Surgery Procedures   

1)Hysterectomy (TLH)

What is a hysterectomy?

A hysterectomy is an operation to remove a woman’s uterus (womb). The uterus is where a baby grows when a woman is pregnant. Sometimes the fallopian tubes, ovaries, and cervix are removed at the same time the uterus is removed. These organs are located in a woman’s lower abdomen (see image below). The cervix is the lower end of the uterus. The ovaries are organs that produce eggs and hormones. The fallopian tubes carry eggs from the ovaries to the uterus.

If you haven’t reached menopause yet, a hysterectomy will stop your monthly bleeding (periods). You also won’t be able to get pregnant.


There are several types of hysterectomy:

If you haven’t reached menopause yet, a hysterectomy will stop your monthly bleeding (periods). You 
also won’t be able to get pregnant.

There are several types of hysterectomy

 o  A Complete or total hysterectomy removes the cervix as well as the uterus. This is the most common 
     type of hysterectomy.

 o  A partial or subtotal hysterectomy (also called a supracervical hysterectomy) removes the upper part of 
     the uterus and leaves the cervix in place.

 o  A radical hysterectomy removes the uterus, the cervix, the upper part of the vagina and supporting
     tissues. This is done in some cases of cancer.

Often one or both ovaries and fallopian tubes are removed at the same time a hysterectomy is done. When both ovaries and both tubes are removed, it is called a bilateral salpingo-oophorectomy.

If the ovaries are removed in a woman before she reaches menopause, the sudden loss of her main source of female hormones will cause her to suddenly enter menopause (surgical menopause). This can cause more severe symptoms than a natural menopause.

How common are hysterectomies done?

Hysterectomy is the second most common major surgery among women. (The most common major surgery that women have is cesarean section delivery). The latest technique is Total Laparoscopic  Hysterectomy Surgery

Why do women have hysterectomies?

Hysterectomies are most often done for the following reasons:

 o  Uterine Fibroids –

Fibroids are common, benign (noncancerous) tumors that grow in the muscle of the uterus. More hysterectomies are done because of fibroids than any other problem of the uterus. Fibroids often cause no symptoms and need no treatment, and they usually shrink after menopause. But sometimes fibroids cause heavy bleeding or pain.

There are alternatives to hysterectomy to treat fibroids, which may be especially important for younger women who hope to have children. Sometimes fibroids are treated with medicine or other treatments designed to shrink the fibroids. But, this is only temporary – when the medicine is stopped, the fibroids will grow again. A type of surgery to remove only the fibroids without removing the uterus is called a myomectomy.

 o  Endometriosis –

This is another benign condition that affects the uterus. Endometriosis is the second leading reason for hysterectomies. It is most common in women in their thirties and forties, especially in women who have never been pregnant. It occurs when endometrial tissue (the inside lining of the uterus) begins to grow on the outside of the uterus and on nearby organs. This condition may cause painful menstrual periods, abnormal vaginal bleeding, and; sometimes loss of fertility; (ability to get pregnant). Endometriosis is usually not a problem for women after menopause.

Women with endometriosis are often treated with hormones and medicines that lower their levels of estrogen. Surgery to remover the patches of endometrial tissue causing the symptoms may be done using a laparascope or through a larger cut in the abdomen (laparatomy). A hysterectomy is generally not done unless other treatment has failed.

o  Uterine Prolapse –

This is a benign condition in which the  uterus moves form its usual place down into the vagina. Uterine prolapse is due to weak and stretched pelvic ligaments and tissues. Other organs such as the bladder can also be affected. Childbirth, obesity, and loss of estrogen after menopause may contribute to this problem. Uterine prolapse accounts for about 16 percent of hysterectomies.

Treatment may include estrogen therapy, exercises to strengthen pelvic floor muscles, or use of pessary, a plastic ring inserted in to the vagina to help support the uterus. In more sever causes, surgery can restore the sagging organs to their normal location and repair the supporting tissues. Sometimes a hysterectomy may be done if the prolapse is causing severe problems.

Cancers affecting the pelvic organs account for only about ten percent of all hysterectomies. Endometrial cancer (cancer of the lining of the uterus), uterine sarcoma, cervical cancer (cancer of the cervix), and cancer of the ovaries or fallopian tubes often require hysterectomy. Depending on the type and extent of the cancer, other kinds of treatment such as radiation or hormonal thereapy may be used as well.

Other reasons why hysterectomies are done include chronic pelvic pain, heavy bleeding during or between periods, and chronic pelvic inflammatory disease.

What should I do if I am told that I need a hysterectomy?

If you have a condition that is not cancer, such as fibroids, endometriosis, or uterine prolapse, there are often other treatments that should be tried first. In most cases, a hysterectomy need not be done immediately. There is time for you to get more information and look into possible alternatives.

In cases of serious disease, such as cancer; a hysterectomy may not be optional and may be a life-saving choice. Before you decide what to do, it is important that you understand your condition and your options for dealing with it.

If you are suffering from continuing, severe problem with pelvic pain and abnormal uterine bleeding and other treatments have not helped, a hysterectomy may provide welcome relief. Studies have shown that a hysterectomy often improves sexual functioning and quality of life for women suffering from these problems.

Frequently Asked Questions (FAQs)

 Here are some frequently asked questions related to laparoscopy:

Q: I'm confused about the medical terms for minimally invasive surgery and the traditional open operations. Which is which?
A: Laparoscopy means surgery in the abdominal cavity using thin long tubular rods like instruments which are introduced into the abdomen via tiny incisions on the abdomen, to the end of the Laproscope is attached a camera which allows us to view, magnify and record the image on a monitor. This is minimally invasive, or Band-Aid, surgery, since very small incisions are made.

Laparotomy is the term for the traditional open surgery on the abdomen, which involves a larger incision. There are many different terms used for specific types of minimally invasive surgery and the instruments used.

Q: Why do people recover faster from minimally invasive surgery?
A: Mainly because of the small incisions, there is less tissue trauma, no exposure of the abdominal contents to the atmosphere, and very minimal handling of the abdominal organs. The large incision used in many traditional operations causes more damage to layers of skin, muscle, and other body tissue. It takes a long time for the body to repair that damage - usually about six weeks. During that period, patients often have to restrict their normal activities so that the incision heals properly

Q: Since the incisions are so small, why can minimally invasive surgery not be done with a local anaesthetic?
A: It still is necessary for most operations, including those on the abdomen and pelvic areas to be done under general anaesthesia. That's because the general anaesthesia does more than block the sensation of pain; it also relaxes muscles and makes it easier for the surgeon to work inside the body and complete the operation.

