Dr. Megha K Sharma

Anti-Müllerian Hormone, or ‘AMH’ as it is often called, is a hormone which is given off by developing follicles, which are egg sacs containing immature eggs. By measuring this with a blood test, it gives an idea of the state of ovarian reserve and how many eggs are left in the ovaries. This can help determine whether and how urgently treatment is needed, and also how a woman may respond to treatment. AMH naturally decreases with age as the ovarian reserve is depleted, and women in their 40s frequently have low AMH results. AMH levels are considered ‘satisfactory’ if they are above 21.98 pmol/l, although age and other circumstances have to be taken into account in order to make the most accurate assessment.Low AMH is not a cause of infertility, but it is an indication of a decreased egg reserve. When there are fewer developing eggs in the ovaries, the chance of a mature and healthy egg being released and fertilised decreases. In age-related low AMH, the quality of the eggs may also be affected, as eggs accumulate mutations over time. This may mean that the chances of abnormal fertilisation and miscarriage are increased. your detail reports are required for further treatement. you may consult privately

Ayurveda is helpful in the management of this disorder.You can take kancanara guggul 2 tabs twice a day along with ashoka arista 3 tsf in glass of luke warm water half an hour after meals.Do brisk walk 30 minutes a day.Cut on sugar snd salt intake .Take more of veggies in your diet .Stay in touch .Good luck

wearing heel is not issue. it's just matter of your stitches don't wear for three months latter you can wear

Sperms and ova survive for 2-4 days depends on so many factor its not joke and easy to calculate exactness as your caculating foolishnessly preg test + after 7 days of missed pd the way your anxious I do not think it every thing ok in your system, how do you know perfect egg came on particular time?

You need to regular exercise too. You need to check your sleeping schedule too. Have adequate sleep and keep your body hydrated. Have more fruits, it will help to detoxify your body. Have salad before every meal. You may also consult homoeopathic doctor for the same.

It is important to rule out hormonal as well as structural causes of heavy bleeding by through history, examination and investigations so as to manage it well. Flow may decrease with some drugs like tranexamic acid but the reasons needs to be found.

Hello, Lybrate uset, Tk, plenty of water to hydrate yourself ,to eliminate toxins & to dilute your blood to establish your flow by regulating metabolism to absorb neutrients to nourish your body.  * go for meditation to reduce your stress, anxiety to calm your nerve, improving Oxygen volume in blood in order, to establish your smooth flow, improving haemoglobin level. * your diet be simple, non- irritant, easily digestible on time to maintain your digestion, avoiding gastric disorder. •TK, Apple,carrots, cheese,milk, banana,papaya, pomegranate, spinach,almonds, walnuts to improve your haemoglobin to release your flow, timely. • Tk, Homoeo medicine, gentle & rapid in action with no adverse effect, thereof. @ Pulsatilla 30-6 pills, thrice. @ Sepia200 -6 pills at bed time. * Ensure, sound sleep in d night for at least 7 hrs. • Avoid, caffiene,junkfood, dust,smoke, exertion •Your feedback will highly b appreciated for further, follow up.•Tk, care,

Hello, its normal to experience irregular menses in the initial 2-3 years after they start due to anovulation and they get better with age.

Hello, If you are experiencing blood in urine then you are likely to be suffering from cystitis. Please get a urine culture done.

Keep your body hygienic especially genital parts, have balanced diet and regular exercise, avoid stress, think positive.

Hi lybrate-user. The injection that you have been told about is given if she her blood group is negative. Mild pain is common in pregnancy. But as you has a miscarriage earlier I would suggest you do an ultrasound scan of baby and see if all is well and also do a urine routine and microscopy done to check for infections.

Please do semen analysis. For further assistance and treatment for complete cure you can consult me privately.

Hi. The gap in between vertabras is something mechanical, so no medicine as such for that, but yes, she can opt yogasanas under proper qualified yoga-teacher and / or physiotherapy both. For irregular menses, she can take homoeopathic Rx - Pulsatilla 200/ twice daily for 15 days. Revert me back.

Anti ageing fruits.
1 oranges
2 oats
3 salmon
4 green tea
5 herbal tea
6 dry fruits.

