Well Woman Clinic

Polycystic Ovary Syndrome (PCOS) is a condition, which is born due to an imbalance of hormones within the female body. When this happens, the female body faces anumber of problems as far as her periods or menstrual cycles goes, besides finding it difficult to conceive naturally and easily. Let us find out more about this condition.

PCOS and hormones
To begin with, let us understand what hormones are. These are chemical impulses that send messages to various parts of the brain and rest of the body to signal the release of other kinds of hormones that may be vital for various functions. In PCOS, it is normally seen that the sex hormones are thrown out of balance, due to which the ovaries start producing a small dose of some male hormones. This creates problems as far as ovulation is concerned and also, it gives rise to the growth of facial hair, acne and changes in the overall appearance of the patient. Insulin resistance is another cause that may also trigger PCOS. It is also an inherited issue in many cases.

Symptoms
From irregular periods to an increase in acne and facial hair, there are many symptoms that may point at the existence of this condition. Fertility problems and issues related to normal ovulation are also often seen in women who are suffering from this condition due to the irregular periods. Additionally, depression may be seen in many patients who are suffering from this condition on a chronic basis. Thinning of hair and excess weight gain with difficulty in losing extra pounds may also be indicative of PCOS.

Love making is generally portrayed as a way to great pleasure. However, what most may not know is that intercouse can be painful, very painful, so much so that you at times  don’t want it. In fact, an alarming 75% of women have had pain during sex at some point in their lives. There are physical and psychological components to this, both of which can be managed easily if identified. While some may be frank and talk about it, a lot of them go unspoken and therefore endure the pain in silence.

Painful intercourse, which is a major deterrent for a happy intimate life, has a lot to do with the mindset and emotions than actual physical or physiological problems. Fear of being hurt, performance anxiety, sexual inhibitions, past history of abuse, etc. are major contributors for painful intercourse.

Physical causes for the pain include temporary reasons like the ones listed below.

1. Vaginal Infections: Fungal infections of the vagina and surrounding organs are very common and there could be sores or lesions, which can turn painful with sex.
2. Vaginismus: Another common condition leading to painful sex, these are involuntary contractions, which often happens as a defense mechanism. The woman has the fear of being hurt and so these spasms happen.
3. Gynaecological Issues: Ectopic pregnancy, ovarian cysts, menstrual disorders, endometriosis, cervical problems and vulvar injuries are other causes which can lead to painful intercourse.

With any of these, the remedy lies in acknowledging the problem.
If there are no physical issues, talking about the past, discussing her fears and anxiety can help. Many times, the expectations are often unspoken and there is a lot of uncertainty, fear and anxiety between the couple, especially with respect to intimacy. A frank talk can help ease both of them, and that can often help in reducing pain during sex. If required, counselling can be sought,so that she opens up. In most cases, one or two sittings with both couples and a counsellor can help find the problem and work out a lasting solution.

Lubrication is often another problem that leads to pain. When there is not sufficient mental stimulation, the chances of a dry vaginal mucosa are high. Artificial lubricants can be used to help with easy penetration and reducing the pain. Infections can be managed with antibiotics, often topical, unless it is very severe and requires systemic antibiotics. Women who have delivered babies should refrain from sex for complete healing, as it can be painful. 

Menopause is another reason for painful sex and this is due to lower hormone level. Using hormones either topically or supplements like birth control pills can improve overall sexual urge and lead to painless sex. In case you have a concern or query you can always consult an expert & get answers to your questions!

Pregnancy is one of the most exciting and anxious phase in a woman’s life. There is definitely an information overload from all sources i.e. family, friends, medical team, books, Internet, etc., that is dumped on the mother-to-be. The idea is to prepare her for the delivery. What needs to be borne in mind though is that each delivery is unique and there are no two women who have had the exact same experience.

