Gynecological Issues:

A woman’s body undergoes constant changes physically and hormonally and has to bear with such changing demands for the duration of her lifetime. Dr. Chandana delivers holistic healthcare to women of all ages from teens to old age. She has an expertise in providing care for adolescent issues, healthcare needs of women in their reproductive age, and post-menopausal care.

Polycystic Ovaries

Polycystic ovarian syndrome (PCOS) is very commonly associated with women of reproductive age group. As per the data of multiple research studies in India, it has been found to be prevalent in 6 to 20% of the women population, of which, the prevalence is higher in women of the urban region and, in young-adults. Women with this condition can face multiple gynaecological issues ranging from irregular periods to inability to conceive.

PCOS leads to the appearance of lots of tiny fluid-filled sacs in your ovaries. Women with PCOS often report of irregular menstrual cycle, fertility problems, and symptoms such as excessive hair growth in unwanted areas of the body due to increase in the level of male hormones. By the early identification and treatment PCOS can be treated and its symptoms can be alleviated.

What Causes Polycystic Ovaries?

There is no exact cause for PCOS, it can occur due to multiple factors. But some important reasons that can play a role in its development include resistance to insulin, obesity, and hereditary. Due to an interplay of various such factors, ovulation doesn’t occur normally in women with PCOS. The ovaries in such a condition thus become cystic with multiple small immature ova. An imbalance in female hormones, along with an increase in male hormones or androgens also occurs in PCOS.

Symptoms of Polycystic Ovaries

The symptoms of polycystic ovaries usually first appear when you are in your late teens or early twenties. Possible effects of polycystic ovaries include:

• Irregular periods or your period stopping completely.
• Difficult getting pregnant as your ovaries are unable to release eggs each month.
• Excessive hair growth on the face and body, which is linked to the higher levels of male hormones.
• Thinner hair.
• Oily or spotty skin.
• Women with PCOS may also be at higher risk of developing problems such as type 2 diabetes.

What to expect when you visit a gynaecologist?

A detailed physical check-up, ultrasound, and blood tests are often required to make a diagnosis of PCOS.

The treatment for PCOS is mostly medicinal but in some cases, surgeries can also be required to restore ovulation. Intervention through laproscopic procedures or LASERs are less invasive and available as treatment options. Women are advised to keep a check on their weight and stay physically fit, which helps in preventing and reducing its severity. Since early identification reduces the risk of long-term complications, it is advisable for women to meet their gynaecologist at the earliest in case of any doubt of PCOS.

No matter how severe the disease be, the good news is that women with PCOS can still conceive normally with no complications once they get the right treatment. If you have any symptoms which can point out to PCOS, then visit your gynaecologist today.

Heavy Menstrual bleeding

Menstrual periods with abnormally heavy or prolonged bleeding are termed menorrhagia. Though many women may experience a heavy flow of blood during their periods, not all may fit into the category of menorrhagia. If you are experiencing heavy periods then consult your gynaecologist in order to know the cause for it. Early identification of cause can prevent complications.

Symptoms of Menorrhagia

It may be difficult to tell whether your periods are heavier than usual. Some symptoms that point towards heavy menstrual flow include:

• Soaking through one or more sanitary pads every hour for several hours.
• Need of double sanitary protection to control blood flow.
• Waking up at night for a need to change the sanitary pad.
• Bleeding persisting for more than a week.
• Restricted daily activities due to menstrual blood flow.
• Loosing around 1/3rd of a cup of menstrual blood per cycle for two cycles.

What causes Menorrhagia?

Heavy periods can occur due to various reasons. Some causes for heavy periods include:

• Hormonal imbalance- Any imbalance between female hormones, estrogen and progesterone can lead to heavy periods. Such an imbalance can be seen in women with PCOS, thyroid disorders, obesity etc.
• Polycystic ovaries.
• Pelvic infection.
• Uterine Fibroids.
• Endometriosis.
• Intrauterine devices.
• Bleeding disorders.
• Female cancers.
• At times consumption of some medicines can also be a cause for heavy periods.

