Deciding where to deliver your baby

There are few important points you are not supposed to miss when you are near to your delivery. One among them is deciding where to deliver your baby. Usually all women go to the same treating obstetrician to deliver their babies where their antenatal checkups have been done. 

But if you are planning to deliver in different place from where you had a routine check up, you need to be a little careful in choosing the place of delivery. 

You need to see the following in a hospital when considering it as a place of delivering your baby before you join for delivery:

1.Availability of the obstetrician. Check if that hospital is your doctors home hospital or not. Check with her first to see if she does rounds at more than one location and, if so, tour both to see in which hospital she stays for a long time.

2.Availability of neonatal care unit and pediatrician is also important. Incase your baby needs some care after delivery, no need to rush to other hospital for neonatal care. 

3.Availability of good investigations department which include all  blood tests, urine tests, radiology department in the hospital.

  1. Availability of 24*7 pharmacy is a must.
  2. Check if that hospital is covered by your insurance provider and talk to them about the availability of rooms under insurance before you join.

Some more things you need to keep in mind if you are near to your delivery are:

1.Map out which hospitals are close to your home. You may need to go to the hospital quickly while you are in labor. 

2.Enquire about your doctors availability at the time of your delivery.

3.Check with your insurance company about what all you need to submit during admission

4.Don’t be alone during your delivery period. Ask anyone to stay along with you at home or when you go out.







Planning your support systems especially if you are having an older child.

Even though you’ve been through pregnancy and childbirth before. Being aware of the changes to come and helping your older child understand what to expect is the best way to prepare for this joyous event.

Understand the needs of your first child before your delivery so that you can arrange all things in a systematic way.

  1. Encourage your toddler to socialize and play with other children, perhaps in a playgroup. This helps your child to develop the social skills they will need to have a good relationship with their new sibling.
  2. Take help from your elders as you cannot give attention to both of them at the same time. Explain to them about food and sleep timings, likes and dislikes of your older child to your elders so that they can take care accordingly.
  3. Remind visitors to pay attention to your older child, and not just the baby.
  4. Point out the benefits of being an older child, like choosing what to eat, being able to go to the park and play, and having friends.
  5. If you don’t have the help of elders from family, hire a nanny few months before the time of delivery so that your child and nanny get acquainted with each other



Dr. Y. Alekhya

Tips to deal with breast pain

Breast pain is experienced by women at some point in their lives. Sometimes, it may interfere with daily activities and cause a lot of fear and anxiety in the person suffering from it. It is therefore important to know some home remedies that can be used as basic management. If the given tips do not provide relief then it must be discussed with the doctor.

Some of the well-known and tested home remedies and tips to deal with breast pain shall be discussed.

Tips to deal with breast pain-

  1. Wear a supportive bra – it is important to find out the correct size and fitting and also use sports bra when exercising.
  2. Use less salt – especially just before your periods.
  3. Apply local heat to the painful area. During pain peaks, alternating hot and cold packs can help.
  4. Avoiding caffeine has shown a significant reduction in breast pain in women who have it often.
  5. Intake of fish oil /omega-3 supplements is found to be useful- Natural dietary sources include- dark green leafy vegetables, ocean-raised (“wild”) cold-water fish, flax, walnuts, and sesame. Omega-3 supplements are also available by prescription and over-the-counter.
  6. Vitamin E has also been helpful in reducing breast pain and therefore a short term course after consultation with your doctor can be helpful.
  7. Evening primrose oil is now widely advised for helping with breast pain.
  8. Dietary modifications such as eating a low-fat diet – is really beneficial.
  9. If you take birth control pills and seem to find aggravation in breast pain or tenderness, it is advisable to talk about it with your doctor and find out suitable alternatives.
  10. If you are overweight, then losing that excess weight with the help of regular exercise and a healthy diet can really help in the reduction of episodes of breast pain.
  11. Lower your stress levels through stress management techniques such as yoga, deep breathing exercises, etc has been shown to reduce breast pain.
  12.  Smoking can worsen breast pain, it is high time to quit smoking if you have breast pain.
  13. Stock in some pain relieving medicines after consulting your doctor if you have very serious breast pain episodes.
  14. Mild massage can help improve blood circulation and reduce inflammation and pain.
  15. Estrogen dominance in some women causes breast tenderness and pain. Eat plenty of fiber to help your body flush out extra estrogen. You can get fiber from cabbage, broccoli, sprouts, legumes, and whole grains.
  16. Drink plenty of water throughout the day to get rid of toxins from the body.
  17. Reduce your intake of hydrogenated oils, found in margarine, packaged baked goods, and snack products.


