Dr. Tripti Raheja

Amenorrhea is the medical condition wherein a woman misses the menstrual periods. Girls aged 15 or more who have not yet started menstruating are at the maximum risk of this condition. The most common cause of amenorrhea is pregnancy. Other causes of amenorrhea include problems concerning the reproductive organs or glands that help to regulate hormone levels. Treatment of the underlying conditions often resolves amenorrhea.

Some of the main causes and solutions of amenorrhea are:

1. Dieting: In some women, dieting may cause amenorrhea. This is reversible, simply by eating a balanced diet.
2. Anorexia: Women who suffer from anorexia nervosa are highly likely to suffer from amenorrhea. In this case too, the only solution is to eat a healthy balanced diet.
3. Obesity: In some women, being overweight can cause amenorrhea. They should restrict the amount of fat consumed and should exercise daily to maintain an ideal body weight.
4. Vigourous Exercise: However, extreme exercise is also a cause of amenorrhea. More than 8 hours of vigorous workout, in a week, for a prolonged period of time, can cause amenorrhea. Try to strike a balance between the right kind of exercises and the time devoted to them.
5. Emotional stress: Excessive stress can often cause normal menstrual cycles to be disrupted. This can be cured by simply dealing with the cause of stress. Once stress levels come down to normal, so will menstruation.
6. Addiction: Excessive consumption of alcohol or smoking of cigarettes can also cause amenorrhea. Maintaining a safe distance from all such intoxicants is advised.

Once the cause of amenorrhea is determined, treatment is directed at correcting the underlying disease, which should restore normal menstruation. In case of any anatomical abnormalities of the genital tract, surgery may be advised. Treatment with medications such as dopamine agonists, Glucophage or oral contraceptives is also helpful. Hormone replacement therapies are used in those cases wherein a lack of estrogen is the cause behind it.

A word of caution
While many individuals and companies have marketed herbal therapies as a successful treatment for amenorrhea, none of these have been conclusively proven to be of help. In fact, some of these have been associated with serious and even fatal side effects, though in rare cases. Some preparations have been found to contain high levels of toxins. Before deciding to take a natural or an alternative remedy for amenorrhea, it is best to seek the advice of a healthcare practitioner.

Amenorrhea is very easily avoidable by eating healthy and balanced diets, exercising moderately, maintaining ideal body weight and avoiding excessive alcohol consumption and smoking.

While the decision to breastfeed or not to is a personal one, however, it is known to have a number of benefits for both the baby and the mother. Ideally, a newborn baby should be fed only mother’s milk for the first six months of his or her life. This not only provides a nutritious diet for the infant, but it can also protect the baby from a number of diseases that could affect them now and in the years to come.

Here are a few reasons a mother should breastfeed her baby

1. Well balanced nutrition: Mother’s milk is better than any form of infant formula. This is because it contains the perfect mix of vitamins, proteins and fats essential for your baby’s growth. Also, these nutrients are made available to the baby is easy to digest form which increases the amount of nutrition absorbed by the baby’s body. By breastfeeding a baby, the chances of them being overweight in their later years is also reduced.
2. Immunity booster: Along with nutrients breast milk is also rich in antibodies that protect your baby against viral and bacterial infections. Breastfeeding a baby reduces their risk of suffering from asthma and other allergies in future and also reduces the frequency of ear infections, respiratory diseases and diarrhea.
3. Better bonding: When a baby is being breastfed it is held close to the mother’s body and skin to skin contact is established. This benefits both the baby and the mother and helps build a strong bond between them. For the baby, this skin to skin contact builds a sense of security and for the mother, breastfeeding the baby can help deal with postpartum depression and make her feel connected to the baby.
4. Helps the mother recover: Breastfeeding helps the mother get her body back to its pre-pregnancy condition faster. This is because breastfeeding burns calories and hence helps the mother lose pregnancy weight faster. It also triggers the release of hormones such as oxytocin which reduce uterine bleeding after delivery and help the uterus get back to its original size.

