Everything you need to know about delayed menstrual periods

A delayed period can be really stressful for women who usually have regular periods. The best way to deal with this anxiety is to educate oneself about the situation.

The first and the most important thing is to know what is normal and what is abnormal so that you are not stressed by a mere normal variation of your menstrual cycle! 

 Menstrual cycle: The time from the day a menstrual period starts to the time the next period starts. 

An average menstrual cycle is about 28 days long. However, a normal cycle may be shorter or longer and may range anywhere from 21 to 35 days long. 

The factors that may cause variation in a menstrual cycle are- Stress, travel, diet, illness, medication, contraceptive pills, excessive exercise, being on extremes of body weight range-either low weight or overweight, hormonal imbalances such as thyroid hormone imbalances and PCOS (polycystic ovarian syndrome), infections of the genital tract.

To know if or not your period is actually delayed, it is important that you have regular cycles – the dates and the length of the cycle must be known to you. It can be difficult to know for sure if your period is late if you don’t know your average cycle length and the date of your last period. 

Quick tip 1- if you have trouble remembering the dates or maintaining calendars- there are many apps online that can help you. Downloading one and feeding the date per month can really help.

If you have a regular cycle then a variation of 5-7days is considered to be normal. A menstrual period is considered to be late if it hasn’t started 7 or more days after the day you expected it to start. A period is said to be missed if there is no menstrual flow for 6 or more weeks after the start of the last period.

What is to be done in case of the delayed or missed period depends on the following factors-

Whether you have a regular cycle or not

Whether you are sexually active or not; If sexually active, whether you are using contraception; If yes, which method?

Whether you suffer from any major hormonal imbalance disorders such as hypothyroidism or PCOS or any other chronic health issues

If your cycles are regular and you have been sexually active, then it is advised to take a pregnancy test if your period is around 9-10 days late. In case of getting a negative result, it is advisable to wait for another week and repeat the test. If your cycles are irregular and you have been sexually active then you can take a pregnancy test about two weeks after your last unprotected sexual encounter.

If you are not sexually active and yet have missed periods, it is advisable to visit your doctor after observing for at least 1 more cycle.

If the pregnancy tests came out to be negative and you still haven’t had a period in more than 90 days, it is important to meet with your doctor for a detailed evaluation and testing on what could be the cause in delay of the period.

Quick tip 2- having a log of periods (dates, duration, any stressful activities, changes in diet, recent fitness activity, any recent illness, any changes that were observed in the previous period) for at least a month before visiting your doctor can come really handy!

Written by-

Dr. Afroze Fatima

 

https://helloclue.com/articles/cycle-a-z/why-is-my-period-late

https://www.summitmedicalgroup.com/library/pediatric_health/hhg_period_late_or_missed/

https://www.healthline.com/health/womens-health/why-is-my-period-late

https://www.medicalnewstoday.com/articles/318317.php

https://www.beingtheparent.com/what-to-do-when-my-periods-are-late/

https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/menstrual-cycle/art-20047186

https://newsnetwork.mayoclinic.org/discussion/many-possible-causes-of-irregular-periods/

https://connect.mayoclinic.org/discussion/reasons-for-a-late-period/

 

BARTHOLIN’S CYST

Bartholin glands are located on either side of the vaginal wall opening. These glands help secrete fluids which lubricate the vagina.

In some cases these glands become obstructed, causing the fluid to back up in the gland leading to formation of the cyst. It is called as bartholins cyst.

If the fluid in the cyst becomes infected you may develop collection of pus surrounded by inflamed tissue.

Symptoms:

If the cyst becomes infected, you may experience:

  • Painful lump near the vaginal opening
  • Pain during intercourse
  • Fever
  • Discomfort while walking and sitting

Diagnosis:

Only a doctor can tell you for sure. She/he will physically examine and if there is abscess or pus formation then he/she may take a culture of it and send it to lab.

Treatment:

Most of the cases don’t require any treatment if there are no symptoms.

Sometimes treatment depends on severity of the symptoms

Treatment options include:

Sitz baths:  soaking in tub filled with warm water three to four times a day may rupture the cyst and drain on its own.

Surgical drainage: large cysts are drained by making incision which can be done under local anesthesia.

Antibiotics: if the culture reports are indicative of infection, then antibiotics are prescribed for a period of time.

