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What is Adenomyosis? 

Adenomyosis is a condition in which the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus (the myometrium). The tissue that breaks through is called ectopic tissue. It continues to act as it normally would—it thickens, breaks down, and bleeds with each menstrual cycle. Because there’s no way for this blood to exit your body, it gets trapped. This can cause your uterine walls to thicken, which can cause pain and heavy periods. Adenomyosis can also cause bloating and cramping in your abdomen. 

What are the Symptoms

The symptoms of Adenomyosis include,  

• Severe menstrual cramps 
• Heavy or prolonged bleeding during periods 
• Pain during sex 
• Bleeding between periods (not spotting) 
• Pelvic pain/pressure at other times of the month, especially while moving around and being active (like running or jumping) 
• It can also lead to bladder pressure, constipation, and uterine enlargement

However, it’s not clear why these symptoms happen with Adenomyosis. You should visit a Gynecologist if any of these things are happening to you or if they seem to be getting worse over time. 

What Causes Adenomyosis? 

While the exact cause of Adenomyosis is unknown, some factors may affect your risk of developing it. These include: 

• Your Age: Adenomyosis is most common in women between 40 and 50 years old. 
• Past Uterine Surgery: Having a cesarean delivery or other types of uterine surgery such as surgery for treating uterine cancer may increase your risk of developing Adenomyosis. 
• Endometriosis: Women with endometriosis have an increased risk for Adenomyosis. 

Other risk factors include family history, cervical cancer or uterine cancer treatment, pelvic inflammatory disease (PID) 

Who is at Risk? 

Adenomyosis most often affects women in their later reproductive years—the average age of diagnosis is 47, but you can be diagnosed at any age, even as early as puberty. Women who have had uterine surgery, women who have had many pregnancies, women who have had children at a young age, and women with endometriosis are at a higher risk of developing Adenomyosis.  

How is Adenomyosis Diagnosed? 

Your Obstetrician and Gynecologist will start by asking you about your symptoms and medical history, perform a physical exam, perform additional tests and procedures, and analyze all information to see if Adenomyosis is the most likely diagnosis. 

Physical Examination: Your Gynecologist will start by performing a pelvic exam to check for abnormalities or tenderness in your uterus. They will also check for abnormalities in your uterus’ size, shape, and position, which can sometimes help rule out other possible causes of your symptoms. 

Ultrasound: This test uses sound waves to create images of internal structures such as organs and blood vessels. A handheld device called a transducer sends sound waves into the body during an ultrasound. The transducer collects information about the echoes that come back and sends this information to a computer, which interprets it and creates an image of the inside of your body. 

Magnetic Resonance Imaging (MRI): MRIs use radio waves, magnets, and a computer to create images of body structures. This test can help your doctor determine the location and severity of the endometrial tissue in your uterus. 

Uterine Biopsy: During this test, a doctor takes a sample of uterine tissue so they can examine it under a microscope. The two common types of biopsy are endometrial biopsy and hysteroscopy with dilation and curettage (D&C). 

Hysteroscopy: During this procedure, a surgeon inserts a small telescope through your vagina into your uterus to examine it more closely. A hysteroscopy can help your doctor determine whether you have Adenomyosis or endometriosis. 

What is the Best Treatment for Adenomyosis? 

If you have been diagnosed with Adenomyosis, your doctor will likely recommend lifestyle changes like exercise and dietary changes. However, suppose these steps are not enough to alleviate your symptoms. In that case, there are several treatments available to help manage your condition, including,  

Hormone Therapy: Hormone therapy can be taken in pill or patch form to reduce uterine swelling and loosen fibrous growths. This treatment can also help to decrease menstrual bleeding. 

Pain Medication: Pain medication such as NSAIDs or opiates can be used to manage pain caused by Adenomyosis.  

Uterine Artery Embolization: Uterine artery embolization is a minimally invasive procedure that involves blocking off blood vessels supplying the uterus, thereby shrinking fibrous tissue growths. 

Surgery: Surgery may be an option for women who wish to become pregnant in the future and who have not responded well to other treatments, including hormone therapy and embolization procedures. A surgical procedure known as endometrial ablation can also be used to reduce heavy bleeding associated with Adenomyosis. 

Can you Get Pregnant with Adenomyosis? 

It is possible for women with Adenomyosis to become pregnant. However, it can be more challenging since Adenomyosis increases the risk of miscarriage. Suppose you have Adenomyosis and are trying to get pregnant. In that case, it is essential to work closely with your Obstetrician and Gynecologist and be aware of your body’s reactions to treatments to seek help sooner rather than later if you encounter a problem that needs attention. 

Does Adenomyosis Cause Infertility? 

Adenomyosis can affect your ability to get pregnant and increase your infertility risk. Some women are only diagnosed with Adenomyosis after they’ve struggled to conceive. Fortunately, there are ways to manage this condition and improve your chances of getting pregnant if you’re trying to conceive. 

With early recognition, timely treatment, and simple lifestyle modifications, you can prevent Adenomyosis. The first step in determining the best treatment options is to understand the disease and what it is, so we hope that you share this information with your female family members and friends. If you are having difficulty getting pregnant and suspect your problem is physical or hormone-related, talk to your Gynecologist as soon as possible. 

What is Loop Electro Excision Procedure (LEEP)? 

The Loop Electro-Excision Procedure (LEEP) is a minor surgical procedure used to treat cervical dysplasia and conditions like genital warts and polyps. This condition occurs when the cells of the cervix change and become abnormal. When the cells of the cervix become abnormal, they may become cancerous. In order to prevent cancer from forming, these abnormal cells need to be removed. 

