Dr. Meenakshi Rajiva Kumar

Menopause is a natural change in a female body that occurs after or around the age of 45, when the ability to bear children stops permanently. The fertility diminishes and the menstrual cycle stops. A decrease in hormone production, especially in the levels of estrogen, happens after the onset of menopausal years.

During this time, there are a number of physical changes that take place inside the woman’s body. The noticeable changes happen in the female breasts.

Some visible changes to breasts during menopause

1. Non-cyclical breast pain is mostly not related to menstrual cycle and slowly stops with time.

2. Loss of glandular tissues is common and causes shrinkage in size.

3. With age, the connective tissues also lose elasticity and causes sagging

4. Breast pain could also be due to fibrocystic breast changes

5. There could be a chance of developing breast cancer

6. Density of the glands decreases inside the breasts and fat develops.

It is advisable to get any kind of discomfort examined by the doctor to make sure you are in the safe zone. Hormone replacement therapy (HRT) is not generally advised as it may create hormonal issues in the long run.

It is also important to follow a healthy diet comprising of protein, calcium , magnesium and other vital nutrients as advised by your doctor. Reduction in smoking and alcohol intake is highly beneficial and cuts down risk of major diseases. It is also necessary to exercise, remain physically active and maintain a healthy body weight during this time.

Regular check-ups, mammograms and self-examination of breasts help to diagnose and detect early signs of breast tumours and cancer and are highly recommended, especially for women who are in the perimenopausal and menopausal years.

The woman’s reproductive system is an extremely complex one. The uterus which is the main organ with its appendages helps in conception, pregnancy, and childbirth by undergoing marvellous changes. The uterus measures just about 7.5 x 4.5 in a normal woman and expands to accommodate a full-term baby within her during gestation.

The uterus is lined with smooth muscles, and due to unknown reasons, this lining material could be found in other parts of the pelvic organs. This condition is known as endometriosis and is one of the main causes of pelvic pain. Most women suffer through it, and it mostly gets diagnosed when some other issue is being investigated.

For women with endometriosis, there are mainly two issues to deal with i.e. pain and depression.

Pain: While the pain per se is one issue, the way it affects daily normal life is another thing to be considered. For the pain to minimally affect routine life, the following are effective ways.

1. Exercise: Anything that you prefer like swimming, jogging, dancing, aerobics, cycling. This will help in stress management and pain relief.
2. Rest: Get adequate rest of 8 to 9 hours per night. On severely painful days, go ahead and sleep for a couple of hours extra.
3. Stress management: Whether through yoga or meditation or music, learn to manage stress better. Nobody is without stress but managing it is the key.
4. Eat healthy and fresh: Whole grains, fresh fruits and vegetables, increased fibres are definitely useful. Reduce whites including sugar, salt, and dairy products if possible.
5. Social life: Stay connected with people whose company you enjoy – be it family or friends, or even counsellor if required.
6. Speak up: Let your close circle of friends at work know your problem, so they can help when you need it the most.

Depression and mood swings can be managed in the following ways.

1. Do what makes you happy: There are some activities which will definitely make you feel better. A quiet walk to get some fresh air. Watching a dance video. Listening to your favourite soundtrack. Changing body language to one without stopped shoulders and frowning foreheads can make a big difference.
2. Focus on the good: Writing down or thinking about what went well for the day can cheer you up and overcome the blues that is so common in women with endometriosis.
3. Positive thinking: Instead of saying, I can not try saying I will try. It makes a BIG difference, and you will be amazed at the results.
4. Keep happy company near you: Surround yourself with happy, positive people and see your happiness quotient go up!!!

Endometriosis is definitely an enigma that is not well known, understood, or identified. However, the above are definitely useful way to cope with it.
 

Pregnancy is that wonderful and beautiful phase that most women rejoice about. However, many may find it hard to believe that pregnancy can bring with it a condition known as ‘antenatal depression’. This is a common condition in expecting mothers and should not be ignored.

Depression during pregnancy like regular depression is a clinical condition and requires further investigation and management. Pregnancy is related to the female hormones and therefore, mood swings are common (as during PMS and menopause). However, depressed pregnant women would typically have the following associated symptoms too.

1. Altered eating habits

2. Altered sleeping patterns (too much or too less)

3. Loss of attention/ability to focus

4. Losing interest in activities which usually interest the person

5. Feeling very anxious

6. Constant feeling of sadness

7. Uncertainty about the future

8. Feeling of worthlessness

9. Suicidal tendencies

It has been noted about 25% of women can get depressed during pregnancy for varying periods of time. Some potential reasons for this are as below.

1. Strained relationships: One of the most important factors for a healthy pregnancy is a happy relationship, not just with the partner, but with immediate and close family members with whom there is a high level of regular interaction.

2. Work stress: For working women, a stressful office environment could take a toll on their moods.

3. Previous miscarriages: This can cause anxiety and depression about possible repeat incident.

4. Potential complications: If the periodic examinations showed up possibility for complications in pregnancy, the chance of depression in the mother increase.

How it affects pregnancy?

A depressed mother would not be able to care for herself and  therefore, the baby may not get adequate nutrition for its development. Additionally, the potential for nicotine and alcohol abuse increases, which also negatively impacts the baby’s growth. There could be low birth weight, premature birth and developmental delays after birth.