Diagnosis of Menorrhagia

Your will be asked about your medical history and menstrual cycles first. Additionally, a detailed physical examination and one or more tests or procedures may be needed to form a diagnosis for heavy periods. Some tests that you may be advised can include:

Blood tests: For iron deficiency and other conditions, such as thyroid disorders or blood-clotting abnormalities. Pap test: In this test, cells from your cervix are collected and tested for infection, inflammation or any abnormal changes. Endometrial biopsy: A sample of tissue from the inside of your uterus can be taken to be examined by a pathologist. Ultrasound: For the visualisation of the uterus, ovaries and pelvis. Hysteroscopy: This exam involves using a lighted instrument to see the inside of your uterus.

Treatment of Menorrhagia

Menorrhagia can be treated with medicines or may require surgical intervention depending on the cause of it.

Painful periods

More than half of women who menstruate have pain during their periods. Such pain, referred to as dysmenorrhoea is usually mild, but in some women, it can be disturbing and severe which can keep them from doing their daily activities.

Types of Dysmenorrhoea and Nature of pain

A woman with painful periods can either have a primary or secondary type of dysmenorrhoea.

Primary- This is when painful periods are observed ever since a woman starts menstruating. Such pain usually starts a few days before the start of periods, continues for a day or two during periods, after which it starts decreasing and goes away by the end of it. The cause for this is usually hormonal variations that occur during periods. A hormone named prostaglandin is responsible for shedding of the uterine lining and causing bleeding during periods; during this process, it also results in such pain. This type of pain usually reduces after a woman gives birth to a child.

Secondary- In this case, a woman may have had normal periods, which become painful with time. The pain experienced due to this type is more severe. It usually starts a few days before the period begins, continues to increase as periods continue, and may not go away even after the period stops. Such pain causes discomfort on most days and may interfere with daily activities also. The reason for such pain is a disorder in the reproductive system and the following may be some causes of concern for this type:

Endometriosis: This is the growth of the uterine lining in other areas of the body, such as ovaries, fallopian tubes, pelvic region, etc. By the stretch and scar of the uterus that occurs in this condition, pain may result.
Adenomyosis: This is when the lining of the uterus grows inside the muscular wall of the uterus. This condition is more common in older women who have had children.
Fibroids: These are non-cancerous growths inside the uterus. Though small fibroids may be non-painful, larger fibroids in the wall of the uterus can be a reason for pain.
Other medical conditions - Such as cervical stenosis, Pelvic inflammatory disease, Chron’s disease or urinary disorders, etc. may also result in secondary dysmenorrhea.

Either type of pain may also be associated with symptoms such as diarrhea, nausea, vomiting, or headache in some women. Women with irregular periods, heavy flow during periods, family history of painful periods, and women who smoke, are more likely to experience painful periods.

Home care for painful periods

Some home remedies can be followed by women for relief of pain and discomfort during periods. This can include:

Exercising: Regular exercising during other days of the month can help one stay fit and it also helps in the production of some chemicals which block pain. Jogging, walking, aerobics, swimming, etc. should be followed by women for a better lifestyle.
Heat application: To soothe painful periods, local application of warm pads, hot water bottle over the abdomen, or taking a warm shower can be helpful.
Sleep: Adequate rest can help one cope up with discomfort during periods.
Relaxation therapy: Meditation, or yoga can be practiced for relaxation and can help one cope up with pain.
Medication: Over-the-counter pain killers such as NSAIDs can help one during such pain. Such medication should be taken at the first sign of pain, but should not be taken by women who are asthmatic, who have gastrointestinal problems, ulcers, bleeding disorders, or who have an aspirin allergy. It is always recommended to inform the gynaecologist about the usage of any such medications.

When should one meet a gynaecologist?

It is recommended to speak to a gynaecologist in case of painful periods. If the pain is of not much concern, then your gynaecologist may recommend reinforcement of home care.

However, in some cases, your gynaecologist may recommend a pelvic examination or other tests like an ultrasound or laparoscopy depending on the severity of the condition. Treatment for painful periods not relieved by simple measures at home can be provided by the gynaecologist, and depends on the underlying cause of it.

Endometriosis

Endometriosis is a painful condition in which tissues similar to the one that lines the inside of the uterus, grows outside the uterus. With early diagnosis and right treatment, the symptoms of endometriosis can be relieved and potential complications can be prevented.

What Causes Endometriosis?

