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Symptoms 

The common Ovarian Cyst symptoms include: 

• Fever
• Discomfort
• Vaginal discharge
• Nausea and vomiting
• Pain in the lower abdomen 

Causes 

The common causes of Adnexal Tumours in premenopausal women include: 

• Endometriomas (Cyst formation in the inner wall of the Uterus)
• Ectopic pregnancy (attachment of the embryo in a location other than the Uterus)
• Corpus Luteum Cysts (a type of Ovarian Cyst)
• PolyCystic Abscesses (a Liver Disease)
• Ovarian Adnexal Cysts 

The causes of Adnexal Tumour are different for postmenopausal women, which include: 

• Cancer
• Fibroids (abnormal masses that develop in the Uterus)
• Fibromas (benign Tumours like growths)
• Diverticular Abscess 

Risk factors 

The common conditions that keep you at a higher risk for developing Adnexal Tumours are: 

• Infertility
• Early menarche
• Late Menopause
• Family history of Cysts
• Certain drugs (Tamoxifen therapy may increase the chances of Ovarian Cysts)
• Obesity - Being overweight can increase your chances of developing Cysts in the adnexal of the Uterus 

Complications 

The major complications of Adnexal Tumour include: 

• Infection
• Necrosis (death of the tissue)
• IntraCystic Haemorrhage (bleeding within the Ovaries)
• Leakage from the Tumour 

Diagnosis 

A physical examination is performed to know if the Tumour is palpable or impalpable. 

In premenopausal women the adnexal masses are mainly benign; they may be malignant rarely. Based on the nature of your Adnexal Tumour your doctor would order different types of diagnostic tests, which include: 

• Cervical cultures
• Quantitative β-hCG
• Cancer antigen 125
• Blood typing and Rh
• Complete blood picture
• TransVaginal UltraSonography 

Treatment 

If you are diagnosed with Adnexal Tumours based on the Adnexal Cyst symptoms, the following are the treatments performed. 

If asymptomatic, small, adnexal masses are observed in physical examination and radiological studies, your doctor would prescribe oral contraceptives. 

If your Adnexal Tumour or mass is symptomatic and has the characteristics of malignancy, then it requires surgical intervention. 

The Adnexal Cyst treatment procedures include: 

• Removal of Ovarian Cysts: Your surgeon will remove the whole Cyst and make sure that it does not re-grow
• If the Tumour is benign, then your doctor performs a resection procedure that removes the mass alone or the whole Adnexal structure.
• If the Tumour is malignant, then your doctor would perform a Bilateral Oophorectomy, Omentectomy, or Total Abdominal Hysterectomy. 

Self-management 

You can manage the discomfort caused by Adnexal Tumours at home, Some of the self-management tips are: 

• You can use warm compression on the abdominal muscles to relieve cramping
• You can use (OTC) medications such as acetaminophen and aspirin etc., but you must talk to your doctor before using them
• You must empty your Bladder as soon as you feel the urge to urinate; this reduces the strain on the pelvic muscles
• You must include high-fiber foods in your diet to avoid Constipation. Constipation increases the pressure on the pelvic muscles. 

When to call a doctor? 

You must call your doctor immediately if: 

• You have severe Vaginal bleeding
• You experience a sudden sharp pelvic pain with nausea and vomiting
• You feel dizzy or weak with abdominal discomfort that lasts for a longer time 

Types of Amenorrhea 

Amenorrhea can be primary or secondary. 

Primary Amenorrhea refers to the condition where the female has not started menstruating even at the age of 16 years and above. 

In Secondary Amenorrhea, the woman may have started menstruating but the periods are irregular, like they occur once in 3 to 4 months. 

Amenorrhea is a symptom and not a disease. To treat Amenorrhea effectively, the doctor has to go to the root of the underlying cause. 

Causes 

Primary Amenorrhea can occur due to the following reasons; 

• Abnormal chromosomes
• Problem with the hypothalamus (area in the Brain that regulates the menstrual cycle)
• Diseases of the Pituitary Gland (gland present under the Brain that regulates the menstrual cycle)
• Obstruction of Vagina due to a membrane that blocks menstrual flow 

Secondary Amenorrhea can occur due to the following reasons; 

• Use of birth control pills, stress
• Pregnancy
• Breastfeeding
• Low body weight
• Heavy exercise
• Use of medications like antipsychotics, Chemotherapy medicines and antidepressants 

Diagnosis 

It is important to know the underlying cause for Amenorrhea which requires certain tests conducted by the doctor. 