Other than the above-mentioned tips, it is vital for all women to examine their breasts at least once in 2-3 months and any difference in the size or shape of your breasts is felt then it is important to consult a doctor.

Written by Dr.Afroze Fatima


Breast pain – Mastalgia

With the increased cases of breast cancer and the awareness that is spread about it, even a simple breast pain may cause a lot of fear and panic in the person suffering from it. It is agreed that breast pain is not something to be ignored, however in the majority of the cases; it is nothing to be panicked for too!

Breast pain is experienced by every woman at some point in their lifetime. It’s effects vary, and in some cases, make every day functions like getting dressed, walking and simple acts of intimacy very uncomfortable. If you suffer from breast pain on a frequent basis then it is important to understand why you are experiencing it and what you can do about it.

There are 3 types of breast pain that we must be aware of to understand the causes and to learn to deal with the pain.

  1. Cyclical breast pain– The pain is linked to menstrual periods with dull, heavy or aching accompanied by breast swelling or lumpiness. It affects both breasts, particularly the upper, outer portions, and can radiate to the underarm and is known to get Intensified prior the two weeks leading up to the start of your period, then eases up afterward.
  2. Noncyclic breast pain. The origin of pain in this may be the breast or outside the breast too such as nearby muscles or joints and may be felt in the breast. It is not related to the menstrual cycle. It is usually described as tight, burning or sore. It affects one breast. The pain may be in a localized area or may spread more diffusely across the breast.
  3. Extramammary breast pain– The term “extra mammary” means “outside the breast.” This kind of breast pain feels like it starts in the breast tissue, but its source is actually somewhere else, for example, pulling a muscle in your chest.

Common causes of breast pain

  1. Wearing the wrong bra – It is important to know the right size and right fit and wear a supportive bra when needed such as during exercise.
  2. Hormonal changes – Changes that take place before menstruation and during pregnancy are linked to breast pain. Cyclical breast pain has a strong link to the menstrual cycle.
  3. Fatty acid imbalance – an imbalance of fatty acids within the breast cells may affect the sensitivity of breast tissue to circulating hormones.
  4. Breast size – Women with large breasts tend to have noncyclic breast pain due to the size of their breasts.
  5. Medication use – Certain medications, including hormonal pills used for infertility treatments, oral birth control pills, hormonal replacement therapy, and certain antidepressants may cause breast pain.
  6. Breast structure – Noncyclic breast pain often results from certain changes that occur in the breast tissue in response to hormonal changes. These include cysts.
  7. Breast trauma – prior breast surgery or other factors localized to the breast can lead to breast pain.
  8. Stress – During extreme periods of anxiety, pressure, and stress, women may experience breast pain.
  9. Caffeine – using too many caffeine-containing drinks has been linked to increased cases of breast pain.
  10. Issues with bones of rib – also known as costochondritis. It is an inflammation costal cartilage and may reflect as breast pain in women.

Now we know the causes of breast pain. A woman’s breast shows changes at multiple points in life. Breast pain usually has the above-discussed causes and if it gets intolerable, it is advisable to visit your doctor.

Written by: Dr.Afroze Fatima

Preventive measures for urinary tract infections..

Urinary tract infections (UTIs) which can affect the bladder, kidneys and the uterus can be more dangerous if they are left untreated. By taking simple steps, everyone especially women, can avoid getting a UTI.