Why is LEEP Performed? 

The Loop Electro-Excision Procedure removes the abnormal cells from the cervix by applying an electrical current to them with a thin wire loop. While the procedure is different from a standard surgical procedure, it is performed in a hospital or surgery center under general anesthesia and involves an incision into the body. 

How is LEEP Performed?  

The Loop Electro-Excision Procedure, or LEEP, is used to treat a variety of precancerous growths and cancers of the cervix. The procedure is performed by inserting a wire loop into the cervix. The loop is electrified and cuts away a small sample of tissue for biopsy. If the test results are positive for cancer, the sample may be analyzed further to determine how much tissue should be removed. LEEP is also used to treat non-cancerous conditions. In some cases, it can resolve the condition without treatment. Other conditions require LEEP to remove abnormal tissue that interferes with reproductive health or causes symptoms such as pain or bleeding during sex. 

Advantages of Loop Electro Excision Procedure 

Advantages of LEEP include, 

• Low complication rate 
• Minimum size of the wound 
• No scarring 
• Easier to treat small areas 
• Quick recovery time 
• Lower risk of infection compared to other treatments 
• Local anesthesia has fewer side effects than general anesthesia 
• Most women can return home immediately after their LEEP, and they may resume normal activities within 24 hours of the procedure 
• High accuracy. The loop electrode takes an accurate and precise view of the area being treated. The surgeon can see exactly what tissue is being cutaway 

Loop Electro Excision Procedure has become the gold standard in treating precancerous or cancerous lesions of the cervix. If you suffer from a precancerous or cancerous condition of your cervix, talk with your Gynecologist about this treatment option. 

What Does It Mean?

Triple-Negative Breast Cancer (TNBC) is a name that has historically been applied to tumors that lack expression of the estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2), which occur on the surface of the cancer cell and are dependent on hormones. 

What Causes Triple-Negative Breast Cancer (TNBC)? 

The general cause of breast cancer is unknown, which also applies to the triple-negative subtype. 

Who is at Risk of TNBC

TNBC is more commonly diagnosed in women younger than 40 years than women over 50 years. Other risk factors include,  

Positive BRCA Mutation Status – Up to 15% of patients with TNBC carry a breast cancer susceptibility gene (BRCA) mutation, mainly in BRCA1.  

Less than 6% of breast cancers are connected with a BRCA mutation. Given this result, any patient with a triple-negative condition should be referred to a genetic counselor for a BRCA testing discussion. In addition, any patient younger than 60 years old with TNBC should have BRCA germline testing. 

Premenopausal Status has been linked to a higher diagnostic rate of TNBC than postmenopausal status. The assessment of premenopausal women’s tumors for the presence of ER-positive and HER2-positive illnesses is essential. 

Other factors – According to studies, obesity and young age at first pregnancy are associated with an increased risk of TNBC.  

Similarly, breastfeeding and parity may be related to reduced risk. 

How is TNBC Diagnosed? 

The standard mammography and ultrasound cannot detect TNBC, and in some circumstances, MRI is required. Oncologists use the term “triple-negative” to describe tumors with 1% expression of ER and PR as measured by immunohistochemistry (IHC), and for HER2, 0 to 1+. The cancer type is identified by biopsy, the gold standard for cancer diagnosis. 

TNBC is typically more aggressive than other breast cancer kinds.  

TNBC has become the most receptive type of cancer as a result of numerous new advancements in medication, such as powerful immunotherapy designed specifically for this type.  

It accounts for around 15% of breast cancers and is caused by genetic alterations in most instances. 

Why is Triple-Negative Breast Cancer a Cause of Concern?  

This type of breast cancer develops swiftly if not found and treated as soon as possible. Thus, it is cause for concern in most instances. 

How is Triple Negative Breast Cancer Different from the Other Types of Breast Cancer? 

• Infiltrating Ductal Carcinoma is the most prevalent kind of invasive breast cancer, accounting for 70% of invasive lesions. These lesions are characterized by cords and nests of cells with variable gland development and cytologic characteristics ranging from benign to extremely malignant. 
• Infiltrating Lobular Carcinoma accounts for approximately 8% of all invasive breast cancers. They are characterized microscopically by tiny cells that enter the mammary stroma and adipose tissue singly and in a single-file arrangement. 
• The Mixed Ductal/Lobular Carcinoma has ductal and lobular characteristics and is classified as mixed invasive carcinoma. These account for 7% of invasive breast cancers. 

• Other Histologic Types – Metaplastic, mucinous, tubular, medullary, and papillary carcinomas are also metaplastic, mucinous, tubular, and medullary carcinomas. They collectively account for less than 5% of invasive malignancies.  

Molecular Subtypes – The following molecular subtypes have been identified based on gene expression profiles.  

• Luminal Subtypes are luminal A and luminal B. They constitute the majority of estrogen (ER)-positive breast cancers and are the most prevalent subtypes of breast cancer. The term “luminal” refers to the resemblance in gene expression between these tumors and the breast’s luminal epithelium. Typically, they produce cytokeratins 8 and 18. 
• HER2-Enriched – The human epidermal growth factor receptor 2 (HER2)-enriched subtype accounts for 10 to 15% of breast tumors and is distinguished by the high expression of the HER2 and low proliferative expression of the luminal and basal gene clusters. These cancers frequently lack ER and progesterone receptors (PR). On molecular profiling, only half of the clinical HER2-positive breast tumors are HER2 enriched; the other half can contain any molecular subtype but consists primarily of HER2-positive luminal subtypes. 
• Basal Subtypes – Most of these tumors are triple-negative breast cancers since they are negative for ER, PR, and HER2. Separately, subtypes of ER-negative breast tumors are discussed in further detail. 