The first test the doctor conducts is a pregnancy test to check if the reason for Amenorrhea is pregnancy. 

The doctor does a complete physical examination and enquires about your past medical history. 

An examination of the pelvis is done to check the reproductive Organs for any problems. 

To check for any hormonal problems, blood tests like evaluation of prolactin level and Thyroid Function Tests are done. 

If the woman has increased hair growth, the level of male hormones is checked. 

To know if your menstrual cycle has stopped due to lack of estrogen, a progestin challenge test is done in which the doctor prescribes progestogen hormone for 7 to 10 days due to which menstrual bleeding occurs. 

The results of the test confirm whether Amenorrhea is due to lack of estrogen. 

To check for any abnormalities in the reproductive organs and to detect Pituitary Tumours imaging tests like Magnetic Resonance Imaging, Computerized Tomography and Ultrasound are conducted. 

Hysteroscopy or Laparoscopy may be conducted which is a Minimally Invasive Surgery that is done to check the internal Organs for any abnormalities. 

Treatment 

The treatment of Amenorrhea depends on the underlying problem that is causing it. Depending on your stress level, physical activity and weight, lifestyle changes have to be made. If the reason for Amenorrhea is Pituitary or Thyroid Disorder, then it is treated with medications, whereas if it is Hypothalamic Amenorrhea, then it is treated by prescribing oral contraceptives. 

Points to remember 

You need to eat healthy and exercise regularly. 

Stress in life also affects your health adversely. To decrease stress, connect with your family and friends and allot some time for recreation daily. 

If your periods are irregular, note down the dates in your diary and give the information to your doctor. 

You can use the home pregnancy test to check if you are pregnant. Remember that even if your periods are irregular there is a possibility of you getting pregnant. 

Consulting your doctor at the earliest is the best way for effective treatment. 

Symptoms 

Based on the symptoms, Anorgasmia is classified into three types as below: 

• Primary Anorgasmia - If an orgasm is never achieved at any point in life
• Secondary Anorgasmia - If orgasm could be attained in the past but not any longer in the present
• Situational Anorgasmia - If an orgasm cannot be achieved only in certain situations 

Causes 

There are several causes of Anorgasmia which are similar for both men and women. 

Psychological problems: Performance anxiety is the most important psychological problem for Anorgasmia. However, other problems such as stress can be corrected in a relatively short duration. Some persons may develop negative attitudes towards sex, either due to sexual abuse or rape which can be another cause for Anorgasmia. Certain other perceptions such as monotonous sex life, boredom with the relationship and marital strife also contribute to Anorgasmia. In others, it can be due to the fear of painful intercourse, fear of pregnancy, the undesirability of the partner, etc. 

It is estimated that psychological problems are the cause of about 90% of Anorgasmia-related cases. 

Medical problems: Several medical conditions are also found to be associated with Anorgasmia. They include Diabetic Neuropathy, Radical Prostatectomy, Multiple Sclerosis, Spinal Cord Injury, Genital Surgery, Pelvic Trauma, hormonal issues (low levels of testosterone and thyroid), Hypertension and Chronic Pain. 

Risk factors 

In males, the biggest risk factor is the use of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs). 

SSRIs can affect nearly 25% of the users in terms of attaining orgasm. 

Alcohol or drug abuse (opioids and heroin) can cramp your ability to the climax of sex. 

During the ageing process, several changes occur in your hormones, anatomy, the neurological and circulatory system which can affect your sexuality. While reaching Menopause, estrogen levels get tapered which reduces circulation to the genitals, either delaying or stopping orgasm. 

Diagnosis 

Initially, your doctor will ask about your sexual history, current relationship, and surgical history. Do not hesitate to answer these questions, as they provide a clue to your doctor about your problem. 