Q: The doctor wants to do a diagnostic laparoscopy to find out why I'm having pelvic pain, the surgery will take less than an hour, and I can go home right away and back to work the next day. If it is really that simple, why do I have to bring someone to the surgery center to drive me home?
A: Because of the effects of general anaesthesia. You may feel groggy for a few hours after you awake and you may not be in complete control of the reflexes needed to drive a vehicle. It is safer to have someone else who is fully alert do the driving.

Q: Why does the doctor want to videotape my surgery? Is that standard for laparoscopic operations?
A: A videotape gives the most detailed possible record of the operation. Surgeons normally dictate an account of the operation and a paper record goes into the patient's file, but the amount of detail varies from surgeon to surgeon. Almost every operating room with modern laparoscopic equipment can videotape each procedure, creating a visual document of the operation. A record of the operation clearly shows what the surgeon found during the first operation, what difficulties were encountered, and what procedures were done. The record is very important for other doctors who may be involved in your care at some point.

Putting It All Together

Here is a summary of the important facts and information related to laparoscopy:

§         Laparoscopy is surgery on the abdomen performed through very small incisions in the body. It is used to diagnose and treat many different conditions and diseases.

§         Doctors perform laparoscopy with a pencil-thin instrument called a laparoscope. It has a strong light and a miniature camera that sends images of the surgery area to a video monitor above the operating table.

§         Laparoscopy is called minimally invasive surgery because the incisions are so small. Common non-technical names for the procedure are belly button surgery and Band-Aid surgery, a key hole surgery.

§         For minimally invasive operations on the abdomen, incisions may be only half an inch long, compared to four to six inches for traditional "open" surgery.

Minimally invasive surgery has many advantages. Individuals remain in the hospital for a shorter period, experience less discomfort, heal quicker, and can return to daily activities faster than is possible with traditional "open surgery."


Laparoscopic Hysterectomy

What is Laparoscopic Hysterectomy?

What are the advantages of Laparoscopic Hysterectomy over conventional surgery?

Who can undergo Laparoscopic Hysterectomy?

Can a person who has undergone operations in the past go in for Laparoscopic Hysterectomy?

Can associated ovarian, tubal or uterine disease all these be treated in the same operation laparoscopically?

Do I need any special investigations for Laparoscopic Hysterectomy?

Do we need any preparation / medicines before undergoing Laparoscopic Hysterectomy?

Can a person having disease like Diabetes or Hypertension undergo this procedure?

Where should one get the Laparoscopic Hysterectomy done?

Do I have to get admitted a day before the surgery?

Under what type of Anaesthesia is itcarried out?

How is the surgery performed?

After how many days can I go back home after the surgery?

What are the usual precautions I have to take after I reach home?

When do I see the doctor again after the operation?

When can I resume my normal activity / go back to work?

What is Laparoscopic Hysterectomy?

It is a procedure by which Hysterectomy (removal of uterus) is carried out laparoscopically. It is a broad term which includes the removal of Uterus with the aid of Laparoscope and very fine instruments, without making a big incision on the abdomen.

What are the advantages of Laparoscopic Hysterectomy over conventional surgery?

Its advantage over the conventional hysterectomy are that it gives rise to minimal tissue handling and thus much less trauma to other adjacent normal organs resulting in very less pain and lesser chances of adhesion formation; after the operation. 2-3 very small incisions of 0.5-1.0 cm (as compared to 10-15 cms in conventional procedure) are given on the abdomen resulting in less blood loss and lesser chances of wound infection with decreased hospital stay and early recovery time as compared to conventional surgery.

Who can undergo Laparoscopic Hysterectomy?

Usually all the patients who have been advised for hysterectomy can undergo Laparoscopic Hysterectomy.

Can a person who has undergone operations in the past go in for Laparoscopic Hysterectomy?

Yes, a patient who has undergone operations in the past can undergo this procedure and if there are adhesions because of previous operations, they can be removed along with the laparoscopic hysterectomy, in the same sitting.

Can associated ovarian, tubal or uterine disease all these be treated in the same operation laparoscopically?

Yes, it is very much possible to treat/remove the ovaries and tubes while carrying out laparoscopic hysterectomy.

Do I need any special investigations for Laparoscopic Hysterectomy?

The usual routing tests are required as for any other operative procedure and no special investigation is required for laparoscopic hysterectomy.

Do we need any preparation / medicines before undergoing Laparoscopic Hysterectomy?

To make the operation easier, the recovery after the operation faster and resumption of normal work/activity earlier, some medicines along with diet restriction is started 2 days before the operation.

Can a person having disease like Diabetes or Hypertension undergo this procedure?

Yes, after controlling the Diabetes and Hypertension a person can undergo this procedure, and in fact the advantages of lesser chances of infection and early recovery are much beneficial for them.

Where should one get the Laparoscopic Hysterectomy done?

It is an advanced laparoscopic surgery procedure, and its always advisable to get it done in an advanced care institution, where the whole set of equipment is present along with complete backup facilities.

Do I have to get admitted a day before the surgery?

If you are fully investigated and have undergone Anaesthetic checkup, you can get admitted the morning of the operation.

Under what type of Anaesthesia is it carried out?

This procedure is carried out under general anaesthesia.

How is the surgery performed?

A small incision (about one cm) is made at or near the navel. Through this a laparoscope is introduced inside the abdomen. It is a tube having lenses inside and a special camera attached to the outside end. This is then connected to a television monitor and allows the surgeon to see inside the abdominal cavity. After that two / three small half to one cm incisions are made on either side on the abdomen, to allow the introduction of thin long instruments, with which the operation is carried out.

After how many days can I go back home after the surgery?

On an average the total hospital stay is for one – two days, after which you can go back home.

What are the usual precautions I have to take after I reach home?

On an average, two hours after lunch and eight hours rest after dinner is what is usually recommended. You can climb stairs for two to three floor slowly, walk to one km slowly and carry out sedentary work at home without much difficulty. One can have bath as the dressing is waterproof.

When do I see the doctor again after the operation?

Routinely, the patient is called seven days after the operation for the change of dressing and then after four weeks for a routine checkup.

When can I resume my normal activity / go back to work?

You can resume normal activity like walking, jogging, cooking, driving, sitting in front of the computer within few days. Intercourse, strenuous exercise, lifting of heavy weights, swimming etc. has to be avoided for a period of twelve weeks.

