Dr. Mahantesh Karoshi - Gynaecologist

05/08/2025

What keeps me going….

24/07/2025

Are We Going Back to Square One on Menopausal Hormone Therapy?

🔗 Original Article: American Family Physician, July 2025

For over two decades, menopausal hormone therapy (MHT) has been the subject of intense debate. First heralded as a near-panacea for aging women, then sharply criticized after the landmark Women’s Health Initiative (WHI) study, it now seems we’re facing another turning point—one that risks repeating past mistakes.

In the latest issue of American Family Physician, Dr. Adriane Fugh-Berman and Dr. Barbara Mintzes revisit the risks of MHT with a powerful editorial: “Menopausal Hormone Therapy: Limited Benefits, Significant Harms.” Their message is crystal clear: the harms of long-term MHT—such as stroke, pulmonary embolism, gallbladder disease, and increased risk of breast and ovarian cancer—are still very real and should not be ignored or downplayed.

Key takeaways:

The WHI trial, involving over 27,000 women, found increased risks of invasive breast cancer, dementia, and cardiovascular events with combined hormone therapy.

Estrogen-only therapy was linked to increased stroke and ovarian cancer risks, but not breast cancer.

Despite these findings, narratives around MHT have softened—prompting concern that risks are being trivialized.

The editorial reminds clinicians that MHT is not recommended for long-term use or for prevention of chronic disease.

Yet, the piece doesn’t deny MHT’s role in treating vasomotor symptoms and vaginal dryness. These are valid, quality-of-life issues. But the therapy should be used only at the lowest effective dose and for the shortest time necessary.

👩‍⚕️ As clinicians, we must strike a careful balance between symptom relief and long-term safety. Patients deserve full, nuanced information—not oversimplified reassurance.

Let’s not forget: the drop in MHT use after WHI findings was followed by a dramatic decline in breast cancer rates worldwide. That was no coincidence.

So, are we going back to square one?

We shouldn’t be.

23/07/2025

The Vanishing Hysterectomy?

This recent article touches on an increasingly relevant issue in gynaecological practice — the declining surgical case load.

Gone are the days when our consultants performed hysterectomies for heavy periods on patients with relatively straightforward anatomy — thin-built women with no prior surgery. It was often a “routine” operation.

Fast forward to today:
⚖️ Obesity is more common.
🔪 Caesarean deliveries and other abdominal surgeries are increasing.
🧩 And every surgical case seems more complex.

For many gynaecologists, the decision to proceed with a hysterectomy is no longer straightforward. It’s not just the surgeon — anaesthetists and theatre teams alike brace for challenges: transferring a patient with high BMI, handling distorted pelvic anatomy, and managing post-operative risks.

What’s more, the average surgical exposure for consultants is declining. It’s not just about being technically trained — it’s about regular hands-on experience. The combination of reduced case volumes and increased complexity can leave even senior consultants questioning their readiness.

And rightly so — because non-surgical options have come a long way. Women today are more informed, more empowered, and often prefer uterine-preserving choices.

This trend should push us to reflect:
👩‍⚕️ Are we doing enough to maintain surgical skills in a rapidly changing landscape?
📉 What happens when experience doesn’t keep up with case complexity?

It’s time for open conversations, structured training updates, and realistic surgical expectations in the modern gynaecology era.

Would love to hear your thoughts.

20/07/2025

An interesting insight from Sweden…

30/06/2025

New Concept for Couples Trying to Conceive Naturally

If a couple is aiming to achieve pregnancy through natural means, it’s important to focus on timing and s***m quality. For the male partner, regular ej*******on plays a key role. Ideally, this means:
• Having sexual in*******se every other day, or
• Ej*******ng every alternate day (even outside of in*******se)

Why does this matter? Regular ej*******on helps maintain healthy, good-quality s***m, which increases the chances of fertilising the egg during the fertile window.

29/06/2025

Why Do RFA Devices Need TWO Diathermy Pads, Not One?

🧐I’ve asked this question so many times.

Why does radiofrequency ablation (RFA) require two grounding pads, when standard diathermy works perfectly fine with just one?

🤔 Most couldn’t give a clear answer.

So I went digging—through vascular surgery, neurology, and liver ablation literature—and here’s what I found:

🔍 Let’s break it down simply:

🔹 Standard Diathermy (1 pad):
Think of a caesarean section. The RF energy is highly focused, with tip temperatures up to 1000°C. The heat travels in a linear path—ideal for cutting or cauterising. Quick, sharp, controlled.

🔹 RFA for Fibroids (2 pads):
Completely different goal.
Here, we’re not cutting—we’re ablating a whole fibroid (like the size of a lime or clementine).
We need a 3D, spherical zone of heat—not a line. That means even, slow, balanced energy all around the needle tip.

👥 Using two pads helps distribute the energy evenly, prevents hotspots, and ensures a proper spherical burn zone for complete fibroid necrosis.

⚡ Here’s the energy logic:

▪️ 1 pad = Linear energy = cutting/coagulating
▪️ 2 pads = Spherical energy = ablating/diffusing

Big difference in purpose = Big difference in technique.