Preventive measures which are widely used to prevent UTI:

  1. Drinking plenty of water is the first step towards prevention, dehydration can concentrate your urine thus leading to infection. If you are not emptying frequently, it leads to bacterial overgrowth in the bladder.
  2. Do not ‘hold on’ when you need to go.
  3. Make sure even your children follow the same.
  4. Make sure that personal hygiene is maintained.
  5. There is some evidence that unsweetened cranberry juice stops bacteria from sticking to the walls of the bladder.

Advice for women 

  • Try to maintain a good hygiene, wiping the area from front to back after going to the toilet.
  • Wear cotton underwear.
  • Avoid tight-fitting or synthetic clothing.
  • Using soap or perfumed products in the genital area should be avoided.
  • Use a lubricant during sex.
  • Emptying the bladder soon after sexual intercourse is important.
  • Don’t use douches, sprays or powders in genital area.



Dr. Y. Alekhya

How to deal with menopausal symptoms?

The menopause is a physiological event that occurs in all women who reach midlife. Symptoms shown to be associated with estrogen deficiency after menopause are hot flashes or flushes and night sweats, insomnia and vaginal dryness.

However, many other symptoms and conditions (irregular menstrual bleeding, osteoporosis, arteriosclerosis, dyslipidemia, depressed mood, irritability, headache, forgetfulness, dizziness, deterioration in postural balance, palpitations, dry eyes, dry mouth, reduced skin elasticity, restless legs, and muscle and joint pain) have also been implicated as associated with the menopause but are not necessarily correlated to oestrogen levels. It is not necessary that every woman will have all of the above mentioned symptoms during their menopause, as it varies from person to person.

How to stay healthy during menopause to avoid its symptoms:

Before deciding on any form of treatment, discuss with your doctor about your options and the risks and benefits involved with each. Nutrition, Exercise and a routine healthcare altogether will help to deal with menopausal symptoms.

  • Maintain sufficient levels of calcium and vitamin D
  • Hormone therapy, low-dose antidepressants, and Gabapentin have been shown to decrease menopausal hot flashes
  • Strengthen your pelvic floor – pelvic floor muscle exercises, called Kegel exercises, can improve some forms of urinary incontinence.
  •  Eat a balanced diet that includes a variety of fruits, vegetables and whole grains and that limits saturated fats, oils and sugars. Aim for 1,200 to 1,500 milligrams of calcium and 800 international units of vitamin D a day.
  •  Optimize your sleep – avoid caffeine and engage in relaxation techniques, such as deep breathing, guided imagery and progressive muscle relaxation, to help with sleep problems.
  •  Decrease vaginal discomfort – Using water based vaginal lubricants or moisturizers. Staying sexually active also helps.
  • Avoid smoking – smoking increases your risk of heart disease, stroke, osteoporosis, cancer and a range of other health problems. It may also increase hot flashes which can lead to earlier menopause.
  • Exercise regularly – get at least 30 minutes of moderate-intensity physical activity on most days to protect against cardiovascular disease, diabetes, osteoporosis and other conditions associated with aging.
  • Schedule regular checkups – talk with your doctor about how often you should have mammograms, Pap tests, lipid level (cholesterol and triglyceride) testing and other screening tests.



Dr. Y. Alekhya

Menstrual cup and how to use it

Women around the world has been using tampons and sanitary napkins during menstruation since many years but they have their own hazards and disadvantages. The discomfort associated with sanitary napkins are constant awareness of bulk and friction, fear of leakage, problems in disposal, chaffing of the skin, contamination of the pad by urine and feces and hence infection.

Tampon can cause vaginal infections and can be associated urinary tract infection.


The modern solution to have a hassle free period is menstrual cups. It is made up of medical grade silicon and is worn inside the vagina during menstruation. The cup needs to be removed and cleaned for hygienic purposes depending on the women’s flow. . While the concept of menstrual cups continues to be fairly new in India, gynecologists have continued to encourage their use instead of cloth, sanitary pads and tampons.


