Miscarriage is the early loss of foetus within 20 weeks of pregnancy. It is also known as  spontaneous abortion . According to research, about 8-20% of the pregnancies end in miscarriage. Out of the total number of miscarriages, 80% of them end within 12 weeks of pregnancy.

Types of Miscarriages and their Symptoms 

Threatened Miscarriage   As the term suggests, in this condition the process of miscarriage might have begun. This is the initial stage of the process. In threatened miscarriage, there is slight bleeding accompanied by cramps and pain in the lower back, which is usually mild. The cervix (the lower part of the uterus) remains closed. 
Inevitable and Incomplete Miscarriage   In these conditions, there is bleeding along with an open cervix. When there is dilatation and thinning of the cervix, miscarriage is inevitable. In incomplete miscarriage, part of the tissue comes out and a part remains inside the uterus. In inevitable and incomplete abortions, the bleeding and cramps are more severe. 
Complete Miscarriage   Complete miscarriage is when the embryo has completely emptied from the uterus. The pain and bleeding reduce once the foetus is expelled. This can be confirmed through ultrasound. 
Missed Miscarriage   In Missed miscarriage, there is no sign of the life of the embryo and there is no expulsion of the embryo. It can be detected from the absence of heartbeat of the embryo found on ultrasound. 
Recurrent Miscarriage   It happens when there are two or three miscarriages one after the other. It affects about 1% of the pregnancies. 
Risk Factors 

Increased maternal age i.e., women above 35 years. 
Excess or insufficient chromosome in embryo. 
Placenta is the organ which links mother and the baby for blood supply. Problem in the development of placenta can cause miscarriage. 
Excessive smoking and drinking during pregnancy. 
Obese women have higher risk of miscarriage. 
Long-term health conditions like high blood sugar, high blood pressure, liver disease etc.
Infections like rubella, malaria etc. 
Weakened cervix, which is the result of previous injury or surgery, can also result in miscarriage. 
What are the symptoms of a miscarriage? 

Bleeding or spotting can be one of the symptoms of miscarriage. It should be kept in mind that not all pregnant women who suffer from spotting or bleeding, end in miscarriage. 
Lower backache starts before or right after bleeding, which can be persistent or you could have cramps which may be mild or sharp and can feel like more of pelvic pressure. 
Missed miscarriages are detected through ultrasound when the doctor finds that there is no heartbeat of the embryo or when the uterus is not growing. 
What are the treatment options in miscarriage? 

Medical   In most of the cases, there are no specific drugs to stop a miscarriage from occurring. In some cases, certain hormonal preparations help. There is no point in prescribing medicines for prevention of miscarriage if there is heavy bleeding. 
Surgery   Dilatation and evacuation (D&E) is a simple operation which is done under general/local anaesthesia. In this operation, the cervical canal is dilated and contents present in the uterus are evacuated. There is no cutting involved as it happens through the vagina. The process needs only five to ten minutes, but the patient has to stay in the hospital for about 3-4 hours. 
This process is opted when: 

There is heavy bleeding. 
The patient suffers from missed miscarriage. 
What can you do to prevent miscarriage? 

Nothing much can be done to prevent miscarriage in most of the cases. However, following supportive measures may help: 

There should not be overexertion during pregnancy. Moderate amount of physical activity is permissible. 
One should have a well-balanced diet. Studies have shown that a diet loaded with fruits and veggies helps in overall well-being during pregnancy. One should limit the consumption of caffeine. 
Avoid smoking, alcohol and certain drugs to prevent miscarriage. 
Avoid stress and anxiety. 
Report to Doctor (preferably Obstetrician) as soon as any symptom related to miscarriage appears.

Miscarriage - Symptoms, Treatment and Prevention

Menopause is a condition that marks the end of the menstrual cycle. It is a normal phenomenon that women experience with age. Menopause affects the bone health adversely. Bone health is directly tied to oestrogen, the hormone responsible for reproductive cycles, pain sensitivity. As a woman moves out of her fertile years there is an internal change in the reproductive system and the consequences can be seen and felt all over the body, including the bones.

The years just preceding menopause, with their hormonal fluctuations can set the stage for later health issues like bone weakening. As the oestrogen level drops, the bone density starts to decline which continues for a long period of time. The bone loss can become significant during perimenopause (the decades making up to menopause) and will speed up in the first few years of menopause.

The oestrogen level directly affects the process known as bone remodelling; the constant breakdown and the remodelling of the bone in the skeleton. With less oestrogen in the body cells called osteoclasts are able to absorb bone at a faster rate than osteoblasts (bone-building cells) are able to regenerate new bone. Thus the bone remodelling equation is no longer equal and the bone density continues to decline.