MYOMECTOMY

At our hospital all fibroids are removed Endoscopically either Laparoscopically or by Hysteroscopic resection depending on their location.

Before the Day of the Surgery –

Before you’re scheduled for the surgery you will need an appointment with the doctor. You will need to have a few routing lab test done. These tests tell us if you are well enough to undergo the surgery.

Follow instructions provided whereby. You are kept on a liquid diet for 2 days prior to surgery.

Do not eat or drink anything after midnight and the morning before the procedure

Do not eat or drink anything after midnight and the morning of the procedure.

Do not even drink coffee, tea or water. On the day of the surgery :

o You are usually in the hospital for a day

o By the evening of the
   operation you can walk to the bathroom and by the next morning
   you can have a shower.

o The anaesthesiologist may ask questions about the patients health, discuss the procedure and explain 
   what to expect from the anaesthesia.
o Before the surgery, an intravenous line, which consist of a small flexible plastic tube, may be inserted
   into a vein in the patients arm or hand. It is used to give medications and fluids during the operation. Sometimes intravenous medication is administered
   before surgery to help the patient relax.
o The small incisions are stitched with self absorbing sutures which do not have to be removed. So you
   will only have a dressing on the incisions.
o If you have had hysteroscopic myomectomy you will not have any scars on the abdomen, but may
   have bleeding which may last few days.

What to Expect after the Surgery :

The effects of general anaesthesia make most people feel groggy at first, but they quickly become more alert. Some people experience nausea for a short time after awakening from a general anesthesia. In the recovery room, the individual first rests in bed, then gradually sits up, stands and walks as balance and mobility are regained.
Some laparscopic procedure require an overnight hospital stay.

What problems can occur after Surgery?

Complications after laparoscopic surgery are rare. Most people recover quickly and resume their normal activities without problem. However, the risk of infections or other problems exists as with any kind of surgery.

1. There may be some soreness near the incisions, especially when twisting or stretching the body.
2. There may be discomfort in the abdomen, upper chest, shoulders, and neck area but this disappears
    quickly. You may notice a change in bowel habits for a few days.
3. You may stay in the hospital 1 to 3 days to recover from the surgery. You are started on liquid diet the next day after surgery and gradually shifted
    to soft and later full diet.
4. You can resume your normal routine activity within a couple of days.
5. You should avoid heavy strenuous activity.
6. You are expected to come back for a follow up after one week.

Recovery at Home:

What Self –Care is necessary after returning home?

Individuals who have laparoscopic surgery should carefully follow their doctor’s instructions after going home. The exact kind of care needed depends on the type of surgery, the individual’s age and general health, and other factors. In general, people recovering from Laparoscopic surgery should care for their incision as directed by the doctor, be cautious about certain activities, and watch for any of the warning signs. You should report to the hospital in case of any change in health. There is a doctor on call 24 hrs.

Following laparoscopy on the abdomen or pelvic areas, it is most likely that one will :

o Leave the adhesive bandage or dressing on the incision till your next visit. The bandage is waterproof so
   you can have a shower with it on.
o In case the bandage comes out, please wash the area with soap water, dry it and apply a water
   proof Band-Aid.

How long will it take for full recovery?

Recovery time depends on the kind of procedure, the patient’s age, and health before the procedure. The following is a normal timetable for recovery from minimum invasive surgery on the abdomen.

o The groggy feeling from the anesthetic disappears the day after surgery and the individuals is fully
   alert once again.
o Any pain in the shoulders or neck are usually goes away after a few days.
o Soreness in the incisions disappears within a few days and the incisions heal after about five days.

o The bloated feeling after abdominal or pelvic laparoscopy goes away within a few days.

When can I go back to work?

Depending on the procedure most people feel well enough to return to work or normal daily activities three to five days after laparoscopy, although some people may need a week or more of rest.

Looking towards the future

New developments in minimally invasive surgery should result in operations that are even easier on the patient and the treatment of a wider range of diseases. In the future, minimally invasive surgery will:

o Use even smaller incisions that heal faster with almost invisible scars. The standard laparoscope is
   about one-half inch in diameter. Newer micro-laparoscopes are about one-tenth of an inch in diameter
   so that some procedures can be performed through small hollow needles.
o Be done for more and more disease. Researchers are developing minimally invasive methods for
   many types of surgery that currently require larger “Open” incisions.

Use computerized technology developed to run industrial robots. A doctor located hundred or thousands of mile from the operating room may perform laparoscopic surgery. The doctor may use an image transmitted over the internet, and move surgical instruments by remote control

Endometrial Ablation

What is a Endometrial Ablation?
Endometrial ablation is an alternative to hysterectomy for women with heavy bleeding. During this procedure, the uterine lining and any fibroids extending into the uterine cavity are destroyed with electric or laser energy. After the procedure, uterine bleeding usually decreases remarkably or even stops.Since this surgery does not involve removal of the uterus, it is the prefered procedure for younger women who wish to retain their uterus but have finished their child bearing. Recovery from ablation is rapid. However, if fibroids continue to grow, you may later need a hysterectomy.

Risks and Complications

The procedure is done with the use of operative hysteroscope-resectoscope and utilises fluid medium for distention of the uterine 
cavity. This fluid sometimes gets absorbed into the body causing fluid overload.

Procedure

Steps

Under General anaesthesia, a hysteroscope is inserted into the uterine cavity via the birth passage and the lining of the uterus is removed using electrosurgery.

Before the Day of the Surgery

Before you're scheduled for the surgery, you'll need an appointment with the doctor. You'll also need to see the anesthesiologist who'll answer your questions about anesthesia. You'll need to have a few routine lab tests done before you see the anesthesiologist.These tests tell us if you are well enough to undergo the surgery.

Follow the instructions provided by your doctor. You are advised to take a light meal on the night before surgery. Do not eat or drink anything after midnight and the morning before the procedure. Do not even drink coffee, tea, or water.

On the Day of the Surgery

• You are advised to report to the hospital on the morning of the surgery along with your reports. The nurses prepares you for the procedure and give you some medication with a sip of water. This medication prevents acidity.
• The anaesthesiologist or nurse anaesthetist may ask questions about the patient's health, discuss the procedure and explain what to expect from the anaesthesia. 
• Before the surgery, an intravenous line, which consists of a small flexible plastic tube, may be inserted into a vein in the patient's arm or hand. It is used to give medications and fluids during the operation. Sometimes intravenous medication is administered before surgery to help the patient relax.