Prevention:

It is not clear why bartholin’s cysts develop. But it can be prevented by taking few measures such as

  • Practicing safe sex
  • Prevent sexually transmitted diseases
  • Maintaining Personal hygiene

                                                                                                                            …….. Dr.chandrashekar

 

Reference:

https://www.nhs.uk/conditions/bartholins-cyst/

https://www.mayoclinic.org/diseases-conditions/bartholin-cyst/diagnosis-treatment/drc-20369981

https://www.webmd.com/women/guide/bartholins-gland-cyst#2

 

Missed abortion

A miscarriage is the loss of foetus before 20 weeks of pregnancy. It is also called silent abortion.

A missed abortion gets its name because this type of miscarriage doesn’t cause symptoms of bleeding and cramps that occur in other types of miscarriages. This can make it difficult for you to know that the loss has occurred.  

Causes of missed abortion

The causes of missed abortion are not fully known. About 50% of miscarriages happen because the embryo has the wrong number of chromosomes. Other causes can be-

  • Uterine scarring
  • Heavy smoker
  • Autoimmune disease
  • Physical trauma

If you have a missed miscarriage, your doctor most likely won’t be able to pinpoint a reason. In a missed miscarriage, the embryo simply stops developing and there’s usually no clear explanation.

Symptoms

It is common to have no symptoms with a missed abortion. There may be a slight brownish discharge or pregnancy symptoms like nausea, breast tenderness lessen or disappear.

How is missed abortion diagnosed?

After a diagnosis of pregnancy, a woman may not have any obvious symptoms and  missed miscarriage may be diagnosed by ultrasound before 20 weeks gestation. Usually, the doctor diagnoses it when they cannot detect a heartbeat at a prenatal checkup. In pregnancy less than 10 weeks, your doctor will check for Hcg hormone in the blood.  If the hCG level doesn’t rise at a typical rate, it’s a sign the pregnancy has ended.

Treatment

Expectant management-This is a wait and watch approach. In almost 65% of the cases, missed abortion is left untreated and the embryonic tissue passes on its own. If it’s not successful,  medication or a minor procedure may be needed to pass the embryonic tissue and placenta.

Medical management- In this, you may be advised to take tablet misoprostol by your doctor which triggers the passing of remaining embryonic tissue to complete the abortion.

Surgical management-Dilation and curettage (D&C) surgery may be necessary to remove remaining tissue from the uterus. Your doctor may recommend a D&C immediately following your diagnosis of a missed miscarriage, or they may recommend it later if the tissue doesn’t pass on its own or with the use of medication.

Usually normal periods return after 4-6 weeks, physical recovery takes weeks to months and emotional recovery takes longer.

Your doctor might recommend waiting for at least three months after the miscarriage before trying to conceive again.

If you feel you have missed your periods and developed initial signs or pregnancy like nausea, vomiting, breast tenderness or fatigue which disappear abruptly, there may be strong suspect of missed abortion and you should see your doctor at the earliest.

-Dr Prerna Gaur

Acknowledgements-

https://www.ajog.org/article/0002-9378(69)90688-7/fulltext

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC536088/

 

Pic Credits: Internet

 

Injectable contraceptives

Depo-Provera (medroxyprogesterone acetate or DMPA) is a form of birth control. It is an injection, or shot, that contains progestin. This is a natural hormone that your ovaries produce each month as part of your menstrual cycle.

How does it work?

Depo-Provera prevents pregnancy by stopping ovulation (the release of an egg by your ovaries). It thickens your cervical mucus, which makes it hard for sperm to reach and fertilize an egg. It also thins your uterine lining, which makes it hard for a fertilized egg to implant, or attach, to your uterus.

How is it administered?

Your doctor will give you the injection in either in your upper arm or buttock. It is given into  your muscle (intramuscular).

Depo-Provera works for about 3 months at a time. To prevent pregnancy, you have to get 1 shot from your doctor 4 times a year, about 12 to 14 weeks apart. If you get it in the first 7 days of your cycle, it works right away. If you don’t, you’ll need to use another form of birth control for 1 week. Your doctor will confirm you are not pregnant before giving you the injection.

What is the effect of DMPA on periods?

