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

Treatment:

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.

References:

https://www.mayoclinic.org/diseases-conditions/menorrhagia/symptoms-causes/syc-20352829

https://www.healthline.com/health/womens-health/menometrorrhagia#self–management

By,

Dr. Y. Alekhya

 

Menopause

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.

Management:

  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.

Indications:

  • 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

References:

https://www.webmd.com/menopause/default.htm

https://www.healthline.com/health/menopause

By,

Dr. Y.Alekhya.

 

Endometriosis

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.

https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656

https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661

https://www.healthline.com/health/endometriosis

https://www.medicalnewstoday.com/articles/319692.php

https://www.healthline.com/nutrition/endometriosis-diet-tips

 

By,

Dr. Afroze Fatima

 

Oral Contraceptive Pills

The combined oral contraceptive pill (COCP), often referred to as the birth control pill or as “the pill”, is a type of birth control that is designed to be taken orally by women. It includes a combination of an oestrogen and progesterone.

Women take the pill by mouth to prevent pregnancy and it can be 99% effective if it’s taken correctly and continuously. However, the pill does not protect against sexually transmitted diseases, including HIV (the virus that causes AIDS).

What are the types of birth control pills?

Combination pills

Combination pills contain synthetic (man-made) forms of the hormones oestrogen and progestin. Most pills in each cycle are active, which means they contain hormones. The remaining pills are inactive, which means they don’t contain hormones. There are several types of combination pills like Monophasic pills(same dose of hormone in 1  cycle),Multiphasic pills(different levels of hormone in 1 cycle),extended pills(13 weeks cycle)

Progestin-only pills

Progestin-only pills contain progestin and no oestrogen. This type of pill is also called the mini pill. Progestin-only pills may be a good choice for women who can’t take oestrogen for health or other reasons.

Deciding on a type of birth control pill

Not every type of pill is a good fit for every woman. Talk to your doctor about which pill option would work best for you. Factors that can affect your choice include:

  •         your menstrual symptoms
  •         whether you are breastfeeding
  •         your cardiovascular health
  •         other chronic health conditions you may have
  •         other medications you may be taking

How do birth control pills work?

Combination pills work in two ways. First, they prevent your body from ovulating. This means that your ovaries won’t release an egg each month. Second, these pills cause your body to thicken your cervical mucus. This mucus is fluid around your cervix that helps sperm travel to your uterus so it can fertilize an egg. The thickened mucus helps prevent sperm from reaching the uterus.

Progestin-only pills also work in a few different ways. Mainly, they work by thickening your cervical mucus and by thinning your endometrium.

How do I use birth control pills?

You will receive a set of pills packaged in a thin strip. Pill packs containing regular birth control pills have either 21 or 28 pills.

Twenty-one-day pill packs contain 21 active pills.

Twenty-eight day pill packs contain 21 active pills and seven inactive (placebo) pills.

The pill packs are marked with the days of the week to remind you to take a pill every day. The seven inactive pills in the 28-day pill pack are added so that you are reminded to start a new pill pack after 28 days.

How Soon Do Birth Control Pills Work?

When taken as directed, birth control pills are usually effective the first month you begin taking them. To be safe, some doctors recommend the use of another form of birth control, such as condoms and foam, during the first month. After the first month, you can just rely on the pill for birth control.

What are the advantages?

  • Up to 99% effective
  • Easy to use
  • Doesn’t get in the way of sex
  • Lighter blood flow and lesser cramps.
  • As soon as you stop taking the pill, you can get pregnant
  • It reduces your risk of ovarian and endometrial (lining of the uterus) cancer by 50%
  • Some pills can help with pimples/acne, ectopic pregnancy, thinning of bones, anaemia associated with excessive blood loss during periods, and non-cancerous breast growths.

What are the disadvantages of birth control pills?

Birth control pills don’t protect against sexually transmitted infections. To make sure you’re protected against these infections, you need to use condoms in addition to your daily pill.

Also, you have to remember to take your pill every day. And you need to make sure you always have a new pack ready to go when you finish a pack. If you miss a pill or delay starting a new pack after finishing a cycle, your risk of pregnancy increases.

Are there any side effects?

Serious side effects are rare. Smokers have increased risk of stroke or heart disease.

Some pills can increase the risk of blood clots in the legs from 2 in 10,000 women per year to 6 times that rate.The risk of a blood clot from the pill is higher for certain women. This includes women who:

  •         are very overweight
  •         have high blood pressure
  •         are on bed rest for long periods

If any of these factors apply to you, talk with your doctor about the risks of using birth control pills.

We will discuss How to use Oral Contraceptive Pills in subsequent articles.