What to Expect after the Surgery?
The effects of general anaesthesia make most people feel groggy at first, but they quickly become more alert. Some people experience nausea for a short time after awakening from a general anesthesia. In the recovery room, the individual first rests in bed, then gradually sits up, stands, and walks as balance and mobility are regained. 6 -8 hours after the procedure, you are allowed liquids and are usually fit to be sent home with in 12 - 24 hours. There are no cuts and no stiches for this surgery.

After endometrial ablation, you usually have bleeding followed by discharge which may last upto 10 - 14 days after the procedure.

What Problems Can Occur After Surgery?
Complications after Hysteroscopic surgery are rare. Most people recover quickly and resume their normal activities without problems. However, the risk of infection or other problems exists as with any kind of surgery.

• If a breathing tube was used for the surgery, patients may have a mild sore throat. 
• There may be headache or heaviness which may last upto a couple of days.    

Recovery in Hospital

You may stay in the hospital 12 to 24 hours to recover from the surgery. You are started on liquid diet 6 - 8 hours after surgery and gradually shifted to soft then full diet.

Recovery at Home

You may feel weak and drained as after a flu for a few days but are allowed all activity that your body feels comfortable about.

What Self-Care Is Necessary After Returning Home? 
The exact kind of care needed depends on the individual's age and general health, and other factors. In general, people recovering from Hysteroscopic surgery are very comfortable performing all their routine within a day or two and resume work within few days. There is no restriction regarding climbing stairs, or strenous activity as there are no stiches / cuts involved. You are allowed  full diet, however due to the antibiotics you may not have a good appetite which will return once your medication stops.

How Long Will It Take For Full Recovery?
Recovery time depends on the kind of procedure, the patient's age, and health before the procedure. And is usually within a week.

When can I go back to work?
Depending on the procedure most people feel well enough to return to work or normal daily activities three to five days after hysteroscopy, although some people may need a week or more of rest.

Looking towards the future.

New developments in minimally invasive surgery should result in operations that are even easier on the patient and the treatment of a wider range of diseases. In the future, minimally invasive surgery will:

• Be done for more and more diseases. Researchers are developing minimally invasive methods for many types of surgery that currently require larger "open" incisions.

Use computerized technology developed to run industrial robots. A doctor located hundreds or thousands of miles from the operating room may perform laparoscopic surgery. The doctor may use an image transmitted over the internet, and move surgical instruments by remote control.

Hysteroscopy

  Hysteroscopy provides a direct view of your uterus through a thin,
  lighted tube(hysteroscope). The tube is passed through the vagina
  into the uterus, allowing visual inspection of fibroids and other
  uterine abnormalities.
  
  Hysteroscopy thus enables us to see  inside the uterine cavity.

  This is helpful for diagnosing the shape of the uterine cavity   presence of any fibroids or polyps in the cavity which can   cause infertility / bleeding / repeated abortions. In case of   
  infertility  hysteroscopy also helps to see the opening of the   fallopian tubes

·  The procedure consists of introduction of 4mm Hysteroscope, which is an optical system of rod lens, into the uterine cavity via the normal birth passage, this has a camera attached to the eyepiece which allows us to view the uterine cavity on  a monitor and record the image.

·  Different procedures such as myomectomy(removal of fibroids), polypectomy (removal of polyp), removal of septum (partition), removal of adhesions, removal of lost Iucd & Endometrial biopsy can be performaed useing operator hysteroscopy

·  Various attachments such as resectoscpoe, versapoint can be used.

·  Tubal cannulation for blocked tubes can be donefor infertility.

·  Hysteroscopy has been recognised as a gold standard for treatment of all intra-uterine pathologies.

·  Hysteroscopy is also done before implantation of embryo during IVF.

Menopause

Menopause is a natural transition a woman makes in her journey through life. It is often likened to a bridge that a woman crosses into a new dawn where she discovers a more confident self.

Undoubtedly though, Menopause is a difficult bridge to cross. It is peppered with a large measure of emotional stress as each woman experiences basic biological changes within her.

This is a time when a woman needs understanding and care, when myths need to be brushed aside with credible information.

General Information

What is Menopause?
Menopause is the cessation of a woman's menstrual periods. Just as puberty signals the start of the 'childbearing phase' in a woman's life, Menopause marks the end of childbearing and the beginning of the next phase in a woman's life.

For many women today, the end of fertility brings a sense of freedom. They feel more empowered and energised than in their younger years. For some women, however, Menopause - coupled with midlife emotional crisis - can contribute to serious health problems.

For all women, however, Menopause is a time to focus on a good health programme. It is a phase when women need to care for themselves, now more than ever before.

Will I go through Menopause?
Yes, every woman goes through Menopause. It is a natural part of the life cycle.

When will Menopause begin for me?
There is no fixed age for the onset of Menopause but it usually occurs between the age of 35 and 55 years. No woman can be sure when she will go through Menopause, as each one has a unique biological cycle.

Menopause does not occur overnight. The changes set in slowly, usually over a period of 3 to 5 years. Menopause is complete when a woman has not had a menstrual period for 12 months in succession.

Causes

What causes Menopause?
Natural Menopause - This is caused by a natural decrease in the hormones produced by your body. Natural Menopause is a gradual biological occurrence, not a 'hormonal deficiency disease'. When you are younger, your body produces hormones like estrogen to prepare you for pregnancy. These are the hormones that cause monthly periods. Menopause begins when the level of hormones in your body starts to decline. With lower levels of hormones, your periods become erratic and eventually stop.

Surgical Menopause - Some women need to have their ovaries removed surgically. This leads to an immediate Menopause, unlike the gradual process of natural Menopause. Irrespective of the age at which such a surgery is undertaken, Menopause follows right away. This is called 'Surgical Menopause' A woman going through surgical Menopause usually faces more problems and almost always needs medical assistance to help her cope.

Sometimes a woman's ovaries are removed when she has her uterus (womb) removed for fibroids or cancer. Surgical removal of the uterus is called a Hysterectomy. But removal of the uterus alone does not cause Menopause. That happens only when the ovaries are removed.

Symptoms

How will I know I'm going through Menopause?
The first hint that Menopause might be commencing could be changes in the pattern of your periods.

You might
1. miss periods
2. have periods more often
3. bleed between periods
4. bleed much less than usual
These changes could be indications that your body is preparing itself for Menopause. These variations in periods may last for a year or more. Bleeding more than usual is not a sign of Menopause. Be sure to see your doctor if that happens.

