30 yr f plz suggest urs valuable opinion nd management

What is your opinion of doing bilateral salpingo Oophorectomy at the time of hysterectomy. Coz patients are of the opinion that if they undergo Tubectomy,they will land with a BIGGER operation that is hysterectomy.therefore some people come asking to do a hysterectomy after child bearing. If only hysterectomy is done when indicated and later if they require laparotomy for ovarian cyst /tumour,patients question "why you didn't remove these appendages earlier. One patient had hysterectomy,followed by laparotomy again for an ovarian cyst,later another cyst on other side -third surgery .she again developed cystic mass in the pelvis for which she had fourth surgery . Though we leave ovaries ,their function gradually comes down after hysterectomy and they have PMS and osteoporosis. When I have to do a hysterectomy ,I remove the appendages if she is above 40 years and retain them if she is young. What are your opinions

22 y femal suffering from PCOD she suffering from irregular periods last 4 years she used hormonal medicines now she want conceive pregnancy what is the treatment now no regular periods

F.24. Married for 4yrs. No issue. Cycle regular and average flow. HSG.

A 23 years old lady c /o heavy bleeding during menses for 2 months. Married 6months. Pain in the lower abdomen < before and during menses. Vomiting during menses which doesn't relieve the pain. Menses regular. Duration 7or 8days. Large brown cloted blood. Abdominal pain during the cloted blood discharged out. Pain > tight bandage. Leukorrhea thick and yellow. slightly offensive. < after menses. sweat on hands and feet. Feels internal heat and wants to pour cold water over the body. Fainted easily from anger and weeping. USG report attached. Please suggest your views.