-Dr Prerna Gaur

Acknowledgements-

https://www.webmd.com/sex/birth-control/birth-control-pills#4

https://www.medicinenet.com/oral_contraceptives_birth_control_pills/article.htm

https://www.nhs.uk/conditions/contraception/combined-contraceptive-pill/

 

Fever in Pregnancy

It is a well-known fact that pregnancy is a state of low immunity. Fevers during pregnancy are not unusual.

It must be remembered that fever is only a symptom. Mild fevers that last only a short time usually are not a concern. If your temperature reaches 100 degrees F, consult your doctor.

It is advisable to keep an idea of the symptoms of few basic diseases causing fever. Reach out to your doctor if you have fever with any of the following signs –

Urinary Tract Infection(UTI) – in case of symptoms like high urge to urinate, sensation of burning while passing urine, cloudy urine or blood in it, pelvic pain, UTI must be suspected.

Common Cold – In situations when the infection persists beyond 2 weeks or if symptoms of common cold are getting worse, there is a high likelihood that the cause is much severe .Do not delay in such cases and immediately consult your doctor.

Influenza – if the fever is accompanied by chills, nausea, coughing, vomiting and body pains, then this might be influenza. Pregnant women are at higher risk of developing flu and can get seriously ill due to their suppressed immune system.

Gastrointestinal Virus – Besides fever, GI bug can cause vomiting and diarrhoea that may culminate in serious problems for pregnant mothers if not treated in time.

Important Do’s and Don’ts –

– A low fever in early pregnancy does not cause serious problem but having high fever is dangerous for baby. Therefore it is very important to get it in control as soon as possible.  Paracetamol is safe to be taken but not for more than 3 to 4 days without consulting the doctor..

– Even if fever subsides on its own or after taking paracetamol/acetaminophen, it’s always best to play it safe and see your doctor anyway

– Drink plenty of water and other cool beverages to prevent dehydration

– Take a tepid bath or shower or use a cool cloth on your head.

– If the fever is accompanied by vomiting or diarrhoea then Vital electrolytes lost through vomiting and diarrhoea, must be replenished.

– Consume balanced and healthy diet which contains fruits and vegetables. This healthy diet will supply you several antioxidant vitamins and minerals which helps in fighting infections

– Get plenty of rest when you have fever. Inactivity helps the body to stay cool and decreases falling and stumbling risk because of dizziness.

– If you are in your first trimester and have a fever higher than 102 degrees, be sure to seek treatment right away. This will help prevent short- and long-term complications for your developing baby

 

By,

Dr.Afroze Fatima

References

http://www.newkidscenter.com/Fever-During-Pregnancy.html

https://www.webmd.com/baby/tc/fever-during-pregnancy-topic-overview

https://www.healthline.com/health/pregnancy/could-fever-harm-my-baby#4

https://www.thebump.com/a/fever-during-pregnancy

https://www.whattoexpect.com/pregnancy/pregnancy-health/fever-during-pregnancy/

 

Postpartum depression

Being a new mother is a challenging phase as lots of adjustments are needed. Hence dealing with disruption of sleep wake cycle, responsibility of the baby, breastfeeding irregularities and recovery from the delivery is difficult. All these issues can lead to “Baby blues” or minor mood swings and irritability which generally disappears in a week or two post delivery without any treatment.

Postpartum depression is severe clinical depression after child birth.It can occur soon after delivery or within a year and requires treatment.

Causes of postpartum depression

Causes can be

  • Changes in body both before and after delivery
  • Changes in work and social relationships
  • Less time and freedom for leisure
  • Lack of sleep
  • Worrying about the ability to be a good mother
  • Inadequate support from the partner and family

What are the risk factors?

You may have a higher chance of developing postpartum depression, if you are

  • Under 20 years of age
  • Did not plan the pregnancy and have mixed feelings about it.
  • Had history of depression in the past or in the family
  • Have poor relationship with the partner, or a single parent
  • Financial and social issues
  • Currently drinks alcohol, smokes or takes illegal substances
  • Dealing with death, illness of a dear one

Symptoms of postpartum depression

Feelings of anxiety, restlessness, mood swings and tearfulness just after pregnancy is known as baby blues which mostly disappear in a week without treatment.

Postpartum depression may occur when the baby blues do not fade away or when signs of depression start 1 or more months after childbirth.