Hot flashes
Hot flashes are sudden feelings of heat in the face and upper part of the body. These last a few minutes. Hot flashes can also occur while you are asleep. These may cause sweating and disturb your sleep.

Dry Vagina
During Menopause, the vagina could become dry. This may cause itching and pain during intercourse.

Bladder control
Many women begin to experience a loss in bladder control during Menopause. This could cause a leak in urine, especially when they sneeze or cough.

Bladder control
Many women begin to experience a loss in bladder control during Menopause. This could cause a leak in urine, especially when they sneeze or cough.

Mood swings
Menopause can cause emotional changes. With the hormonal levels changing in your body, you could experience unexplained mood swings. You might find yourself depressed, exhausted or cranky for no apparent reason. However, if you continue to feel this way most of the time, please consult your doctor or nurse.

Other possible symptoms
Some women develop additional symptoms at this stage. These may include weight gain, aching bones or forgetfulness. While some of these changes might be due to Menopause, others could be for a different reason or simply because you are getting older. Remember, please mention any such changes you notice to your doctor.

Will all this happen to me?
You may or may not experience all the symptoms. Some women notice many changes during Menopause, while others notice just a few. The experience of Menopause is unique for each woman.

Potential Side-effects

What are the long term effects of Menopause?
Menopause can sometimes affect different parts of your body and make you susceptible to other ailments.

Heart related ailments
Menopause makes you vulnerable to the risk of heart related ailments. This is further aggravated if you

• smoke

• have high blood pressure

• have high Cholesterol

• do not exercise

• have a family history of heart ailments

Osteoporosis
The presence of estrogen in our body also protects our bones. With a drop in estrogen levels after Menopause, women are more likely to develop Osteoporosis. This leads to a weakening of the bones, thereby increasing the risk of fractures, particularly in the back, hip and arm.

Care and Guidance

What can I do to feel better?
There are many lifestyle changes that can make you feel better when Menopause starts. You owe it to yourself to make these changes and focus on your health at this time. These will also help keep your heart healthy and your bones strong.

Will I need treatment?
While most women may not need any treatment for symptoms during Menopause, some may benefit from treatment. Since estrogen levels are decreasing in all women during Menopause. An Estrogen Replacement Therapy (ERT) or Hormone Replacement Therapy (HRT) may be recommended in some cases. This could
        1. relieve dry vagina and hot flashes
        2. prevent heart related ailments and Osteoporosis.

But these treatments can have some side-effects too. Therefore, they are prescribed after evaluating each case individually.

Do I need to see my doctor?
Yes, advice from a good doctor can be of great use as you go through Menopause. This is a good time to visit your doctor at BEAMS. Talk to your doctor about your symptoms and seek advice on what you can do to reduce your chances of developing weak bones and heart related ailments. A caring and informative environment can make a significant difference in preventing Menopause related problems and to help you lead a healthier lifestyle.

During your visit, you could consult our professionals on all these measures that will help you stay healthy, such as

• a complete examination by a Gynaecologist

• breast examination and mammography

• PAP smear

• pathological investigations

Also, consult your doctor on

• the best ways to exercise

• the right food to eat

• how to stop smoking (if you do smoke)

• calcium pills and vitamins

• HRT and other treatments

• any other concerns or worries that you might have

Misconceptions About Menopause

The experiences related to Menopause have many a yarn spun around them. We would like to dismiss some of these for you.

It is all "down hill" after Menopause
This is certainly not true as many women report feeling far more confident and full of life following Menopause.

Your looks will go after Menopause
A few wrinkles that you might notice appearing during Menopause are related to the natural ageing process and have no connection with Menopause.

Menopause causes depression
Hormonal fluctuation can cause temporary mood swings, but any prolonged depression is not caused by Menopause.

Menopause means the end of intercourse and romance
On the contrary, with no more need to worry about pregnancy, many women feel far more romantic and sexually inclined.

Hysterectomy is the best way to deal with menopause
Absolutely not. Hysterectomy is a removal of the uterus and not necessarily that of the ovaries. Moreover, the removal of ovaries too does not prevent Menopause related problems.

You cannot get pregnant once your periods stop
Since Menopause is not complete till you have missed 12 menstrual periods in succession, you can still get pregnant even after missing periods for a few months. Please consult your doctor about the best kind of birth control at this stage.

Your looks will go after Menopause
A few wrinkles that you might notice appearing during Menopause are related to the natural ageing process and have no connection with Menopause.

Menopause causes depression
Hormonal fluctuation can cause temporary mood swings, but any prolonged depression is not caused by Menopause.

Menopause means the end of intercourse and romance
On the contrary, with no more need to worry about pregnancy, many women feel far more romantic and sexually inclined.

Hysterectomy is the best way to deal with menopause
Absolutely not. Hysterectomy is a removal of the uterus and not necessarily that of the ovaries. Moreover, the removal of ovaries too does not prevent Menopause related problems.

You cannot get pregnant once your periods stop
Since Menopause is not complete till you have missed 12 menstrual periods in succession, you can still get pregnant even after missing periods for a few months. Please consult your doctor about the best kind of birth control at this stage.

There is no fear of AIDS after Menopause
You are still equally vulnerable to diseases such as AIDS after Menopause. Always use a condom if you are sexually active.

Menopause is not a twilight zone. It is merely a "pause" before you move on to a new beginning. It offers you the opportunity to take special care of yourself for a healthier life. Make the most of it.

Your best clue
Your mother is your best guide on when to expect Menopause. Her experience can provide your best clue. Familial and genetic factors do affect the onset of Menopause. If she began Menopause late, there's a good chance that you will also start it late and vice versa.

Take Special Care

1. Eat a nutritious diet
2. Include calcium in your diet or through supplements
3. Stay calm during hot flashes
4. Discuss these problems with family and friends
5. Exercise regularly
6. Include bladder control in your exercise routine 
7. Consult your doctor on countering vaginal dryness 
8. Learn new ways to relax
9. Stay active
10. Avoid smoking

Various Diagnostic Test

Before recommending surgery, your doctor may perform one or
  more tests to help confirm the diagnosis. 


  Your Pelvic Exam

  This exam can help find the source of your pain. Your health care provider feels for any lumps or tenderness and looks at your cervix and vagina to rule out inflammation. You may also have a rectovaginal exam (one finger inserted in the rectum) to check for endometriosis

  Pap Smear
  A Pap smear is a simple procedure in which a sample of cells is
  removed from your cervix during a pelvic exam. This sample is later
  examined under a microscope for abnormal cell changes. Cell
  samples may also be examined for vaginitis or sexually transmitted
  diseases.

