Gynaecologist_London (Mr. Mahantesh Karoshi)

MD, FRCOG #Surgeon,Author, #ConsultantObstetrician & #Gynecologist, #RoyalFreeLondon NHS Foundation Trust,Barnet Hospital,#London, UK

[Gynaecologist_London (Mr. Mahantesh Karoshi) @Karoshi_M]

Outpatient Hysteroscopy
In hysteroscopy, a thin telescope is placed through cervix and into the uterus to look at the lining of the uterus
Patient also has the opportunity to see what’s wrong inside her
#hysteroscopy
#painlesshysteroscopy
#wombcancer
#uterinepolyp
#ashermans

[Gynaecologist_London (Mr. Mahantesh Karoshi) @Karoshi_M]

@mikefutia Claw

[Gynaecologist_London (Mr. Mahantesh Karoshi) @Karoshi_M]

Understanding your options for RPOC (retained pregnancy tissue) removal can protect one’s future fertility

PROBLEM: Retained tissue needs removal.
GOAL: Remove tissue + Protect uterine lining.
BEST METHOD: Hysteroscopy (seen here).

Why? It’s hysteroscopy guided. Minimises scarring.

Key for: Women in late 30s/40s & prior D& C procedures.

THE RANKING (From Safest to Riskiest for the Lining to cause intrauterine adhesions – Asherman’s syndrome)

Hysteroscopy-Guided ( least traumatic)

Ultrasound-Guided Vacuum ( Medium Risk(

Traditional Surgical Evacuation ("D&C") ( Highest risk)

This precise approach is vital for preserving fertility.

I am so thankful to my patient for sharing her experience to help others feel informed and less alone. I sincerely thank for her consent to share this video for wider audience to benefit them.

Always discuss the best option for you with your doctor. 💛

#RPOC #MiscarriageCare #Hysteroscopy #FertilityPreservation #WomensHealthTok #MedicalAdvocacy #Gynecologist

[Gynaecologist_London (Mr. Mahantesh Karoshi) @Karoshi_M]

@RX_forLiberty Labs

[Gynaecologist_London (Mr. Mahantesh Karoshi) @Karoshi_M]

If AI is so fast, accurate, and intelligent, why can’t it manage a patient on its own?

It’s tempting to think medicine is simple: data in, answers out. Symptoms go in, diagnoses come out. With enough scans, blood tests, and guidelines, surely an AI trained on millions of cases should outperform humans.

But medicine doesn’t work like that.

In Range, David Epstein explains the difference between kind and wicked environments. Chess is kind — clear rules, fast feedback, repeatable patterns. Machines thrive there.

Medicine is a wicked environment. The rules aren’t clear. Feedback is delayed or misleading. Outcomes may take months or years. The same decision can help one patient and harm another. So how do you train an algorithm when the “right answer” keeps changing?

AI excels at pattern recognition — but only when patterns are stable. Real patients aren’t. Context reshapes meaning constantly, and when patterns collide, purely statistical reasoning starts to break down.

Doctors do something AI can’t replicate easily. They use analytical reasoning (tests, probabilities, evidence) and inductive reasoning (stories, behaviour, emotion, uncertainty) at the same time — switching between them continuously.

Patients aren’t datasets. They change their story, misunderstand symptoms, and respond unpredictably. Doctors don’t just diagnose — they carry responsibility and make judgment calls when the evidence is incomplete.

AI absolutely belongs in medicine. But as a tool, not a clinician.

Medicine isn’t chess.
Patients aren’t puzzles.
And care isn’t pattern recognition alone.

AI will assist.
It won’t manage.
And that distinction matters.

[Gynaecologist_London (Mr. Mahantesh Karoshi) @Karoshi_M]

Teenage girls and pelvic pain…
Even if her mother had endometriosis, keyhole surgery should not be the starting point….

Many teenage girls live with pelvic pain for months or even years before anyone takes it seriously.
You may hear, “It’s just periods” or “She’s too young for endometriosis.” Sound familiar?

Here’s the reality: teenage girls with pelvic pain can have endometriosis — but even if her mother had it, keyhole surgery isn’t the starting point.
Why…?
Endometriosis is microscopic disease- if a surgeon did get into the trap of doing a keyhole surgery- very likely it will be negative because of its microscopic disease character and usually in young girls it is microscopic and even if a surgeon identifies and excises or ablates, he/she would not cure the problem…as it is hormonal dependent condition as long as her ovaries work, she carries the risk….

So what should come first?

Careful listening.
A detailed history.
Thoughtful, evidence-based medical management.

I’ll say this clearly: laparoscopy is a diagnostic and therapeutic tool, not a reflex response. In adolescents, rushing to surgery can cause more harm than good and rarely addresses the whole problem.

Let’s explore this together.
Early recognition matters. Education matters. Reassurance matters.
And most importantly, young patients deserve a measured, compassionate pathway — not an operating list as step one.

If we want better outcomes in endometriosis, we have to start by changing how we think about pelvic pain in teenagers.

[Gynaecologist_London (Mr. Mahantesh Karoshi) @Karoshi_M]

🌟 What Is Sarcopenia? 🌟

Ever feel like everyday tasks are getting harder — lifting shopping bags, climbing stairs, or even getting up from a chair?
It’s not “just ageing.” It might be sarcopenia — the gradual loss of muscle mass and strength.