Following this, a physical examination is performed to check if the underlying cause is any medical condition or if there is any physical or anatomical reason for Anorgasmia. 

Confirmatory diagnosis of Anorgasmia is done by performing several blood tests. A detailed neurological examination, evaluation of the hormonal levels, sugar levels in the blood and genital blood flow is performed. 

 Treatments 

A sexual therapist can best manage orgasm problems. The success rate for the Anorgasmia treatment is about 80-90% while for secondary Anorgasmia it is 10-75%. You must consult your doctor if you have the problem of reaching orgasm. 

• If the condition is due to any medical condition, then that needs to be addressed first.
• If your problem is due to psychological issues, then you will receive communication training which involves reducing pressure and developing relaxed and playful interactions.
• Counselling primarily involves teaching the mechanism of sexual arousal to the couple, focusing on the differences in their sexual response cycle. It also focuses on the emotional and situational factors of both partners, which contribute to the problem.
• Changes in lifestyle and sexual practices. Certain sensate focus exercises, Kegel exercises, directed masturbation, and systematic desensitization techniques are suggested by your physician which can be followed at home.
• Trying different techniques of sexual arousal, using devices such as vibrators and vacuum pumps.
• Hormonal imbalances can be treated with hormonal therapy, which is mostly used for women. Estrogen Therapy increases blood flow to the genitals, increasing the sensitization. These are available either as pills or as patches.
• Medications such as phosphodiesterase inhibitors (mainly sildenafil, popularly known as Viagra) are found to be effective for both males and females. Vardenafil is approved for use in men. The drug needs to be taken an hour before having intercourse. The other beneficial drugs include bupropion, amphetamine, amantadine, cabergoline and yohimbine.
• If Anorgasmia is due to drugs, then decreasing the dose of such drugs can reverse the condition. It is safe to coordinate with your psychiatrist before making any changes, especially with SSRIs. 

Anorgasmia cannot be treated completely if the nerves supplying the genitals are damaged. 

Coping and support 

It can be frustrating for both partners if either of them is having a problem reaching orgasm. Most of you might have an opinion that sex is more or less van-rocking or earth-shaking as telecasted in movies. But this is not true. So come out of such expectations. Instead of thinking about orgasm, focus on mutual pleasure. You will experience a sustained pleasure plateau which is as satisfying as the orgasm. 

Symptoms 

The condition leads to painful sexual intercourse and distressing urinary symptoms. Signs and symptoms include: 

• Thinning of the Vaginal wall
• Vaginal dryness
• Vaginal burning
• Vaginal discharge
• Burning micturition
• Atrophic urethritis
• Itchiness of the skin around the Vagina
• Frequent urinary tract infections
• Urinary incontinence 

Causes 

A decrease in estrogen levels causes Atrophic Vaginitis leading to thinning of the Vaginal wall. The condition decreases the elasticity of the Vaginal wall making it more fragile and susceptible to injuries. 

Besides Menopause, Atrophic Vaginitis can also occur during Breastfeeding, after the removal of Ovaries, after Chemotherapy for the treatment of Cancer, after Pelvic Radiation Therapy for Cancer or after Hormonal Therapy for Breast Cancer. 

 Risk factors 

Your risk for Atrophic Vaginitis increases if you smoke. Smoking affects the action of estrogens in the body and also affects blood circulation in the Vagina. If you have never given birth Vaginally, the risk for Atrophic Vaginitis increases. Sexually inactive women are also at risk of developing this condition as sexual activity increases blood circulation and elasticity of the Vaginal wall. 

Complications 

Complications of Atrophic Vaginitis include Vaginal infections and Urinary System Atrophy. The acidic environment in the Vagina makes it more prone to bacterial infections. In the case of Urinary System Atrophy, there will be incontinence, increased susceptibility to urinary infections, and burning micturition. 

Diagnosis 

Your doctor may ask you questions about your health history, medications, perfumes, soaps, lubricants, and other products that you use. This information would be helpful because some cosmetics are sensitive to sexual Organs, and your doctor may understand the underlying causes. Other tests performed are: 

• Pelvic examination: External genitalia are examined to observe physical signs of atrophy.
• Vaginal Smear Test: Vaginal tissue is scraped from the Vaginal wall to examine cells for the presence of bacteria that cause atrophy.
• Vaginal Acidity Test: A paper indicator strip is inserted into the Vagina to collect Vaginal secretions for examination.
• Blood and urine tests: These tests help to know the estrogen levels in the body. 