If you wanted children then you can participate in sex with out protection and and get ejaculation inside.

Hello, Lybrate user, Tk, plenty of water to hydrate yourself ,to eliminate toxins & to dilute your blood to establish your flow by regulating metabolism to absorb neutrients to nourish your body.  * go for meditation to reduce your stress, anxiety to calm your nerve, improving Oxygen volume in blood in order, to establish your smooth flow, improving haemoglobin level. * your diet be simple, non- irritant, easily digestible on time to maintain your digestion, avoiding gastric disorder. •TK, Apple,carrots, cheese,milk, banana,papaya, pomegranate, spinach,almonds, walnuts to improve your haemoglobin to release your flow, timely. • Tk, Homoeo medicine, gentle & rapid in action with no adverse effect, thereof. @ Pulsatilla 30-6 pills, thrice. * Ensure, sound sleep in d night for at least 7 hrs. •Avoid, caffiene,junkfood, dust,smoke, exertion •Your feedback will highly b appreciated for further, follow up.•Tk, care,

Today 18th October is WORLD MENOPAUSE DAY....
Aging is an inevitable phenomenon in our lives. Often our parents or grand-parents say “we are aged now, so it’s just a matter of few years”. But is it really so? French author Jules Renard said “It`s not how old you are, it`s how you are old”. Scientific studies has shown that “we can expect to become old”. There are mainly two reasons for it. One is our life style changes, leading to faster aging of the general population. The second thing is profound improvement in medical care that made it possible to conquer death even at the age of 80 years.In 1000 BC, the life expectancy was only 18 years. By 100 BC, the time of Julius Caesar, it had reached 25 years. In 2005, it was 80 years for women and 75 years for men. And today, you can expect to reach 82 years if you are a male and 85 years if you are a female. Men and women population need to be addressed differently from social, economic and biological points of view. Half of men at 85 and above live with their wives, but only 10% of elderly women live with their husbands. Aging is nothing but a sign of maturity. There are three signs of maturity in each sex. Two of them are common in both men and women; graying of hair and cataract in eye. The third one is unique to each sex. In men, it’s increased size of prostate gland (prostatism) and in female, it’s menopause.

Menopause is unavoidable in a woman’s life. In simplest term, it is the cessation of menstruation permanently at the end of reproductive life. The ovaries stop secreting female sex hormones- mainly estrogen and progesterone. In medical terminology, menstruation should be absent for 12 consecutive cycles to define it as menopause. Though menopause is the stoppage of reproductive function, it has profound effect in almost every organ of the body. Despite our socio-economic improvement, the age of menopause remains relatively the same; average 51 years with range of 45 to 55 years. However, there are some causes that may cause early menopause. If it occurs before 40 years, it’s called premature menopause. This needs medical consultation because it is caused by some serious diseases like genetic causes (may have family history of premature menopause- in elder sisters and mother), smoking, autoimmune disorders (body makes destructive substances against itself) etc. Sometimes premature menopause is the side-effect of some treatments like drugs (especially anti-cancer drugs), radiation and removal of ovaries by surgery. On the other hand, if menstruation continues to occur after 55 years, it’s called delayed menopause. It also deserves consultation with gynaecologists, as it is often caused by diabetes, some tumours and even some cancers. So, if menopause occurs too early or too late, it should never be ignored.

But if menopause occurs in time, do the women should consult gynaecologists? Well. You can find the answers from this article. Most of the women have some common problems after menopause; they become irritable or depressed and sometimes very much emotional and moody. Even suicidal tendency is not uncommon. Often they complain of sudden sensation of excessive warmth, the hot sensation, as if there is something burning on the head, the ears or other parts of the body. This is called “hot flush”, which is often associated with excessive sweating at night, palpitation and anxiety. This happens due to absence of estrogen hormone. These problems can be solved by hormonal drugs. Even non-hormonal drugs also work well. So, timely treatment can give them good quality of life and you don’t have to say “my mother has become intolerable these days”.