Ultrasound

  

  Ultrasound uses sound waves to produce pictures of your uterus
   or ovaries to detect abnormal growths. An instrument is either
   placed on the abdomen or inserted into the vagina.

A few routine tests need to be done before any surger

• Complete Blood Count, ESR.
• Blood Group Rh typing
• BT, CT PTT
• Blood Sugur
• TSH
• Sr HIV
• Sr HbsAg
• Urine Routine
• Electro Cardiograph
• X-Ray Chest PA view
• Other specific tests depending on your age and surgery involved.

Hysteroscopy



  Hysteroscopy provides a direct view of your uterus through a thin,
  lighted tube(hysteroscope). The tube is passed through the vagina
  into the uterus, allowing visual inspection of fibroids and other
  uterine abnormalities. Hysteroscopy is often performed at the same
  time as D&C.
  Biopsy
  Biopsy is the removal of a tiny sample of tissue, which is later
  examined for abnormal cells. Both cervical and endometrial biopsies
  can be performed.

What is a Fibroid?

You probably just found out you have fibroids (myomas). What you may not yet know is that fibroids are very common and treatable. Fibroids are round growths of muscle in the wall of your uterus-and are almost always noncancerous (benign) and harmless. They start as pea-sized lumps, but can grow steadily during your reproductive years. Many fibroids just need to be monitored. Others may require treatment if they become too large or cause symptoms. Although fibroids tend to run in families, no one really knows why some women have them and others don't.

 Symptoms

Many fibroids cause no symptoms at all. But a fibroid that grows rapidly in your uterus can cause one or more of the following problems:
1. Abnormal uterine bleeding
2. Difficulty urinating or having bowel movements
3. Achiness, heaviness, or fullness
4. Back pain
5. Difficulty getting pregnant
Only rarely, if fibroids are allowed to grow unchecked, will they lead to serious problems such as cancer

Medical Evaluation
When fibroids are suspected, a medical evaluation can determine whether you have fibroids, rule out other problems, and help you and your doctor decide which treatment, if any, is best for you. Before a diagnosis is reached, your doctor will ask you questions about your medical history and perform a pelvic exam. Your doctor may also suggest that you have one or more diagnostic tests, which can help provide details on the size and location of any fibroids.

Medical History
To look for signs of fibroids and to begin to plan your treatment, your doctor may ask you about one or more of the following:
1. The pattern of your menstrual bleeding.
2. When, if ever, you experience pelvic pain
3. Your birth control method, if any
4. Your family history of fibroids
5. Your plans to have children

Pelvic Exam
During a pelvic exam, your doctor examines your reproductive organs. The tenderness, texture, and overall size of your uterus are checked. If you have abnormal bleeding, your doctor will also check your vagina and cervix for signs of infection or small breaks in the skin. Samples of cervical cells may be taken for closer examination (a Pap test) to check for infection or cancer. Since fibroids can grow on the back wall of your uterus, your doctor may also do a rectal exam.

Diagnostic Tests
Three common tests can provide close-up views of the inside or outside of your uterus and confirm the size and general location of fibroids. Ultrasound is quick and painless. Hysteroscopy and laparoscopy are slightly more involved procedures.

1. Ultrasound is often used to monitor the growth of fibroids. An instrument is placed on your lower abdomen or inserted into your vagina. Sound waves bounce off your reproductive organs, creating a picture on a video screen.

2. Hysteroscopy is used to evaluate fibroids that extend into the uterine cavity. During hysteroscopy, your doctor looks directly at the inside of your uterus through a hysteroscope, a thin "telescope" with a light attached.

3. Laparoscopy allows your doctor to check for fibroids by providing an outside view of your reproductive organs. Your doctor inserts a laparoscope, another type of "telescope," through a small incision near your navel.

Treatment Options
You and your doctor may choose one of three types of treatment: simply monitoring the fibroids, removing the fibroids, or removing your entire uterus. Your decision will depend partly on the severity of your symptoms. It will also depend on the size and condition of the fibroids and how fast they're growing. If your doctor recommends removing your uterus, you will also need to consider your plans for future children and how important it is to you to keep your uterus. Your doctor can describe the risks and benefits of all your treatment options.

Monitoring the Fibroids
1. Waiting and watching the fibroids with regular pelvic exams or ultrasound may be a good option if the fibroids are small or if you're nearing menopause (the end of menstrual cycles). At menopause, fibroids often shrink naturally due to decreasing levels of estrogen, a hormone that makes fibroids grow.
2. If you are taking hormones, your fibroids may require special monitoring. Your doctor may recommend that you try another birth control method if you are taking birth control pills and the fibroids are growing. If you are on hormone replacement therapy, you may need to try a lower dose.
3. If you are pregnant, the fibroids may grow rapidly, but most don't cause serious problems. Surgery to remove fibroids is usually not done at this time. However, you may need a cesarean (surgical delivery), especially if the fibroids are large or block the vagina, or if you've had previous uterine surgery.

Removing the Fibroids
Fibroids can be removed either through the vagina with hysteroscopy (if inside the uterine cavity) or through an abdominal incision with abdominal myomectomy (open outdated surgery) or laparoscopically (latest technology - tiny key hole incisions) . These procedures preserve your uterus and your ability to have children, but fibroids may later return. Your doctor may prescribe anti-estrogen medications to shrink the fibroids before surgery. During surgery, you'll have general anaesthesia (which allows you to sleep during the procedure).

Removing Your Uterus
Having a hysterectomy (removal of the uterus) guarantees that fibroids will never return: But it also means you won't be able to have children. For women with large or many fibroids or unbearable symptoms, hysterectomy may be the best solution. The uterus and cervix may be removed either through a small abdominal incision or through the vagina, under general anaesthesia. The ovaries are often kept in place to allow the continued production of hormones.

Endometrial ablation
Endometrial ablation may be an alternative for women with heavy bleeding who have a few small fibroids. During this procedure, the uterine lining and any fibroids extending into the uterine cavity are destroyed with electric or laser energy. Afterward, uterine bleeding usually decreases or stops. Recovery from ablation is rapid. However, if fibroids continue to grow, you may later need a hysterectomy.

Recovery
Treating your fibroids is likely to relieve your symptoms. But your doctor will want to schedule regular checkups to monitor your progress and make sure your fibroids don't return. If you have had surgery, ask your doctor about any additional follow-up visits you might need.

What is a Endometriosis? 