Treatment 

The Atrophic Vaginitis treatment goals are to treat symptoms and the underlying causes. 

Topical estrogens: These are available in the form of creams or Vaginal tablets. Creams are applied at night time onto the Vagina with the help of an applicator. Vaginal tablets are inserted into the Vagina with the help of a disposable applicator. Initially, you have to use topical estrogens for a couple of weeks and later one or two times a week. 

Oral estrogens or Hormone Replacement Therapy: Your doctor prescribes oral estrogens to treat Vaginal dryness and hot flashes. These drugs are not prescribed for prolonged use as they may cause Cervical Cancer. However, if you have a history of Cancer, your doctor doesn’t prescribe oral estrogens. 

Progestin is the synthetic estrogen which is available in the form of a pill or patch. The drug may cause bleeding, so consult your doctor immediately if you experience postmenopausal bleeding. 

Moisturizers or lubricants: Vaginal lubricants or moisturizers can help treat your Vaginal dryness. 

The symptoms must improve within three weeks of the treatment; otherwise, consult your doctor immediately for further evaluation. 

Self-management 

Besides treatment, you can adopt some measures to improve the symptoms. 

• Wear cotton and loose-fitting clothing.
• Use an over-the-counter water-based lubricant.
• Be sexually active as sexual arousal can cause Vaginal lubrication that can treat dryness or burning. 

Symptoms 

Here are a few symptoms of Bacterial Vaginosis. They are: 

• Abnormal foul-smelling discharge from the Vagina
• Milky or grey discharge
• Watery or foamy discharge
• Uncomfortable and painful intercourse
• Irritation in the Vagina
• Burning sensation while passing urine 

In some women, BV may be deceptively symptomless. 

Diagnosis 

The doctor will need to inspect your Vagina to conduct a clinical examination and collect a sample of your discharge for laboratory analysis. The sample is then examined for bacteria under a microscope and tested for acidity. To facilitate a proper collection of a sample, try and avoid any Vaginal deodorants, douches, sex objects or tampons for at least 24 hours before seeing the doctor. Schedule your examination when you are not having your period. 

Treatment 

Treatment is highly recommended for BV even when it is symptomless or not serious. Antibiotics are used to treat BV. These include metronidazole and clindamycin. These can be taken by oral route or may be applied locally in the Vagina to act at the site of infection. Metronidazole and clindamycin are available in gel form. In addition, there are also tablets available that need to be inserted into the Vagina. These are called Vaginal suppositories. When taken by mouth, clindamycin tablets of strength 300 mg are taken twice daily for seven days. Metronidazole tablets in the strength of 250 mg are taken thrice in a day for seven days or in the strength of 500 mg are taken twice daily for seven days. Clindamycin arrests the growth of the unwanted bacteria and metronidazole kills them. These are effective antibiotics for Vaginitis treatment. 

Sometimes, a repeat cycle of treatment may be required for the more severe infections. BV can occur again in which case it needs to be retreated. Both these antibiotics are active against a variety of organisms that can cause BV and have a broad spectrum of activity. Your partner will not need to be treated. It is rewarding to finish the entire course of medication and not discontinue it when you get some relief. It is important to treat BV if you are to undergo a diagnostic or treatment procedure in the Uterus, have an abortion, or are planning to have an intrauterine device (IUD) inserted into your Uterus for birth control. 

Risk factors 

Bacterial Vaginosis can cause many risk factors. They are mentioned below: 

• Risk of getting Sexually Transmitted Diseases like HIV
• Infertility
• Premature babies
• Abnormalities in the newborn
• Pelvic Inflammatory Disease 

Prevent it before it gets you! 

You can take some precautions to prevent a second or recurrent infection. Here are a few preventive measures to can follow to lead a hygienic and healthy life. 

