Menarche is the first menstrual cycle or first menstrual bleeding in women.

Normal cycle: The normal length of a woman’s menstrual cycle is 28 days, but this varies between individuals. Irregular menstruation is when the length of the cycle is more than 35 days, or less than 21 days, generally.

Reproductive age: Periods usually start during puberty between the age of 10 and 16 years, and they continue until menopause when a woman is 45 to 55-years old.

A period, or menstruation, is the part of the menstrual cycle in which endometrium, which is the lining of the uterus, is shed in the form of bleeding through the vagina.

Irregular periods can occur if there is a change in contraception method, a hormone imbalance, around the time of the menopause, stress, weight and diet changes, PCOS, hypothyroidism, etc.


Various factors that may be related to irregular cycles are mostly related to hormone production. The two hormones that impact menstruation are estrogen and progesterone that regulate the cycle.

Hormonal influences

Life cycle changes that influence the hormonal balance include puberty, pregnancy and childbirth, breastfeeding and menopause.

During puberty, the body undergoes major changes. It can take several years for the estrogen and progesterone to reach a balance, and irregular periods are common at a young age.

Periods are generally absent in pregnant and breastfeeding women.

Contraceptives can cause irregular bleeding. An intrauterine device (IUD) may cause heavy bleeding, whereas, the contraceptive pill can cause spotting between periods with small bleeds that are generally shorter and lighter than normal periods for the first few cycles of about 3-6 months and may go away after a few months.

Before menopause, women often have irregular periods, and the amount of bloodshed may decrease gradually, that may eventually stop. Menopause can be considered when a woman has no period for about 12 consecutive cycles.

Medical Conditions that are associated with irregular periods include:

  • Polycystic ovarian syndrome (PCOS) is a condition in which a number of small, fluid-filled sacs known as cysts develop in the ovaries.
  •  thyroid disorder can cause irregular periods. The thyroid gland produces hormones that affect the body’s metabolism.
  • extreme weight loss
  • extreme weight gain
  • emotional stress
  • eating disorders, such as anorexia or bulimia
  • Endurance exercise, for example, marathon running.

A number of other medical conditions are also linked to missed or irregular menstruation.

Endometriosis is a condition in which cells that are normally found inside the uterus, called endometrial cells, grow outside it. In other words, the lining of the inside of the uterus is found outside of it. If released blood gets stuck in the surrounding tissue, it can damage the tissue, causing severe pain, irregular periods, and infertility.

Pelvic inflammatory disease (PID) is an infection of the female reproductive system. Most common symptoms include bleeding between periods and after sex, lower abdomen pain, foul-smelling vaginal discharge, etc.

Cervical or uterine cancer (cancer of the womb) these may cause bleeding between periods, after menopause or during sexual intercourse.


The primary mode of treatment may generally be directed towards treatment of the underlying cause or medical condition if needed.

Puberty and menopause: Irregular periods that occur during puberty or as the woman approaches menopause do not usually need treatment.

Birth control: If irregular bleeding is due to contraception, and if it continues for more than 3-6 months, discussing other options with a health-care professional may be a good idea.

PCOS and obesity: In cases of PCOS, overweight or obesity, losing weight may help stabilize menstruation. Lower weight means the body does not need to produce so much insulin. This leads to lower testosterone levels and a better chance of ovulating.

Thyroid problems: Treatment for the underlying problem is likely to be, that may include medication, radioactive iodine therapy or surgery.

Stress and eating disorders: Psychological therapy may help if emotional stress, an eating disorder, or sudden weight loss have triggered irregular periods. This may include relaxation techniques, stress management and talking to a therapist.

Endometriosis, PID: treatment is targeted to the underlying condition.

………………………………………………. Dr krishna priya


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Management of Snake bite

India is a country known to the western population as a country of snake charmers. Snake-bites are well-known medical emergencies in many parts of the world, especially in rural areas and India is one among them. 

Rural farmers and livestock workers and their children are commonly affected.

The estimated number of deaths in India due to snakebite is almost 50 thousand/year. There is also a lack of proper registration of snake bite.

Most of the snake bites do not harm the patient apart from causing panic attack and local injury. However, there are 13 known species that are poisonous and of these four, namely common cobra, saw-scaled viper, common krait  and Russell’s viper, are highly venomous and believed to be responsible for most of the poisonous bites in India.

