Lybrate - Dr.Nupur Gupta talks about Cervical Cancer.
Hello I am Dr. Nupur Gupta consultant gynecologist and obstetrician practicing in Gurgaon. Today I am going to talk about cervical cancer and its prevention. We all know it is one of the very common cancers amongst females all over the world especially in developing countries, it is more common in developed countries because of poor maternal health. The patients don’t want to go to the gynecologist. There are no guidelines which they know about and they can go for screening for cancer. There are various symptoms that women should know that how cervical cancer can be diagnosed and when is the right time for them to report to their gynecologist. Especially with women, it can happen at any age and especially women who are sexually active with multiple sexual partners who have been infected with human papillomavirus at some point during their life and who have irregular vaginal bleeding and who have bleeding after intercourse which is called Postcoital bleeding and who have intermenstrual bleeding or sometimes they have foul smelling and vaginal discharge. These are all the symptoms which should prompt any female in reproductive age or during menopause, postmenopause to come to a gynecologist and go for screening.
There are various guidelines which are developed in UK, in US and over world and especially in India for females. When should Pap smear be done in any female, is every three years after three samples are negative in three consecutive years. After the age of 60 to 65 years we do it every five years and so on. So women don’t need to fear about cervical cancer anymore because now-a-days research has led to development of a new vaccine, a new innovation in health care which is vaccine against human papillomavirus which leads to this kind of cancer in females. It can be given to adolescent girls from nine years of age onwards and now-a-days it is also part of Indian Academy of Pediatrics immunization in India.
In some countries even boys are given this vaccine because this virus is known to be transmitted from male to female. Upto 26 years of age, any women is eligible to take the vaccine and also women above 26 but who are not sexually active and never had intercourse till date. But taking the immunization doesn’t mean that Pap smear need not be done, still Pap smear screening is mandatory to detect cervical cancer as far as possible. So now we know that cervical cancer is preventable and there is a vaccine which is available, there is Pap smear that can be done in women who are sexually active.
So if you want to know more about this cancer and prevent yourself being affected by this kind of cancer and go for screening you can consult me on lybrate.com which has all modes of consultation audio, video or a text mode of consultation.
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Caesarean Section Procedure
Treatment Of Female Sexual Problems
Termination Of Pregnancy Procedure
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Well Woman Healthcheck
Treatment Of Female Sexual Problems
Treatment Of Medical Diseases In Pregnancy
Treatment Of Menstrual Problems
Intra-Uterine Insemination (IUI) Treatment
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Patient Review Highlights
All of sudden I developed this polycystic ovary synDrome and didn't know what to do. I was having this polycystic ovary synDrome, but the symptoms were not very visible. My boss referred me this Nupur Gupta. They took very nice care of me, i never felt that I am in a Paras Hospital. Paras Hospital can handle all types of emergency cases. Her advice and counselling has helped me immensely. Nupur Gupta has so much knowledge that for everything my family takes her reference.
I was having very bad thoughts regarding my no periods issue. She is not just friendly, but also is very motivating. The overall atmosphere in the Paras Hospital is very soothing. I had lost hope, but treatment given by Dr Nupur Gupta has helped me regain my confidence. It was amazing, the Paras Hospitall was so nicely made. she has in depth knowledge and ensures that she explains the problem in detail.
I was quite depressed as my child was facing ROP. I consulted a number of specialists but the way Dr Nupur treated was the best. She is not just friendly, but also is very motivating. I had lost hope, but the rop treatment given by Nupur Gupta has helped regain my confidence. The overall atmosphere in the Paras Hospital is very soothing. The guidance she gave has helped me immensely with my situation.
I remember, I read an article of Dr Nupur Gupta in the paper and made contact. I consulted her for the heavy periods issue. Thanks to her I am totally satisfied with the results. I have consulted so many doctors but nobody till now was able to understand my concern properly, until i consulted her . I had a wonderful experience and Now I am totally fine.
