Dr. Shashikala

Planning your pregnancy means thinking about what it means to have a baby and making decisions with your partner about the future of your family. Are you ready to be parents now? Or do you want to wait a while?
Certain tips you must follow before you try to get pregnant:

1. Schedule a preconception visit: You don't have to have a doctor or midwife lined up to deliver your baby yet, but consult gynaecologist, midwife or family doctor now for a preconception checkup.Your practitioner will likely discuss diet, weight, exercise and any unhealthy habits you may have (such as smoking, drinking, and taking drugs); recommend a multivitamin; make sure you're up to date on your immunizations.
2. Take folic acid (and watch out for vitamin A): You can buy folic acid supplements at the drugstore, or you can take a prenatal or regular multivitamin. Check the label on multivitamins to make sure they contain the 400 mcg of folic acid you need.
3. Give up binge drinking, smoking, and drugs and get help if you need it: If you smoke or take drugs, now's the time to stop. Many studies have shown that smoking or taking drugs can lead to miscarriage, premature birth and low-birth-weight babies.
4. Stock your fridge with healthy foods: You're not eating for two yet, but you should start making nutritious food choices now so your body will be stocked up with the nutrients you need for a healthy pregnancy.
5. Check your caffeine intake: While there's no consensus on exactly how much caffeine is safe during pregnancy, experts agree that pregnant women and those trying to conceive should avoid consuming large amounts.
6. Aim for a healthy weight: You may have an easier time conceiving if you're at a healthy weight. Having a low or high body mass index (BMI) makes it harder for some women to become pregnant.
7. Create and follow an exercise program: Start and stick to a fitness plan now, and you'll be rewarded with a healthy body that's fit for pregnancy.

It is perfectly normal for women to experience the periodic monthly bleeding cycle. However, if a woman experiences uterine bleeding which is abnormal and dysfunctional, it could be a symptom of infection. Other causes of abnormal uterine bleeding include hormonal imbalance, infection in cervix and cancer of the uterus. Many women can also experience abnormal uterine bleeding during first trimester of pregnancy.

The following are considered to be abnormal or dysfunctional uterine bleeding:

1. A menstrual cycles occurs between 21 to 35 days, anything shorter or longer than this is abnormal
2. No period for 3–6 months (amenorrhea) is abnormal
3. Spotting or bleeding between periods
4. Spotting or bleeding after intercourse
5. Bleeding that is heavier or lasts longer than usual
6. Spotting or bleeding after menopause

What can cause such a situation?

Some of the common causes leading to abnormal bleeding are as follows:

1. Miscarriage
2. Ectopic pregnancy
3. Pregnancy
4. Cervical or uterine infections
5. Fibroids
6. Hormonal imbalances
7. Problems with blood clotting
8. Polyps
9. Polycystic ovaries
10. Endometrial hyperplasia
11. Cancer of the reproductive tract

How to Diagnose it?

Most women tend to ignore abnormal bleeding, taking it as something to do with age or hormones. A detailed physical examination and history is done to understand menstrual cycle patterns and family history. In addition, the following would be used.

1. Ultrasound: The pelvic organs are examined through sound waves to locate the problem area
2. Hysteroscopy: Through a thin device that is inserted into the vagina, the doctor takes a look at the inside of the organs and identify the cause for the bleeding
3. Endometrial biopsy: The uterine lining tissue is removed and examined under microscope to look for tissue changes that could be causing the bleeding

How Best to Treat It?

This would depend on the reason for the abnormal bleeding. However, in most cases, combinations of the following are useful in treatment.

1. Hormone replacement can be done depending on the age and gynecological history, the type and the dose of the hormone would be decided upon. These could be in the form of tablets, vaginal creams, injections, or through an intrauterine device
2. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are useful in reducing bleeding and controlling cramps during excessive menstrual bleeding.
3. Antibiotics may be useful if there is infection of the pelvic organs.
4. Polyps, cysts, cancers, and other growths can be removed via hysteroscopy and sent for biopsy to confirm they are not cancerous.
5. Endometrial ablation where the endometrial tissue is treated with heat can be used to control bleeding permanently.
6. Hysterectomy would be done if other forms of treatment have failed. This could depend on their gynecologic history and other considerations as she cannot get pregnant after this.

Do not ignore if you see a change in the pattern of your uterine bleeding. It definitely calls for medical attention and if identified early, can be managed in much simpler ways.