Most women who use Depo-Provera have changes in their menstrual periods. These may include:

  • bleeding or spotting between menstrual periods
  • an increase or decrease in menstrual bleeding or no menstrual bleeding at all

About half of women who use Depo-Provera stop having periods after 1 year. This is not harmful. Menstrual bleeding usually returns to normal when you stop using Depo-Provera. It may take about 9 to 10 months to get pregnant after your last shot.

What are the advantages?

  • Convenient, requires only four shots per year
  • Discreet
  • Very effective
  • Reversible
  • Very light or no periods beneficial in conditions like iron deficiency anemia,excessive bleeding,cramping during periods. May be a desired lifestyle change; can also decrease the risk of dysfunctional menstrual bleeding in women who are overweight.
  • Lack of estrogen in DMPA makes it appropriate for smokers older than age 35, postpartum, breastfeeding women, and others who have contraindications to estrogen.

What are the disadvantages?

  • Requires visit to clinician for quarterly injection.
  • Initial irregular bleeding
  • Weight gain may occur in some women due to increased appetite, particularly those who are sedentary or overweight when they begin DMPA.
  • Short term reversible bone mineral density loss.
  • Delayed return to fertility: the median time to conception for those who do conceive is 10 months after the last injection, much longer than with other hormonal methods.
  • No protection against STIs.

 What are the possible side effects?

  • weight gain
  • headaches
  • nervousness
  • abdominal pain
  • dizziness
  • weakness or fatigue
  • osteoporosis (loss of bone density)
  • blood clots

Contact your doctor right away if you have abnormally heavy or nonstop bleeding.

Also To renew your DMPA prescription you will need to see a doctor for review once a year. A review of risks for loss of bone density (osteoporosis) will take place at this visit.

Injectable contraceptive is a good option for you if you choose to use contraception methods at a leisure and to avoid daily usage of pills or insertion of IUDs.Discuss with your doctor if DMPA is a good choice for you keeping in mind the risks and benefits.

Acknowledgements

https://www.ncbi.nlm.nih.gov/books/NBK51044/

https://www.cdc.gov/reproductivehealth/contraception/mmwr/spr/injectables.html

https://www.uptodate.com/contents/depot-medroxyprogesterone-acetate-for-contraception

-Dr Prerna Gaur

Pain during menstruation

Menstrual cramps (dysmenorrhea) are throbbing or cramping pains in the lower abdomen. Many women experience menstrual cramps just before and during their menstrual periods.

For some women, the discomfort is merely annoying. For others, menstrual cramps can be severe enough to interfere with everyday activities for a few days every month.

Menstrual cramps that aren’t caused by an underlying condition tend to lessen with age and often improve once a woman has given birth.

Symptoms:

Symptoms of menstrual cramps include:

  • Throbbing or cramping pain in your lower abdomen that may be intense
  • Dull, constant ache
  • Pain that radiates to your lower back and thighs

Some women also experience:

  • Nausea
  • Loose stools
  • Headache
  • Dizziness

Causes:

During your menstrual period, your uterus contracts to help expel its lining. Hormone-like substances (prostaglandins) involved in pain and inflammation trigger the uterine muscle contractions. Higher levels of prostaglandins are associated with more-severe menstrual cramps.

Severe contractions may constrict the blood vessels feeding the uterus. The resulting pain can be compared to the chest pain that occurs when blocked blood vessels starve portions of the heart of food and oxygen.

Menstrual cramps may also be caused by:

  • Endometriosis. In this painful condition, the tissue that lines your uterus becomes implanted outside your uterus, most commonly on your fallopian tubes, ovaries or the tissue lining your pelvis.
  • Uterine fibroids. These noncancerous growths in the wall of the uterus may be the cause of pain.
  • Adenomyosis. In this condition, the tissue that lines your uterus begins to grow into the muscular walls of the uterus.
  • Pelvic inflammatory disease (PID). This infection of the female reproductive organs is usually caused by sexually transmitted bacteria.
  • Cervical stenosis. In some women, the opening of the cervix may be so small that it impedes menstrual flow, causing a painful increase of pressure within the uterus.

Risk factors:

You may be at greater risk of menstrual cramps if:

  • You’re younger than age 30
  • You started puberty early, at age 11 or younger
  • You have heavy bleeding during periods (menorrhagia)
  • You have irregular menstrual bleeding (metrorrhagia)
  • You’ve never given birth
  • You have a family history of dysmenorrhea
  • You’re a smoker

Complications:

Menstrual cramps don’t cause any other medical complications, but they can interfere with school, work and social activities.