When breastfeeding a baby it is important to recognize when the baby is hungry and feed him or her before they start crying. Typically an infant should feed on each breast for 10-20 minutes at a stretch. It is also important to be patient and comfortable while breastfeeding so as to allow milk to flow evenly and to prevent fatigue.

Ovarian cysts are common and most women will have at least one during their life. In most cases they do not display any symptoms and are discovered only during routine physical exams and ultrasounds. In most cases, it is nothing to worry about but in rare cases it can lead to complications and hence it is best to get an ovarian cysts checked out by a doctor.

Ovarian cysts usually affect women in their child bearing years. They can be described as fluid-filled sacs that develop in either of the ovaries. In an ultrasound image, these can look like small bubbles. Problems usually arise when these cysts grow larger or rupture.

In such cases, you may experience symptoms that include:

1. Pain in the lower abdomen
2. Painful intercourse
3. Irregular menstruation
4. Painful urination and bowel movement
5. Pelvic pain after exercising
6. Nausea and vomiting
7. Bloating
8. Spotting between periods
9. Heartburn and indigestion

If the doctor suspects ovarian cysts, an ultrasound is usually used to confirm the diagnosis. A pelvic ultrasound or a sonograph as it is also known is a non-invasive imaging technique that uses high-frequency sound waves to produce images of the body’s internal structure. In some cases, an endovaginal ultrasound may also be required. This involves inserting a covered wand or probe into the vagina through which a clearer image of the ovaries can be seen.

If the cyst does not trigger any of the above symptoms, it usually does not require treatment. Instead a pelvic ultrasound may be scheduled after a month to check on the size of the cyst. In most cases, these cysts resolve themselves within a month or two. In the case of larger cysts, a biopsy may be required to rule out the chances of the cysts being cancerous. Birth control pills may be prescribed to address the pain associated with this condition. These pills are also used to stop ovulation and reduce the risk of developing further cysts.

Surgery is considered only if the cyst grows in size or continues to pain. In such cases, surgery can be of two kinds: laparoscopy or laparotomy. Laparoscopy involves the removal of cysts through a telescope like an instrument that is inserted through a small incision made in the abdomen. This is usually used to remove small cysts. Larger cysts and ovarian tumours are treated with a laparotomy. This involves making a bigger incision in the stomach and may also involve the removal of the ovaries, fallopian tubes and uterus depending on the tumour. 

Cervical cancer can throw life completely off balance. It is one of the most common types of cancer affecting women worldwide. Lack of an early diagnosis makes this life threatening condition almost untreatable. A Pap smear also referred to as a Pap Test comes as a ray of hope for many women.

A Pap smear is a screening test that plays a pivotal role in the diagnosis and detection of cervical cancer in women. A Pap smear may further be used to point out any abnormalities in the cervical cells which may have a potential to turn malignant in the future. Doctors recommend all women (between 21-65 years of age) to undergo a pap smear to be on the safer side. While most women are advised to repeat the pap smear between every 3-5 years, women with the following conditions or ailments should be extra careful.

1. Women who are HIV positive or those with a weak immune system.
2. Those who have undergone an organ transplant.
3. Any woman whose pap smear indicates the presence of precancerous cells.
4. Women who had chemotherapy sessions.

The above mentioned conditions do not necessarily imply a 100% probability of cervical cancer. Consult your doctor and follow the necessary advice and precautions.

The procedure involved in a Pap smear
The Pap test is not a very tedious process and is often carried out in the doctor's clinic itself. The person to undergo the test is made to lie down on her back (the knees should be in a bent position). The physician then carefully inserts a speculum into the vagina. The main idea is to widen the vaginal walls so that the doctor can have a clear view of the cervix. Next, using a spatula, the doctor will collect samples of your cervical cells and send it for examination.

The significance of the Pap smear result

• A negative test indicates a healthy cervix with no precancerous cells.
• A positive result can, however, have many implications, such as there can be a condition known as dysplasia (minute alterations in the cervical cells). There may be some inflammation. However, the condition may be nothing to lose your sleep over. In many women, the condition heals by itself. A thorough investigation, (colposcopy followed by a biopsy) may be needed if the problem persists for long.