However, it is good for the mother to know what to expect so that she is mentally prepared and not totally caught unawares when the actual scenes unfold. The following are the sequence of events that she should be aware of and watch out for:

1. With the due date nearing, she should keep a watch for the water breaking. This is passing of fluid surrounding the baby and is usually colorless and odorless. However, if it is green or brown, it is an indication that something might be wrong. Immediate medical help should be sought in that case.
2. Along with water breaking, contractions is the next thing to watch out for. This is due to the tightening and releasing of the uterus, indicating that the baby has begun to descend down towards the cervix. If these last for up to a minute, occur every five minutes, and persist for up to an hour, it is a clear indication that it is delivery time and you must head to the hospital.
3. Two sensations very prominent during delivery are pain and pressure. The pressure is from the baby passing down the birth canal. As the cervix and the vaginal canal expand to allow passage of the baby, there would be a great deal of pain and pressure. It is not just the mother, even the baby exerts significant pressure to come out of the womb during labor.
4. The process of the baby getting out of the womb is what is medically termed as labor and has three distinct stages to it:
   • The first stage has two parts to it i.e. an initial, gradual phase that may last for a few hours and a later, quicker phase. The rate of progress of delivery is steady.
   • The second stage usually lasts for about two hours, during which the cervix is minimally dilated and pushing begins. This stage lasts until the baby is out of the womb.
   • The third and the last stage is where the placenta is extracted and the umbilical cord is cut.

Some common problems you may expect include injury or tearing of the vagina or cervix, need for episiotomy, vomiting, passing of motion, anesthetic complications, etc. However, what would remain etched in the mother’s memory would be the first sight of the baby.

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

What is Bacterial Vaginosis?

Bacterial Vaginosis is an infection that occurs in and around the female genitalia. It does not usually pose a major health threat and is a mild infection that can be controlled and cured with timely medical intervention. Although it is believed to be sexually transmitted, it can also affect women who are not sexually active.

Bacterial Vaginosis can however, be dangerous for women who are pregnant and are near to their delivery date. It can cause severe uterine infection and increases the chance of miscarriage.

In some cases, pelvic surgeries, which include caesarean, hysterectomy, abortion or other abdominal surgery, bacterial vaginosis can be contracted during the surgical procedure. This can further complicate the condition of the patient.

Bacterial Vaginosis is a common complaint among women who have physically reached the child bearing age and symptoms of this physical problem can become prominent at any time of the menstrual cycle.

Causes of Bacterial Vaginosis

1. Unhygienic washrooms

2. Dirty, unwashed underwear

3. Multiple sexual partners

4. Change in the vaginal pH, causing the reduction in the protective acidic secretion that prevents the growth of other harmful bacteria

5. It can also arise from the placement of Intrauterine device (IUD), a contraceptive device placed to prevent the eggs released by the ovaries, from reaching the uterus.

Symptoms of Bacterial Vaginosis

1. The most common sign of bacterial vaginosis is a foul smelling vaginal discharge.

2. The discharge increases after sexual activities.

3. Discomfort during urination

4. In some rare cases, there is itching and dryness

5. In most cases, bacterial vaginosis does not reveal too many symptoms and does not even cause intense irritation.

Treatment

1. Bacterial Vaginosis can be treated with antibiotics that are generally to be continued for a course of 7 days.

2. Symptoms and discomfort of bacterial vaginosis generally recede within 2-3 days. However, it is recommended that the medicine should not be stopped even after the symptoms disappear.

3. Only in rare cases, certain antibiotics may lead to a vaginal yeast infection. In case of redness, inflammation, irritation and undesirable discharge, you must seek medical attention immediately.

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

Miscarriage is termed as the loss of the fetus in or before 20th week of pregnancy. Medically, miscarriage is known as spontaneous abortion though the word spontaneous is more of a keyword as it is not an abortion. Symptoms of Miscarriage are weakness, back pain, fever, abdominal pain along with severe cramps and bleeding which starts from slow to heavy.

Common cause of miscarriage is when the fetus is known to have fatal genetic problems and these are not related with the mother. The other causes are:

• Infection, medical problems like thyroid and diabetes, immune system rejection, hormonal imbalance, abnormalities of the uterus, and physical problems of the mother.
• If a woman is over 35 years of age, has thyroid and diabetes and has had an earlier miscarriage then that woman is at a high risk of getting a miscarriage.

Sometimes a miscarriage might take place due to the cervical insufficiency. This is due to the weak cervix, also known as the incomponent cervix, which is unable to hold the pregnancy. A miscarriage in this condition usually occurs in the second trimester. Though there are a very few symptoms in this but there might be a feeling of sudden pressure that the water is going to break and tissues from the placenta and fetus are released without any pain. This can however be treated by a stitch in the cervix at 12 weeks. 