In endometriosis, tissue that normally lines the Uterus (womb) grows outside the uterus. This tissue swells with blood during each menstrual cycle. The result can be severe cramps and pain. Many women think these cramps are normal. They may not seek medical help. But if you have this disease and it is not treated, your health and ability to have children can be affected.

Endometriosis can also affect your work, emotions, and sexuality. But, with early diagnosis and treatment, endometriosis can be managed.

Endometriosis affects your reproductive organs and monthly menstrual cycle. The average cycle is about 28 days. During the first 3 weeks, the lining of the uterus swells with blood. This lining is called the endometrium. If you have endometriosis, endometrial tissue grows outside the uterus in parts of the pelvic cavity.

This endometrial tissue also swells with blood, irritating nearby structures. No one knows for sure what causes endometriosis. Some think that menstrual blood carrying endometrial cells may back up through the fallopian tubes, spilling onto the pelvic organs. Others believe endometrial cells may be present in the pelvic cavity from birth. Some cases of endometriosis may be caused by exposure to toxic substances.

The normal endometrium lines the inside of the uterus. It is made up of tissue, blood, and mucus. Every month, the endometrium thickens with blood. This is so it can nurture an egg if one is fertilized.

With endometriosis, endometrial tissue growths are scattered throughout your pelvic cavity. These growths, called implants, can occur on the reproductive organs, bladder, or bowel. Just like other endometrial tissue, these implants fill with blood.

Symptoms
If you have endometriosis, you may have one or more of these symptoms:

1. cramps and menstrual pain severe enough to keep you in bed a few days each month
2. severe pelvic pain during your period
3. trouble getting pregnant (infertility)
4. pain during sexual intercourse

Stages of Endometriosis

1. Mild
   Shallow implants on pelvic lining and on one ovary, with light adhesions on the outer ovary.

2. Moderate
   Deep implants on pelvic lining and one ovary, with dense adhesions on the other ovary.

3. Severe
   Deep implants on ovaries, with dense adhesions on ovaries, fallopain tubes, and pelvic lining.

Types of Endometriosis

1. Classic blue-gray spots


2. Raspberry spots with shagy tissue

3. Flat or raised white tissue, like scarring

4. Clear "berries" with small peaks

5. Chocolate cysts filled with old blood

Medical Evaluation

The earlier endometriosis is diagnosed, the sooner you can get relief. You also have a better chance of preventing infertility and major surgery. Your evaluation may begin with a medical history. A pelvic exam and one or more lab tests may be done. You  may be recommend a laparoscopy. With this minor surgical procedure, your doctor can see into your pelvic cavity and look for endometrial growths.

Menstrual History

Your menstrual cycle may give clues as to whether you have endometriosis. At what age did your periods begin? Did your cramps or other symptoms start with your first period or years later? In what ways does the pain affect your lifestyle or cause emotional distress? These questions and others will help your health care provider diagnose your problem.

Pelvic Exam

This exam can help find the source of your pain. Your doctor feels for any lumps or tenderness and looks at your cervix and vagina to rule out inflammation. You may also have a rectovaginal exam (one finger inserted in the rectum) to check for endometriosis.

Lab Tests

A blood test and urinalysis may be done to help rule out other conditions. You might also have an ultrasound. It is a painless test that uses sound waves to make a "picture" of any abnormal tissue that might be endometriosis. If your bowel movements are painful around your periods, a barium enema (an x-ray of the lower bowel) may help find the source of your pain

Treatment Options

If you have endometriosis, you have three options. They are hormone therapy, surgery, or a combination of both. Hormone therapy regulates or blocks the hormones that control your menstrual cycle. This means it can limit the swelling of your endometrium and endometrial implants. This treatment may be used before, instead of, or after surgery. The doctor will discuss side effects and dosage with you.

Almost every woman with endometriosis considers surgery at some time in her life. Surgery can range from the most minor procedure (laparoscopy) to complete removal of all reproductive organs. Your doctor will discuss your surgery options and their effects on your fertility with you. The best option for you will depend on your age, the severity of your disease, and whether you want to have children

Hormone Therapy
1. GnRH Agonists

GnRH agonists are forms of the gonadotropin releasing hormone.

How they work:

Over time, GnRH agonists keep the pituitary gland from producing FSH and LH. This stops production of estrogen and progesterone. You quit ovulating and stop having your period. Your endometrium may shrink. GnRH agonists are usually prescribed for 6 months or longer. Treatment results may last for 6 months or longer after therapy.

Side effects:

Hot flashes, insomnia, headaches, and vaginal dryness. Bone density may decrease slightly during treatment, but is usually regained after treatment is stopped.

2. Danazol

Danazol is a hormone.

How it works:

Danazol blocks FSH and LH at the pituitary gland. This means that estrogen and progesterone levels stay low. You quit ovulating and stop having your periods. Your endometrium may shrink. Danazol is often used for 6 months or longer. Treatment results may last 6 months or longer after therapy. It may be repeated later, if needed.

Side effects:
Weight gain, hair growth, acne, hot flashes, vaginal dryness, sleep problems, headache, decreased sex drive, and emotional changes. Liver problems may require you to stop treatment.

3. Birth Control Pills

Birth control pills contain estrogen and progestin, a form of progesterone. They may be taken every day for several months or prescribed in cycles, 3 weeks on and 1 week off.

How they work:

Birth control pills regulate the levels of estrogen and progesterone in your body. Ovulation, bleeding, and endometrial growth are controlled. Birth control pills may be used for 6 months or longer. Treatment results may last for 6 months or longer after therapy.

Side effects:

Weight gain, nausea, blood clots, and phlebitis (inflammation of veins).

4. Progestins

Progestins are a form of progesterone.

How they work:

Progestins keep estrogen and progesterone levels low. This prevents ovulation and limits endometrial growth. Progestins may be used for 6 months or longer. Treatment results may last for 6 months or longer after therapy.

Side effects:

Midcycle bleeding, weight gain, headaches, stomach upset, acne.

5. Other Medicines 

This medicine helps you have less cramping and pain during your period. Many women also find relief in over-the-counter medicines such as aspirin and other anti-inflammatories. These work best if taken early in the pain cycle.

Surgery

1. Surgical Laparoscopy

Laparoscopy is often used for mild or moderate endometriosis. Looking through the laparoscope, your doctor uses tiny surgical tools to remove implants. Implants may be trimmed (excision), burned away (cautery), or removed with a laser. Because your doctor operates through tiny incisions, you will have less bleeding and scarring than with other surgeries. Laparoscopy preserves your ability to have children. You will need 3 to 10 days to recover.

