Dr. Mahantesh Karoshi - Gynaecologist

10/10/2026

Found one of vintage recording by my colleague and friend long time ago. This was before Sonata, before Ryeqo, before Yselty, before HIFU…

05/10/2026

“Where exactly does it hurt?”

“Every colour is a different nerve. That’s why ‘where does it hurt?’ matters.”

It sounds like a simple question. In pelvic pain, it’s often the most important one.
The pelvis isn’t one structure. It’s supplied by several different nerves, and each has its own territory on the skin. The map in this image shows those territories: every colour is a different nerve.
Why does this matter?
📍 Location points to the source. Pain at the groin, the inner thigh, the v***a, the perineum or the buttock can each implicate a different nerve: ilioinguinal, genitofemoral, obturator, pudendal, posterior femoral cutaneous.
📍 Scans can be normal. Nerve pain rarely shows on ultrasound or MRI. A careful map can reveal what imaging can’t.
📍 Not all pelvic pain is gynaecological. Mapping helps separate pain arising from the uterus and ovaries from pain arising in nerves, muscles, bladder, bowel or an old surgical scar.
📍 It guides treatment. A targeted nerve block, pelvic physiotherapy or surgery only work when aimed at the right structure.
📍 It tracks progress. A map that shrinks over time is objective evidence that treatment is working.
If you live with pelvic pain, try this before your appointment: draw where it hurts, where it travels, and what sets it off (sitting, movement, periods, in*******se). Bring it with you.
Being specific about your pain is super important . It’s giving your doctor the most useful clue there is.
Mr Mahantesh Karoshi MD FRCOG
Consultant Gynaecologist, London
This post is for education and is not a substitute for individual medical advice.

27/09/2026

Endometriosis cycle….360

20/09/2026

Since 70-80% of women have fibroids. Half of them will be symptomatic and ultimately fair share of the 50% will need some help, either Hysteroscopic or radiofrequency ablation ( sonata) or open or keyhole removal depending on symptoms and goals

15/09/2026

13/09/2026

Understanding Adenomyosis….

02/09/2026

Sometimes, all patients need is education rather than treatment as such.
Take for example, everywoman through reproductive ageing has to go through perimenopausal transition to menopause. HRT can bridge that gap. But, it does come with side effects and few risks.
When HRT is used in a perimenopausal transitioning woman, essentially she is been treated as a menopausal woman and in real fact it is hormones on hormones, meaning her body is going to produce oestrogen and progesterone and on the top of it she is going to take oestrogen and progesterone ( HRT)
The consequence being bodily exposure to more oestrogen and more progesterone and some may experience side effects from them. More over benign conditions such as fibroids grow, endometriosis worsens, adenomyosis deepens…so a balanced approach is all that is needed….

31/08/2026

Belling the cat

Everyone agrees the cat needs a bell. In committee, in the corridor, over coffee — the mice all nod. Someone should tell her. Someone should say the words: you need to lose weight.
The trouble was never the plan. The bell sits right there, ready. What’s missing is the mouse willing to walk up to the cat and tie it on.
In clinic, the “cat” is rarely one person’s job. The GP assumes the hospital team will raise it, since the patient’s there for something specific. The specialist assumes the GP already has, since they know the patient longitudinally. The nurse assumes it’s above her pay grade. The patient, if she raises it herself, often gets a vague “yes, that would help” and nothing more — no referral, no plan, no follow-up.
Everyone is right that it matters. Everyone is right that it’s hard. And the diffusion of responsibility means the conversation that could genuinely change someone’s fertility, surgical risk, or long-term health keeps getting deferred to whichever brave mouse goes next — which is often no one.
The fix isn’t finding a braver mouse. It’s building it into the system: a named point in the pathway — pre-op assessment, first fertility consult, annual review — where weight is always raised, with a referral pathway attached, so it stops depending on any one clinician’s nerve on any one day.

30/08/2026

Does FDA removal of black label change anything for NICE/BMS guidance for Hormone therapy?

The FDA just removed the “black box” warning from HRT labels in the US. Does this change anything here in the UK?
Short answer: not really — and that’s actually the point.
The “black box” was a US-specific regulatory label, added after the original 2002 Women’s Health Initiative (WHI) study was interpreted far too broadly. There’s no direct UK equivalent — our HRT information has always sat in the standard MHRA-approved patient leaflet, not a boxed warning.
More importantly, NICE and European menopause guidance have for years already taken the more nuanced, individualised view the FDA is only now catching up to: for most healthy women under 60, or within 10 years of menopause, the benefits of HRT generally outweigh the risks — and the WHI data that frightened a generation of women (and doctors) never told the whole story.
So this isn’t new evidence. It’s a US label finally aligning with what UK and European guidance has said for a long time.
What it doesn’t mean: that HRT is right for everyone, risk-free, or something to start without a proper conversation about your own history and risk factors.
If you’ve avoided HRT because of the old headlines, it might be worth revisiting that conversation with your GP or menopause specialist.