Further, there can be 

• Squamous intraepithelial lesion: This, unfortunately, indicates the presence of precancerous cells.
• Squamous cell cancer: As the name suggests, this more than often, confirms the presence of malignant or cancer cells.
• Atypical squamous cells of undetermined significance: Here the squamous cells appear very flat and thin, growing on the cervical surface. The condition may not necessarily indicate something serious. The person concerned may require further tests for a better interpretation of the condition.

A Pap smear is for your good. Go for a Pap smear and also encourage women in your circle to indulge in this healthy practice. In case you have a concern or query you can always consult an expert & get answers to your questions!

Breast cancer is a medical condition that refers to the uncontrolled growth of cells in the breast. These cells can be like small tumours or lumps. The tumour can be malignant if it is found that the cells are growing into surrounding tissues or are spreading. It occurs mostly in women.

Breast cancers can originate from any part of the breast. Most of these cancerous growths start in the milk-carrying ducts. There are also cancerous growths in the glands that produce milk. These are known as lobular cancers. In rare cases, cancer may also start from the breast tissues. These are known as sarcomas and lymphomas.

Here are some of the ways to get prevented from the possibility of developing breast cancer:

1. Check your weight: It is important that you maintain a healthy weight. You don’t need do follow the hard and fast dieting charts or starve. But eat a balanced diet and exercise a bit to maintain a stable and healthy weight throughout. Being obese or overweight increases the chance of developing breast cancer.
2. Be Active: A sedentary lifestyle devoid of activities is something that invites diseases. It has been found that women who are physically active and exercise for at least 30 minutes a day are at a low risk of developing breast cancer.
3. Don’t avoid fruits and vegetables: It is important for you to have a balanced diet. Include lots of leafy vegetables and fruits in your diet to avoid the possibility of developing any form of cancer. Don’t drink excessive alcohol on regular basis. Remember a healthy diet is a key to a healthy life.
4. Don’t Smoke: Smoking increases the chance of developing heart diseases, stroke and 15 types of cancers. It also increases the risk for breast cancer.
5. Breastfeed your baby: It is mandatory for good health that you breastfeed your baby. Exclusive breastfeeding is best for the health of your baby as well as yours. It lowers the chances of developing breast cancer.
6. Avoid Post-Menopausal Hormones: Post-menopausal hormones have an adverse effect on the health. They increase the risk of some diseases while lowering the effects of other ones. It should be taken for a shorter period and its prolonged use must be avoided.

 In case you have a concern or query you can always consult an expert & get answers to your questions!

Genital warts refer to small (sometimes invisible), cauliflower-shaped bumps, which form around the genital region and severely affect the moist tissues around the concerned region. Genital warts are more common in sexually active people and are one of the most commonly transmitted sexual diseases. The virus responsible for the disease, Human Papillomavirus can also cause other serious disorders such as genital cancers.

Genital warts can occur in both the genders. The virus generally spreads through sexual intercourse. In men, warts appear around the scrotum, the tip of the penis or the anus. In women, warts might form around the vaginal walls, the cervix or around the anal canal. If you had any form of oral contact with the genitals of an already infected person, genital warts can form around your throat or mouth.

The symptoms of genital warts are as follows:
1. Severe itchy sensation and discomfort around the genital areas.
2. Bleeding during sexual intercourse
3. Formation of numerous small, grey bumps around the genital region
Genital warts are caused by genital HPV’s, which are transmitted, primarily through sexual contact. In most of the cases, the immune system is able to combat the virus and makes you less susceptible to this disorder.