This stitch helps to hold the cervix until the full term is completed. If it is first pregnancy and cervical insufficiency is diagnosed then also a stitch can be applied thus resulting in full term and avoiding miscarriage.

Diagnosis of Miscarriage: 

1. The doctor does a pelvic test, an ultrasound and blood tests to confirm a miscarriage.
2. Blood tests are done to analyze the pregnancy hormone hCG. This is monitored regularly if miscarriage is suspected.
3. Genetic tests, blood tests and medication are important in women who have a history of prior miscarriages.
4. Pelvic ultrasound and hysterosalpingogram are tests which are done when there are repeated miscarriages.
5. Test like hysteroscopy is also done. In this the doctor observes the inside of the uterus with a device which is thin and like a telescope. This is inserted in the vagina and cervix.
6. If the cervix is dilated, then the woman might be diagnosed with an incompetent cervix and this can be corrected by cerclage - a procedure done to close the cervix.
7. If the blood type of the pregnant woman is Rh negative, she is prescribed a blood product called Rh immune globulin (Rhogam). This prevents from forming antibodies which could turn to be harmful for the baby.

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

What exactly happens during menopause?

You may have heard the word menopause mentioned by women with both excitement and trepidation; excitement because menopause means the end of painful and annoying periods, but trepidation, because it comes along with uncomfortable symptoms and also means the end of a woman's fertility.

A woman officially goes through menopause twelve months after her last cycle. In other words, if you don't have a period for twelve months, you are considered to be in menopause. While the age that this happens often varies, the average age is 51 years.

Menopause is a natural process that, on average, takes four years to complete. During the process, a woman's ovaries get smaller and eventually stop producing the hormones estrogen and progesterone.

Since these hormones control the menstrual cycle, once they are not produced anymore, the eggs become depleted and eventually she is no longer able to get pregnant.

The different stages of menopause are:
Perimenopause, during which your periods become irregular but don't stop. Perimenopause usually occurs to women in their late 40s, along with uncomfortable symptoms such as the famed 'hot flashes' (a quick feeling of heat sometimes accompanied by a flushed face and sweating), lower energy, vaginal dryness, sleep problems, night sweats, and changes in metabolism and mood. While you may be in the early stage of menopause, don't think you cannot get pregnant because you can! if you don't want to become pregnant, we recommend that you use some form of birth control to be safe.
Menopause. Menopause can really only be determined after the fact and since it starts 12 months after your last period. The same symptoms that can occur during perimenopause can also occur during menopause.
Postmenopause, a stage that lasts for a woman's entire life after menopause. Unfortunately, a recent study found that women can experience symptoms of menopause for an average of 4.5 years after their last period, so don't be surprised if you have hot flashes even while you are postmenopausal.
What can you do to relieve symptoms?
To clarify, menopause doesn't need treatment it's a natural part of life! but the symptoms can be uncomfortable, so there is no reason you shouldn't seek to relieve them, especially if the symptoms interfere with the quality of your life. So what can you do?
Maintain a healthy diet and regular exercise
Kick your bad habits, such as smoking and drinking a lot of alcohol
Avoid caffeine (caffeine often triggers hot flashes)
Remain sexually active! it can help preserve the lining of the vagina
Talk to your doctor about a prescription medication for hot flashes
Other causes of menopause: other causes of menopause (or early menopause) can be a hysterectomy, chemotherapy or radiation therapy, chronic diseases or primary ovarian insufficiency. If this describes your situation, speak to your doctor about how to relieve your symptoms. You should also speak to your doctor if you experience any vaginal bleeding in your postmenopausal state.
Your sex life after menopause
Just because you no longer get your period doesn't mean you can't have sex. In fact, some women report an increased sex drive after menopause, because they don't have the same anxiety about getting pregnant. On the other hand, other women report a decreased sex drive, which can be due to any number of reasons, including vaginal dryness, sleep problems, medications, depression, or more difficulty getting aroused. These symptoms, however, are able to be treated, if there is a will.