For the management of snake bite it is important to know the species of the snake responsible for the bite. This may be achieved by identifying the dead snake or by inference from the clinical syndrome of envenoming. 

First Aid:

Currently recommended first aid is based around the mnemonic  “CARRY NO RIGHT”  It consists of the following: 

  1. CARRY = Do not allow victim to walk even for a short distance; just carry him in any form, especially when bite is at leg. 
  2. No– Tourniquet, No- Electrotherapy, No- Cutting, No- Pressure immobilization Nitric oxide donor (Nitrogesic ointment/ Nitrate Spray) 3. R– Reassure the patient. Most of the snake bites are from non venomous species. Among them only 50% of bites by venomous species actually envenomate and cause harm to the patient.
  3. I = Immobilize in the same way as a fractured limb. Use bandages or cloth to hold the splints, avoid blocking the blood supply or applying more pressure which won’t help. Tight ligatures, they don’t work and can be dangerous! 
  4. GH= Get to Hospital Immediately. 
  5. T= Tell the Doctor of any systemic symptoms that manifest on the way to hospital. 

Traditional remedies have NO PROVEN benefit in treating snakebite. 

Get the victim to the hospital quickly, without recourse to traditional medical approaches which can dangerously delay effective treatment. 


A few milliliters of fresh venous blood is placed in a new, clean and dry, glass vessel and left at ambient temperature for 20 minutes. After 20 minutes gentle tilting without shaking can be done to see if the patient is having incoagulable blood. If a blood clot  is present, the test result is negative, whereas if no clot forms and the blood remains liquid, the test result is positive, indicating the presence of coagulopathy and the need for antivenom treatment.


  1. Antivenom is the only effective antidote for snake venom and is an essential element of treatment for bites by poisonous snakes.
  2. Indications for antivenom include signs of systemic and/or severe local envenoming. Judicious use of antivenom saves people from unwanted antivenom reactions, and saves people who really needed it.
  3. Antivenom should be given by slow intravenous injection or infusion to prevent complications.
  4. Epinephrine (adrenaline) should kept ready as it is given if there is any antivenom reaction.
  5. When no antivenom is available, judicious conservative treatment can save the life of the patient.
  6. Never give painkillers(NSAIDs) which can cause more bleeding.
  7. Never give Morphine- can cause respiratory failure
  8. If the patient is unable to perform a neck lift then they will be transferred to a higher centre with mechanical ventilatory capability.
  9. The rational application of ASV and repeat doses as needed has resulted in patients being discharged earlier.

Preventive measures to avoid snake bite:

Be aware of your surroundings. If you see a snake, back away slowly, let it go away or walk carefully around it. No matter what type of snake it is, do not attempt to handle, kill or trap it.

Other snake-bite preventive measures:

  •  Avoid walking in tall grass and fallen leaves, if you must work over there, be careful during that time.
  • Avoid climbing on rocks or piles of Wood.
  • Snakes are more active during the night and in warm weather, be aware during that time.
  • Wear boots and long pants when working outdoors; snakes can bite through some types of clothing and footwear.
  • Wear leather gloves when handling brush and debris.
  • Make noise, snakes will avoid people if given enough warning.
  • Take added precautions in the event of drought conditions or a natural disaster such as a hurricane, fire or flood. Snakes may be forced from their natural habitats and into areas where they would not normally be seen or expected, including houses. 
  • Finally, if you live in an area where snakes are prevalent, know which snakes are commonly present in your area and learn how to recognize the snake species. 


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                                                                            Dr. Y. Alekhya.

Flatulence – all you need to know about bloating

Flatulence is the passage of gas from the digestive system. We know it more commonly as “passing wind” or “farting”. Even though farting is laughed about and is a topic of jokes, it is worthwhile to know that it is a normal biological process. It is something everyone experiences on a regular basis! An average person passes gas 14 to 23 times a day. Even though it is absolutely normal, excessive flatulence or farting is not only embarrassing but also may indicate underlying digestive issues.

One cause of passing gasses is that when we eat food, we tend to swallow small quantities of air which collects in the digestive system and after passing through the entire gut, it is passed out as gas. 

One other cause is that the friendly bacteria in our gut help digest foods that our bodies have trouble breaking down, these bacteria also produce gas.