Which is the Most Serious Type of Breast Cancer? 

TNBC is regarded as the most severe kind of breast cancer, although it is crucial to note that, due to recent improvements in therapy, TNBC is now easier to treat. TNBCs exhibit rapid growth and are more likely to be discovered clinically instead of through mammography than ER-positive tumors or tumors diagnosed between mammograms.

However, intrinsic variability in breast tissue density among women diagnosed with TNBC could account for these variations in presentation. The most prevalent form of TNBC is infiltrating ductal carcinoma, while medullary carcinoma, a rare subtype, is typically triple-negative. TNBCs may display geographic necrosis, an expanding invasion boundary, and a lymphocytic stromal reaction. Histopathologically, a unique subtype of TNBCs is identified as metaplastic. This is, nevertheless, a broad collection of cancer forms ranging from squamous to stromal.

Global Statistics of Breast Cancer 

Australia, Europe, and North America have the greatest incidence of breast cancer. In the UAE 1030, new breast cancer cases were reported in 2020. 

What is the Estrogen Receptor, and How is it Linked to Breast Cancer? 

On the surface of cancer cells is a specialized receptor called estrogen, which acts as a hand, consuming hormones from the body and using them as fuel to thrive. TNBC can survive without these receptors because it has a whole new survival mechanism. Estrogen receptor (ER) and progesterone receptor (PR) are predictive markers for invasive breast cancer, especially within five years of initial diagnosis. 

What are the Treatments Available for Triple-Negative Breast Cancer? 

TNBC can now be effectively treated with cutting-edge drugs, transforming it from a challenging form of cancer to one that is manageable. ER, and PR-positive patients are suitable for neoadjuvant or adjuvant endocrine therapy. Immunohistochemistry (IHC) for ER and PR is greater than 1 percent of tumor cells defines ER-positive. Pembrolizumab is approved in combination with chemotherapy for patients with metastatic TNBC whose tumors express PD-L1 with a Combined Positive Score of 10; however, overall survival (OS) data for this treatment have not yet been reported. For breast cancer patients who are BRCA carriers, we can employ PARP inhibitors, which are advanced drugs that target these abnormalities. 

What is the Success Rate of Treating Triple-Negative Breast Cancer? 

The most prevalent kind of breast cancer in the United Arab Emirates is hormone-positive HER2-positive, hormone-positive HER2-negative, hormone-negative HER2-positive, and hormone-negative HER2-negative. 

Locally advanced TNBC was discovered in a 35-year-old woman with Leukocyte adhesion deficiency. This patient had a combination of chemotherapy and immunotherapy as neoadjuvant treatment (pre-surgical medical treatment). After surgery, we discovered what we refer to as a complete pathologic response, which means we could not detect any trace of her cancer. This is the best possible outcome for a patient. In the past, we were unable to observe such excellent outcomes as frequently as we do now, but this has changed due to more advanced treatments. 

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Dr. Mohanad Diab

Consultant Medical Oncology

Burjeel Hospital, Abu Dhabi | Burjeel Day Surgery Center, Abu Dhabi

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Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder that affects approximately one in nine women. Women with PCOS produce higher-than-normal amounts of male hormones. This hormone imbalance causes irregular periods and may make it harder to get pregnant. It can also cause unwanted changes in the way you look. If left untreated, it can increase the risk of developing diabetes and heart disease later in life.

Global Stats of PCOS

Polycystic Ovary Syndrome (PCOS) is a prevalent condition. It affects as many as 10-15% of women worldwide. However, as much as 75% of patients with the condition are left undiagnosed. This is likely due to patient presentation variability and lacks public awareness about the condition.

PCOS Risk Factors

PCOS affects women of all ages, but it is most commonly diagnosed in women between 18 and 44. Women of all body types, races, and ethnicities can also develop PCOS. It is also more common in women with a family history of diabetes or other metabolic conditions. Certain lifestyle factors such as being overweight or obese and not getting enough exercise can also contribute to developing the condition and exacerbates the symptoms of PCOS.

Signs and Symptoms of PCOS

It is a hormone disorder common among women of reproductive age. Since this condition may affect women as early as their teens, it is essential to understand the symptoms and its effects. Some common symptoms include:

Irregular periods: It’s common for people with this condition to have rough periods and even complete absence of their periods in severe cases

Increased facial and body hair: High androgens (male hormones) can cause excess hair growth in manly places, e.g., on the face, chest, stomach, thumbs, or toes.

Difficulty Getting Pregnant: It can become difficult to get pregnant because it might stop you from ovulating regularly. You may have trouble getting pregnant if you have irregular periods or no periods.

Weight Gain: People with this condition often gain weight around their abdomen and waist that is hard to lose. This condition may also be linked with insulin resistance, where the body does not respond appropriately to insulin, increasing the risk of type 2 diabetes.

Acne: This is due to an increase in testosterone production, making skin more greasy

Hair Loss on the Scalp: Especially around the sides and the top of the head, similar to male pattern baldness.  High levels of male hormones also cause this in the blood binding to hair follicles.

Patches of Darkened and Thickened Skin: These patches generally appear on the neck, armpits, elbows, or groin area.