How to use it


A menstrual cup is designed to engage and retain itself in proper position. It acts as a catch basin for the flow of blood and seals of upper vagina like a diaphragm. A menstrual cup is folded in a c-shape, and then inserted into the vagina. It unfolds automatically after insertion and creates a light seal against vagina walls. You may need to twist the cup a little to ensure that it is fully open inside the vagina.




Following are some of the advantages of using menstrual cups

  • Safe, sanitary and comfortable
  • More hygienic and no risk of infections especially serious infections like Toxic shock syndrome
  • Can be sterilised and reused 
  • Cost effective
  • Can be worn for longer durations (upto 12 hours)
  • Can be reused hence no issue of disposal
  • Can be used by women of any age




Following are the few shortcomings of using menstrual cups

  • Proper sterilization is must for reuse
  • May be difficult to insert or remove for initial few months but can be resolved with education
  • Advised to remove during intercourse


So clearly the advantages of using menstrual cups are more than the disadvantages which can be overcome with education.


For a developing country like India, the use of menstrual cups is encouraged as many women in the rural parts of the country do not have any access to sanitary napkins. Women and girls refrain themselves from social gatherings while on their menstrual cycle due to fear of leakage and inadequate sanitation facilities. Menstrual cups can surely work wonders for these women.


  • Dr Prerna Gaur




Menorrhagia – Heavy menstrual bleeding

It is a medical term used for prolonged or heavy menstrual bleeding. If you are using more than one sanitary pad or tampon every hour for more than 2 consecutive hours, and if the bleeding continues even after 1 week, it should be evaluated further to find out the cause.

Total menstrual blood loss is between 35-80ml, if the blood loss is more than 80 ml it is termed as menorrhagia.

There are several causes for heavy menstrual bleeding and some among them are:

  1. Hormonal imbalance is the most common cause among all.
  2. 40-60% of those who complain of excessive bleeding have no pathology and this is called dysfunctional uterine bleeding.
  3. 20% of cases are associated with anovulatory cycles and these are most common at the extremes of reproductive life.
  4. Fibroids, Endometrial polyps, Adenomyosis, Endometritis, Endometrial hyperplasia, Pelvic inflammatory disease, Carcinoma, especially endometrial carcinoma in women aged over 40; this usually presents with postmenopausal bleeding, but 20-25% of cases present with abnormalities of the menstrual cycle.
  5. If you have a blood clotting disorder, which means if your body is unable to clot the blood, there will be more bleeding.
  6. Certain medications like anticoagulants,estrogen or progestin pills, can cause more bleeding.

Symptoms to be referred:

  1. Irregular bleeding
  2. Increased blood loss other than normal.
  3. Intermenstrual bleeding
  4. Post coital bleeding(bleeding after intercourse)
  5. Pain during intercourse
  6. Pelvic pain
  7. Pre menstrual pain


First we need to find the cause of the heavy menstruation, and treat accordingly. Treating anemia and abdominal pain is also challenging. The main aims of treatment are to improve symptoms and also quality of life. Treatment is always based on the cause, if hormonal imbalance is the cause, they should be replaced by oral contraceptive pills. If there is iron deficiency anemia, correcting it by giving iron supplements is the best treatment. Surgery is the main option for uterine conditions like fibroids, tumor etc. If even after the treatment the symptoms persists and there is trouble in leading the normal life, hysterectomy is the option.



Dr. Y. Alekhya



Menopause is the permanent cessation of menstruation owing

to loss of follicular activity of the ovaries. Lack of menses for 12 months period is called menopause in a woman in the age of menopause. “Menopause” is derived from the Latin word “meno” for month  and “pausia” meaning halt. By this, a woman’s life undergoes a transition from the reproductive to the non-reproductive stage.