I feel strange that I am suffering from delay periods and I am so happy that I chose therDr.Nupur Gupta for my treatment as now I am perfectly fine. The overall atmosphere in the Paras Hospital is very soothing. The complete process of delay periods treatment was so painless and quick, and i am so relieved that I chose to consult her.
Due to my problem of infertility I was feeling very depressed and had no hope. Due to Dr Nupur Gupta and the infertility treatment I didn't lose hope. Thanks to her I am much better now. Everything was just spick and span in the Paras Hospital. The waiting area in there is very comfortable for elderly patients.
Initially the problem of irregular periods were not that severe but then it became worse. She is very courteous and behaves very aptly with elder patients. During the treatment, Dr Nupur Gupta supported me a lot. I am so much benefitted with her treatment, that i am perfectly fine now.
Hi All, I wanted to give a feedback for dr Nupur Gupta from Paras Hospital in gurgaon. She did my abortion. I want to say that she made this risky process very easy for me. I was very doubtful about my safety and health. She took good care of everything.
very good dr. she is very friendly dr. be can talk any issues like a friend. thanks dr. for helping me.
Very very good happy
Giving birth is a life-changing event for every mother and it leaves an everlasting impression in your life. Every delivery is unique and you can just gain from the experience of others, but don’t expect it to be the same.
You will experience many changes in your body and will learn to take care of yourself and your growing baby as soon as you find out that you are pregnant. Pain is a part of labour that every woman has to undergo. It is the fear of labour pain that make many pregnant women opt for c-section. However there is no denying the fact that c-section is a major surgery and requires several days to recover.
Keep in mind the following tips to go in for a normal delivery:
- Try to get prenatal education, which guides you about labour, birth and natural labour pain management techniques, such as breathing, self-hypnosis, relaxation and other coping mechanisms. You should check with your hospital too as most of them offer an evening or weekend course.
- Pick a gynaecologist who has a history in delivering babies naturally.
- Keep yourself physically active by doing mild exercises throughout pregnancy.
- You should keep a calm environment in your labour room.
- Don’t gain too much weight as women who aren't overweight do not have much difficulty in delivering babies vaginally.
- Opt for fewer rather as more tests, treatments and interventions during your pregnancy tend to interfere with normal birth. Whenever tests or procedures are recommended, you should ask about the need of undergoing such tests.
- Continue with your walks as it helps in relieving the pain.
- Go in for a water therapy. A shower, bathtub, birthing pool and hot compresses are other tools for easing pain and helping you relax. Spend as much time as possible in water.
- Use various positions such as sitting on the toilet, kneeling, and squatting to ease vaginal delivery.
- Massage/back rubs equally help in easing the pain.
- You can also go in for Effleurage which is a light massage of the abdomen to ease your vaginal delivery.
- Apply warm or cold compresses.
- Avoid hearing negative stories about labour.
- Eat a healthy balanced diet as the health and development of your baby depends on your nutrition.
- Stay away from stress and anxiety. Read good books about parenting and be in the company of good lively people.
- Use relaxation/breathing techniques to keep yourself calm.
- Guided meditation and prayers undoubtedly will reinforce your faith in yourself to deliver a baby vaginally.
- Have adequate sleep. Avoid drinking tea or coffee two hours before going to bed in order to have uninterrupted sleep.
Following these tips religiously can definitely increase your chances of having a normal delivery.
Also known as tubal sterilization, tubectomy is a permanent method of contraception in women. It is a surgical procedure in which a portion of the fallopian tubes are blocked to prevent an egg that is released from the ovaries, from reaching the uterus. In case an egg is present in the uterus, it carries with it the risk of fertilization, thus, can lead to pregnancy. Sometimes the patient may change her decision and ask for a reversal of the process. However, it should also be kept in mind that the surgery is a complex one. The results are often not guaranteed.
- Tubectomy refers to cutting or blocking a small portion of the fallopian tubes that prevent the released eggs from reaching the uterus.