Diagnosis of PCOS

Most women don’t know that they have PCOS until they have problems getting pregnant. This is because most causes are mild, without apparent symptoms. If you are concerned that you might have PCOS, your Gynecologist will want to rule out other conditions that cause similar symptoms. The Gynecologist will use several methods to diagnose and rule out other conditions, including:

1. History and examination; A history of irregular or infrequent and even absent periods and examination showing acne, excess hair growth, and dark patches on your skin
2. Blood Tests. These can measure hormone levels and check for abnormal male hormones (androgens). Blood tests also can check your risk of diabetes and heart disease. Tell your doctor if you or any family members have diabetes or heart disease.
3. Ultrasound scan of your pelvis revealing polycystic ovaries

Based on the results of these tests, The doctor will let you know if you have PCOS and devices a treatment plan moving forward.

Rotterdam Criteria

The Rotterdam Criteria is a set of guidelines that doctors follow when diagnosing patients with PCOS. According to these guidelines, a patient must have 2 out of 3 of the following conditions to be diagnosed:

• Irregular periods due to lack of ovulation
• Higher than normal levels of androgens (male sex hormones)
• Polycystic ovaries on ultrasound scan

In the absence of any other cause of the above symptoms and findings

Long-Term Effects of PCOS

Polycystic Ovary Syndrome (PCOS) can cause many serious, long-term health problems. While some women may experience only mild symptoms, PCOS can be severe for others. Some of the potential long-term effects of PCOS include:

Type 2 Diabetes or Prediabetes: Insulin resistance is common in women with PCOS.  They are more likely to develop diabetes in pregnancy.  PCOS can lead to type 2 diabetes. The risk of developing diabetes increases if you are obese have a family history of diabetes, are over 40 years old, or have had gestational diabetes in pregnancy.

Uterine Cancer: Women with PCOS are slightly more likely to develop uterine cancer, especially if they have less than three periods in a year and don’t regularly shed the lining of their uterus (endometrium). To protect the lining of your womb from developing precancerous or cancerous changes in the cells, you should have a period once every three months to shed and renew the lining of your womb. See your doctor help you achieve this.

PCOS does not increase your risk of developing ovarian or breast cancer

High Blood Pressure (Hypertension). A woman’s risk of developing hypertension increases if she has PCOS and obesity or insulin resistance.

Sleep Apnea. This sleep disorder causes you to stop breathing during sleep temporarily. It can cause disturbed sleep and snoring and cause you to feel tired and sleepy during the day. It is associated with obesity.

PCOS Treatment

The first step in treating PCOS is to visit your Gynecologist or doctor to determine that you have this condition and there is no one-size-fits-all solution. Treatment will depend on what symptoms are present.

It is essential to start with lifestyle modifications for all patients in managing PCOS. A healthy lifestyle with a balanced diet and regular 30 minutes of exercise at least three times a week are fundamental to reducing the risk of developing the long-term complications of PCOS.  While the cause of PCOS isn’t known, doctors think extra weight may contribute to PCOS symptoms by increasing insulin production in your body.

For patients who are overweight or obese, reducing their weight by as little as 5-10% can dramatically improve their insulin resistance,  androgen levels, menstrual pattern, acne, and excess hair growth.

If your menstrual cycle is affected by PCOS, you may use medicine such as birth control pills to help regulate it. Other medicines include metformin (Glucophage), which helps control blood sugar levels, and spironolactone (Aldactone), which blocks the action of male hormones in women.

PCOS is a disorder that impacts millions of women worldwide every day. This article was an opportunity for us to share our learnings about this chronic condition with you and shed light on the potential treatments. If you are concerned about PCOS, the best thing you can do is visit your Gynecologist. Managing your PCOS effectively means individualized treatment and attention from your physician. It’s critical to take charge by seeking answers to all of your questions, paying close attention to any symptoms you experience, and making sure that you’re addressing your PCOS with the most effective treatments currently available.

Retinopathy is a disease of the retina, which is the thin layer of light-sensitive cells at the back of your eye. The retina is part of the inner eye that allows you to see.

Causes of Retinopathy

It can occur when blood vessels in your retina are damaged, causing them to leak fluid or blood into the area. This can lead to swelling, bleeding, and scarring in your retina. These changes can affect your vision and lead to severe vision loss if not treated.

Symptoms of Retinopathy

The retinopathy symptoms are often mild at first, and you may not realize you have it until it is diagnosed. The most common symptoms of include:

• Floaters in the eye
• Blurred vision
• Colors seem faded or dull
• Double vision (diplopia)
• Unusual perception of light (photopsia)

Types of Retinopathy

There are several types of retinopathy, including:

Diabetic Retinopathy: This condition affects the blood vessels in the retina and can cause a loss of vision. It is caused by diabetes, a disease affecting blood sugar levels.

Non-Proliferative Retinopathy: This affects the retinal pigment epithelium (RPE) cells that support the photoreceptors (rods and cones) and helps with vision. It causes blurry vision and floaters, which are spots that appear to float in your field of vision.

Proliferative Retinopathy: This is a condition where new blood vessels grow on top of old ones, causing them to break down. The new vessels can bleed into your retina and cause scarring, affecting your eyesight if it occurs too close to your macula (the central part of your retina).

Retinopathy Global Stats

Retinopathy affects one in every 100 individuals worldwide. Retinopathy can affect anyone, but it’s most common among those with diabetes and those with high blood pressure for many years. According to the American Diabetes Association (ADA), almost half of all people with diabetes have some level of retinopathy.

Stages of Retinopathy

There are three stages of retinopathy, each with its own unique symptoms:

Stage-1: In this stage, the retina is beginning to separate from the back of the eye. Symptoms include blurry vision and floating spots in your vision.