The exact cause of endometriosis is still unknown. Some causes which are suggestive include:

• During menstruation, some of the tissue backs up through the fallopian tubes into the abdomen – reverse menstruation, where it attaches and grows.
• Endometrial tissue may travel and implant to the outside of uterus via blood or lymphatic channels.
• Cells in any location may transform into endometrial cells.
• Immune system disorders may lead to endometriosis at times. In such a case the body may be unable to identify and destroy the unwanted growth of cells.
• Certain families may also have predisposing genetic factors to the disease.

Symptoms of Endometriosis

The symptoms of endometriosis can vary depending on which parts of the body are affected and how much endometrial tissue has formed. Some women only have mild symptoms, but endometriosis can have a significant impact on your life. Some symptoms of endometriosis include:

• Pain, especially excessive menstrual cramps that may be felt in the abdomen or lower back.
• Painful intercourse.
• Abnormal or heavy menstrual flow.
• Infertility.
• Painful bowel movements and urination during menstrual periods.
• Gastrointestinal problems, such as diarrhoea, constipation and/or nausea.

Pain experienced during endometriosis may not be related to the severity of disease. If you are experiencing any of the symptoms as mentioned above then meet your gynaecologist.

Diagnosis of Endometriosis

• Diagnosis begins with a gynecologist evaluating a patient’s medical history and completing a physical examination, including a pelvic exam.
• Diagnosis of endometriosis can only be confirmed, when the doctor performs a laparoscopy, and biopsy of any suspicious tissue taken from the areas of tissue growth. Laparoscopy is a minor surgical procedure in which a laparoscope, a thin tube with a camera at the end, is inserted into the abdomen through a small incision. Laparoscopy is also used to determine the location, extent and size of the endometrial growths.
• Imaging such as ultrasound, CT scan and MRI scan may also be needed at times to make a diagnosis.

Treatment of Endometriosis

It is important to see a doctor if you think that you might have endometriosis as it can have a major impact on the quality of your life. The treatment required will vary as per the extent of your disease and can include:

• Pain medication to ease out your cramps.
• Hormone therapy to alleviate symptoms and restrict the progression of disease.
• Conservative surgery to remove the diseased part laparoscopically or conventionally, in women who are trying to get pregnant.
• Complete hysterectomy with removal of ovaries.

Fibroids

Fibroids are non-cancerous benign tumours that grow within the uterus. Fibroids are common and affect one in five women during their childbearing age. By the age of fifty half of women have fibroids.

They can be very small in size, and need a microscope to be detected or can be huge and weigh several pounds.

Where can Fibroids form?

They can grow in various portions of the uterus including:

• The muscular wall of the uterus
• Under the lining of the uterus
• Outside the lining of the uterus

What are the symptoms of Fibroids?

Depending on their size and the portion of the uterus they are growing they can cause various symptoms. In some women they may not cause any symptoms and may be discovered accidentally during an ultrasound or a pelvic examination, however in others they may lead to symptoms such as:

• Heavy periods as described above including blood clots.
• Periods that last longer than a week.
• Need to urinate more frequently.
• Painful periods.
• A feeling of fullness in the lower abdomen.
• Backache or leg pains.

Fibroids contribute to heavy menstrual flow, by applying pressure on the uterine wall, hindering normal contraction of the uterus, stimulating the growth of blood vessels, or by causing hormonal imbalance. Very rarely a fibroid may also cause acute pain. This can be in a case when it outgrows its blood supply.

Why do Fibroids develop?

The exact reason for the development of fibroids is not known, but most of them can be linked to hormones or genes. Fibroids develop mostly in reproductive women when their oestrogen levels are the highest. This is the reason why they may shrink as the woman reaches her menopause, and her monthly periods stop. In some women, fibroids may also develop due to more growth factors or extracellular matrix material which makes them overgrow.

Diagnosis and Treatment of Fibroids

Fibroids can be diagnosed upon pelvic examination by your gynaecologist, who may also advise for an ultrasound to confirm the diagnosis. At times, other tests such as MRI, hysteroscopy, or biopsy of the uterine lining may be done for a detailed study of fibroids.

For treating fibroids various modes of treatments may depend upon, the severity of symptoms, age, and whether the woman with fibroids wants to get pregnant in the future or not. The treatments may range from medications to surgery. In some cases, hysterectomy or complete removal of the uterus through conventional surgery or laparoscopy may be done to get rid of fibroids completely.

What you can do to prevent the development of fibroids?