Why does it happen?
Because as we get older, our muscles break down faster than they rebuild. Hormonal changes, less activity, low protein, and chronic health issues all add to the problem.

What does it lead to?
• Weakness
• Slower movement
• Higher fall risk
• Loss of independence
• Constant fatigue

The good news?
You can fight it. And you can start today.

✔ Strength training 2–3 times a week
✔ Protein with every meal
✔ Check your vitamin D
✔ Optimised menopause care / HRT when appropriate
✔ Manage underlying conditions

[Gynaecologist_London (Mr. Mahantesh Karoshi) @Karoshi_M]

Endometriosis is a microscopic disease, and its management is fundamentally about controlling microscopic disease activity. As specialists, we offer keyhole (laparoscopic) surgery, but many patients mistakenly believe that this procedure will cure their condition. In reality, it will not—regardless of who performs the surgery.
The scientific basis of endometriosis lies in its microscopic nature. During surgery, a surgeon can only remove visible disease safely, meaning only lesions that can be seen with the naked eye are excised. However, microscopic endometrial lesions that are not visible during surgery may remain and can continue to grow over time, especially since endometriosis is hormonally dependent.
To manage these remaining lesions and prevent further progression, additional measures are essential. These may include using progestogen-only medications, inserting a levonorgestrel-releasing intrauterine system, managing body weight if necessary, adopting a non-inflammatory diet, reducing stress, and prioritizing mindfulness, meditation, and adequate sleep.
In summary, laparoscopy is not a cure for endometriosis. It can provide temporary or short-term relief, but long-term control requires a comprehensive, hormone-based, and lifestyle-focused approach.
#endometriosis
#microscopicdisease
#nocure

[Gynaecologist_London (Mr. Mahantesh Karoshi) @Karoshi_M]

“You might notice:
emotional ups and downs, mood swings or feeling tearful.

cramping or mild abdominal discomfort.

mild spotting or light bleeding.

fatigue or bloating for a few days.

and some women report feeling a kind of ‘hormonally flat’ sensation for a week or two.”

[Gynaecologist_London (Mr. Mahantesh Karoshi) @Karoshi_M]

@tomcrawshaw01 SEARCH

[Gynaecologist_London (Mr. Mahantesh Karoshi) @Karoshi_M]

Ever wonder why some women feel like they’ve got food poisoning on day one of their period?

It’s not a stomach bug — it’s their hormones.

Just before and during menstruation, the uterus releases high levels of prostaglandins (especially PGF2α). These hormone-like chemicals help the uterus contract to shed its lining — which causes cramps.

But here’s the catch: they don’t stay in the uterus.

Once they enter the bloodstream, prostaglandins affect other smooth muscles — especially the gut.

🔁 What can happen?
– Increased bowel movement → diarrhoea
– Stomach lining irritation → nausea
– Strong gut contractions + uterine cramps → vomiting (in more sensitive individuals)

Studies show that 30–50% of women experience looser stools or diarrhoea on day one of their cycle — and it often eases by day three, as prostaglandin levels drop.

But there’s more at play:

🩸 A sudden drop in progesterone removes its calming effect on the gut.
📈 A relative rise in estrogen can heighten gut sensitivity.
🧠 Hormonal shifts also impact serotonin and endocannabinoid systems — both linked to nausea.
💢 Pain-induced vasopressin release may reduce gut blood flow, worsening nausea.

Women with endometriosis, adenomyosis, or IBS often feel these symptoms more severely due to heightened prostaglandin sensitivity or gut reactivity.

Why only some women?
Because of genetic differences in prostaglandin production, breakdown, and gut sensitivity — and yes, the microbiome plays a role too.

What helps?

✅ NSAIDs like ibuprofen, naproxen, or mefenamic acid → block prostaglandin production.
✅ Hormonal contraceptives → reduce uterine lining buildup and lower prostaglandin release#endometriosis #fibroids womenshealth

[Gynaecologist_London (Mr. Mahantesh Karoshi) @Karoshi_M]

A common scenario, I face almost everyday….
This is how it goes…..
One miscarriage — what’s my next thought? I’m in my thirties, my husband too, and I’m seriously wondering whether to try for another natural pregnancy, knowing there’s around a 20% risk of miscarriage, or invest £10K–£15K in IVF with PGTA, where that risk is greatly reduced. It’s not an easy decision, but life is about taking calculated chances — balancing hope, science, and the courage to try again. #miscarriage #ivf #pgta #womenshealth #london

[Gynaecologist_London (Mr. Mahantesh Karoshi) @Karoshi_M]

Myth Buster for BV don’t just focus on women also focus on men involved in the relationship.
Men are the problem!(most of the time)

if you want to read more about new evidence, the link is below :
https://t.co/akMrSpZaxn #bacterialvaginoisis #sexhealth#sti #WomensHealth #BV

[Gynaecologist_London (Mr. Mahantesh Karoshi) @Karoshi_M]

Adenomyosis

[Gynaecologist_London (Mr. Mahantesh Karoshi) @Karoshi_M]

@alex_prompter AI

[Gynaecologist_London (Mr. Mahantesh Karoshi) @Karoshi_M]

@alex_prompter “AI”

[Gynaecologist_London (Mr. Mahantesh Karoshi) @Karoshi_M]

Perimenopause- the unexplored,untalked condition….