However, you might be at an increased risk of developing genital warts because of the following reasons:
1. Engaging in unprotected sex, that too with different partners.
2. Past history of other sexually transmitted infection
3. Being sexually active from an early age
4. Having unprotected sexual intercourse without being aware of one’s medical history

Treatment:

Doctors will only treat patients who have visible warts. The type of treatment depends on:

• The location of the warts
• How many warts there are

Treatment is aimed at getting rid of the visible warts and lowering the number of viruses present. If the amount of viruses can be lowered, the patient's immune system has a better chance of fighting them off. If the warts are causing significant pain and discomfort for you, your doctor might opt for one of the following procedures to get rid of the same:

1. Application of Imiquimod creams around the affected area might help treat the condition.
2. A regulated application of ‘Trichloroacetic’ acid on the affected areas might help to burn off genital warts.
3. Application of a solution of ‘Podophyllin’ on the affected areas might help destroying the soft tissues around the genital areas.
4. If your warts are significantly large in size or do not respond well to medications, you can also opt for surgical excision or laser therapies to get rid of them

Birth control is a method by which unwanted pregnancy is prevented. Partners can plan their childbearing in a better way using the increased levels of awareness about birth control. When it comes to birth control, women have more options than ever — but more choices also means there’s a lot more to consider. So how can you choose which pregnancy prevention method is right for you?
 
Methods of birth control:

1. Intrauterine devices (IDs): These are most effective methods of birth control. The intrauterine device (IUD) is a long-acting and reversible form of contraception for women. It is of two types: Copper IUD (contains copper) and Hormone-releasing IUDs (progestin hormone is released into the womb slowly). It is a small device that is fitted inside the womb and it provides contraception by preventing fertilization of the egg. It prevents implantation of embryo.
2. Sterilization: This is a process of birth control that renders a woman incapable of conception or a man incapable of sperm delivery. The process is conducted with the consent of the individual and can be done using either surgical or non-surgical methods. In both the cases, tubes carrying sperms (in males) and fallopian tubes (females) are either cut or blocked.
3. Condoms: These are the most commonly used measures for birth control. Male and female condoms act as barriers and prevent the sperm from reaching the uterus.
4. Oral contraceptive pills: These pills are the most popular measures of birth control used by women across the world. This is the most convenient way of postponing pregnancy. It doesn't have that many side-effects rather it's a very safe method with minimal side effects and no effect on future fertility.
5. Contraceptive Injections: In this method, one hormone injection is administered, the effects of which last inside the body for a time period of 8 to 12 weeks i.e. 2-3 months. The contraceptive injection has the similar effects as that of contraceptive pills on birth control. Evidently, the shot is irreversible, which makes the woman infertile for a period of three months. However, similar to the pill, protection from STDs is not offered by contraceptive injections. But these injections can guarantee 99% safety and surety on being used.
6. Birth Control Implant: An implant, the size of a cardboard match stick, is implanted underneath the skin of the upper arm. There are two brands that offer this implant which are Nexplanon and Implanon. This birth control method will help protect against pregnancy for up to 3 years.
7. Diaphragm: A diaphragm is a piece of dome-shaped silicon which is inserted into the vagina, to cover the cervix and reduce the risk of pregnancy. Diaphragms prevent pregnancy by putting a barrier between the vagina and the cervix, thereby preventing sperm from accessing an egg. If the sperm cannot access an egg, fertilization cannot take place. Without fertilization, pregnancy is not possible.
8. Natural Family Planning: Even though it is not any external pill or device, Natural Family Planning is also a method of birth control. It relies on the knowledge of timings of the menstrual cycle (periods) so that the couple can avoid sex during the time period when the woman is fertile.

Uterine fibroids are referred to as benign, abnormal growths which tend to develop in the uterine walls of a woman. The size of such growths can range from a few centimeters to even excess of a few inches. As such, they can cause the uterus to increase to the size of a five month pregnancy. Although, the symptoms of fibroids are not always apparent, they often cause heavy bleeding and pain in women. A recent research concluded that around 60 to 75 percent women contract such fibroids by the age of 50, at least once in their life.

Depending on the site of formation, uterine fibroids are distinguished into different types. Intramural fibroids in the lining of the uterus and subserosal fibroids which develop outside the uterus are the most commonly observed fibroids.