Though due to the genetic and hormonal association that fibroids have, they cannot be completely prevented. But some lifestyles changes can reduce your risk of getting them. Regular exercise is recommended for all women, which helps control weight and in turn keeps the hormones in balance. Eating fresh fruits and vegetables helps maintain a healthy lifestyle.

When to meet your gynaecologist for fibroids?

It is recommended, that in case of heavy bleeding, feeling of fullness in the lower abdomen, or having excessive menstrual cramps one meets their gynaecologist. Besides, regular gynaecological check-ups are recommended which can help one get aware of developing fibroids at an early stage.

Vaginitis

What is Vaginitis?

Vaginitis is inflammation of the vagina. It is reported that almost one-third of women have symptoms of vaginitis sometime during their lives. This condition may affect women of all ages but is most common in women during their reproductive years.

What causes Vaginitis and how to identify it?

Various infections, hormonal changes, or allergies can result in vaginitis. Depending on the cause it can be of the following types:

Bacterial vaginosis

This can occur due to an alteration in the bacterial flora of the vagina. One or more bacteria may overgrow and cause this. This is more commonly seen in women who are sexually active, more so in ones with multiple sexual partners. However, women who are not active sexually can also get bacterial vaginosis.

Symptoms of Bacterial vaginosis:

• Increased vaginal discharge which is usually thin and dark or dull grey.
• Strong fishy odour along with discharge.
• Itching in case of heavy discharge.
• Some women may also report a greenish discharge.

Yeast infection

Such an infection is one of the most common causes of vaginosis. It is caused by the fungus Candida albicans. It can occur due to overuse of certain antibiotics, or also when the body’s immune response is compromised.

Symptoms of Yeast infection:

• Itching and burning sensation around the vagina.
• White and lumpy odourless discharge.

Trichomoniasis

This condition is caused by a parasite that can commonly be acquired through the sexual route.

Symptoms in Trichomoniasis:

• Yellow-Gray or greenish discharge.
• Fishy odour in discharge.
• Irritation and redness of vaginal region.

Viral vaginitis

Sexually transmitted viruses such as Herpes and Human Papilloma virus may be responsible for vaginitis.

Atrophic vaginitis

Reduction in the levels of oestrogen in the body, during menopause can result in thinning of the vaginal lining leading to this type of vaginitis. This can also result at other times when there is hormonal alteration such as at the time of breastfeeding.

Non-infectious Vaginitis

This can occur due to allergic reaction to various products, such as vaginal sprays, scented detergents, and spermicidal products. Objects such as tissue papers and tampons which stay inserted for long periods inside the vagina can also result in this.

How to Prevent Vaginitis?

• Good hygiene: Maintaining a clean and dry vagina can help prevent any infection in it. Normal cleansing is recommended and douching should be avoided.
• Avoid irritants- Harsh and strongly scented soaps should be avoided. Care should be taken to remove the tampons timely.
• Wiping from front to back is recommended for cleansing- This prevents any transmission of faecal microorganisms to the vagina.
• Wear comfortable cotton underwear- This helps to keep the area dry and is recommended since yeast thrives well in moist areas and can be prevented by this.

When to meet a doctor?

It is recommended to meet a doctor in case you have any vaginal discomfort. Note for:

• Increases vaginal discharge.
• Foul odour.
• Itchiness or burning of the vagina.
• Painful urination.
• Vaginal bleeding.
• Fever or chills accompanying vaginal discomfort.
• Never had any discomfort in the vagina before.
• Had discomfort previously but routine medications fail to work.
• Discomfort in the vagina after a sexual intercourse.

The treatment of vaginitis will depend on the cause of it. Ankura hospital for women and children has a team of gynaecologists who are experts in treating vaginitis of all kinds.

Postmenopausal problems

Menopause is an important natural life event that hits women at an average age of 45-55years. A phase marked by the termination of monthly periods, menopause leads to multiple hormonal changes in a woman’s body, which in turn is responsible for menopausal symptoms and changes. While some women may experience mild menopausal symptoms, some go on to experience severe symptoms.

Various symptoms women face during menopause

Menopause causes a lot of changes in a woman’s body.