How it can be managed?

While the hormonal changes during pregnancy causes mood swings, diagnosing if it is depression is important. A consultation with a psychiatrist may be required for some women.

Some of the options available for treatment include support groups, individual counseling, and medications.

1. It is important to understand that this is a common condition and you are not the only one going through this. Talking to other women who feel depressed can help in mood uplifting of all involved.

2. If you are too shy about it, individual counseling could be the next best thing.

3. Stress management including light exercise, music, meditation, rest, diet, and support from close friends and family are highly recommended.

4. Since most antidepressants would reach the baby, it is advisable to avoid these less you need them as a last resort.

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

Pregnancy can wreak havoc in your body; be it your hormones overflowing or the constant crying of your newborn that makes you agitated after a point of time. Your baby will probably be your top priority in times like these but maybe, you can put yourself on the list as well once in a while because carrying a human inside isn’t a very easy task.

Vaginal soreness
On the off chance that you suffered a vaginal tear or an episiotomy while delivering, the injury may sting for a couple of weeks. Broad tears may take more time to heal. Meanwhile, you can promote healing by:

1. In case of sitting becoming uncomfortable, try sitting on a cushion or cushioned ring.
2. Utilize a squeezer-bottle in order to pour lukewarm water over the vulva while you're urinating. Press a cleansed washcloth immovably against the injury when you hunker down for passing stool.
3. Cool the injury using an ice compress, or place a cool witch hazel cushion between the wound and a clean sanitary napkin.
4. Take stool softeners or analgesics as prescribed by your healthcare provider.
5. For treatment of episiotomy wound in 1st week - betadine wash should be used 3-4 times a day.

While you're recovering, anticipate that the uneasiness will gradually reduce. Contact your doctor if the pain increases; the injury gets swollen, hot and excruciating; or if you notice a discharge with pus.

Vaginal discharge
Vaginal discharge (lochia) might be a problem for several weeks post-delivery. Expect a red, overwhelming stream of blood for the initial few days. The release will continuously decrease, getting to be watery and changing from pink or chestnut to yellow and finally white. Contact your doctor if:

1. You have substantial vaginal drying
2. The discharge has a foul scent
3. You have a temperature of 100.4 F (38 C) or more

Contractions
You may feel contractions for the initial few days post-delivery. These constrictions, which frequently seem like menstrual cramps help in preventing excess bleeding by compressing the vessels. These contractions have a tendency to get more intense with subsequent deliveries. Your healthcare supplier may suggest an OTC pain reliever as well. Contact your healthcare personnel in the event of fever or if the stomach area is tender to your touch. These symptoms and side effects could show a uterine disease. In case you have a concern or query you can always consult an expert & get answers to your questions!

After carrying the baby for nine months and delivering it, the next big step for the mother is to learn to breastfeed. For a woman who has had her first delivery, this could be a thing that can scare her and put her at discomfort. In addition, some mothers can also experience physical pain, which is even more worrisome.

In the initial stages of breastfeeding, it is normal to have pain as the baby and the mother have not yet identified the correct method i.e. the mother in terms of holding the baby, while the baby in terms of latch correctly to get milk. However, in most cases, the mother detaches and repositions the baby. This often helps in relieving the pain and after some repetition of this exercise, both the mother and the baby would know the correct position.

Let down reflex, also called milk ejection reflex, is set off by hormone oxitocin which is released whenever your baby feeds, it stimulates muscle cells in your breast to squeeze milk and may cause pain. Oral thrush, which is a yeast infection, in baby's mouth, can cause sore nipples and pain. The baby’s oral features like a short mouth, short tongue, small chin, high palate, etc., can lead to improper suction and cause pain. However, this pain from suctioning will disappear within a couple of days. Another cause for breast pain could be engorgement. When the breasts are engorged, due to feeding after a long break, there is too much milk, which can cause pain as soon as the baby latches on. Pressing out some milk before the baby latches on can help reduce the pain. lmproper size of bra, too tight or too loose, can be a cause of breast pain.

Nipple pain, when exposed to cold weather, is another condition. This occurs due to constricted blood vessels and is known as Raynaud’s phenomenon. If required, pain medication can be taken, but this type of pain usually subsides.

Allergies such as poison ivy and eczema can also lead to nipple soreness. Even topical issues like use of creams, soaps and deodorants can cause soreness. These require no intervention and minute changes would usually suffice. It is important to remember that any medication taken can reach the baby during the breastfeeding and unless absolutely essential, it is best to avoid any medication for the mother. If a baby is being fed well after the 6th month of life, teething begins and this can be a cause for pain during breastfeeding.

Treatment:

In most cases, proper breastfeeding techniques usually take care of the issue. However, if there are other issues, for instance, the child’s oral features, they may require correction as they not only need to be addressed because of this problem, but also otherwise.

Using warm moist compresses is useful in soothing the pain. Empty the breast properly after feeding the baby. Try to avoid chemicals like Linolin, hydrogel, as far as possible, if applied to cracked nipples, clean it properly before feeding the baby. Applying freshly squeezed milk from the breast is another wonderful option, given its antibacterial properties. The warmth of wet tea bags may also give a soothing effect. Remember to avoid chemicals like lanolin or hydrogel, as this pain is a temporary issue and usually disappears over a period of time.