The osteoporosis risk after menopause is a serious one, yet so many women refuse to pay it much attention. Perhaps it s because the bone damage isn t visible, or that bone loss continues so gradually for so many years. While the bone loss cannot be completely halted, there is plenty that can be done to slow it down. Here are some ways to take care of your bone health before or after menopause.

Stay active: Adopting an active lifestyle after menopause helps in protecting the bones. It's recommended that adults between 19 to 64 years of age should do moderate to intense activity. This could include activities such as cycling or brisk walking. Sitting for long hours should be avoided. Weight-bearing exercises and resistance exercises are particularly important for improving bone strength and helping to prevent osteoporosis.
A balanced healthy diet: A healthy, balanced diet that includes calcium and vitamin D will help maintain healthy bones after the menopause. Good sources of calcium include green, leafy vegetables (but not spinach), nuts, seeds, dried fruit, tinned fish with the bones in, and dairy products like milk, yoghurt and cheese. Good food sources of vitamin D include oily fish, eggs, and fat spreads or breakfast cereals
Hormone replacement therapy: HRT can be an effective treatment for common menopausal symptoms like night sweats, sleep disturbance and achy joints. It works by replacing oestrogen, which naturally begins to lower post menopause. HRT can also help to maintain bone density and reduce the risk of osteoporosis.

Bone Health - Know How It Is Affected Post Menopause!

The menopause can take three very different routes for women. There are those who sail through it with very few symptoms or problems and don't even notice that their ovaries have stopped producing the hormone. Then there are those for whom it is a matter of a few hot flushes and a couple of night sweats, doesn't last long and not really a bother. This usually marks a relief from the periods. But for some it is abject misery accompanied with crippling fatigue, absolute exhaustion, hot flushes, vaginal drying, mood swings along with low desire or lack of sexual feelings. These symptoms might persist for more than 7 years.
Hormone Replacement Therapy (HRT) is considered to be an effective treatment for menopausal symptoms. The other problems linked with menopause can also be influenced by HRT in a positive manner.

HRT is indicated in:
1. Treatment of symptoms of menopause and the risk benefit ratio is apt for the women and they have been informed about the same
2. For women who are around 51 years and are reaching menopause even though they are asymptomatic
3. In women who are at the risk of osteoporotic fractures and are under 60 years and the non-estrogen treatments cannot be given
4. HRT is not recommended in women who are above 60 years

Benefits of HRT:
The benefits of HRT usually are more than the risk if done in a woman who is under 60 years of age. 
These include:
1. Improvement in quality of life by relieving muscle pains and improving sleep
2. The mood swings are controlled and low moods are usually alleviated by HRT. Low moods usually arise due to menopause.
3. It reduces the vasomotor symptoms, usually within four months of the treatment with maximum benefit in three months
4. HRT improves the urogenital symptoms by lowering the vaginal dryness, vaginal atrophy, urinary frequency and symptoms. 
5. HRT reduces the risk of osteoporosis. HRT is believed to preserve the bone mass density of the skeletal sites thus reducing the chances of vertebral and nonvertebral fractures.
6. HRT also reduces the risk of colorectal cancer and cardiovascular diseases

Risks of HRT
The main risks of HRT are stroke, endometrial and breast cancer, thromboembolic disease, pulmonary embolism and gallbladder disease. Though other risks are:
1. It increases the risk of ischemic stroke
2. There is a small risk associated with breast cancer and the risk increases more, if the woman is underweight or overweight, alcohol user, smoker and stops HRT suddenly
3. Estrogen only HRTs can increase the risk of endometrial cancer. If cyclical progestogen is used for 10 days for 28 cycles then the risk is eliminated.

The Efficacy of Hormone Therapy in Early Menopause

4 Exercises That'll Help You During Labour

There are technical ways in which you can get your body all set for labour. Although you may not know how your labour will progress, you can ease the pain that you experience during childbirth to a significant extent by doing these four exercises:

1. Kegel exercises: These exercises target the muscles that provide support to your bladder, uterus, urethra and rectum. By strengthening the muscles of the pelvic floor, these exercises help in improving the flow of blood to your vaginal and rectal area. Kegel exercises involve contracting of the muscles of your pelvic floor as you would do if you had to prevent passing urine or stool. It is also known to reduce the duration of the pushing stage of childbirth, which is the second stage. You can do the exercises sitting or standing and in either of the two ways-

Slow Kegels: For this, contract the muscles of your pelvic floor and hold them for 3-10 seconds. Release and repeat the exercise for ten times.

Fast Kegels: To be able to do this, you need to contract and loosen up your pelvic muscles 25-50 times. Do the set for about 4 times with 5 seconds interval between each set.