 Some eating habits such as eating too fast, over-eating, not chewing food properly and eating food with high-fat content may cause excessive gassiness. 

Certain underlying health conditions of the gut, such as indigestion or irritable bowel syndrome may also cause increased flatulence. Being sedentary, lack of exercise and stress are also known causes of bloating and flatulence.

Tips to control Flatulence- The main target to treat gas problems is to change your diet and train yourself to swallow less air.

  1. Eat slowly and chew your food well.
  2. Identify the foods/drinks that cause bloating in you and avoid them through the elimination diet (eliminate foods that cause gastric distress by identifying them)
  3. If you constantly suffer from bloating and gassiness many days in a row then it is best to avoid overeating- eat small foods in regular planned intervals.
  4. Being physically active-Walking, bicycling, running, and other forms of exercise can help move gas through your digestive tract, easing bloating and thus reducing flatulence.
  5. Reduce or quit smoking.
  6. Avoid taking fizzy/carbonated drinks.
  7. Learn to manage your stress well. Practicing ways to reduce stress and anxiety, such as breathing exercises or progressive muscle relaxation, may help reduce acidity, bloating and excess gas.
  8. Dairy products can be a source of intestinal distress and bloating if you have trouble digesting lactose, or milk sugar. It is best to observe if you suffer flatulence on taking these and discuss it with your doctor.
  9. Whole grains are very healthy due to their high fiber content. But fiber is an indigestible carbohydrate and therefore sudden increase in the number of whole grains/fiber in your diet may cause gas, bloating. It is advised by nutritionists to slowly increase the fiber content in your diet to allow your body time to adjust and at the same time, increase water intake.
  10. Ensure the proper movement of food through the digestive tract by hydrating well in between meals with pure water. Proper hydration is important in removing waste from the body because it lubricates fiber causing it to swell preventing it from becoming stagnant along the digestive tract.  Moving things through your system minimizes fermentation and reduces gas formation.
  11. Adding probiotics to the diet can really help.

Temporary bloating or flatulence is nothing to worry about. But if you’re troubled with them on a regular basis, it is important to discuss the possibilities with your doctor.

Written by 

Dr. Afroze Fatima



Mumps is a viral infection that primarily affects the salivary glands(glands which produce saliva) which are located near your ear. It is a contagious disease that spreads from person to person through saliva, nasal secretions, and close personal contact.

Who is affected?

Most cases of mumps occur in young adults who have not received MMR vaccine as a part of the vaccination schedule in their childhood or didn’t have mumps as a child. Once exposed to mumps virus through infection or vaccination, there is lifelong immunity for any further infection.


Symptoms appear 2-3 weeks after exposure to the virus. The primary sign of mumps is swollen salivary glands that cause puffy cheeks. Other signs and symptoms may include:

  • Pain and swelling in the  salivary glands on one or both sides of your face
  • Pain while chewing or swallowing
  • High grade fever
  • Headache
  • Muscle aches
  • Weakness and fatigue
  • Loss of appetite


Mumps is caused by a virus hence antibiotics are ineffective however symptomatic treatment is advised. Follow these tips-

  • Rest when you feel weak or tired.
  • You can take OTC pain relievers, such as acetaminophen and ibuprofen, to bring down your fever.
  • Soothe swollen glands by applying ice packs.
  • Drink plenty of fluids 
  • Eat semi-solid diet of soup, yogurt, and other foods that aren’t hard to chew (chewing may be painful when your glands are swollen).
  • Avoid foods and beverages that are acidic that may cause more pain in your salivary glands.

You may be advised to return to work/school in seven days after the diagnosis as it is no longer contagious. 


Complication of mumps is rare but serious if left untreated.

  • Inflammation of the testicles(Orchitis)  in boys may be due to mumps. 
  • Females infected with mumps may have swelling of the ovaries. The inflammation can be painful but doesn’t harm a woman’s eggs. However, if a woman contracts mumps during pregnancy, there is a higher-than-normal risk of experiencing a miscarriage.
  • Meningitis(inflammation of the brain lining), Encephalitis(inflammation of the brain).
  • Pancreatitis (inflammation of the pancreas)

Vaccination for mumps

Vaccination can prevent mumps. Most children receive a vaccine for measles, mumps, and rubella (MMR) at the same time. The first MMR shot is generally given between the ages of 9 months at a routine child visit. A second vaccination is given between 15-18 months. 