• Keep your Vagina clean (Always wipe from the front backwards, i.e., from Vagina to the anal opening)
• Avoid too-tight underpants
• Give up douching
• Practice safe sex
• Use condoms If possible
• Have only one sexual partner
• Get yourself examined regularly 

You can certainly keep your Vagina hygienic and healthy and enjoy safe sex! 

Causes 

Most of the Cervical Cancers are caused due to Human Papillomavirus (HPV) infections. But, most people who are diagnosed with HPV infection may not develop Cancer. There are different types of HPVs and only specific HPV cause Cervical Cancers, and other types may lead to skin or genital warts. 

A change in the structure of deoxyribonucleic acid (DNA) present in the human cell is called mutation which leads to Cancer. This mutation alters the control of cell growth leading to Cancer. The Cancer cells in the Cervix break off from the Tumour and spread to other parts of the body causing metastatic Cancer. 

Two types of Cervical Cancer include Squamous Cell Carcinoma and adenocarcinoma. 

• Squamous Cell Carcinoma affects the outer lining of the Cervix. Approximately 80 to 90 per cent of Cervical Cancers are Squamous Cell Carcinoma.
• Adenocarcinoma may develop in the mucus-secreting glands located in the outer part of the Cervix. 

 Symptoms 

In the early stages of Cervical Cancer, you may not experience any symptoms. The advanced Cervical Cancer symptoms include: 

• Vaginal bleeding
• Water, bloody Vaginal discharge
• Pelvic pain 

Risk factors 

The factors that increase your chance of getting Cervical Cancer include the following: 

• Sexually Transmitted Diseases (STDs): If you are diagnosed with other STDs such as Chlamydia, Gonorrhoea, Syphilis and HIV/AIDS increases the risk of HPV infection which ultimately leads to Cervical Cancer.
• Smoking: Women who smoke are twice at increased risk of developing cancer when compared to those who do not smoke. The tobacco damages the DNA of the Cervix cells and may result in Cervical Cancer.
• Poor nutrition: An intake of a diet that is low in fruits and vegetables may increase your risk for Cervical Cancer.
• Overweight: Being overweight or obese may lead to adenocarcinoma.
• Long-term use of oral contraceptives: Several research studies reveal that the risk of Cervical Cancer is doubled if you excessively use oral contraceptives.
• Family history of Cancer: The genetic predisposition may increase the risk of Cervical Cancer. 

Diagnosis 

Screening tests: 

Cervical Cancers are prevented with certain screening tests which include: 

• Pap test: During the procedure, your doctor may scrape and brush the Cervix cells and then check for abnormalities
• HPV DNA test: The test involves examining the Cervix cells for any HPV infection 

Diagnostic tests: 

If your doctor suspects Cervical Cancer, then you may need to undergo any of the following tests: 

• Punch biopsy: The diagnostic procedure involves identifying Cancer by collecting a small tissue from the Cervix.
• Endocervical Curettage: The Endocervical Curettage uses a small, spoon-shaped instrument to scrape the tissue from the Cervix. 

 Treatment 

If Cervical Cancer is diagnosed in the early stages, it can be treated effectively. The type of Cervical Cancer treatment varies on the stage of Cancer. The standard treatment for Cervical Cancer includes the following: 

Surgery: 

Your doctor may recommend surgery depending on how advanced is your Cancer. The types of surgeries include: 

• Cryotherapy: Cryotherapy involves the destruction of abnormal cervical cells by freezing.
• Laser Ablation: A surgical laser is used to remove the cancerous tissue.
• Cone Biopsy: The Cone Biopsy involves removing of cone-shaped part of the Cervix.
• Hysterectomy: The Hysterectomy involves the removal of the Cervix and Uterus.
• Radiation Therapy: Radiation Therapy uses high-energy beams that destroy the Cancer cells. Radiation Therapy can be given externally or internally.
• Chemotherapy: It involves certain medications such as bevacizumab to treat Cervical Cancer. The Chemotherapy is given in cycles for a specific period. Other drugs used to treat Cervical Cancer include blenoxane, hycamtin, and platinol. 

Coping and support 

You may feel difficulty coping with the diagnosis of Cervical Cancer. It can affect you both physically and emotionally. But, it is very important for you to acquire the appropriate information about your Cervical Cancer and also about how it is best treated. You must seek a support group of women with Cervical Cancer or the women who survived Cervical Cancer. This may add invaluable emotional support. 

