Women's Gynaecological Health in Pune: Common Conditions and When to Seek Help

Women's gynaecological health encompasses far more than reproductive medicine. From the first menstrual period through the perimenopausal transition and beyond, the health of the female reproductive system — the uterus, ovaries, fallopian tubes, cervix, and vagina — intersects with almost every dimension of a woman's physical and emotional wellbeing. Yet gynaecological conditions are consistently under-discussed, under-diagnosed, and undertreated in India — partly due to cultural reticence about reproductive health, and partly due to a healthcare system in which specialist gynaecology care is still not universally accessible.

This guide covers the most important gynaecological conditions seen in Indian women of all ages: their symptoms, their impact on fertility and quality of life, and — crucially — when they warrant specialist evaluation rather than watchful waiting.

Uterine Fibroids

Uterine fibroids — benign smooth muscle tumours of the uterus — are among the most common gynaecological diagnoses. Up to 70 to 80% of women will have fibroids by the age of 50, though most are asymptomatic and require no treatment. Symptomatic fibroids, however, are the most common indication for gynaecological surgery in reproductive-age women.

Symptoms that warrant evaluation: heavy or prolonged menstrual bleeding (often leading to iron deficiency anaemia), pelvic pressure or fullness, urinary frequency, constipation, pelvic pain, or — when fibroids distort the uterine cavity — difficulty conceiving or recurrent pregnancy loss.

Not all fibroids need operating. The decision to treat depends on their location (submucosal fibroids in the cavity are most clinically significant), size, symptoms, and fertility intentions. See the dedicated fibroid article for a full guide to when surgery is and is not indicated.

Endometriosis

Endometriosis — growth of endometrial-like tissue outside the uterus — affects approximately 10% of reproductive-age women in India and up to 50% of infertile women. It is severely underdiagnosed: the average delay from symptom onset to diagnosis remains 5 to 7 years.

Symptoms that should raise suspicion: severe, progressively worsening period pain (dysmenorrhoea) that is debilitating and does not respond to standard pain relief; deep pain during intercourse (dyspareunia); chronic pelvic pain; pain during bowel movements around menstruation; and infertility. Notably, some women with significant endometriosis have minimal symptoms — infertility may be the presenting complaint.

Endometriosis cannot be diagnosed from symptoms or ultrasound alone in its early stages. Definitive diagnosis requires laparoscopy. Treatment depends on the severity, the presence of endometriomas, and fertility goals. Dr. Sunita Tandulwadkar's dual expertise in advanced laparoscopic endometriosis surgery and IVF makes Solo Clinic a specialist centre for women who need both the surgical and the fertility dimensions managed cohesively.

Polycystic Ovary Syndrome (PCOS)

PCOS is the most common hormonal disorder in Indian women of reproductive age, affecting an estimated 20 to 25% of the population. Its gynaecological manifestations — irregular periods, chronic anovulation, androgen-related skin and hair changes — are covered in depth in Pillar 3. From a gynaecological perspective, the long-term risk of endometrial hyperplasia and endometrial cancer from chronic anovulation is a critical concern: women with PCOS who have fewer than 4 periods per year need regular progestogen-induced withdrawal bleeds to protect the endometrium.

Ovarian Cysts

Ovarian cysts are fluid-filled sacs in or on the ovary. They are extremely common — many women will have a functional cyst (a normal physiological cyst that resolves spontaneously) at some point. The critical clinical question is whether a cyst requires intervention or observation.

Functional cysts (follicular cysts, corpus luteum cysts) are physiological and typically resolve within 1 to 3 menstrual cycles. They rarely cause significant symptoms and do not require surgery. Persistent cysts (endometriomas, dermoid cysts, mucinous or serous cystadenomas) may require intervention — the decision depending on size, appearance, symptoms, and fertility implications. The full guide in P7-5 covers this decision in detail.

Adenomyosis

Adenomyosis — the presence of endometrial glands and stroma within the myometrium (the muscular wall of the uterus) — is a significantly underrecognised condition. It causes a characteristically enlarged, globular, tender uterus and presents with heavy, painful periods and sometimes infertility. It is distinct from fibroids (which are well-defined tumours) and from endometriosis (which is outside the uterus), though it frequently coexists with both.

Adenomyosis is increasingly diagnosed as MRI and high-resolution ultrasound have improved — and it is increasingly recognised as a cause of failed IVF implantation. See the dedicated P7-6 article for a full discussion.