Frequently our mothers and grand-mothers complain of having back-pain or pain in the bones. This is due to osteoporosis; the destruction of components of bones and joints. They often get fracture with minor trauma. Again, this is due to deficiency of estrogen and also inadequate calcium intake. So, the treatment of this problem is exercise (at least 30 minutes per day), avoidance of smoking and the drugs that inhibits bone formation and adequate calcium and vitamin D intake. Hormone therapy is also effective and there are many non-hormonal drugs that can prevent destruction of bone. Thus timely medical consultation may stop our mothers saying “I cannot go outside for pain in my knees”.

Cardiovascular disease is the leading cause of death in elderly. Before the age of 40 years, males are more likely to die, than females, due to heart attacks. After 40, the sex difference is lost. This is because of absence of estrogen in women after menopause that alters the composition of fat (especially cholesterol) in blood. Cholesterol get deposited in the wall of blood vessels. Such problems can be avoided by dietary control, control of high blood pressure and diabetes and regular medical checkup.

The worst problemof the menopause is faced by the urinary and reproductive systems, i.e., the private parts of the body. In medical terminology, this is called “pelvic atrophy”. Our women remain very silent of it; most of them do not consult doctors for such problems. There is feeling of increased frequency of urination (women has go to the toilets frequently), burning sensation during urination and sometimes inability to hold the urine until they can reach the toilet or leakage of urine during coughing and sneezing (medically called “urinary incontinence”). The incontinence is not only a medical problem but also a social and hygienic embarrassment, for which many women avoid participation in social activities and even do not want to go outside. Sexuality is a thing that is often ignored both by the elderly people as well as the doctors. Menopause does not mean end of the conjugal life. Often the women may feel decreased libido (the desire) because of low hormone levels. And again there is difficulty in keeping intimacy for problems in the concerned area (due to decreased blood supply), again due to deficiency of estrogens. This may even lead to damage to the private parts and bleeding, while leading the conjugal life. For this, the couples should not suffer silently. There are many treatments that can avoid such urinary and sexual problems. Sometimes, simple counselling and some special exercises may prove to be adequate. Otherwise hormonal drugs (estrogens) can be used. And for this purpose, even we don’t need to take the hormones orally or by injection; simple local use of some creams or jellies help a lot. You will be surprised to know that testosterone may also help some women, because testosterone is not only found in male but is also an important female hormone. Those who want to avoid hormones, can try other non-hormonal agents. Even pregnancy is possible after menopause. There have been many examples of conception, either naturally or by test-tube baby (in vitro fertilization), after menopause. The recent socio-economic trend of delaying the age of marriage and child-birth is making this issue of pregnancy after menopause very much relevant.

Cancer is the second leading cause of death in elderly, after heart attack. Lung cancer is increasing day by day in women and even non-smokers can also have lung cancers. Discharge of blood with cough or vomiting, long-standing cough, chest pain and weight loss needs consultation with chest physician. Breast cancer is a major cause of death in women. This can be avoided by monthly self-breast examination and consultation; if any abnormal swelling or discharge is found. Colo-rectal cancer (cancer of lower part of our digestive tract), recently showed increased incidence in all the age groups. So, if there is any bleeding with stool or passage of black coloured stool, it should never be ignored. Ovarian cancer is showing increased incidences all over the world. Despite significant improvement in cancer management, ovarian cancer is a nightmare of the gynaecologists. Often, even after best possible treatment, patients of ovarian cancer don’t survive beyond one year of diagnosis. So, if you have any problems in digestion, abdominal discomfort, pain and swelling, please don’t just go to medicine shop to take antacids; instead go to your doctor. Post-menopausal bleeding is a medical term, used to describe the condition where there is bleeding through vagina, after menopause. Even if the bleeding is only one drop, it should never be ignored. Though, most causes of such bleeding are not worrisome (due to drugs and ‘’pelvic atrophy”- as mentioned earlier), some cancers may present in this way. Cancer of endometrium (the inner lining of uterus) almost always present with post-menopausal bleeding. Cancer of cervix (the mouth of uterus) is the commonest cancer of reproductive system in our country, which is totally preventable by timely diagnosis by screening (even before actual cancer occurs) and timely HPV vaccination.

