Sex, which gives pleasure to most, can be painful for some. Many women, mostly in their menopausal or post-menopausal phase find intercourse and penetration extremely painful. Menopause results in hormonal imbalance, with a significant drop in the estrogen level. The reduced estrogen level results in Vulvovaginal Atrophy (dryness of the vagina and thinning and weakening of the vaginal tissues). In such cases, women experience irritation, Vaginismus (vaginal tightness) and soreness after sex.
 
One can also experience a burning sensation during urination. There may be inflammation of the vaginal tissues. If untreated, the inflammation can cause infection and other complications. "Dyspareunia" or pain during intercourse is very common in postmenopausal women. The pain experienced during sex can be due to "Vulvodynia" as well. Vulvodynia is a condition whereby a women experiences chronic pain in the external genitals or vulva. A number of other factors can also contribute to the pain during sex. A thorough and detailed investigation is thus very important.
 
Treatment
Many women find it extremely embarrassing to discuss menopausal problems with their partners and doctors. The key to effective treatment lies in timely diagnosis and medication. There is nothing to be embarrassed about. The postmenopausal changes can vary from person to person. Thus it is very important to discuss every minute detail with your physician.

Many options are available to make intercourse a less painful experience:

Keep dryness at bay: In most cases, painful intercourse results from dryness of the vagina. Use of a lubricant can ease the pain to a great extend. A water-based lubricant is highly recommendable. Regular use of vaginal moisturizers is also effective to deal with vaginal dryness.

Vaginal care and hygiene: It is very important to keep the vagina clean. Avoid using soaps, bath oils and shower gels. They do more harm than good to the vagina. It is advisable to wash the vagina with warm to lukewarm water. Undergarments should be changed twice daily.

More is good: Having sex at regular intervals is a healthy practice. It not only enhances and improves the blood flow, but also helps to overcome vaginal dryness.

The Pelvic Floor Therapy: It is immensely beneficial. In this therapy, a gentle pressure is exerted in the pelvic region to relax the stiffened and tightened muscles. One can also massage the area to relax the muscles.

Squat: It is a very effective exercise to strengthen the buttocks and hip muscles. Exercises to strengthen the pelvic floor muscles are also very helpful.
Other therapies: One can also opt for Local Estrogen therapy and Systematic Estrogen Therapy.

Menopause should not affect your conjugal and sexual life. Visit here to know more and forget painful intercourse forever.

Pain With Intercourse In The Postmenopausal Woman

What is Endometrium?

The uterus is where the fetus grows and develops. It has three linings- the outermost lining, the middle layer and the innermost lining. The innermost layer is called Endometrium. The endometrium is made of mucosal tissues.

How the endometrium changes and what is its function?

Before ovulation, when an egg is released, the functional layer of the endometrium undergoes a change. Vascularization takes place i.e. a buildup of blood vessels and tissues that thickens the endometrium in anticipation of implantation of a fertilized egg. If conception does not take place, the tissues and cells are shed from the endometrium lining. This is when a woman gets her period.

When conception does take place, the fertilized egg attaches itself to the endometrium. The endometrium also supports the placenta, which provides the fetus with oxygen and nutrition.

What is the ideal thickness of the endometrium?

In pre-menopausal women, the thickness of the endometrium should be-

  Between 2-4 millimetres during menstruation,
  5-7 millimetres at the onset of the early proliferative phase
  Around 11 millimetres during the late proliferative phase
  16 millimetres during the secretory phase



What is a poor/thin endometrium?

If the endometrium lining does not meet standard thickness and is not conducive to implantation, it is called a poor endometrium.

Causes behind thin endometrium

There could be many reasons that can lead to a poor endometrial layer-

  Inadequate secretion of estrogen
  Insufficient blood flow
  Prolonged use of birth control pills
  Substandard quality of endometrial tissues
  Presence of fibroids (small uterine tumours)
  Amenorrhea (unnatural periods/ excess bleeding or too little bleeding)
  Intrauterine adhesions (scar tissues form between the layers of the uterus and glue them together)
  Pelvic inflammatory disease
  Use of clomiphene

What are the symptoms of poor endometrium?

