What is your opinion of doing bilateral salpingo Oophorectomy at the time of hysterectomy. Coz patients are of the opinion that if they undergo Tubectomy,they will land with a BIGGER operation that is hysterectomy.therefore some people come asking to do a hysterectomy after child bearing. If only hysterectomy is done when indicated and later if they require laparotomy for ovarian cyst /tumour,patients question "why you didn't remove these appendages earlier. One patient had hysterectomy,followed by laparotomy again for an ovarian cyst,later another cyst on other side -third surgery .she again developed cystic mass in the pelvis for which she had fourth surgery . Though we leave ovaries ,their function gradually comes down after hysterectomy and they have PMS and osteoporosis. When I have to do a hysterectomy ,I remove the appendages if she is above 40 years and retain them if she is young. What are your opinions

48 yr female with bleeding PV since a month.. usg suggested fibroid.. grossly uterus was bulky with myometrium showing trabeculations and blood filled cysts.. please comment on histopathology of uterus and cervix

Definition of Dysmenorrhea *********************************** Dysmenorrhea is the term associated with the monthly blood flow or menstruation of women. It refers to the pain that some of women feel during the time of their menstruation. It is normal to have cramps at the start of menstruation period but some women feel too annoying pain to affect their routing activities. Reason of Dysmenorrhea There are normally no underlying causes of dysmenorrhea and it is very common among girls having heavy blood flow, low body weight, early started periods.  But it is sometimes caused due to following Uterine fibroids (smooth muscle tumours of uterus) Ovarian cysts (fluid filled sac within ovary) Adenomyosis (abnormal presence of endometrial tissues) Endometriosis (inflammation of inner lining of uterus) Pelvic congestion (pelvic vein incompetence) Main key Symptoms of Dysmenorrhea Following are the symptoms of painful periods. Back pain Pelvis pain Lower abdomen pain Diarrhoea Nausea Headache Fatigue Constipation Dizziness Disorientation Common Types of Dysmenorrhea There are two types of Dysmenorrhea. The types of dysmenorrhea are described as follows Primary Dysmenorrhea In this type, the pain has no underlying cause and it is very common among girls. These are also known as common cramps during menstruation. The hormonal changes and ovulation is associated with this type. Secondary Dysmenorrhea This type of period pain is caused due to some problem.  Endometriosis is the most common cause of secondary Dysmenorrhea. In addition, pelvis congestion, adenomyosis, leiomyoma and ovarian cysts also cause secondary dysmenorrhea. How to Diagnose Dysmenorrhea? Physical Exam Dysmenorrhea is normal in women but still doctor may perform a complete physical examination in case to check infection or abnormalities in reproductive organ of the woman, if he suspects any disorder. Imaging Scans If the cramps seem abnormal or doctors suspects any abnormality inside the woman after physical exam, he may ask for scans like Ultrasound, CT scan and even MRI of reproductive organs including uterus, ovaries, cervix and fallopian tubes to get complete details. Laparoscopy Laparoscopy is the advanced stage, though not normally needed in case of dysmenorrhea, in which a tube holding camera is passed through the uterus through small incisions in the abdominal region. The pictures and video captured by the camera help in detection of any issue like fibroids, cysts, pregnancy inside the tubes, endometriosis or any corrosion inside the reproductive organs causing pain.

42 yr old female came with lower abdominal pain since 3 months... more during night time also complains of burning micturation since 7 days. o/e GC mod Afeb. vitals stable *on P/V vulva vagina NAD cervix closed tender uterus anteverted bulky.8 week size. mobility decreased Adnexal masses felt POD - NAD *Menstrual h/o - menarche 15 . cycles irregular - 35 - 45 days lasts for 4 days.. pain aggravates during menstruation normal flow * USG Done s/o uterus with adenomyosis with 2 Fibrods evidence of cervicitis Rt ovary 2 cysts Kindly suggest further management ....?????

TAH specimen... 1&3 sections from the cervix, 2,4,5&6 from the uterine mass