• Hot flushes and sweats are the most common symptoms. Flush is a sudden feeling of heat, which is mostly felt in the head and neck but may spread across the whole body.
• Some psychological symptoms that can be faced by women during menopause include low mood, irritability, lack of confidence, anxiety, and at times, cognitive changes such as difficulty in memory and concentration.
• Joint pain and stiffness may be faced by some.
• Genitourinary symptoms that one can face during menopause include frequent urinary tract infections, frequent urination, incontinence, and vaginal itching dryness, and soreness.
• Sleeping difficulties.
• Changes in bleeding patterns before one experience a complete loss of monthly periods. This may include heavier and more irregular periods, which thus leaves one more unprepared for it.

Bone health during menopause

Bone health changes during menopause due to altered levels of hormones. Below are some points you should know about it:

• Due to reduced estrogen levels in the body during menopause weak bones or osteoporosis tends to occur.
• Overall osteoporosis is three times more common in women than men, and it has been reported to be prevalent in as high as 62% of postmenopausal women in India.
• Due to a sudden fall in estrogen which is normally responsible for maintaining bone strength, bone health deteriorates in post-menopausal women. This occurs especially in a case when women have a lesser than ideal peak bone mass before menopause.
• Bones in osteoporosis become thin with less bone density which are easily susceptible to fractures. Osteoporosis is a silent disease where one may not realize what’s lying underneath until a sudden strain or fall results in such a fracture of a bone.
• Women have been shown to lose up to 10% of their bone mass in the first five years after menopause.

Maintaining good bone health at all times and especially during the peri-menopausal period leads to a reduced prevalence of such osteoporosis.

How to maintain good bone health post menopause?

• Lifestyle recommendations for good bone health include, maintenance of good levels of calcium in the body by adequate consumption of foods rich in it which includes dairy or non-dairy products such as almonds, dark green leafy vegetables, fish, etc.
• Vitamin D which helps in the absorption of calcium should be maintained at adequate levels by exposure to sunlight or consumption of supplements as recommended by one’s doctor.
• Exercising regularly on most days of the week helps prevent osteoporosis.
• Care should be taken to avoid smoking and excessive alcohol and caffeine consumption. In case menopausal osteoporosis occurs, it can be diagnosed by specific radiological and laboratory tests and is treatable.
• Various medications and exercises can help one regain the bone mass back.

One is never too young or old to take care of their bones. Understanding menopausal problems and good lifestyle habits can help you protect your bones and can reduce your risk of getting postmenopausal osteoporosis. If you are near your menopause or have gone through it already and your doctor hasn’t spoken to you about the health of your bones, then it’s time for you to bring it up.

Cervical cancer

According to the estimate given by the World Health Organisation, one woman is diagnosed with cervical cancer every minute globally. In India, one woman dies of cervical cancer every eight minutes. Cervical cancer is the second most common cancer in Indian women and the current estimates indicate that every year 123907 women are diagnosed and 77348 die due to it. But though this cancer is highly prevalent and lethal, it can be prevented through a vaccine.

What is cervical cancer and how can it develop?

Cervical cancer affects the cells of the cervix, the lower part of the uterus that connects to the vagina. It is caused by the multiple types of Human papillomavirus, which can be transferred through sexual contact. Though the body’s immune system fights to prevent severe damages from this virus, in some cases it causes HPV-related cancers or genital warts.

How can one identify cervical cancer?

One may notice symptoms like a bloody vaginal discharge, pelvic pain, or pain during intercourse in case of cervical cancer. But in most cases symptoms are noticed only in later stages of the disease, thus making early screening and prevention very crucial.

Cervical cancer screening

Screening through Pap smear test, HPV test or a pelvic examination can help detect cancer in an early stage or identify it in a precancerous state. Screening tests are available for women aged 25 years or above.

Vaccination against cervical cancer

Vaccination for the prevention of cervical cancer provides protection against multiple HPV variants. Two licensed vaccines are available in India. Vaccination can be done in girls from the age of 9 years onwards. The HPV vaccine is known to be most effective before women become sexually active, which is before they get exposed to the virus. Thus, just like many other vaccinations that a child receives, this too can be planned in consultation with an expert. If not given at an earlier age, then the vaccine can be administered till the age of 26 years for protection. Vaccination is also approved for women from 27 to 45 years. But, at this stage, women should discuss it with their gynaecologist to know whether they should receive it.

Vaccination against cervical cancer and regular screenings are crucial for reducing the burden of this deadly cancer in India. It can help prevent its spread and reduce the loss of lives due to it.

* * * * * If you suspect any signs of cervical cancer visit a gynaecologist near you at the earliest! * * * * *