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


Image Credits: Internet

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. 


Image Credits: Internet



                                                                            Dr. Y. Alekhya.


As the name suggests these are a group of tests done to see how the lungs are working. Pulmonary Function Tests are useful in understanding how well you are able to breathe and how effectively your lungs are bringing oxygen to rest of your body. These are valuable in diagnosing a respiratory disease. Not only in the diagnosis, pulmonary function tests are used to know the response for the treatment and based on these tests your doctor can change or continue the treatment plan. 


  • To diagnose a condition if you have any lung disease related symptoms.
  • To know the disease severity and progression in 

Chronic Obstructive Pulmonary disease, Asthma, Sarcoidosis, Congestive Heart Failure, Congenital Heart Disease, Sarcoidosis, Myasthenia Gravis, Guillain-Barre syndrome, Multiple sclerosis etc.

  • To know the lung status before any major surgery. Eg: Cardiac surgery, Thoracic surgery, Organ transplantation etc.
  • If you are regularly exposed to some substances at workplace or environment.

Pulmonary function test performance technique:

  • A nose clip is placed when the patient is in sitting position. He needs to breathe in and breathe out several times before the actual test begins. They need to take deep breaths as much as they can.
  • Mouth should completely cover the mouthpiece. Ask him  to blow out as fast and quickly as they can.
  • After blowing out they need to take deep breaths. Whole test should be repeated thrice. Goal is to get a result which is consistent. You may need to repeat the test more than three times in order to obtain an internally valid test.



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

Tips for having acne free skin

Acne is so common that it’s considered a normal part of growing from a kid to an adult.

But knowing that doesn’t make it easier when you look in the mirror and see a big pimple on your chin! The good news is that knowing about acne and taking some simple steps can help you deal better with Acne and prevent Acne.

  • Oil build up on your skin can lead to acne, wash your face once or twice a day with warm water along with a mild soap or cleanser.
  • Don’t scrub your face. Scrubbing can actually make acne worse by irritating the skin. Wash gently, using fingertips instead of a washcloth.
  • If you wore makeup, moisturizer, or sunscreen, make sure they are “oil-free” based and are “noncomedogenic”.
  • Hair sprays or gels can clog pores, try to keep them away from your face 
  • If you have long hair, keep it away from your face and wash it regularly to reduce oil.
  • Helmets and other hats can cause pimples along the hairline. Avoid them if you think your acne is getting worse by them.
  • Wash your face after you’ve been exercising and sweating a lot.
  •  Diet with a low glycemic (sugary)load may help.
  • Moisturizers containing aloe vera at a concentration of at least 10 percent can have a soothing and possibly anti-inflammatory effect.

  • Hold the mobile phone away from the face when talking, as it is likely to contain sebum. 
  • Clean spectacles often as they collect sebum, and skin residue.
  • Avoid anxiety and stress, as it can increase the production of cortisol and adrenaline, which aggravate acne.
  • Never pick. Picking may result in further inflammation and scarring.
  • Wear daily sunscreen since some acne medications may increase the skin’s sensitivity to sunlight.

We hope the tips given above will help you to have acne free skin. Remember that you’re not alone. Look around and you’ll see that most are in it together!

Dr Krishna Priya



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


Skin tags

Skin tags, formally known as acrochordons, are small pieces of flesh that protrude from your skin. They’re attached through a stem or stalk. Skin tags are most commonly found in folds of skin i.e, around 

  • your neck
  • Armpits
  • and groin area

 usually, appear in people of middle age and both women and men get equally.

Causes and risk factors:

While the exact causes of skin tags are unknown. 

however, the risk factor includes

  1. Older people
  2. People who are obese
  3. Type 2 diabetic
  4. Pregnancy
  5. Family history
  6. Sex steroid imbalance especially if they are changes in estrogen and progesterone.

When to see a doctor:

Skin tags are usually harmless, non-contagious and non-cancerous benign growths but when it bleeds, itches, or changes colour, contact your doctor immediately.


Small and tiny skin tags may fall off on their own.

Most skin tags stay attached to your skin. In general, skin tags don’t require treatment.

skin tags are only a cosmetic concern, not a medical problem.

Various treatment methods include:

Cryotherapy: Where freezing the skin tag with liquid nitrogen.
Surgical removal: Removing the skin tag with scissors or a scalpel.
Electrosurgery: Burning off the skin tag with high-frequency electrical energy.
Ligation: Removing the skin tag by tying it off with surgical thread in order to cut off its blood flow.

Removing skin tags at home may cause heavy bleeding and infection hence not suggested.

Dr. Krishna Priya.