  Infertility (inability to conceive)
  miscarriage
  Irregular menstruation
  Painful periods
  Inadequate bleeding during menstruation

Treatment for poor endometrium

  Since the most common cause of poor endometrium is insufficient estrogen, doctors prescribe estrogen pills that can raise estrogen levels.
  If poor endometrium is the result of poor blood flow, an Ultrasonography Test will reveal that. Then doctors prescribe Vitamin E pills and L-arginine amino acid pills to thicken the endometrium layer.
  Regular exercising increases blood flow to the uterus
  Acupuncture is a very effective stress buster. Chronic stress could lead to a shrunk uterine wall. Acupuncture can allay the stress and promote the health of the uterus.
  Intrauterine adhesions can be extracted through surgery.
  Natural remedy (through natural therapy) includes asparagus, royal jelly, cover and they help in thickening the endometrium layer.
  Granulocyte Colony Stimulating Factor if injected into the body raises endometrial thickness and combats infertility.

Only an endometrium of normal thickness can support a pregnancy. If the lining is not thick enough medical intervention may be necessary.

Poor Endometrium - Can It Be Treated?

Lumpectomy is a surgery where a cancerous or benign tumour is removed from a breast along with some surrounding tissues. The amount of tissue removed varies according to the nature of the tumour. It is a form of breast-conserving surgery. It is also called a partial mastectomy.

Lumpectomy is the first option of treatment for women diagnosed with early-stage breast cancer.

What is the goal of lumpectomy?

Lumpectomy aims to remove the cancerous cells from the breast and at the same time maintaining the appearance of the breast. Studies have proved that for early stage breast cancer, lumpectomy is as effective as mastectomy (complete removal of the breast).

Doctors may recommend lumpectomy to remove precancerous cells as well.

Pre lumpectomy measures-

If you are under any other medication or if you suffer from allergies, inform your doctor. Other pre-surgery measures include-

  Stop taking aspirins or any pain relieving medication

  Your doctor will recommend you to not drink or eat anything 8-12 hours prior to the surgery.

The procedure:

A mammogram and a biopsy reveal the exact location of a tumour. Lumpectomy is performed under general anaesthesia. The surgeon makes a small incision over a tumour to extract the cancerous cells and the surrounding tissues. Sometimes doctors have to perform sentinel lymph node surgery or axillary node dissection.

The surgeon then closes the incisions with sutures. The sutures may dissolve over time or may have to be extracted later by a doctor.

If you have undergone lumpectomy and sentinel node biopsy, you will be discharged on the same day as the surgery as soon as your blood pressure stabilizes.

However, after lumpectomy with axillary node extraction, you may have to stay in the hospital for 2-3 days.

Therapy after lumpectomy

Your oncologist will recommend a follow-up radiation therapy to destroy the mutated cells that may have remained in the area where a tumour had developed. Radiation reduces the risk of breast cancer recurrence.

You might also have to undergo hormone therapy. Some types of breast cancer need female hormones like estrogen and progesterone to grow. Hormone therapy inhibits the development of cancerous cells by not allowing these hormones to reach the cells.

Your doctor will advise you to avoid strenuous physical activities for at least a month after the surgery.

Lumpectomy is a safe surgical procedure that can root out tumours or precancerous cells from the breast without deforming the shape of it.

Breast Lumpectomy - All You Should Know!

There are two methods by which abortion can be done:

Medical Abortion - Non-surgical abortion in which medicines are used to induce abortion

Surgical Abortion - Use of transcervical procedures for terminating a pregnancy, including vacuum aspiration, and dilatation and evacuation (D and E).

Surgical or Medical Abortion for Unwanted Pregnancy

If pregnancy is lesser than = 7 weeks; medical method with Mifepristone with Misoprostol is favorable as the success rate is as high as 97%.

If pregnancy is between 7-12 weeks; surgical abortion is the only option.

If pregnancy is beyond 12 weeks - 20 weeks, then the woman needs to be hospitalized and will be given either Mifepristone followed by Misoprostol tablet or only Misoprostol tablets and woman will then abort like a miscarriage in the hospital. If any products are remaining, then it will be evacuated surgically.

Surgical abortion is preferred if patient desires concurrent tubal ligation or IUCD (CuT) insertion.

If a woman fulfills the criteria for selecting either method i.e. before 7 weeks, final choice has to be given to the woman.

Summary of choice between Surgical or Medical abortion in India

lesser than = 7 weeks - Medical method or surgical method

7-12 weeks - Surgical abortion

12 - 20 weeks - Medicines with or without surgical procedure in hospital

Advantages of Medical Abortion

Avoid surgery

Controlled by the woman and may take place at home

No need for admission to the hospital

Usually, well tolerated by women, if properly counselled and motivated

No need to take leave from work, as bleeding can be managed with menstrual pads even while in the office or at work.