What causes Uterine Fibroids?
Although, the exact reason for the formation of fibroids are obscure, medical professionals have determined certain factors that may affect their formation. Some of them are:

1. Hormones: Progesterone and estrogen, produced by the ovaries regenerate the uterine lining during each menstrual cycle and trigger the growth of fibroids.
2. Family history: If you have had a family history of uterine fibroids, then you are likely to develop the condition yourself as well.
3. Pregnancy: The production of progesterone and estrogen increases during pregnancy which increases the likelihood of fibroids.

What are the signs of the condition?

Many women who have fibroids don't have any symptoms. In those that do, symptoms can be influenced by the location, size and number of fibroids. In women who have symptoms, the most common symptoms of uterine fibroids include:

1. Heavy bleeding and blood clots during periods
2. Pain in the pelvis
3. Frequent menstrual cramps
4. Pressure and pain in the lower abdomen
5. Swelling in the abdomen
6. Pain while intercourse

Rarely, a fibroid can cause acute pain when it outgrows its blood supply, and begins to die.

Fibroids are generally classified by their location. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus.

When to see a doctor

See your doctor if you have:

• Pelvic pain that doesn't go away
• Overly heavy, prolonged or painful periods
• Spotting or bleeding between periods
• Difficulty emptying your bladder

Seek prompt medical care if you have severe vaginal bleeding or sharp pelvic pain that comes on suddenly.

What is the procedure of the treatment?
Ultrasound and pelvic MRI are common diagnostic procedures to check for uterine fibroids. After diagnosis, depending on your age, size of the fibroid and your comprehensive health, the doctor would prescribe you with appropriate medications. Only after medications prove futile, doctors opt for minimally invasive surgeries.

Your body goes through drastic changes when you are pregnant. Your body makes more blood during pregnancy; for instance, prior to pregnancy, your body made approximately 5 litres of blood, but now it produces 7 to 8 litres of it.

Producing excess red blood cells requires haemoglobin, which in turn requires plenty of folate, iron and vitamin B12. If there is a deficiency in any of these requirements, you might develop anaemia.

Types of Anemia During Pregnancy

Several types of anemia can develop during pregnancy. These include:

1. Iron-deficiency anemia
2. Folate-deficiency anemia
3. Vitamin B12 deficiency

Risk Factors

Anaemia is a condition, which is characterized by a lack of red blood cells in the body. The risks of becoming anaemic during pregnancy include:

1. Being extremely fatigued
2. Miscarriages, premature birth, or low birth weight
3. The baby can inherit anaemia from the mother
4. The child can have certain developmental delays
5. Postpartum depression (post-childbirth depression)

Symptoms of Anemia During Pregnancy

The most common symptoms of anemia during pregnancy are:

1. Pale skin, lips, and nails
2. Feeling tired or weak
3. Dizziness
4. Shortness of breath
5. Rapid heartbeat
6. Trouble concentrating

In the early stages of anemia, you may not have obvious symptoms. And many of the symptoms are ones that you might have while pregnant even if you're not anemic. So be sure to get routine blood tests to check for anemia at your prenatal appointments.

How can it be prevented?

To prevent such risks, it is important to implement the proper diet. Here are some dietary tips to prevent anaemia during pregnancy:

1. Consume iron-rich foods: Foods that provide you with the best source of iron are 

• Poultry and eggs
• Dark green and leafy vegetables (for example: spinach, broccoli and kale)
• Seeds and nuts
• Beans and lentils
• Tofu
• Beetroot
• Ripe bananas

2. Don't forget the supplements: Foods are great sources of the nutrients you require, but they may be lacking at times. Ask your doctor for supplements like vitamin, folic acid and iron supplements mostly. Consuming supplements before pregnancy can go a long way in preventing anaemia.

3. Folic acid is important: Folic acid is very important for pregnant women. You must consume 400 milligrams of it to prevent anaemia and birth defects in babies. Foods that are rich in folic acid include:

• Beans
• Muesli
• Broccoli
• Brussel sprouts
• Asparagus

4. Vitamins are crucial: Vitamin C helps in iron absorption which boosts haemoglobin production. Some foods rich in vitamin C include

• Citrus fruits
• Strawberries
• Kiwis
• Tomatoes
• Bell peppers

5. Be vigilant while cooking: Sometimes while cooking foods, the wrong method can strip them of their iron content. So be careful not to fry, boil or stew such foods too much. Certain foods are best consumed raw; read the labels properly if in doubt.