Stage-2: In this stage, new blood vessels are growing on the retina’s surface. Symptoms include more frequent floaters and blurring in your peripheral vision.

Stage-3: In this stage, the new blood vessels have become swollen and fragile, leading to bleeding in or around them. Bleeding may cause flashes of light in your vision and make it difficult to see at night—which could be dangerous if you’re driving or operating machinery at night!

Advanced Stages: At this point, there is severe damage to both eyesight and blood flow to the optic nerve.

Diagnosis of Retinopathy

Retinopathy is diagnosed through a comprehensive eye exam. Your Ophthalmologist will look at the back of your eye to check for any signs of damage to your retina.

The eye is examined under dilated pupils, which allows the doctor to look at the small blood vessels in your retina. The doctor may also use a slit lamp, which helps them see the surface of your eye more clearly. The slit lamp is used during what is called a fluorescein angiogram. In this test, a dye is put into one of your eyes, and then your doctor looks at the dye as it flows through your eye using the slit lamp. This helps them see if any fine blood vessels are damaged in that area of your retina.

The doctor may also use a special camera called an indirect ophthalmoscope (IOP) to look at the retina more closely. This is especially important if you have diabetes and show signs of diabetic retinopathy. The doctor may also check for other eye diseases that can cause similar symptoms as diabetic retinopathy, such as age-related macular degeneration (AMD) and different types of retinal degeneration.

Risk Factors of Retinopathy

The risk factors for retinopathy include:

Age: As you age, the blood vessels in your retina become more fragile and are more likely to break.

Diabetes: If you have type 1 or type 2 diabetes, your blood vessels are more likely to break and leak fluid into your retina—causing macular edema or swelling.

Obesity: People who are obese are at higher risk of developing retinopathy because they have higher blood pressure and increased cholesterol levels, leading to atherosclerosis (or hardening of the arteries).

Family History: If a parent or sibling has had retinopathy, you may be more likely to develop this condition.

If you’re experiencing any of the symptoms mentioned above, or notice anything unusual in your vision, take a trip to the eye doctor as soon as possible. Early diagnosis can help stave off serious vision problems down the road, which is why it’s so important to check up on your vision health with regular checkups—and come back annually for your comprehensive and dilated eye exams.

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Dr. Madhava Rao

Consultant Ophthalmology

Burjeel Hospital, Abu Dhabi

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Specialist Ophthalmology

Burjeel MHPC

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Uterine fibroids are benign tumors that grow from the uterine wall. They are common in women of reproductive age and tend to grow slowly, but they can cause problems with fertility and pain.

Symptoms of Uterine Fibroids

Uterine fibroids are the most common cause of abnormal vaginal bleeding in women post-menopause; however, they can also cause pain and heavy periods in younger women. Some women may not have any symptoms associated with uterine fibroids at all. The signs may include:

• Pain during sex or deep penetration during sex (dyspareunia)
• Heavy periods (menorrhagia)
• Bleeding between periods (metrorrhagia)
• Intermenstrual spotting or bleeding (intermenstrual vaginal bleeding or intermenstrual bleeding)

Causes for Uterine Fibroids

The exact cause of is unknown. There is some evidence that they may be due to an imbalance between estrogen and progesterone hormones.

Diagnosis of Uterine Fibroids

Diagnosis is based on a medical history and physical examination. A pelvic ultrasound can be used to confirm the presence of uterine fibroids. In some cases, additional imaging tests such as MRI angiography may be used to measure the size of the fibroid and determine whether it is causing any pressure to adjacent structures like the bladder.

Importance of Treating Uterine Fibroids

If you have uterine fibroids, it’s essential to treat them because they can cause other health problems if left untreated. For example:

• Uterine fibroids can interfere with your ability to become pregnant. The larger your fibroid grows, the more likely it will block the fallopian tubes and prevent conception from occurring.
• Uterine fibroids can cause heavy menstrual bleeding, leading to anemia if left untreated or uncontrolled. Iron deficiency anemia is characterized by fatigue and weakness.
• Suppose you have uterine fibroids that are large enough to press against your bladder or rectum (which happens in about 40% of cases). They can cause constipation or urinary frequency—both symptoms of bladder diverticula or rectal prolapse, respectively.

Treatment for Uterine Fibroids

Treatment for uterine fibroids is based on the size and number of your fibroids and the severity. Your doctor will discuss your options with you to determine what’s best for you. Below are some of the treatment options

Hysterectomy: A hysterectomy is the removal of the uterus. It is performed by a gynecologist and can be done either through an abdominal incision or via laparoscopy (using small incisions). The procedure requires hospitalization. Patients need a recovery period of three months to return to normal activities.

Myomectomy: Myomectomy is the surgical removal of uterine fibroids. It is also known as uterine myomectomy or fibroid removal surgery. Myomectomies are typically done by a gynecologist or general surgeon and may require hospitalization or outpatient surgery.

High intensity Focused Ultrasound (HIFU): HIFU treatment occurs while you Lay in a particular MRI machine. The machine produces sound waves. These methods cause a burn inside the fibroid, which later turns into a scare. It will treat only a few fibroids, which subsequently can grow again.

Uterine Fibroid Embolization (UFE)

Uterine Fibroid Embolization (UFE) is a minimally invasive procedure that can treat fibroids without surgery. In UFE, a catheter is inserted into the uterine arteries. This catheter will help in delivering embolization material to the fibroids tumors. A substance called a “Particles” is then injected through the catheter into the fibroid tissue, which cuts off its blood supply and causes it to shrink over time; the time needed is between 3 months to 12 months. Patients start feeling better over time.