Consult your doctor about an immunization schedule for you and your children.

-Dr Prerna Gaur


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Are you feeling postpartum blues?

Are you feeling postpartum blues? Are you finding new responsibilities, lack of sleep, and not having time for yourself challenging?

Do not worry, you are not alone. It is a very common finding amongst new mothers to have issues like mood swings, crying spells, anxiety, sadness, irritability, feeling overwhelmed and difficulty in sleeping. Baby blues typically begin within the first two to three days after delivery and may last up to two weeks to six months.

Postpartum depression is not a character flaw or a weakness

Sometimes it’s simply a complication of giving birth. If you have postpartum blues, prompt treatment can help you manage your symptoms and help you bond with the baby.

If you’re feeling depressed after your baby’s birth, you may be reluctant or embarrassed to admit it. Sometimes it goes away on its own within three months of giving birth. But if it interferes with your normal functioning at any time, or if it lasts longer than two weeks, you should seek treatment. Talk to a doctor on ekincare, anytime you need to. 

About 90% of women with postpartum depression can be treated successfully with a combination of medication and psychotherapy.

Also, with the help of family and friends and with the correct diagnosis you will be able to cope with it well.

Ask for help for household chores, set aside quality time for yourself, spend time with spouse, try and follow a sleep schedule, eat meals on time and start with exercise and meditation and you will bounce back to your usual self in no time. Take up simple challenges on ekincare to motivate yourself! 

-Dr Prerna Gaur

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Adenoids are made of lymph tissue and are located in the space above the roof of the mouth and are not visible through your Child’s throat. They help in fighting infections. They may cause a problem if they increase in size due to inflammation leading to adenoiditis.


  • Breathing through mouth 
  • Noisy breathing 
  • Snoring 
  • Nasal speech 
  • Restless sleep 


Adenoids can be swollen for different reasons.  There can be enlarged adenoids at birth or the body is fighting an active infection leading to swelling of adenoids.


Have to consult an ENT specialist who will take a detailed medical history and examine the child’s throat and neck for any swellings.

Doctor may use 

  • A special mirror to visualize the back of the throat where adenoids are located 
  • An x-ray may be suggested to rule out the growth of adenoids 


It depends on the severity of the condition.


If symptoms are not too bad he or she may not need any treatment. Some nasal spray will be advised to reduce the swelling and along with the antibiotic course to control the infection.


In some cases, the doctor may decide to go with the removal of adenoids.

These are

  • Repeated infections of adenoids, causing ear infections and fluid buildup in ears 
  • In cases where antibiotics are not able to get rid of the infection 
  • If they block the airways leading to breathing problems.





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Why get a uric acid test done?

The uric acid test is most often used to:

  • Help diagnose gout 
  • Help find the cause for frequent kidney stones 
  • Monitor uric acid levels in people undergoing chemotherapy or radiation therapy 

When to get tested?

  • When you have joint pain or swelling in joints, especially the big toe, ankle or knee.
  • Reddish shiny skin around.
  • Joints that feel warm when touched.

What is uric acid?

Uric acid is generally produced in our body and is excreted out in urine as a waste product of metabolism. In some people, the body produces excess uric acid or the produced uric acid is not excreted by the kidneys in urine, which leads to increased concentration of acid levels leading to hyperuricemia. in some people, the uric acid gets deposited in the joints causing pain and inflammation leading to a diseased condition called gout.

Factors causing high uric acid levels:

  • Drinking too much alcohol 
  • Genetics
  • hypothyroidism 
  • obesity 
  • psoriasis 
  • purine-rich diet 
  • renal insufficiency 

Tips to lower uric acid levels:

  • Maintain a healthy weight 
  • Drink plenty of fluids 
  • Consume low-fat  dairy products 
  • Avoid excessive consumption of meat and seafood.
  • Avoid too much alcohol which interferes with uric acid elimination.

It’s always better to consult a doctor before getting the test done so proper evaluation can be done to rule out the possible diagnosis.




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Menarche is the name given to the time when a girl has her first period.