Certain conditions associated with menstrual cramps may have complications, though. For example, endometriosis can cause fertility problems. Pelvic inflammatory disease can scar your fallopian tubes, increasing the risk of a fertilized egg implanting outside of your uterus (ectopic pregnancy).

What You Can Do:

If you have mild menstrual cramps, take pain reliever, such as acetaminophenibuprofen, or naproxen. For best relief, you must take these medications as soon as bleeding or cramping starts.

Things you may want to try at home include:

  • Exercise. Studies have found that regular physical activity may ease the pain of menstrual cramps.
  • Heat. Soaking in a hot bath or using a heating pad, hot water bottle or heat patch on your lower abdomen may ease menstrual cramps. Applying heat may be just as effective as over-the-counter pain medication for relieving menstrual cramps.
  • Avoiding alcohol and tobacco. These substances can make menstrual cramps worse.
  • Reducing stress. Psychological stress may increase your risk of menstrual cramps and their severity.

Reference :

https://www.webmd.com/women/menstrual-cramps#1

https://www.mayoclinic.org/diseases-conditions/menstrual-cramps/symptoms-causes/syc-20374938

 

By,

Dr.krishnapriya

Can a mother really have INSUFFICIENT or NO MILK

Infants who are not exclusively breastfed are 14 times more likely to die due to diarrhea, 3 times more likely to die of respiratory infection, and twice as likely to die of other infections than an exclusively breast-fed child. Hence, a mother’s concern of insufficient or no milk needs to be addressed with utmost care and empathy.

Did you know that only ONE in a thousand mothers may not be able to breastfeed. The so-called lactation failure is very very rare among mothers. So practically there is no such thing as insufficient milk or no milk, but unfortunately all the important people in a mother’s life including husband, mother, mother-in-law, pediatrician or even the newborn are ignorant of or refuse to accept this fact.

The complaint of “insufficient milk” is just a wrong perception of the mother, fostered by  :

  • Mother’s uncertainty about her capacity to feed her baby properly. New-age mothers do not have first-hand experience of seeing successful breastfeeding and cannot have enough conviction in the process. Even the slightest doubt or difficulty can be discouraging.
  • No knowledge about the normal behavior of a baby (who usually nurses frequently)
  • Negative opinions of significant persons -often in Indian households, mother or mother-in-law who has not breastfed her own children does not particularly encourage breastfeeding. Sometimes they induce doubts in the mother’s mind every time the baby cries or is uneasy.

The reasons why a mother feels that she has insufficient milk are because the baby cries often, wakes up frequently, demands frequent feeds, or is irritable.

It is important to discuss with the mother signs that enough milk is being supplied :

  • Weight gain of 500–1000 gm/month
  • passing urine at least 6–8 times/day is definitely getting enough milk

The following signs indicate that an infant is not receiving enough milk in the first weeks of life:

  • Weight loss greater than 10% of the birth weight, not regaining birth weight up to 2 weeks of life,
  • No urinary output for 24 hours,
  • Absence of yellow stools in the first week and
  • clinical signs of dehydration

Crying among babies is a natural response to express all kinds of feelings of discomfort. Colic pains, extreme heat or cold, blocked nose, new caregiver, unclean caregiver, time of the day, etc are some of the trivial triggers for crying in a baby.

Lactation insufficiency is a public health concern, as the use of breast milk substitutes increases the risk of morbidity and mortality among infants in developing countries, and these supplements are the most common cause of malnutrition.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2280684/pdf/canfamphys00145-0061.pdf

http://breastfeedingtoday-llli.org/how-often-does-breastfeeding-really-fail/

Sultana A, Rahman KU, manjula SM  2013 CLINICAL UPDATE AND TREATMENT OF LACTATION INSUFFICIENCY. Medical Journal of Islamic World Academy of Sciences 21:1, 19-28, https://www.journalagent.com/ias/pdfs/IAS_21_1_19_28.pdf

Preventive measures for women’s health

Preventive measures for women's health

As we grower older, our body needs to be cared better as the chances of health issues are much greater. Especially for women, as time passes, they need to pay more attention to their well being because several changes are taking place in their bodies about which they need to be aware of.  Continue reading “Preventive measures for women’s health”