Dark circles

Common causes of Dark circles are:

  1. Fatigue – sleeping very late, not getting adequate sleep can all cause dark circles.
  2. Eye strain – watching Television or staring into screens for long times cause significant stress on eyes.
  3. Dehydration – lack of water in our body sometimes manifests as sunken eyes. It may cause the area beneath the eyes to look dark.
  4. Unprotected exposure of sun – not covering oneself or not using sunscreen creams, may cause excessive melanin production, thus causing the area around the eyes to look darker than they actually are.
  5. Allergies – cause one to rub eyes recurrently and cause the area around the eyes to become dry and discoloured and may appear as dark.
  6. Hereditary factors and certain other inflammatory skin diseases such as eczema can cause dark circles.

Here are some tips that can help in preventing and dealing with dark circles-

  1. Make sure to have a good quality sleep – it means sleep early on a regular basis and have at least 6-7 hours of sleep.
  2. If you already have dark circles, applying cold compresses under your eyes such as by applying cucumber or potato slices on eyes can help in soothing the irritation caused by allergies and help in reducing dark circles.
  3. Applying cold tea bags to your eyes can improve their appearance. Tea contains caffeine and antioxidants that can help stimulate blood circulation.
  4. Sometimes, when dark circles are too stubborn, concealing them with makeup can help.
  5. Use eye protection in the form of anti-glare eyeglasses if and when long hours of work on screen are to be done and sunglasses when going out.
  6. Applying a sunscreen that suits you before going out in the sun is advisable.
  7. If none of the above are helpful, talking to dermatologist is important.

Dr.Afroze Fatima


Good and Bad of emergency contraceptive

Emergency contraception also known as postcoital contraception is a form of birth control that may be used by women who have had unprotected sex or failure of usual birth control methods.The treatment generally is reserved for specific situations and is not a regular method of birth control. Emergency oral contraception is used in preventing pregnancy and should not be used to end one. 

The Good-

  • Emergency contraception is safe and effective in preventing pregnancy after unprotected sex.
  • Emergency contraception is private. It is your choice if you want your partner to know about it.

The Bad-

  • It has a limited time frame of 5 days following unprotected intercourse..
  • It may cause side effects including nausea, vomiting, stomach pain, and headache.
  • Emergency contraception is not helpful if the woman is already pregnant. Women who are suspecting  pregnancy or are pregnant should not use emergency contraception.
  • Emergency contraception does not provide protection against sexually transmitted diseases (STDs) including HIV.  Use of condoms is advised to reduce the risk of STDs.
  • There still remains a small chance of getting pregnant after emergency contraception.

So it is better to weigh the pros and cons and use it in situations such as above after a discussion with the gynecologist.


-Dr Prerna Gaur



Sleepwalking, or somnambulism is a behavior disorder that takes place during the deepest stage of dreamless sleep. 

Sleepwalking is very common in kids. They tend to sleepwalk within an hour or two of falling asleep. They may walk around for a few seconds to minutes. No matter what they’re doing, a sleepwalker will usually have their eyes open, with a confused, glassy stare. Even so, they’re really and truly asleep, which means they probably won’t remember anything about the incident if you ask them about it the next day.

It’s difficult to wake someone up while they are sleepwalking. When they are awakened they may feel groggy and disoriented for a few minutes.


It’s common in kids than in adults. The condition may run in families.

  • lack of sleep or fatigue
  • irregular sleep schedules
  • illness or fever
  • some medicines
  • stress


What Happens During Sleepwalking?

Getting out of the bed and walking while sleeping is the commonest symptom. 

Other symptoms include 

  • sleep talk
  • be hard to wake up
  • seem dazed
  • be clumsy
  • not respond when spoken to
  • kids sit up and do repeated motions such as rubbing eyes 



Doctors generally don’t do any test to diagnose the condition. They take a detailed history of the child’s sleeping habits.



Children normally outgrow the habit of sleepwalking and treatment with medicines is not necessary.

It can be managed by lifestyle modifications:

  • Improving sleep hygiene to minimize fatigue
  • Avoiding stress and anxiety
  • modifying  the environment to reduce tripping hazards
  • Emptying the bladder before sleep


How to Keep a Sleepwalker Safe

Sleepwalking isn’t dangerous by itself. But it’s important to take precautions so that your sleepwalking child is less likely to fall down, run into something, and walk out the front door.

  • Don’t wake up the sleepwalker because it might scare them. Instead, guide them back to bed.
  • Make sure to lock the windows in your Childs room. Consider child safety locks on doors.
  • Don’t let the child sleep in the bunk bed to prevent falls from height 
  • Move the sharp objects or breakable things from your Childs room 
  • Keep dangerous objects out of reach.


  • Make sure to install safety gates outside your Childs room or at the top of any stairs.