When you start your period, you’ll notice a spot of blood on your underwear or when you use the bathroom. The flow of blood from your vagina is usually light at first and may get heavier for a few days before tapering off. The blood may be a brownish color at first and then turn brighter red. Your period will usually last 3 to 7 days each month.

The age at which menarche happens varies from person to person. Most girls experience the menarche between the ages of 10 and 14 years. This age has been dropping for several years, probably due to improved nutrition and better social conditions

It is uncommon for a regular menstrual cycle to follow the first period. Periods tend to occur in a haphazard way for the first year or 2 before settling into a regular pattern, which is usually once every 24 to 30 days.

Before their first period arrives, most girls will have shown the early signs of puberty — the beginnings of breast development and fine hair growth in the pubic region and axilla (armpit).

Talk early and often:

  • The earlier you begin talking to your child about the changes to expect during puberty, the better.
  • Your child needs to know the facts about the menstrual cycle and all the changes that puberty brings.
  • Some girls experience their first period without knowing what it is, which can be a frightening experience. For this reason it is important for parents to prepare their daughters in advance for the changes associated with growing up.
  • Talking to your child can help eliminate unfounded fears or anxiety, as well as positively influence your child’s body image. Also, the conversations you have with your child about menstruation can lay the groundwork for future talks about sexuality and other intimate issues..

Practical advice preferred:

Your child might want to know when it’s going to happen, what it’s going to feel like and what to do when the time comes.

What is menstruation? Menstruation means the body is physically capable of becoming pregnant. 

When will it happen? No one can tell exactly when a first period will occur. Typically, however, menstruation begins about two years after breasts begin to develop.

How long does it last? The first few periods will likely be light — with only a few spots of blood occurring. Most periods last from three to five days, but anywhere from two to seven days is normal.

Does it hurt? Common symptoms include cramps in the lower abdomen or back or breast tenderness just before and during periods. Headaches, dizziness, nausea and diarrhea also are possible. Exercise, warm baths, a heating pad or an over-the-counter pain reliever can help ease discomfort.

What should I do? Explain how to use sanitary pads, tampons and menstrual cups and the importance of changing them regularly — every four to eight hours for pads and tampons and every eight to 12 hours for menstrual cups. Stock the bathroom with various types of sanitary products ahead of time. Encourage your child to experiment to find the product that works best.
 Explain that pads, tampons and menstrual cups aren’t visible through clothing. Encourage your child to carry supplies in a backpack, purse or locker — just in case

Schedule a medical check-up if your child:

  • Hasn’t started menstruating by age 15 or within three years of the start of breast growth — or breasts haven’t started to grow by age 13
  • Goes three months without a period after beginning menstruation or suspects pregnancy
  • Has periods that occur more frequently than every 21 days or less frequently than every 45 days
  • Has periods that become irregular after having been regular
  • Has periods that last more than seven days
  • Has severe pain during periods
  • Is bleeding between periods
  • Is bleeding more heavily than usual or using more than one pad or tampon every one to two hours
  • Suddenly gets a fever and feels sick after using a tampon




Plantar aspect of the foot is nothing but the sole of the foot. The foot has a thick, fibrous band of tissue called “fascia” extending from the heel to the toes. This tissue supports the muscles on the sole of the foot. Pain on the sole of feet and heel pain are most commonly caused by stretching of this tissue causing inflammation called Plantar Fasciitis.

Stretched and strained muscles of the sole of feet and fasciitis can cause heel spurs and heel pain.It is more common in women than in men. It is commonly seen in athletes, in individuals who stand/walk for several hours in a day, individuals who wear high heels, are overweight, individuals who wear shoes/footwear with thin soles, etc.

Exercises, that help in attaining relief are:

  • Stretching exercises of feet, heel (Achilles tendon), calf (lower leg) muscles, etc. primarily help with relief.
  • Activities such as swimming, cycling may be a good idea as these do not affect/worsen the pain over the sole of feet because these activities do not cause strain on the muscles of the sole of feet.
  • Curling and relaxing of toes, making circular movements at ankles help.
  • Avoid running, jumping, walking for a long duration until the pain subsides.
  • Sit down, place one foot over the other leg, hold the toes and bend them backward gently. This helps in stretching the sole of the foot.
  • Stand facing a wall, place two hands on the wall, place one foot behind the other foot but parallel to each other and lean slightly on the wall with heel still in contact with the ground (without lifting heel above ground), hold for 10 seconds and switch feet. Repeat several times. This helps in stretching calf muscles.
  • Sit down and roll foot back and forth on a frozen/ice packed water bottle for a minute and switch to other foot. 
  • Sit down, place a small folded towel under soles (arches) of foot and pull the towel towards your body by holding the towel ends with both hands for 15-30 seconds, switch feet and repeat.