6. Abstain from certain habits: Alcohol, tea, cigarette and coffee hinder iron absorption. So stop consuming them if you are trying to conceive or have conceived. In case you have a concern or query you can always consult an expert & get answers to your questions!

Caesarean-section or C-Section is fairly common today and most mothers do not realize that once their incision has healed completely, the scar tissue problems can still occur. Unfortunately, there are no instructions for how to heal and care for C-section scars after they go home. The general post-operative instructions from hospital include a list of activities to avoid like lifting heavy articles and driving.

Caesarean scars can cause pain well after they've healed. This happens at the site of incision, but in other areas as well. It's important to remember that the scar you see on a mother's lower abdomen is just one spot that scar tissue has formed. There are also internal scars which can spread throughout the body over a time period. This scar tissue can cause lingering pain and dysfunction well after delivery.

When our body tissue get damaged, scar tissue forms. After a C-section, scar tissue forms along the abdomen and uterus as part of the natural healing process.

Caesarean scars can be painful and mothers feel pain or tightness in their scars when they are reaching, leaning, lifting or standing up straight. The scar can cause muscle, connective tissue, and nerve damage in areas adjacent to scarred area. Over time this can lead to pelvic pain, bowel problems like constipation and irritable bowel syndrome and painful sex.

C-section scars are typically located in an area where they can entrap nerves. This can cause pain and also create an urgency or frequency to urinate. The best thing for a new mother is rest and recovery and doing too much, too soon, after a caesarean is a health risk. It is important that to keep the incision clean, eat well and avoid lifting heavy articles to support healing.

It is recommended that mothers have lymphatic and myofascial massage two days prior to surgery and as soon as possible post-surgery. Lymphatic massage is a light massage assisting in drainage and allows the collagen to align with the incision.

At three months post-caesarean mothers can begin scar tissue release therapy that involves massaging of the scar tissue so it becomes softer and more flexible like the surrounding skin and internal tissues. It needs to be done with three dimensional focus, slowly and gently separating the adhered tissues in all directions. The scar tissue release therapy painful with a burning sensation for some mothers, while some only feel mild discomfort or no pain at all.

Regardless of the age of the scar, one could get benefits from scar tissue release therapy from injuries to burns to surgical scars. Surface and internal scarring from surgeries could be contributing to many of the issues. Sometimes scarring is just a piece of the puzzle of your pain and so a pelvic floor physiotherapy in addition to scar tissue release therapy is recommended. The scar tissue release therapy reduces the appearance of C-section scars. It softens tissues and increases circulation, which all lead to a lightening in colour of the C-Section scar.

Here are five suggestions to speed up your recovery so you can spend less time sore and tired, and more time bonding with your new baby:

1. Get Plenty of Rest: A C-section is major surgery. Just like with any other surgery, your body needs time to heal afterward. Expect to stay in the hospital for three to four days after your delivery (longer if there are complications), and give your body up to six weeks to fully heal.
2. Baby Your Body: Take extra care in getting around while you heal. Avoid going up and down stairs as much as you can. Keep everything you need, like diaper changing supplies and food, close to you so that you don’t have to get up too often. Don’t lift anything heavier than your baby.
3. Relieve Your Pain: Ask your doctor what pain medicines you can take, especially if you’re breastfeeding. In addition to pain medicine, you can use a heating pad to relieve discomfort at the surgical site.
4. Focus on Good Nutrition: Good nutrition is just as important in the months after you deliver as it was while you were pregnant. If you’re breastfeeding, you’re still your baby’s primary source of nutrition. Eating a variety of foods will keep your baby healthy and help you get stronger.

In case you have a concern or query you can always consult an expert & get answers to your questions!