Prevention 

Cervical Cancer can be prevented by a few tips which include: 

• Getting vaccinated against HPV
• Undergoing regular Pap tests
• Practicing safe sex
• Smoking cessation 

Causes 

Early Menopause can occur due to many reasons: 

• Premature Ovarian Insufficiency (POI): It is the condition where the functioning of Ovaries stops leading to early Menopause. There are some possibilities of normal ovarian function after some time in a few cases.
• Induced Menopause: Occurs due to medical treatments such as Chemotherapy and Pelvic Radiation Treatments that damage the Ovaries and reduce their functioning and estrogen production.
• Surgical Treatments: Surgical treatments such as Oophorectomy (removal of both the Ovaries) and Hysterectomy (removal of Uterus) lead to early Menopause. In the case of Oophorectomy, Menopause may be seen right away and in Hysterectomy, the hormones will be produced as the Ovaries will be functioning normally but they no longer have menstruation.
• Genetics: A female with a familial history is more likely to have early Menopause.
• Chromosome Defects: Chromosomal defects such as Turner’s syndrome and fragile X syndrome may also lead to early Menopause.
• Autoimmune Diseases: Some Autoimmune Diseases such as Thyroid Disease, Type 1 Diabetes, Chron’s Disease, Celiac Disease, Chronic Candidiasis and Rheumatoid Arthritis also cause early Menopause.
• Metabolic Disorders: Some metabolic disorders such as Galactosaemia and Aromatase deficiency can cause early Menopause.
• Epilepsy: Females with Epilepsy are more likely to experience Premature Ovarian Failure.
• Infections: Infections such as Mumps, Tuberculosis, Malaria, and Chickenpox
• Women with smoking habits and Low Body Mass Index (BMI) also have chances of early Menopause. 

 Signs and Symptoms 

Irregular or missed periods are the first and the early Menopause symptoms. Sometimes, heavier or lighter periods than usual may also be experienced. Some of the symptoms of early Menopause include: 

• Hot flashes
• Vaginal dryness
• Bladder irritability
• Dryness of skin, mouth, and eyes
• Mild depression
• Mood swings
• Decreased sex drive
• Insomnia
• Changes in cognition
• Anxiety
• Night sweats
• Fatigue 

Complications 

Early Menopause can cause challenges in fertility and desired pregnancy. Some other risks that are associated with early Menopause are Osteoporosis, Depression, Cardiovascular Diseases, symptoms of Parkinson’s Disease, Dementia, Colon Cancer, Ovarian Cancer, cataracts, and Periodontal Diseases. 

Decreased estrogen levels in turn decrease bone density leading to Osteoporosis. This can be prevented by taking calcium calcium-rich diet and vitamin D supplements. Cardiovascular Diseases can be prevented by lifestyle changes, healthy diet, and regular exercise. 

Diagnosis 

Diagnosis can include a physical examination and some of the following tests 

• Pregnancy Test: helps to determine if pregnancy might be the cause of missed periods
• Thyroid Test: It is recommended as it can also be a cause of early Menopause.
• Follicle-Stimulating Hormone (FSH) Test: The FSH test is performed to ascertain the functional status of Ovaries. FSH stimulates the production of estrogen. Reduced estrogen levels can cause the FSH levels to be increased. Higher than 40 mIU/ml of FSH level is considered Menopause.
• Ovarian Hormones Levels Test: Estradiol is an ovarian hormone. Less than 32 pg/ml of estradiol indicates Menopause.
• Prolactin Test: Prolactin is the hormone that is involved in the production of Breast milk. Increased levels of prolactin can stop periods.
• Transvaginal Ultrasound: This test is performed to assess the functioning of the Ovaries. The number and size of the follicles or eggs in the Ovaries are counted and the volume of the Ovaries is measured. The thickness of the lining of the Uterus or endometrium is measured. Any blockage that is stopping menstrual blood flow is assessed. 