Because UFE does not require surgery, no incision is needed during your treatment. The procedure is done under local anesthesia and sedative drugs. After your system, you may experience some cramping, but this should subside within 24 hours. Most patients can return home after their treatment with instructions for self-care and follow-up care instructions from their doctor.

Advantages of Uterine Fibroid Embolization (UFE):

UFE has several benefits over other treatments:

• It’s minimally invasive—you won’t need general anesthesia during this procedure, and you’ll be able to go home soon with pain medication.
• It has no downtime—you’ll be able to go back to work after the procedure with no restrictions on activity.
• It’s effective—the success rate of UFE is approximately 90%, meaning that most women who have it don’t require additional treatments afterward.
• Pregnancy after an embolization — Many centers that perform Uterine artery embolization have confirmed that women who have undergone embolization can have children.

Uterine Fibroid Embolization (UFE) is a less invasive alternative to hysterectomy that can help treat the symptoms of symptomatic uterine fibroids. It can be an effective treatment option for women experiencing symptoms such as heavy menstrual bleeding, pelvic pain, and infertility due to fibroids.

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Dr. Mohamed Almarzooqi

Consultant Interventional Neuroradiology & Interventional Radiology

Burjeel Hospital, Abu Dhabi

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Pelvic Organ Prolapse (or POP) is a common condition where the pelvic organs—the bladder, uterus, bowel, or rectum—slide down from their normal position. These organs are held in place by the pelvic floor, a group of muscles inside your body. When these muscles weaken or become damaged, these organs can slide out of their normal position and into your vagina. This can cause a bulge or lump in your vagina (called a prolapse). The most common types of Pelvic Organ Prolapse are:

• Cystocele, or bladder prolapse
• Rectocele, or rectum prolapse
• Enterocele, or small bowel prolapse
• Uterine prolapse

Gynecologists often use a grading system to determine how severe your condition is,

• Grade 1: mild prolapse; can’t be seen or felt
• Grade 2: more severe; can be seen or felt
• Grade 3: severe prolapse; can be seen outside of your body

Prevalence of Pelvic Organ Prolapse

The pelvic floor consists of muscles, ligaments, and nerves that support the bladder, cervix, uterus, vagina, and rectum. Pelvic Organ Prolapse occurs when the pelvic floor muscles weaken or become damaged and can no longer provide adequate support for these organs. One or more organs may “slip” down into or bulge into the vagina. According to the American Urogynecologic Society, POP affects about 1 in 9 women. It is a common condition—more common than you probably think. It is estimated that between 5-20% of women will have a prolapse during their lifetime.

Symptoms of Pelvic Organ Prolapse

Symptoms of POP can include,

• Problems with urination, such as leaking or having to push organs out of the way to urinate
• Pressure in the vagina or pelvis
• Abnormal sensations, such as a pulling feeling, in the vagina and/or pelvis
• Soreness in the vagina
• Problems with bowel movements, including constipation or incomplete emptying of stool
• Lower back pain
• Low back pain that gets worse when you’re standing for long periods, coughing, or lifting things

Causes for Pelvic Organ Prolapse

The most common cause of POP is pregnancy and childbirth. However, other factors can contribute, including:

• Hysterectomy
• Menopause
• Chronic constipation
• Heavy lifting
• Aging
• Chronic coughing or straining for prolonged periods
• Being overweight
• Family history of prolapse

Risk Factors for Developing Pelvic Organ Prolapse

While some women are more predisposed to developing POP, several lifestyle factors can increase your risk for this condition. These include,

Age: As people age, the muscles and tissues in their bodies often weaken and break down. This natural process can affect the pelvic floor and lead to POP.

Pregnancy and Childbirth: Pregnancy often causes rapid growth of the uterus, which puts increased pressure on the pelvic floor muscles. These muscles expand even more dramatically during childbirth as the baby passes through the birth canal. This can cause weakness and damage to pelvic floor tissues, leading to a higher risk of prolapse

Genetics: Some women have weaker connective tissues than others, causing them to be more susceptible to developing POP over time

Menopause: As estrogen levels drop during menopause, there is a natural decline in collagen production by the body

Diagnosis of Pelvic Organ Prolapse

POP is diagnosed using one or more of the following tests:

Pelvic Exam. The doctor will be able to feel if there are bulges in your vagina that could indicate a prolapse of the uterus, bladder, rectum, or small bowel. Your pelvic floor muscles will also be checked for strength and tone.

Urinary Tract Evaluation. If your doctor suspects you have a prolapsed bladder, you may be asked to urinate and cough to check for urine leakage. Urine can be tested for signs of infection, and you may be asked to record how many times you use the bathroom over 24 hours and how much fluid you drink during that time. You may also need additional imaging tests such as an ultrasound or cystoscopy, in which a tube with a camera at the end is inserted into the urethra to view inside the bladder.

Imaging Tests. If your doctor suspects a prolapsed uterus, they may order imaging tests such as an ultrasound to assess the size of your uterus and rule out intrabdominal organ or growth pushing the uterus down.

What is Irritable Bowel Syndrome? 

Irritable bowel syndrome (IBS) is a common form of functional gastrointestinal disorder. It is more common in women than men and typically begins between 20 and 30.  

What are the Symptoms of IBS? 

If you have irritable bowel syndrome, you may experience one or more of the following symptoms: 

• Abdominal pain and cramping 

• Bloating 
• Constipation 
• Diarrhea 
• Mucus in your stool 

What Causes of IBS? 