“What cannot be cured, must be endured”. We cannot cure the menopause, nor can we avoid it. But definitely we can give our older generation a better quality of life. The first step is obviously making them aware of the menopause and its aftermaths. Second issue is regular health checkup by physicians and gynaecologists, even if they feel no problems as such. But the most important issue is managing their problems. As mentioned above, life-style modifications (like diet, exercise) and non-hormonal drugs play important role. But if we consider the basic problem is menopause, it’s simply deficiency of secretion of female sex hormones from the ovaries. So, if we can artificially introduce those hormones in women, menopausal symptoms can be reduced. This led to emergence of a treatment modality, called HRT (Hormone Replacement Therapy).

Clearly, as discussed earlier, HRT is required in women complaining of menopausal symptoms like “hot flush”, urinary and sexual problems, osteoporosis, and mood depression and also for young women having premature menopause. HRT does not only help to improve these problems, but also has some added advantage like preventing excessive weight gain, problems in oral cavity, eyes and ears and even colorectal cancer. Majority of the women report feeling better and having improved quality of life (social, personal, biological and conjugal) after start of HRT. There are multiple ways to give HRT to a woman. Those include injections (one in 1-3 month), oral tablets, local creams or jellies, skin patches etc. And the drugs include estrogen only, estrogen plus progesterone, tibolone etc.

Now the million-dollar question is, “is HRT absolutely safe?” The answer is difficult to give in one word. After the publication of the reports of the WHI (Women’s Health Initiative) and the MWS (Million Women Study), there have been a great hue and cry regarding safety of HRT. Those study found out many serious side effects of HRT and concluded that HRT should not be used in all the menopausal women. However, subsequently, many flaws of those studies were found out and subsequent review of the WHI study proved that HRT has few side effects. Thrombosis (increased tendency of blood to form clots) is a known side effect of hormonal drugs, but the problem occurs only to those who are at risk of thrombosis due to other causes (like obesity). Breast cancer is definitely a risk factor but the risk is small. So, the women need to continue self-breast examination and yearly checkup by their consultants. Blood fat concentration (cholesterol) may be altered, which needs regular lipid profile checkup. And finally there is increased risk of heart attacks and stroke. But possibility of heart attack is there only if HRT is started in very elderly women (after 60 years) and those who are already have some risks (obesity, smokers, and hypertensive). Even, timely initiation of HRT (before 60 years) can protect the heart and brain against stroke.

Thus HRT is found to have very minimum side-effects and that too at the expense of so many benefits. There are very few women who should not use HRT; those having thrombosis, heart disease or liver disease at present and very high blood fat level (high triglyceride). If the woman has any mass in the breast or post-menopausal bleeding, then HRT should be used only when the diagnosis of the mass or the bleeding is certain. To be on the safe side, before start of HRT, details examination by the consultant doctor is required. This includes checkup of blood pressure, heart, breast, liver and the pelvic organs. The best time to start HRT is as early as after menopause. For premature menopause, the women are relatively younger (before 40, even before 30). So, they should start HRT soon after consultation with doctors, if HRT is suitable for them. For women with natural menopause, HRT should be started before 60 years. Annual visit to the doctor is necessary to detect any side effects and to find whether HRT is needed further or not. HRT need not be continued lifelong. Most of the women can stop it after 5 years. Very few women have to continue it beyond 10 years. Actually, after 2-3 years of HRT, most of the menopausal problems subside and women do not require to continue HRT. However, before stoppage, doctor consultation is required.

In a nutshell, elderly people deserve special care. But that does not mean they should always be in the bed. They should continue their day to day activities. They have the full right to enjoy their life by themselves. What we can do is be supportive to boost up their confidence and self-esteem. That needs social as well as medical attention. Regular touch with physician and gynaecologist cannot be overemphasized. Most of the symptoms can be taken care by life style modifications and drugs. HRT should be used as necessary. HRT is very safe and cost-effective modality. “Not everyone grows to be old, but everyone has been younger than he is now”.

Hello, Ipill is not advised for more than once a month. She can be on low dos doc pills like femilon on a monthly basis to prevent pregnancy.

if you are having sex on a regular basis it will be better if you use regular contraceptive pills .Frequent use of ipill can cause havoc with your health and hormonal balance .The white curdy discharge could be because of candida infection'.It is difficult to predict about your next period .you can wait till 15 0f jan