 Treatments 

No treatment can reverse or prevent early Menopause. Some treatment options are recommended to relieve the symptoms of early Menopause. The early Menopause treatment options include: 

Hormone Therapy (HT): Hot flashes and Vaginal dryness can be controlled effectively by Hormone Therapy. Estrogen is induced into the body in different forms such as pills, patches, transdermal sprays, gels or creams. Localized treatment is also available for intravaginal use. HT is recommended for short-term use as it is associated with certain risks like Heart Attack, Stroke, and Breast Cancer. 

Antidepressant Medications: The selective serotonin reuptake inhibitors are proven effective in controlling hot flashes in 60% of women with early Menopause. 

Vaginal dryness can be treated by non-hormonal vaginal gels, creams, and lubricants. 

Infertility can be overcome by assisted reproductive techniques. 

Types of Cancer in the Uterus 

There are two main Cancers in the Uterus. They are: 

• Uterine Sarcomas which is develops in the muscle layer near the connective tissue of the Uterus.
• Endometrial carcinoma develops in the inner lining of the Uterus. 

Endometrial Carcinoma can be divided into many types based on the microscopic view and one such common type of Endometrial Adenocarcinoma is Endometrioid Adenocarcinoma. They are made up of cells in glands which look like the Endometrium. 

Based on the Endometrial Carcinoma staging the doctor will know the development of the Tumour and will give appropriate medications and treatment. 

Symptoms of Endometrial Cancer 

There are a few Endometrial Cancer symptoms which are listed below: 

• Unusual Vaginal bleeding
• Spotting or discharge from the Vagina
• Pelvic pain
• Weight loss 

Diagnosis 

For diagnosing Endometrial Cancer, a procedure known as Endometrial Biopsy is done where a small amount of uterine tissue is removed by inserting a narrow tube into the Uterus through the Vagina. After removal, this tissue is sent to the lab where it is tested for the presence of any precancerous or Cancerous cells. 

A procedure known as Dilatation and Curettage is done under general anaesthesia (patient is not conscious) wherein dilatation or widening of the Cervix (opening of the Uterus) is done. The uterine tissue is then scraped with an instrument for analysis. 

In patients who are suffering from conditions like Diabetes, High Blood Pressure, Obesity, and other types of Cancers, it is not safe to give anaesthesia. In such cases, CT Scans, MRI Scans and Ultrasound help in the diagnosis of Endometrial Cancer. 

Treatment 

Endometrial Cancer treatment is done by surgical removal of the Uterus, Ovaries, and Fallopian Tubes. The surgical removal of Uterus alone is known as Hysterectomy. 

If the Cancer is severe and spreading to other parts of the body, the doctor will recommend Radiation Therapy in which Cancer cells are killed by high dosages of X-rays. In Chemotherapy, the drugs that kill the Cancer cells are given either orally or intravenously. 

To stop the growth of Cancer cells, synthetic progestin which is a form of progesterone hormone is given. Women with Endometrial Cancer in early stages who do not want to go for Hysterectomy because they want children can go for Progestin Therapy. 

To lower estrogen hormone levels in premenopausal women, an option is Hormone Therapy which is called gonadotropin-releasing hormone agonists. 

Survival and success rate 

The one-year survival rate for Endometrial Cancer is 92%. If the Cancer has not spread then the 5-year survival rate is 95%. If the Cancer has spread to different Organs of the body, then the 5-year survival rate is just 23%. 

Beating all odds 

The life of Fran Descher who is a two-time Golden Globe winner is an inspiration to all women who are suffering from Cancer. Descher was diagnosed with Uterine Cancer and underwent Hysterectomy and she has been doing well since then. 

She took up the initiative to educate people regarding Cancer and wrote it in a book called ‘Cancer Schmancer’. In this book, she stresses the need to detect the signs of Cancer early. 

On the seventh anniversary of her Hysterectomy, she launched a nonprofit organization called the Cancer Schmancer movement which helps women to detect Cancers in stage 1 or the initial stage itself as the prognosis of Cancer is good when detected and treated at the initial stage itself. 

She has not only beaten all odds to survive Cancer, but also she is making a difference in people’s lives by bringing about Cancer awareness. 

Causes 

Infertility in women can be due to several causes and in some women, the cause is not known. 