This transition takes place naturally (spontaneously) at the average age 51, which chronologically begins before menopause and does not end until at least one year after the event. However, in societies with controlled fertility, women complete the reproductive phases of their lives well before menopause.

Other type of menopause are:

Premature menopause: Menopause that occurs in women before 40 years of age.

Induced Menopause: Cessation of menstruation followed by bilateral oophorectomy (surgical menopause), or by any other surgeries  which can cause menopause

Perimenopause : The time period where a woman passes from the reproductive stage of life to the menopause. May starts about 8 years before menopause.

Early symptoms: Hot flashes, Insomnia, mood disturbances, irritability.

Intermediate physical changes:  Vaginal atrophy, skin atrophy, stress urinary incontinence.

Late diseases: Osteoporosis, Cardiovascular diseases, Dementia, Cancer.


  1. Understand menopause
  2. Stop smoking
  3. Have a nutritionally sound diet
  4. Achieve and maintain healthy weight
  5. Reduce stress
  6. Avoid excess alcohol
  7. Say no to drugs and unsafe sex
  8. Hormone Replacement Therapy: hormonal replacement therapy is given by gynecologists to few women after carefully weighing the risks and benefits.


  • Relief of severe menopausal symptoms
  • Contraindications:
  • Existing breast cancer
  • Existing endometrial cancer
  • Venous thromboembolism
  • Acute liver disease
  1. Exercise regularly
  •  Benefits of regular exercise:

                    – Decreases hot flashes

                    – Improves mood and sleep
                    – Decreases/maintains weight
                    – Supports joint/muscle flexibility
                    – Prevents bone loss
                    – Decreases risk of many other diseases



Dr. Y.Alekhya.



Endometriosis is a disorder in which tissue which normally lines the inside of your uterus called “the endometrium” tends to grows outside your uterus.

Endometriosis most commonly involves ovaries, fallopian tubes and the tissue lining the pelvis. Rarely, endometrial tissue may spread beyond pelvic organs.

The main cause of symptoms in case of endometriosis is that this displaced endometrial tissue continues to act as it normally would act inside the uterus. It thickens, breaks down and bleeds with each menstrual cycle. Since this displaced tissue has no way to exit the body, it becomes trapped. This trapped tissue tends to irritate the surrounding tissue which eventually causes scarring and adhesions of the tissues that can cause pelvic tissues and organs to stick to each other.

The symptoms of endometriosis vary. Some women experience mild symptoms while others can have moderate to severe symptoms. The most commonly experienced symptoms are-

  1. Painful periods (dysmenorrhea)- with cramps before and during periods.
  2. Pain with intercourse-Pain during or after sex is commonly felt by women with endometriosis.
  3. Pain with bowel movements or urination- most likely seen during periods
  4. Excessive bleeding
  5. Infertility-Endometriosis is first diagnosed usually in infertile women who are seeking treatment for infertility.
  6. lower back pain that may occur at any time during your menstrual cycle
  7. Other commonly seen symptoms-fatigue, diarrhoea, constipation, bloating or nausea, especially during menstrual periods

In order to diagnose endometriosis,  your gynaecologist may take a detailed medical history, perform a pelvic examination for you and in order to confirm the diagnosis, the following tests may be needed Ultrasound ,MRI , Laparoscopy.

The treatment is different for each woman and is mostly decided by the doctor based on the severity of the symptoms.

Both medical and surgical options are available.

Conservative treatment approach is advised first and if the treatment fails or does not provide the desired results, surgery can be opted for.

Tips to deal with the symptoms of endometriosis

  1. Take omega-3 fatty acids as they are known to act as natural anti-inflammatory agents and can help in dealing with pain and cramps associated with endometriosis.
  2. Avoid trans-fats and red meat
  3. Increase intake of fresh fruits and vegetables.
  4. Work out regularly- as it promoted blood circulation and helps in reducing stress.
  5. Limit caffeine and Alcohol .

It is best to have a consultation with your gynaecologist if you face any of the above symptoms.



Dr. Afroze Fatima