2. Squatting: Practising squatting during your pregnancy can help in preparing your pelvic muscles for labour. While strengthening your thighs, it opens up your pelvis for an easy descent of the baby. So, here's what you should do:

1. Begin by standing behind a chair for support with your feet wide apart

2. While contracting your abdominal muscles, relax your shoulders and chest before lowering your tailbone towards the floor

3. While inhaling and exhaling deeply, push into your legs and go back into a standing position


3. Pelvic Tilt: This exercise helps in strengthening the muscles of your back, pelvis and thigh regions while improving posture. Ensuring your pelvic joints remain flexible, it eases the pain experienced during delivery. 

Here's how it's done:

1. Get down on both your hands and knees while keeping your head in a parallel position with your back

2. While arching your back, pull in your stomach

3. Hold this position for a few seconds before releasing

The exercise needs to be repeated 3-5 times - all the while maintaining a strong hold on your back and stomach.


4. Tailor pose: The tailor pose is designed to help relax your hip joints as well as open up the pelvis. It also helps in improving your body posture while easing the aches that occur in the lower part of your back. For this, you need to perform the following steps:

1. While keeping your back straight, sit comfortably on the floor

2. Placing the soles of both the feet together, press your knees gently towards the floor

3. Keep the position for 10-15 seconds
You can repeat the exercise for 5-10 times.





4 Exercises That'll Help You During Labour

The post-partum period is the first few (usually six) weeks after delivering the baby. Sex might be the last thing you think of during this time. Sexual desires might decrease due to the following:

Healing from the incision (in case of a vaginal delivery)
Cesarean birth healing (abdominal incisions)
Fatigue caused by the whole birthing process and pregnancy
Stress caused by the newly born baby (especially more so in case of triplets or twins)
Shifts in the hormonal levels
Breastfeeding related breast sores
Emotional difficulties such as parenting anxiety, relationship problems with the baby s father
Postpartum blues
After the incision (if any) has fully healed along with the delicate vaginal tissues, it is generally safer to have intercourse. It might take a few weeks for the healing process to fully complete. The doctor will be able to give a more personal advice on when it is ok to start having sex again. Usually in case of a normal delivery, the waiting period is 6 weeks. The emotional readiness and physical comfort is extremely important as well. In a lot of cases it might take up to a year for normal sex life of the couple to resume again.

Also, there is a common misconception amongst many couples that during the postpartum period, having a baby again isn t possible. Condoms should be used if you aren t abstaining from sex in the postpartum period. This helps in avoiding an unplanned pregnancy and the complications that can arise from two successive deliveries.

The body goes through a lot of changes after giving birth. Low libido affects the sex drive. The body needs time to recuperate and might not be ready for sex immediately after giving birth as it switches itself to give care for the new born. A break is often necessary as the body and mind heal.

Vaginal dryness in the postpartum weeks is also very common. Lube and lots of it can help. The vagina, in the initial weeks, stretches out quite a bit. It slowly starts returning to its original contracted state as the muscles become tight again.

It s also important to remember that you can be intimate with your partner after you give birth to a baby, without having sex. Body contact and cuddles are ways of expressing your affection towards your partner. Love doesn t need to be dependent on sex!

How to Manage Sex After Pregnancy?

Polycystic ovarian syndrome or PCOS is a condition in which a woman experiences fluctuation of hormone levels, estrogen, and progesterone which causes cysts in her ovaries, dysfunctional menstrual cycle, cardiac problem, fertility and changes in appearance. Hormones are chemical messengers that can trigger a number of issues in the body. Long term problems due to PCOS can be avoided with an early diagnosis and a proper treatment.

Causes
- Genetics and hormonal imbalance have been identified as the main causes of PCOS although the exact reason has not been discovered.
- Overproduction of androgen, a male hormone in a woman can cause small lumps in the ovaries, irregular development of eggs and abnormal insulin level.

Symptoms
The severity of the symptoms depends on the constitution of the person but the most common one is irregular periods. PCOS occurs when there is a decrease in sex hormones which can lead to the development of certain male features like:

- Deeper voice
- Growth of hair on face, toes, stomach, chest and back
- Reduction in breast size
- Loss and thinning of hair

There are other symptoms as well which can help one to determine the syndrome including:
- Oily skin leading to acne
- Irregular egg formation causing fertility problems and miscarriages
- Depression, anxiety and mood swings
- Hyperinsulinemia, that refers to the presence of too much insulin in the body which can cause obesity
- Difficulty in breathing while sleeping

The severity of the symptoms varies but if you are experiencing any of these problems, it is advisable to seek a professional consultation. A healthy lifestyle, regular exercise, nutritious diets are some of the preventive measures you can take. There are hormone regulating medicines and treatments that attempt to curb the condition but there is no permanent cure.

What is Polycystic Ovarian Syndrome?

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