3. Hysterectomy

Hysterectomy is the surgical removal of your uterus. Any implants or adhesions in your pelvic cavity will also be removed. This surgery is often advised if your disease is severe but involves mainly your uterus. It may also be used if other methods have failed to relieve your symptoms and if you're past childbearing age or interest. Because your fertility is lost, this decision is best made after discussing it with your doctor and partner. Hysterectomy can be done Hyparoscopially.

4. Total Hysterectomy with Bilateral Salpingo-oophorectomy

With this procedure, all of your reproductive organs-uterus, ovaries and fallopian tubes are removed. Any implants or adhesions in nearby tissue are also removed. This surgery is advised for the most severe endometriosis when you're past childbearing age. It is the most complete treatment for endometriosis. But you may have symptoms of menopause once your ovaries are removed.
This is also done Laparoscopically.



 

Living with Endometriosis

Once you know you have endometriosis, you can learn to manage your symptoms and live a comfortable, active life. One of the biggest hurdles you may face is accepting that this is a disease you may live with throughout your childbearing years. Only a few women never have symptoms again after treatment. Most women have symptoms off and on until menopause. Then symptoms usually subside or disappear. For some women, pregnancy relieves symptoms, but only temporarily. In the meantime, there is a lot you can do to help yourself feel better.

Emotions

Along with cycles of pain, you may have emotional cycles or mood swings. You may feel angry if you're up all night with cramps. You may feel depressed if you can't do the things you used to do. Your feelings about being a woman and your sexuality may also be affected. Don't suffer in silence. Talking to someone you trust can really help.

Managing Pain

You can manage your pain by taking medication suggested by your health care provider. A hot bath or heating pad may also relieve your pain. Some women find relief in meditation, yoga, acupuncture, nutritional therapies, and other alternative treatments. To divert there attention from the pain.

Exercise

Exercise often helps relieve pain, especially cramps. But don't exercise if it makes the pain worse. Keeping yourself healthy can help you feel better all over and keep your mind off minor pain

A Partner's Role

Some men are afraid to touch women in pain. Others think the pain is all in her head.? Your partner needs to know that endometriosis causes real pain and distress. If wants help, tell him what he can do to help you better. You may feel better with low-back massage or by being left alone for a while.

Communicating About Sex

Many women with endometriosis have pain with sex during the worst part of their cycles. Others have pain throughout the month. Talk with your partner about other ways you can both show affection. You may also want to find positions for intercourse that are more comfortable.

Early Detection

Women can teach their daughters that severe cramps or pain aren't normal during their period. A teenager with heavy cramps or irregular, heavy bleeding should be evaluated. This is especially important if the mother has endometriosis.

What is a Adenomyosis?

This condition results from abnormal growth of the endometrium into the muscle wall of the uterus. Adenomyosis can cause a spongy, enlarged uterus, abnormal bleeding, and painful cramping.

Glossary

Here are definitions of medical terms related to laparoscopy:

Anaesthesiologist: A doctor who administers anaesthetics and monitors the patient's condition until surgery is completed

Anaesthesia: Absence of sensation, especially artificially induced blockage of pain during surgery

Anaesthetic: A drug that blocks the sensation of pain during surgery.

Appendix: A finger-shaped tube of tissue (vermiform appendix) between the large and small intestine; can become inflamed or infected

Band-Aid surgery: Surgery done through very small incisions that sometimes are covered with adhesive bandage strips; a common name for minimally invasive surgery

Belly button surgery: A common name for laparoscopy, minimally invasive surgery on the abdomen

Biopsy: Removal of a small amount of tissue for examination under a microscope to find out whether part of the body is diseased

Diagnostic laparoscopy: Laparoscopy done to diagnose a condition or disease.

Ectopic pregnancy: An abnormal pregnancy in which the fertilized egg starts growing outside the uterus

Endoscope: A thin instrument, inserted through orifices of the body or through very small incisions, that allows the doctor to see inside the body, diagnose conditions, and perform surgery

Endoscopic surgery:Surgery performed with an endoscope through orifices of the body or through very small incisions

Endometriosis: A condition in which tissue from the inside of the uterus starts growing in other places in the abdominal cavity, causing pain and other symptoms

Fallopian tubes:The ducts that carry eggs from the ovaries to the uterus

Fibroids: Benign or non-cancerous tumors in the uterus that sometimes cause pain, heavy menstrual periods, or other symptoms

Gastroesophageal Reflux Disease (GERD): A condition in which acid from the stomach flows backward into the esophagus, causing heartburn and other symptoms

Hysterectomy: Surgical removal of the uterus

Infertility: Inability to become pregnant

Inguinal hernia: A condition in which part of the intestine bulges through a weakened segment of the abdominal wall

Laparoscope: A thin fiber optic telescope equipped with a video camera, light, and other devices that allows the surgeon to see into the abdominal cavity through very small incisions.

Laparoscopy: A surgical procedure in which a laparoscope and other instruments are inserted into the abdomen through small incisions to diagnose and treat diseases and conditions.

Minimally invasive surgery: Surgery done through very small incisions with miniature instruments.

Nurse anaesthetist: A specially trained registered nurse who helps to administer anaesthetics.

Otorhinolaryngology: A medical specialty dealing with the ear, nose, and throat.

Ovaries: Organs located on each side of the uterus that produce eggs and sex hormones.

Ovarian cyst: Fluid-filled growths in the ovary.

Paranasal sinuses: Hollow spaces in the bones of the face and skull near the nose that sometimes become infected, causing sinusitis.

Pelvic adhesions: Bands of tough, scar-like tissue that form inside the body and interfere with normal functioning of an organ.

Pelvic pain: Pain in the lower abdominal area below the navel or belly button.

Spinal discs: Tough pads of cartilage that separate and cushion the vertebrae, or bones, in the spinal column.

Spinal fusion: Surgery to join two spinal bones and make the back more stable.

Spleen: An organ that removes old red blood cells and disease-causing microbes from the blood.

Splenectomy: Removal of the spleen.

Stage: The extent to which a disease has advanced.

Therapeutic laparoscopy: Laparoscopy done to treat a disease or condition.

Tubal ligation: Female sterilization operation that seals the fallopian tubes and prevents the egg from being fertilized so the woman cannot become pregnant through sexual intercourse.

Ultrasound scan: A diagnostic test that uses sound waves to detect abnormalities inside the body.

Vasectomy: Male sterilization operation that seals the vas deferens and prevents sperm from being transmitted through ejaculation.

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