The term menopause refers to the dearth of menstrual periods for a stretch of 12 months. Although the average age for women to attend menopause is 51 years, the range varies from 45 years to 55 years. It is this span of 10 years that is defined as perimenopause meaning “around menopause”. During this time, a hormonal shift affects the process of ovulation and menstrual cycle.

Common menstrual cycle changes during perimenopause:

While a normal menstrual cycle has a particular flowing pattern of progesterone and estrogen, perimenopause doesn’t show any such pattern. Spotting and irregular bleeding are often faced by women as a result. Other changes include very long or very short periods. There could be months when periods might not occur at all. Some other changes include sleep disturbances, urinary changes, night sweats, changes in sexual desire etc.

Abnormal bleeding-

Close to 25 percent of all women reports heavy bleeding during their perimenopause. Sometimes this condition is known as hypermenorrhea or flooding. The blood flow can be so heavy that even pads might not be able to contain it. Heavy bleeding might lead to anemia as well. At times there could be a feeling of faintness. If all these conditions prevail, it only indicates a loss in blood count. Some quick fix to excessive bleeding include intake of soup, thick juice etc. Intake of NSAID thrice a day also decreases the blood flow by a good 30-40 percent.

Prolonged bleeding is a bad sign and should not be ignored at any point. It is wise to visit a doctor or a healthcare professional to know more about the cause of bleeding. Doctors often suggest tests to understand the blood count and level of iron present in the body. Iron pills have been known to replace blood cells and fight anemia.

Other ways of treating heavy bleeding is progesterone therapy. If all else fails, a doctor might suggest hysterectomy. It is wise to explore a less invasive method before deciding to remove the uterus.

Hot Flashes- A woman going through perimenopause bleeding often experiences hot flashes. This is a symptom where a woman might feel hot and sweaty all of a sudden. It is often followed by cold shivering.

Disturbance in Sleeping- Approximately 20 percent of the women facing perimenopause reports sleep disturbances. Mostly, a woman goes to sleep at the right time but wakes up very early in the morning without getting any sleep throughout the day.

Vaginal Changes- Excessive bleeding in the perimenopause phase can lead to vaginal walls becoming drier and thinner. There are instances where women report of wear and tear in the vagina walls leading to dissatisfaction during intercourse.  

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

Motherhood is a life transforming phase that all women look forward to. With the conception of a baby, a number of physiological and psychological changes take place within the mother’s body. Soon there will be a number of restrictions in the kind of food a mother a can consume, the activities that a mother can perform, the way she sleeps or sits. These restrictions are put so as to allow the baby to grow and develop safely. The restrictions prevent injuries and accidents that can be quite fatal to both mother and child.

Sitting Postures You Must Avoid

1. Do not sit straight on the edge of the chair. Provide a support to your back.

2. Do not sit in a way that pressurises only one side of your hips. Evenly distribute your weight when sitting down. Be comfortable.

3. Do not sit at the same place and in the same position for extended time periods.

4. Do not twist from your waist when you are sitting on a rotating chair. Instead, slowly move the chair along with your entire body to turn around.

Standing Postures You Must Avoid

1. Avoid standing with your pelvis tilted forward or backward. You must stand straight with your stomach held in and up as much as possible.

2. You must not slouch while standing.

3. Do not stand in the same position for an extended period of time.

4. Do not put your weight on one foot. Shift weight occasionally if your feet are hurting, but make sure to evenly distribute the weight.

5. Do not bend too much backwards or forwards.

6. Do not keep your head tilted down or sideways when you are standing. Look up, look straight.

Sleeping Postures You Must Avoid

1. Lying on your stomach

2. Sleeping with pillows under your shoulders. Pillows should only support your head.

3. Do not sleep all curled up. Relax your feet and hands to allow the blood circulation to continue smoothly.

4. Do not jerk up from your lying position. Turn to the side, swing your legs down to the side of the bed slowly and sit up using the support of your hands.

Activities You Must Avoid

1. Hard core gyming

2. Weightlifting

3. Intense cardio

4. Intense aerobics that include a lot of jumping

5. Squatting

6. Lifting heavy weighted objects

7. Travelling by public transport on a jerky road. If you wish to discuss about any specific problem, you can consult a Gynaecologist.

A woman’s body goes through a number of changes during her lifetime and therefore, it is always better to undergo regular health check-ups at proper intervals to ensure that all organs of her body function well.