The symptoms of postpartum depression are the same as the symptoms of depression. Along with a sad or depressed mood, you may have some of the following symptoms:

  • Agitation or irritability
  • Changes in appetite
  • Feelings of worthlessness or guilt
  • Feeling like you are withdrawn or disconnected
  • Lack of pleasure or interest in most or all activities
  • Loss of concentration
  • Loss of energy
  • Problems in doing daily routine tasks
  • Significant anxiety
  • Thoughts of death or suicide
  • Troubled sleep

Also a mother with postpartum depression will be unable to take care of the baby and herself, will be afraid to be alone with the baby and may have negative feelings towards the baby.

Diagnosis

Diagnosis is made by the doctor on the basis of symptoms and history of your illness. If you feel you have any of the symptoms mentioned above, see your physician immediately.

Treatment

Treatment of postpartum depression includes medication and counselling. You may be advised appropriate medication which help in balancing certain brain chemicals linked to depression.

Counselling by a psychologist will help in dealing with the depression better. It helps in recognising negative feelings and handling them in a better way. So it is important to seek help of the psychiatrist as soon as the diagnosis is made.

If you’ve been diagnosed with postpartum depression, there are many things you can do to help yourself

  • Ask your partner, family, and friends for help with the baby’s needs and in the home.
  • DO NOT hide your feelings. Talk about them with your near ones.
  • DO NOT make any major life changes during pregnancy or right after giving birth.
  • DO NOT try to do too much, or to be perfect.
  • Make time to go out, visit friends, or spend time alone with your partner.
  • Rest as much as you can. Sleep when the baby is sleeping.
  • Talk with other mothers or join a support group.

Having good support of your family, partner and friends may help reduce the seriousness of the illness. Also timely diagnosis and treatment will help in quicker recovery. If you have any symptoms of depression as mentioned above, do not ignore it as just mood swings and seek medical help at the earliest.

-Dr Prerna Gaur

Acknowledgements

https://www.psychiatry.org/patients-families/postpartum-depression/what-is-postpartum-depression

https://www.nhs.uk/conditions/post-natal-depression/symptoms/

https://www.medicalnewstoday.com/articles/237109.php

 

Premenstrual syndrome (PMS)

PMS is a condition that affects women’s physical and mental health which typically begin from 2-7 days before menstruation and usually disappears as soon as the periods start.
PMS is frustrating not only for the women but also for those around her.

Symptoms:

  • Breast tenderness
  • Acne
  • Sudden Mood swings
  • Irritability
  • Bloating of stomach
  • weight gain(temporary)
  • Swelling of fingers, toes and face.
  • Depression
  • Lethargy
  • headache
  • Back pain
  • Joint pain
  • Food cravings
  • Irritability, mood swings, crying spells 

No one knows what causes PMS, but hormonal changes trigger the symptoms.

Risk factors:

Women who are at an increased risk of suffering from PMS :

  • Have a family history of PMS
  • Lead a sedentary lifestyle
  • Take an unhealthy diet
  • Are below 30 years of age
  • Have more than two children
  • Suffer from high-stress levels


Some Dos and Don’t for to manage PMS

Do’s:

  • Have a diet high in carbohydrate and low in fat
  • Consume foods rich in vitamin B6 and vitamin E like fish,whole grains, and wheat germ as well as green leafy vegetables and fruits.
  • Take calcium- rich foods such as milk, paneer, curd, fenugreek, drumstick leaves and ragi
  • Finding relaxing activities that relieve tension, such as reading, watching a movie, going for a walk, or having a bath
  • Regular walking, cycling abdominal and pelvic exercises
  • Stretching and breathing exercises, such as yoga
  • Quit smoking, if you are a smoker

Don’t

  1. Take foods containing caffeine like coffee, tea and chocolate in excess.
  2.  Take refined carbohydrates, sugars and tobacco.
  3. Take foods which are oily, fried and spicy.
  4. Skip meals. Follow a regular meal schedule to maintain a more stable blood sugar level.
  5. Sleep too little
  6. Drink alcohol.

When to see a doctor:
You need to visit a doctor if any of your symptoms especially your mood swings, depression, or abdomen, joint and muscle pains are interfering with your day to day activities, or if they do not go away even after menstruation has stopped.

Treatment:

  • Many women experience relief from PMS symptoms through lifestyle changes alone.
  • Over-the-counter pain relievers such as ibuprofen, aspirin or naproxen may help
  • For more severe cases though, your doctor may prescribe medicines such  as..
  1. Antidepressants
  2. Nonsteroidal anti-inflammatory drugs
  3. Diuretics
  4. Hormonal contraceptives
  5. Oestrogen-only patches and implants.
    Prognosis:
    In most women, PMS symptoms begin to subside after age 35. They end at menopause.

Dr. Krishna priya.

https://www.everydayhealth.com/pms/pms-articles.aspx

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418247/