IBS occurs when the muscles in the walls of your intestines contract faster or slower than usual. These contractions can cause food to move through your digestive tract too quickly or too slowly, which leads to diarrhea or constipation. IBS can also cause the nerves in your GI tract to be overly sensitive. When this happens, even slight changes in the motion of your intestines can trigger pain. The exact cause of IBS is unknown. But many factors may play a role: 

• Genetics
• Infection 
• Increased sensitivity of the gut 
• Changes in gut bacteria 

What are the Types of IBS? 

IBS affects people differently and can present different symptoms from person to person. Here are some of the most common forms of IBS: 

IBS-C (constipation-predominant)

People with IBS-C generally experience constipation, difficulty passing gas, and abdominal bloating. 

IBS-D (diarrhea-predominant) 

People with IBS-D tend to have loose stools, cramping, and a feeling of urgency when they need to use the bathroom. 

IBS-M (mixed diarrhea/constipation) 

This form of IBS is usually characterized by alternating bouts of diarrhea and constipation. 

How is IBS Diagnosed? 

IBS can be diagnosed using several different tests. The doctor may order blood tests to check for inflammation in the intestines, anemia, or other problems with the liver or pancreas. The doctor may also have you take a stool sample to look for bacteria or parasites, especially if you have diarrhea. The doctor may also do a colonoscopy or a flexible sigmoidoscopy, which involves inserting a thin tube with a light and camera on the end into the rectum and colon to see what’s inside. These tests are not used for diagnosing IBS but help rule out other conditions that could cause similar symptoms. 

How to Prevent IBS? 

Irritable bowel syndrome (IBS) is something that affects many people, but it’s easily preventable. By making some small adjustments to your lifestyle, you can be IBS-free and on your way to comfortable digestion! 

• Refrain from eating spicy foods 
• Eat slowly and chew thoroughly. This helps to digest food more efficiently 
• Exercise regularly 
• Stay away from artificial sweeteners and sugar alcohols such as maltitol and sorbitol 
• Avoid alcohol, smoking, and caffeine 
• Drink lots of water 

If you think you may have Irritable Bowel Syndrome, be sure to consult a Gastroenterologist because it’s important to rule out any other possible causes of stomach pain and diarrhea first, as they could be harmful if they’re not treated properly.  

What is Colorectal Cancer

Colorectal cancer or bowel cancer is cancer that affects the large bowel (colon) and back passage (rectum). Globally, it is the third most occurring cancer. 

The colon and rectum are part of the body’s digestive system. They make up the large bowel, or large intestine. Their job is to absorb water from partially digested food and remove waste products from the body. The waste products become solid as they travel through the colon and rectum before leaving the body as stools (feces).  

Colorectal cancer can start in any part of the colon or rectum. It most commonly begins in cells lining the inside of the bowel. Most bowel cancers develop very slowly over several years. Bowel cancer is uncommon in people under 50 years of age, and most cases occur in people aged 60 or over.

Causes of Colorectal

Colorectal cancer starts when healthy cells in your bowel become abnormal. These cells grow and divide more rapidly than normal and continue living when other cells would die. These extra cells can form a mass called a tumor. Some cancers, such as bowel cancer, begin as benign tumors, which are not cancerous. They might not spread or threaten life, but sometimes they can become malignant (cancerous). This happens if the cells in the tumor have changed genetically and no longer regulate their growth properly. The tumor then grows uncontrollably, eventually becoming large enough to invade surrounding tissue or spread to distant parts of the body. There are different types of bowel cancer, depending on where it starts: 

• Colon Cancer – is the most common type of bowel cancer; it starts in the large bowel. 
• Rectal Cancer – this begins in the back passage (rectum). 

Symptoms of Colorectal Cancer

The symptoms of colon cancer are: 

• Blood in your bowel movements 
• Bleeding from your rectum or blood in your stools 
• Abdominal pain, cramping, bloating, and gas 
• Diarrhea or constipation that lasts for more than a few days (or alternates between the two) 
• Unexplained weight loss 
• A lump in your abdomen

If you experience these symptoms for two weeks or more, it may be time to talk to a Gastroenterologist or a Gastrointestinal Surgeon about whether you’re at risk for bowel cancer: 

Diagnosis of Colorectal Cancer

Bowel cancer is diagnosed with a range of tests.  

Blood Tests: Blood tests can check for anemia, which happens when a person has low red blood cell levels. Low red blood cell levels are a symptom of bowel cancer. 

Stool Tests: Stool tests are also known as fecal occult blood tests, which means hidden (occult) blood in the stool. If a person has bowel cancer or another gastrointestinal disorder, blood may appear in their stool, though it is not visible to the naked eye. 

Sigmoidoscopy: A sigmoidoscopy is when your doctor looks at the rectum and lower part of the colon with a camera on a flexible tube. This tube is called a sigmoidoscope. 

Colonoscopy: A colonoscopy is when your doctor looks at the entire large intestine with a camera on a flexible tube. This tube is called a colonoscope. 

Biopsy: A biopsy is when your doctor takes tissue samples from the large intestine to look at under a microscope to determine if there are any cancer cells in them. This can help determine if further treatment is needed. 

Prevention

Here are some of the best ways to reduce your risk of bowel cancer,  

• Eating a diet high in fiber, including fruits, vegetables, nuts, and whole grains 
• Drinking at least six glasses of water each day 
• Avoiding processed meats 
• Maintaining a healthy weight (through exercise and eating a healthy diet) 
• Avoiding smoking or drinking alcohol to excess 

While Colorectal cancer is the third most frequently diagnosed type of cancer, it is also one of the most treatable. A bowel cancer screening test is recommended if you are over 50, have a family history of bowel cancer, or have noticed any changes in your normal toilet habits, such as more frequent urination or looser stools. Bowel cancer is easily detectable in its early stages. Patients with early detection have a better chance of survival. 