Disadvantages of medical abortion

Takes time (hours to days) to complete abortion, and the timing may not be predictable. Women experience bleeding and cramping, and potentially some other side-effects (nausea, vomiting, fever, and shivering). May require more clinic visits than surgical abortion.

Advantages of Surgical Abortion

Quick procedure

Complete abortion easily verified by evaluation of aspirated products of conception

Takes place in a hospital so Sterilization or placement of an intrauterine device (IUD) may be performed at the same time as the procedure. It can be performed under local anaesthesia if woman is properly motivated and counselled

Disadvantages of surgical abortion

Requires instrumentation of the uterus

Small risk of uterine or cervical injury

Timing of abortion controlled by the doctor and hospital

Anaesthesia needs to be administered. Most doctors perform this procedure under short general anaesthesia. A woman needs to be in the hospital for at least 6 hours. Effect of sedation will be there throughout the day.

Methods of Abortion for Unwanted Pregnancy

Ectopic pregnancy: Causes and symptoms

Ectopic pregnancy happens if the egg implants itself in the fallopian tube in place of the uterus. That's why this form of pregnancy is called a tubal pregnancy as well. Many a time, it may also implant itself in the belly, ovary or the cervix. If the egg is allowed to develop in the fallopian tube, it brings about the bursting of the tube, leading to instances of heavy bleeding.

What really causes this condition?

In this type of pregnancy, the cause isn't always easy to arrive at. In many cases, certain conditions have been found to bring about this pregnancy and these are:

- Damages to the fallopian tubes in the form of scarring and inflammation due to a preceding medical infection, condition or surgery

- Imbalances in the body's hormone levels

- Abnormalities in the genes

- Birth defects

- Medical problems that have an effect on the shape and condition of the reproductive organs and fallopian tubes

- Though it's rare, ectopic pregnancy can occur while using an intrauterine device or system for birth control

- Inflammation of your reproductive system such as pelvic inflammatory disease

How do you know that you suffer from one?

In terms of signs that will help you to easily identify whether you're having an ectopic pregnancy, the initial signs are:

- Light bleeding from your vagina

- Pain in the abdomen or in the pelvic region, which tends to occur after 6-8 weeks of a missed period

The other symptoms of this condition reveal themselves as you progress through the pregnancy and include,

- Dizziness or fainting as a result of internal bleeding

- Shoulder pain brought on by bleeding in the abdominal region

- Signs of shock

- Worsening of pelvic or belly pain

- Heavy vaginal bleeding

Additionally, a person with ectopic pregnancy also experience signs associated with early pregnancy such as:

- Nausea

- Tender breasts

- Fatigue

- Missed period

- Increased in frequency of urination



What is Ectopic Pregnancy the Most Difficult Type of Pregnancy?

Heavy menstrual bleeding, technically called menorrhagia, is one of the most common types of abnormal bleeding from the uterus. Menstrual bleeding is said to be heavy if there is so much blood that a tampon or pad remains soaked for several hours. 

Here are all the possible causes of heavy menstrual bleeding:
1. Hormonal imbalance
Estrogen and progesterone levels are the primary control mechanism for periods. If the ovaries have a problem in functioning, hormonal imbalances may occur. Heavy menstrual bleeding is most common in females who are at the start of menopause. Puberty menorrhagia can occur in adolescents who are experiencing their first menstrual period. 
2. Fibroids
Fibroids most commonly occur around the age when women can get pregnant. Uterine fibroids are non-cancerous growth on the uterus.
3. Ectopic pregnancy
An ectopic pregnancy is when a fertilized egg stays in the fallopian tube, but does not reach the uterus.
4. Blood thinners
These are medicines, which are usually anticoagulant or antiplatelet drugs.
5. Problems with iud
A non-hormonal intrauterine device is a t-shaped device used for birth control which is inserted into the uterus.
6. Adenomyosis
This is a condition in which the muscular wall of the uterus also gets the lining of the uterus intermingled with it. However, this condition is rare and only happens in middle aged women with several children.
7. Pid
Pid stands for pelvic inflammatory disease and refers to any infection within the organs of the reproductive system.
8. Cancer
Uterine, ovarian and cervical cancer are just some of the cancers, which may cause heavy menstrual bleeding.
9. Other diseases
Liver, kidney and thyroid diseases are all included.

Possible Causes of Heavy Menstrual Bleeding

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