- The surgeon reaches to the fallopian tubes by cutting open a portion of the abdomen in case of an open surgery.
- Laparoscopic techniques are also available to conduct the surgery.
- The fallopian tubes are blocked by an artificial clip to prevent the passage of eggs.
- Tubectomy may carry some risks for patients who have previously undergone abdominal surgeries.
- Ectopic pregnancy can be a late complication if fertilisation happens in the remnant tube.
- Intraoperative haemorrhage is a rare complication.
- Post tubal ligation syndrome (dysmenorrhoea and chronic pelvic pain) may affect some women.
Minimally-invasive surgeries help in quicker recoveries. It is almost 99% effective as a measure of birth control and thus provides a permanent solution. This surgery can even be done immediately after delivery or in the postmenstrual period (interval ligation). Family welfare departments, Government hospitals and Primary health care centres offer free surgery and care to aid and educate about family planning.
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.
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.
The diagnosis of PCOS is usually done with the help of a physical examination as well as a blood test that will primarily help in determining the sugar levels and insulin. The doctor will also conduct other hormone tests so as to understand which hormones are not in balance and which ones may be triggering changes in the body. Apart from all this, the doctor will also study the body mass index (BMI) of the patient to find out if there has been a sudden and drastic change on the weight of the patient. During the lab tests, where the blood and urine are examined, the doctor will also seek to rule out any anomalies in the thyroid gland. An ultrasound of the ovaries will also be conducted.
Weight loss programs as well as diet tweaks that remove excess dairy and meat may be recommended by the doctor. Further, the doctor may also put the patient on birth control pills so as to bring better balance of hormones. Moreover, moderate exercise will be required for the patient so that the normal production of hormones may be resumed eventually. In case you have a concern or query you can always consult an expert & get answers to your questions!
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.
- 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.
- 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.
- 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:
- 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.
- 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.
- 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.
- 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.
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
Dirty, unwashed underwear
Multiple sexual partners
Change in the vaginal pH, causing the reduction in the protective acidic secretion that prevents the growth of other harmful bacteria
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
The most common sign of bacterial vaginosis is a foul smelling vaginal discharge.
The discharge increases after sexual activities.
Discomfort during urination
In some rare cases, there is itching and dryness
In most cases, bacterial vaginosis does not reveal too many symptoms and does not even cause intense irritation.
Bacterial Vaginosis can be treated with antibiotics that are generally to be continued for a course of 7 days.
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.
- 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:
- The doctor does a pelvic test, an ultrasound and blood tests to confirm a miscarriage.
- Blood tests are done to analyze the pregnancy hormone hCG. This is monitored regularly if miscarriage is suspected.
- Genetic tests, blood tests and medication are important in women who have a history of prior miscarriages.
- Pelvic ultrasound and hysterosalpingogram are tests which are done when there are repeated miscarriages.
- 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.
- 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.
- 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.
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.
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.
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
Do not sit straight on the edge of the chair. Provide a support to your back.
Do not sit in a way that pressurises only one side of your hips. Evenly distribute your weight when sitting down. Be comfortable.
Do not sit at the same place and in the same position for extended time periods.
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
Avoid standing with your pelvis tilted forward or backward. You must stand straight with your stomach held in and up as much as possible.
You must not slouch while standing.
Do not stand in the same position for an extended period of time.
Do not put your weight on one foot. Shift weight occasionally if your feet are hurting, but make sure to evenly distribute the weight.
Do not bend too much backwards or forwards.
Do not keep your head tilted down or sideways when you are standing. Look up, look straight.
Sleeping Postures You Must Avoid
Lying on your stomach
Sleeping with pillows under your shoulders. Pillows should only support your head.
Do not sleep all curled up. Relax your feet and hands to allow the blood circulation to continue smoothly.
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
Hard core gyming
Intense aerobics that include a lot of jumping
Lifting heavy weighted objects
- Travelling by public transport on a jerky road. If you wish to discuss about any specific problem, you can consult a Gynaecologist.