy periods or you have pain during your periods. That isn't really normal. You must visit a gynecologist and make sure that there is nothing a problem there.

If you need to consult me I am available on the Lybrate website these gynecological endoscopic procedures are less painful you don't need to stay in the hospital for very long. The bleeding is minimal and of course, Kostas comes down because the medicines required much less. Besides the patient going home soon so you can diagnose most problems with this and treat them also the most common killer in our society for women are cervical cancers utrine cancer and these can be diagnosed and should be diagnosed through these procedures. A minimally invasive technique which is hysteroscopy or laparoscopy helps us diagnose them and treat them so the long periods of staying in hospitalslarge unsightly cutss the huge amount of pain that one has during surgery and after is much less and they don't have to suffer the agony of going through it.

Please look after your health. Please visit your gynecologist so that you can treat these problems and manage them and be healthy as a normal person. Thank you.

Gynaecological endoscopy is a surgical practice that aids in diagnosing the most common female disorders, such as minute vaginal haemorrhages, infertility problems and endometrial polyps (noncancerous growths on the inner uterine wall). It uses a small and slender optical device to diagnose such problems.

Gynaecological endoscopy is of two types

1. Hysteroscopy: A small optical instrument is inserted at the neck of the uterus; it is used to examine the inside of the uterine cavity, and in some cases, is used to remove endometrial polyps.
2. Laparoscopy: It is done through a small incision on the belly to examine the Fallopian tubes, the ovaries and the uterus; it is minimally invasive.

Gynaecological endoscopy has the following advantages

1. Recovery time is minimised
2. Lesser risks of infections, or other side-effects

Preparation
You do not need to do a lot to prepare for endoscopy. Here are the few things you have to go through before this surgery is conducted:

1. The preparation depends on the kind of surgery to be done. You might require imaging tests. Also, the doctor may recommend an enema or even fasting.
2. You need to inform your doctor about any medication you are taking, including supplements or non-prescription drugs. Stop taking your medications before the procedure.

Procedure followed

1. The surgery is mostly done under general anaesthesia.
2. A catheter (a small tube) is inserted to collect urine and carbon dioxide is used to fill your abdomen once you are asleep. The gas keeps your organs safe by keeping the abdominal wall away from them. This reduces the dangers of injury.
3. A small incision in your navel will allow the surgeon to insert the endoscope. The endoscope relays images on a screen, giving a clear image of your organs to your doctor. Consult a gynaecologist online.

Infertility is a condition, which is characterized by the inability to have a baby for over a year in spite of having planned and unprotected sex. It is a pretty common phenomenon for both men and women. However, there are several treatments available for both the sexes to help them recover from this problem. Here are some of the most common treatments available for infertility:

For Men

1. Changing your lifestyle: Certain factors in your lifestyle, which may cause you to be infertile include the medications you take, lack of exercise or not having intercourse frequently enough or not at the right time. The solution for these problems is simply incorporating certain changes in your daily life, such as exercising more, sticking to a healthy diet or having intercourse more often at the right time.

2. Sperm retrieval: Sperm retrieval is the technique used when you cannot ejaculate or when there is hardly any sperm present in your semen. It is also used in case of a low sperm count.

For Women

1. Intrauterine insemination: Intrauterine insemination is a process in which healthy sperm cells are put into the uterus so that the egg gets fertilized when it is released. The sperm cells have to be inserted at the time when your ovaries release eggs; therefore it is crucial to know your menstrual cycle as well as how fertility drugs are affecting it.

2. Fertility drugs: Fertility drugs are used to stimulate ovulation. This is done by administering medications which either regulate or cause ovulation to occur. There are several types of fertility drugs, so you should talk to your doctor about which should be the best for you.

3. Hysteroscopic surgery: This is a last resort, which is taken only when there are significant problems such as intrauterine scar tissue, uterine septum or endometrial polyps.

4. IVF: IVF is an assisted reproductive technology. During IVF, the sperm is first retrieved, after which fertility medications are given to the woman so that the egg can be retrieved. Finally, the egg is fertilized on a laboratory dish and injected back into the mother or a surrogate mother.

The uterus is a very important organ within the human reproductive system as this is the chamber where an embryo grows into a baby. Due to a multitude of factors, the incidence of uterine cancer has been on the rise. Let's look at some of its symptoms.

Symptoms of uterine cancer: When cells within the uterus grow abnormally and turn malignant, it may be termed as uterine cancer. This may be in the form of a fibroid or tumor or be part of the uterine tissue itself. It may be caused due to a multitude of factors such as late menopause, radiation exposure, estrogen treatments and many others. Some of the common symptoms for uterine cancer could be:

• Pain in the abdomen, lower back and especially the pelvic area.
• Pain during urination,
• Weight loss without any apparent reason
• Vaginal bleeding with or without discharge
• Pain during sex

Stages of uterine cancer: Before we understand the stages of uterine cancer you need to know how doctors diagnose the various stages. This is done by the three following steps in the TNM method:

1. Tumor: Doctors try and search for tumors and locate them within the uterus, estimate its size and whether it is malignant or not.
2. Node: If the tumor is malignant, then doctors try to find out whether the tumor has reached the lymph nodes or not.
3. Metastasis: Doctors look for Metastasis, which is whether the cancer has spread to other organs within the body and to what extent.

Stages of cancer: Cancer is primarily grouped in five stages from 0 to V according to the T, N and M stages mentioned below.

• Stage 0 - This is a very early stage of cancer where the cells have malignant growth but are still small in number and haven't spread anywhere.
• Stage I - If the cancer has developed a little, but is restricted within the uterus, it is considered as stage one. This is also further divided into Stage 1A and 1B.
• Stage II - When the cancer has started spreading, but only to some parts of the cervix from the uterus, it is diagnosed as stage 2 uterine cancer.
• Stage III - Categorized into Stage IIIA, Stage IIIB, Stage IIIC1 and Stage IIIC2, it is primarily where the cancer has spread to other organs, but it is only limited to the pelvic area.
• Stage IV A - When the cancer has gone beyond the pelvic area and also spread to the rectum and bladder area.
• Stage IV B - This is where the cancer has metastasized in the groin area or gone to other organs within the body as well.