Occupational health deals with injuries that may be a serious problem which could happen in an office or other work-related environment. These days, more people are getting injured and being treated for injuries arising from occupational health issues. Below are some tips to help you avoid workplace injuries.

Occupation Health Tip #1: Maintain Proper Posture

To keep your back and neck healthy:

• Sit or stand up straight. 
• Roll your shoulders back when working to keep your spine aligned and free from strain, and keep your chin up. You should not be hunched over your computer or reclining in a chair for long periods. 
• When sitting at a desk, keep both feet on the floor and don’t cross them or one leg over the other. 

Occupation Health Tip #2: Make Sure Your Workspace is Ergonomic 

Reaching across a desk to type on a laptop or keyboard, or staring at a screen farther away than it should be, can cause neck and shoulder pain over time. With an ergonomic office desk, you’re less likely to suffer from occupational health issues by reaching across a desk to type on a keyboard, or staring at a screen farther than it should be.

• Place your computer monitor directly in front of you, so you don’t have to twist your neck and shoulders to look at it. 
• Position the computer mouse and keyboard within arm’s reach. 
• Use an adjustable chair for sitting comfortably with your feet flat on the ground.  
• If you work from home, look into purchasing a standing workstation that will allow you to stand up during the day periodically. 
• Know when to take breaks from sitting. 

Being sedentary can lead to eye strain and back pain, especially if you’re not following proper posture guidelines. Get up every 30 minutes, walk around the room, stretch out your legs while standing—do anything that gets your body moving again after being stationary for prolonged periods! 

Occupation Health Tip #3: Take Regular Breaks  

You should take regular breaks to prevent repetitive stress injuries. These injuries happen over time and are usually caused by repeatedly performing the same movements.  

Examples include carpal tunnel syndrome, tendonitis, and tennis elbow. During your break, it’s a good idea to get up from your workstation, stretch, and walk around.  

You should also make sure that you’re frequently changing positions while working. For example, if you stand at work all day, it may be helpful to sit down once an hour for several minutes; if you sit, it can help alternate standing every so often. 

Occupation Health Tip #4: Stretch Your Neck and Shoulders  

Finally, make sure you’re stretching before, during, and after work. Stretching will help keep your blood flowing and prevent many injuries mentioned above.  

To stretch your neck and shoulders, do neck rolls and shoulder shrugs, making sure to rotate your head fully clockwise several times and counter-clockwise.  

If you can do so safely, stretch in 10-minute intervals at least once per hour when on the computer or perform other tasks that require a lot of sitting down. 

To stretch your wrists and arms, hold each arm out for ten seconds with your palm facing up or down and drop it back down slowly. Repeat this exercise five times for the best results. 

Try doing hamstring stretches to loosen those muscles before returning to work for back problems. These are done most easily by standing with both feet together while lifting one leg straight back behind you and one arm before switching sides after holding for 20 seconds. 

Occupation Health Tip #5: Be Aware of Your Surroundings  

Here are some ways to avoid injuries while walking: 

• Be aware of your surroundings. Make sure you can hear clearly, see clearly, and pay attention to what is in front of you while walking. This means: 
• Avoid texting or talking on the phone when walking. Any electronic device that requires your eyes or ears may cause you to miss something important and should be avoided. 
• Avoid eating or drinking while walking. This often causes a person to lose their balance, which could cause them to fall and injure themselves. 
• Avoid carrying heavy objects when walking. This will slow you down but, more importantly, will distract your focus from what is in front of you. 
• Avoid wearing headphones while walking. You should be listening for anything that may pop up in front of you, such as a car making a sudden stop or the sound of another pedestrian’s voice warning you about something ahead of you on the sidewalk.  
• Avoid wearing loose clothing or any other loose articles (i.e., scarves) while walking; these may get caught in doors/fences/etc., putting pressure on certain parts of your body; this could result in injury if pulled too quickly by an unexpected force (such as a gust of wind).

Many Workplace Injuries can be Prevented with a Few Easily Followed Rules

It is estimated that 2.3 million women and men worldwide succumb to work-related accidents or diseases every year; this corresponds to over 6000 deaths every day. Worldwide, there are around 340 million occupational health issues and accidents and 160 million victims of work-related illnesses annually. It may seem like these injuries just happen, but many can be prevented. Let’s look at some of the most common workplace injuries and how to avoid them: 

• Sprains and strains are two of the most common types of workplace injuries. These occur mostly in the back, shoulders, neck, and knees. If you need to lift something, learn how to do it properly—or ask someone else to help you! 

• Cuts are another frequent type of workplace injury; they usually occur when someone is using machinery or tools that have sharp edges or points. Always wear protective equipment like gloves, masks, goggles, and closed-toe shoes when necessary (and don’t be afraid to speak up if you think your tools could use an upgrade.) 
• There are many different types of burn injuries—heat burns from fire or steam; friction burns from falling on a hard surface; chemical burns from chemicals splashed in your eyes —so make sure you know what hazards exist where you work and what steps need to be taken for each one before starting a new job or working with a new substance for the first time. 

Many of these injuries are avoidable if one follows simple safety protocol. This is a simple list of steps that any employee can take to prevent occupational health issues in the future. These include good posture, exercising regularly, avoiding aggressive behavior at work, and reporting injuries immediately and properly.