COMMON GYNAE PROBLEMS

MENSTRUAL PROBLEMS

WHAT KIND OF PERIOD IS NORMAL?
The onset of menstrual periods occurs between the ages of 9-17 with the average age being 13. Adolescents tend to have delayed periods to start with , but they tend to get regular with the passage of time (within an year ). Most adult women will have a menstrual cycle, measured from the first day of any bleeding to the next episode of bleeding, about every 21-35 days. Although women expect to bleed every 28 days, only 15% of women actually have cycles that length. Bleeding usually lasts 4-6 days with some women bleeding a few days longer or shorter. Around the age of 40yrs the periods start getting irregular due to hormonal changes at that time and one needs to consult the doctor at that time just to rule out any underlying disease. . 

WHAT ARE THE CAUSES OF ABNORMAL  BLEEDING ?
Abnormal bleeding is said to occur if you have a period more often than every 21 days, less often than every 35 days, or if you have bleeding or spotting in between periods. Very heavy bleeding is also abnormal. There are a number of causes of abnormal bleeding, and  almost all of them are benign and easily treatable. The most common causes are hormonal changes, ovarian cysts, uterine or cervical polyps, overgrowth of the uterine lining cells (hyperplasia), fibroids, and, rarely, precancerous or cancer of the uterus.

WHAT SHOULD BE DONE IF YOU HAVE ABNORMAL BLEEDING DURING PERIMENOPAUSE OR AFTER MENOPAUSE?
As menopause approaches, most women will experience lighter and less frequent periods. However, the likelihood of bleeding from other causes such as hyperplasia (lining overgrowth), polyps, or precancerous or cancer of the uterus increases at this time of your life. Bleeding that is irregular, very heavy or prolonged (more than seven days) is abnormal and it is important to establish the cause. The diagnostic methods available include hysteroscopy, endometrial biopsy, and D&C.

HYSTEROSCOPY
This test allows the doctor to look inside the uterus by placing the hysteroscope, a small telescope, through the vagina and into the opening in the cervix. Once inside the uterus, the lining cells can be inspected.. It can be done under local or general   anesthesia as a day care procedure and recovery is complete .   

WHAT ARE THE CAUSES OF PAINFUL PERIODS (DYSMENORRHEA)?
Dysmenorrhea refers to the pain accompanying a period. Most menstruating women have uterine contractions of moderate strength that each last for less than thirty seconds and occur about every 3 to 5 minutes. However, women who experience severe pain have cramps that last up to 90 seconds  And, the strength of the contraction may be up to 5 times greater than normal. 

It is due to  the release of a chemical substance, called prostaglandin, from the lining cells of the uterus at the time of the menstrual period. The prostaglandin causes contractions of the muscle wall of the uterus, "menstrual cramps". Women who have dysmenorrhea have been found to produce more prostaglandin in the lining cells of the uterus than woman who do not have cramps. And, when the increased amount of prostaglandin is released at the time of the period, stronger uterine contractions are the result .Medicines  are now available that prevent the formation of prostaglandins in the uterus and thus can prevent or decrease menstrual cramps.

Another cause of having very painful period is ENDOMETRIOSIS. It is a disease in which along with the menstrual bleed , there is some bleeding inside the body cavity from abnormal endometrial cells around ovaries and uterus which gives rise to severe pain .  It can cause infertility, ovarian cysts(chocolate cyst) .Treatment is with medicines in mild cases and surgery (laparoscopic) in advanced cases.

 What Are Fibroids?
Fibroids are non-cancerous (benign) growths of the muscle wall of the uterus. They are probably responsible for more unnecessary gynecologic surgery than any other condition. For many years these growths have been surgically removed, often because of fear of the problems they might cause in the future. And, those problems are often overstated. While approximately 30% of all women will have fibroids during their lifetimes, the vast majority of these women will never have symptoms and will never require treatment. And, for the rest of the  patients who have problems, there are a number of sound and effective options available. Hysterectomy should be the solution of last resort. 

WHAT CONTRACEPTIVE METHODS ARE NOW AVAILABLE?

No method of contraception is perfect, and each has its own set of advantages and disadvantages. The currently available means of contraception are:

Birth control pills

Emergency contraception - pills

Intrauterine devices (IUDs)

Barrier methods such as condoms, the diaphragm, sponge or cervical cap 

Spermicidal creams, 

Rhythm (periodic abstinence) 

Abstinence 

Withdrawal 

Hormonal injections (depo-provera) 

Hormonal implants beneath the skin

Hormonal vaginal ring

Hormonal patch

Female and male surgical sterilization

Male hormonal injections 

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