Heavy Periods (Menorrhagia)

Heavy menstrual bleeding — medically defined as blood loss above 80 ml per cycle, though practically defined by impact on quality of life — is one of the most common reasons Indian women seek gynaecological care. It may be caused by fibroids, adenomyosis, endometrial polyps, PCOS, thyroid dysfunction, coagulopathy, or — in perimenopausal women — hormonal fluctuation. Heavy periods are not an inevitable part of womanhood and are not simply "normal" — they are a treatable symptom warranting investigation.

Menopause and Perimenopause

The menopausal transition typically begins in the mid-to-late forties in Indian women (average menopause age in India is approximately 46 to 48 years — somewhat earlier than the global average). Perimenopause — the years of fluctuating hormones and irregular cycles before the final period — is often the most symptomatic phase, yet frequently receives the least clinical attention.

Hot flushes, night sweats, sleep disruption, mood changes, cognitive effects, genitourinary symptoms, and the long-term risks of oestrogen deficiency (bone loss, cardiovascular risk) all deserve active management — not dismissal as "natural" changes to be endured.

Cervical Health and HPV

Cervical cancer is the second most common cancer in Indian women — and almost entirely preventable through a combination of HPV vaccination and regular cervical screening. Yet cervical screening rates in India remain low, and HPV vaccination uptake is far from universal.

Every sexually active woman should have regular cervical screening (Pap smear or liquid-based cytology, ideally with co-testing for HPV). Any abnormal bleeding — particularly post-coital bleeding (bleeding after intercourse), intermenstrual bleeding, or post-menopausal bleeding — warrants urgent assessment including colposcopy.

Pelvic Inflammatory Disease

PID — ascending infection of the female reproductive tract — is a common and frequently underdiagnosed condition in India. It can present acutely with fever, lower abdominal pain, and purulent vaginal discharge, or subacutely with vague pelvic discomfort that is attributed to other causes. Untreated or inadequately treated PID causes tubal scarring, hydrosalpinx, chronic pelvic pain, and infertility — consequences that are largely preventable with prompt, appropriate antibiotic treatment.

When to See a Gynaecologist

Many Indian women delay seeking gynaecological care due to embarrassment, cost, or the assumption that symptoms are "normal." None of the following are normal and all warrant prompt evaluation:

• Periods so heavy they require changing a pad or tampon every 1 to 2 hours, or passing large clots
• Period pain severe enough to miss work, school, or normal activity — particularly if worsening progressively over time
• Irregular periods — consistently outside the 21 to 35 day range, or fewer than 8 cycles per year
• Pelvic pain that is not related to menstruation
• Abnormal vaginal discharge — particularly if malodorous, blood-stained, or associated with itching or burning
• Bleeding after sex, between periods, or after menopause
• Any lump or swelling in the lower abdomen or pelvic area
• Difficulty conceiving after 12 months of regular unprotected intercourse (or 6 months if 35 or above)

Frequently Asked Questions

Q1. How often should I see a gynaecologist even if I have no symptoms?

Healthy women with no specific symptoms benefit from an annual gynaecological check-up that includes blood pressure, BMI assessment, and discussion of menstrual pattern, contraception, and cervical screening status. In India, where cervical cancer remains a major public health burden, annual or biennial cervical screening from the age of first sexual activity (or at 21) is an important part of preventive care. Women with known conditions (PCOS, fibroids, endometriosis, adenomyosis) should be reviewed more frequently as clinically appropriate.

Q2. Is pelvic pain during sex normal?

Occasional mild discomfort with certain positions is common and not necessarily pathological. Pain that is consistent, moderate to severe, deep (not at the entry point), or getting progressively worse over time is not normal and warrants gynaecological assessment. Deep dyspareunia — pain with deep penetration — is one of the most characteristic symptoms of endometriosis and adenomyosis, and should prompt investigation rather than acceptance.

Q3. I was told I have a "retroverted uterus." Is this a problem?

A retroverted (tilted backward) uterus is a normal anatomical variant, found in approximately 20 to 25% of women. In isolation, it causes no symptoms and has no impact on fertility or pregnancy. A retroverted uterus that is fixed (immovable on examination) — rather than freely mobile — may indicate posterior endometriosis or adhesions and warrants further investigation.

Q4. What is the difference between a gynaecologist and a fertility specialist?

In India, most fertility specialists (reproductive endocrinologists) are trained as obstetricians and gynaecologists first, then subspecialise in infertility and assisted reproduction. Dr. Tandulwadkar practises both gynaecology (including advanced laparoscopic surgery for fibroids, endometriosis, and ovarian cysts) and reproductive medicine (IVF, egg freezing, high-risk obstetrics) — providing genuine continuity of care across the full spectrum of women's reproductive health.