🔥 Science Bite:

The RF probe doesn’t “burn” tissue directly.
It creates an electromagnetic field, which makes water molecules vibrate → this vibration generates heat.

☠️ At:
• 60–99°C → proteins coagulate, cells die
• 100°C → tissue chars = BAD! (Charred tissue blocks further heat), a slow rise to 100°C is fine

✅ That’s why we aim for controlled heating ( slow cooking in a 3 dimensional way)not an instant burn.

📚 So next time someone asks, you’ll know:

2 pads for RFA = precise, spherical, safe ablation.
A whole different philosophy of energy delivery.

29/06/2025

29/06/2025

🍊🍅 Turning Centimetres into Clementines: Helping Patients Understand with Analogies

Let’s face it — medical language doesn’t always land.

Take this common scenario…

Mrs. “X”, a woman in her 40s, comes in with heavy periods. An ultrasound shows multiple fibroids measuring 2 cm, 3.5 cm, 4 cm, 5 cm, and 7 cm.

As surgeons, we explain the findings clearly:
“You have several fibroids ranging from 2 to 7 centimetres.”

But here’s the challenge — once she walks out of the clinic, all she remembers is the word “fibroids” and that there were “a few of them”.
The exact sizes? The details? Mostly forgotten.

⸻

So how do we make it stick?

Here’s what I’ve found works brilliantly: use analogies.

I pause, take a step back, and translate the numbers into something more familiar — something visual, tangible, and easy to explain to a friend or family member.

I say:

“Mrs. X, your fibroids are roughly the size of:
• 🍅 Cherry tomato – about 2 cm
• 🍊 Clementine – about 3.5 cm
• 🍈 Lime – about 4 cm
• 🍊 Orange – about 5 cm
• 🍊 Grapefruit – about 7 cm

They’re all sitting within the wall of your uterus.”

And just like that, her expression changes — confusion becomes clarity.

It’s no longer abstract.
It’s not “just medical”.
It’s real, relatable, and memorable.

⸻

Why does this matter?

Because when patients understand, they:
• Feel more in control
• Are more likely to follow through with treatment
• Can confidently explain their condition to others
• Experience less anxiety about “what’s going on inside”

As clinicians, we spend years learning how to diagnose and treat.
But learning how to communicate it — in a way that truly lands — is an art. And it matters just as much.

⸻

What do you think?

Have you found helpful analogies in your own practice?
What tricks help your patients truly “get it”?

Let’s share ideas — because better understanding always leads to better care.

One patient once told me, after hearing this explanation:

“Oh my god — I’m walking around with a garden in my stomach!”

And that moment? That’s when I knew it worked.

28/06/2025

Where do RFA fit in the spectrum of Radiofrequency energy use in everyday use of electrical energy

27/06/2025

# # The Heat Revolution in Fibroid Treatment

Gone are the days when major surgery was the only option for fibroid treatment. Modern medicine has embraced the power of controlled heat to offer women minimally invasive alternatives that are changing lives—literally from the inside out.

# # # 🌡️ **Why Heat Works**

Heat-based therapies work on a simple yet powerful principle: controlled thermal energy can precisely target and destroy fibroid tissue while preserving healthy surrounding areas. Think of it as surgical precision without the scalpel.

# # # 🔬 **Leading Heat-Based Treatments**

**Radiofrequency Ablation (RFA)**

- Uses radiofrequency energy to generate heat
- Minimally invasive outpatient procedure
- Targets fibroids with pinpoint accuracy
- Recovery time: hours not days, not weeks
- Walk-in, walk-out procedure

# # # ✨ **The Benefits Are Clear**

- **Preserve Your Uterus**: Keep your fertility options open
- **Minimal Downtime**: Back to normal activities within days
- **Reduced Complications**: Lower risk compared to major surgery
- **Symptom Relief**: Effective reduction in heavy bleeding and pelvic pressure
- **No Scars**: no incisions at all

# # # 📊 **Who’s a Good Candidate?**

These treatments work best for women with:

- Symptomatic fibroids causing heavy bleeding or pain
- Desire to preserve fertility
- Preference for minimally invasive options
- Fibroids in accessible locations (determined by imaging)

# # # 🔍 **The Science Behind Success**

Heat-based ablation works by raising fibroid tissue temperature to 50-100°C, causing cellular destruction while protecting surrounding healthy tissue. The body naturally absorbs the treated tissue over time, leading to symptom improvement and fibroid shrinkage.

# # # 💭 **What to Expect**

**Before**: Comprehensive evaluation including imaging studies
**During**: Conscious sedation or light anesthesia, real-time monitoring
**After**: Same-day discharge, gradual symptom improvement over 3-6 months

# # # 🚀 **The Future is Here**

These innovative treatments represent a paradigm shift in gynecological care—offering women effective solutions without compromising their lifestyle, fertility, or recovery time.

25/06/2025

Timeline….of incision free - treatment option for women with fibroid….

25/06/2025

Various treatment options for women with fibroids….