                                                                                    -Dr. Divya Teja Pasupuleti


Dental Hypersensitivity

Dental hypersensitivity is an oral condition characterized by a sharp pain in the affected tooth or teeth. It occurs when the dentin is exposed to any stimuli. It is reported more in females than males. It majorly impacted canines, premolars of both arches. Its prevalence peaks among the age group of 20 to 40 years.

Causes of Dental Hypersensitivity:

Dentin exposure progresses in phases, initially starting as a local lesion with the erosion of enamel, and then further progressing to exposure of dentin tubules. Major factors leading to this are:

  1. Gingival recession: Gingival recession is the exposure of dentin in the roots of the teeth from loss of gum tissue over the root of the teeth. It usually occurs in people with poor oral hygiene and happens due to improper tooth brushing or excessive brushing.
  2. Tooth wear and tear:
  •       Tooth abrasion – Tooth loses its enamel if exposed to vigorous brushing, or consumption of low pH oral fluids.
  •       Tooth attrition – Tooth to tooth contact during excessive teeth grinding or jaw clenching causes damage to the tooth enamel.
  •       Tooth erosion – Repeated exposure of teeth to anaerobic chemical processes or acids whether by consumption of acidic foods or by regurgitation
  1. Age: With increasing age, primary dentin starts wearing off but secondary dentin is deposited and restored throughout life.

Risk factors of dental hypersensitivity:

  • People who have heavy acidic diets or drinks or have frequent munching habits are at high risk.
  • Consuming large amounts of beverages in the form of carbonated drinks, canned juices, beer, flavored waters, machine prepared tea or coffee, energy drinks, sour candies, are at high risk.
  •  People with a history of gastroesophageal reflux disease, gastritis, pregnant women, and people on chemotherapy are at high risk.
  •  Dry mouth disorder, that is people with inadequate saliva formation are at high risk

Diagnosis of Dental Hypersensitivity:

Diagnosis depends on a thorough clinical examination.

  • Response to pain upon tapping the teeth to rule out inflammation of the dental pulp
  •  Response to pain on biting a hard surface, like a wooden stick to rule out a fracture
  •  Dental X-ray  diagnoses fractures of the tooth
  •   The affected area is exposed to a jet of air to examine if there is any pain.

Treatment for Dental Hypersensitivity:

If it is in the initial stages, the doctor would recommend some self-care measures like:

  •  Many over the counter toothpaste available in the market are the most cost-effective way of dealing with dental hypersensitivity.
  •   Brushing is an important part of oral hygiene, great attention needs to be given to the correct way of brushing the teeth.
  • Teeth need to be brushed twice a day with a soft bristled brush.
  • The size and the shape of the brush are very important as it should fit in the mouth properly.
  • A toothbrush needs to be changed every three or four months. If the bristles of the toothbrush are frayed, it needs to be changed immediately.
  • Dental Associations recommend only fluoride toothpaste should be used.
  • The toothbrush should be placed at an angle of 45-degree to the gums and brushing needs to be done back and forth in short strokes in a smooth way.
  • The entire mouth needs to be brushed, the outer, inner and chewing surfaces of the teeth.
  • Do not put excessive pressure while brushing.
  • Use toothpaste containing sodium fluoride and calcium phosphates. The most recommended ones are the toothpaste containing potassium nitrate.
  • Use mouthwash containing potassium or sodium salts to gurgle following any food intake.
  • Reduce the quantity of acidic and high carbonated food intake.
  • Avoid brushing teeth following intake acidic food or drinks.
  • Keep a gap between food intake, and after every meal rinse your mouth with water.

The dentist may recommend the application of desensitizing agents or nerve desensitization therapies to reduce the pain such as

  •         Occlusive therapy
  •         Laser therapy
  •         Ozone therapy
  •         Application of resin-based materials
  •         Use of oxalates
  •         Gingival Grafts

-Dr.Surampally Bhavani Sagar