Endometriosis is something, which every woman is likely to have heard about. However, not many women are aware of what it exactly is. Even fewer know about what they should look out for when it comes to having endometriosis or understanding what it means to be suffering from it. Is it not a lot better to be informed about all of this?

The condition of endometriosis is when the tissue that is supposed to be inside the uterus also known as the womb and lining, starts growing outside it. What effectively happens is that the lining of the uterus, known as the endometrium, is trapped in the pelvic area.

Some amount of discomfort is usually experienced by women who are menstruating. However, when a woman has endometriosis, the amount of pain is pretty persistent, sometimes extending to a month-long duration. Some women also suffer from excess bleeding.

Unfortunately, the symptoms are not only limited to this. Women who are adversely affected by endometriosis usually find having sex painful as well, ironic as it is supposed to provide pleasure.

Also fertility is the primary function affected by it. There are so many complications in this regard. It is said that about 50 percent of women who have endometriosis have trouble getting pregnant and carrying a baby. Effectively, as sad as it is, endometriosis has the potential to take away the entire prospect of motherhood from a woman.

In addition to this, a fair number of cases, show that the symptoms, which are experienced worsen over the course of time. So, what this means is that the lifestyle of the woman may be severely affected as the symptoms get progressively worse; which is just one of the reasons why treatment is something, which should be resorted to sooner than later.

One of the lifestyle changes which may be beneficial in reducing the severity of endometriosis includes a change in your diet. Increased intake of green vegetables and fresh fruits along with a reduced consumption of red meat is definitely worth a try. Regular exercising is also helpful in treating the condition. If you wish to discuss about any specific problem, you can consult a Gynaecologist.

Are you experiencing excessive uterine bleeding? Excessive uterine bleeding may occur between a woman’s periods or before the periods, after having sex, or due to the development of spotting or bleeding after attaining menopause. Any menstrual cycle, which lasts longer than 21–35 days is called excessive, and this is an abnormal form of uterine bleeding.

Causes of Excessive Uterine Bleeding:

The various causes of excessive uterine bleeding are as follows:

1. One of the main causes is hormonal imbalance, as the balance between estrogen and progesterone gets disrupted. This balance is required for the regulation and development of the lining of endometrium or uterus lining. Because of the hormonal imbalance, the endometrium develops excessively causing heavy bleeding.

2. Uterine fibroids, which are non cancerous tumours, may lead to prolonged and excessive uterine bleeding.

3. Polyps are small benign developments on the uterus lining which cause heavy bleeding. They occur because of high levels of hormones.

4. Adenomyosis is a condition which develops when the endometrium glands get embedded in the uterine muscle, leading to excessive uterine bleeding.

5. Using intrauterine devices or IUDs may cause side effects as well.

6. Several pregnancy complications may also lead to excess bleeding. Ectopic pregnancy is a common cause.

7. Several uterine cancers, ovarian cancers and cervical conditions may be responsible as well. Inherited bleeding disorders such as von Willebrand’s disease is another likely cause.

8. Several medicines and drugs, including NSAIDs and anticoagulants are a common cause.

9. Medical conditions such as pelvic inflammatory disease, endometriosis, liver and kidney disease or thyroid problems can also cause excessive uterine bleeding.

Treatment:

There are different ways of treating excessive uterine bleeding, depending upon the cause of bleeding and the patient’s age.

1. Medications: Several medicines are used for the treatment of abnormal uterine bleeding. Hormonal medicines and birth control pills are used to improve the regularity of periods. Non steroidal anti-inflammatory drugs are also used to manage excessive uterine bleeding. Several antibiotics are also used.

2. Surgery: In many cases, a woman has to undergo a surgery for the removal of polyps and fibroids, which cause excessive bleeding. Certain fibroids are removed via hysteroscopy and other techniques for treatment are used as well. Endometrial ablation can be carried out to manage the bleeding. This treatment aims at permanent reduction of the excess bleeding. Hysterectomy has to be carried out when other treatments are unsuccessful. This is a serious surgery and after it, a woman will no longer have periods, and she will not be able to conceive a child.

In case of excessive uterine bleeding, you must consult a doctor as soon as possible. This will enable early treatment and prevent the development of further complications.