Ovulation disorders 

The most important cause of Infertility is a woman’s reduced ability to produce eggs (ovulation). Either the release is not regular, or the released egg may not be healthy. Certain conditions can lead to the above problems such as: 

• Polycystic Ovary Syndrome (PCOS)
• Premature Ovarian Failure (i.e. the Ovaries stop working before a woman turns 40)
• Eating disorders such as Anorexia or Bulimia
• Thyroid problems (both Hypothyroidism and Hyperthyroidism) 

Fallopian Tube and womb defects 

From the ovary, the eggs travel along the Fallopian Tubes into the womb. Fertilization occurs in the Fallopian Tubes while the fertilized egg gets implanted in the womb and grows further. But in some women, damage can occur to the Fallopian Tubes or the womb impairing their functions. This damage can be due to several factors such as: 

• Cervical Mucus Defect which makes it difficult for the sperm to swim towards the egg
• Scarring of the Fallopian Tubes and shortening of the Cervix (neck of the womb) that may result from surgery
• Endometriosis can lead to Infertility due to the new growths that can block the pelvis
• Growth of Fibroids in and around the womb may prevent the implantation of the embryo in the womb leading to Infertility issues
• Pelvic Inflammatory Disease which is an infectious condition can damage the Fallopian Tubes making it nearly impossible for the egg to travel into the womb 

Medicines and drugs 

Some of the drugs can lead to Infertility as a side effect. They include NSAIDs (such as ibuprofen or aspirin), certain chemotherapeutic agents, spironolactone (to treat fluid accumulation), neuropsychiatric drugs, etc. 

Certain drugs which are illegally sold can also affect your fertility, for example, marijuana and cocaine. 

Risk factors 

The factors which increase the risk of a woman getting pregnant are: 

• Age: Infertility problems are more common in women who have crossed 30 years
• Hormonal imbalances especially those of the Thyroid (both Hyper and Hypothyroidism)
• Physical problems: Problems such as excess weight or extremely low weight can affect the normal ovulation cycle
• Medical conditions: Increased risk for Infertility is seen in females with Diabetes, Hypertension, Kidney Diseases
• Lifestyle: Alcohol and drug abuse can hinder the ovulation process and can cause Endometriosis
• Environmental factors: Exposure to toxins in the workplace can impact fertility 

Complications 

Infertility itself does not cause any complications, but the treatments can lead to certain complications such as: 

• Side effects of the medications include nausea, vomiting, stomach pain, diarrhoea, headache, hot flashes, etc.
• Ovarian Hyperstimulation Syndrome is the excess production of eggs with drugs which can be very painful.
• Ectopic pregnancy, i.e. the implantation or attachment of the embryo in the Fallopian Tubes instead of in the womb. 

 Diagnosis 

Female Infertility is diagnosed by a thorough physical examination. Your doctor will ask about your medical history to check if there are any conditions which could have contributed to the problem. 

Following this, one or more of the below-mentioned tests are performed to evaluate fertility: 

Treatment 

Female Infertility is treated with the below therapies, either alone or in combination with others. Most of the couples treated for Infertility can have babies. Below is a list of fertility treatments: 

Hormonal Therapy: To address the hormonal imbalance, short menstrual cycles, or Endometriosis, hormonal therapy is provided. 

Medications: Medications are available to stimulate ovulation. These are called fertility drugs and include clomiphene citrate, gonadotropins, letrozole, bromocriptine, etc. These drugs work similar to the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to trigger ovulation. 

Antibiotic medications may be given to treat any infections. 

Surgery: Minor surgeries may be needed to remove blockages or scar tissues from the Uterus, Fallopian Tube or pelvic area. The surgical procedures include Tubal Ligation Reversal Surgery, Hysteroscopic Surgery, Laparoscopic Surgery, etc. 

In Vitro Fertilization is a complex procedure used to treat the problems related to conception. During IVF the mature eggs are made to fertilize with the sperm in the lab. This is called In Vitro Fertilization. IVF process uses medical techniques to help the woman become pregnant. 

IVF pregnancy is useful for a woman who cannot become pregnant naturally. IVF cost in India is about 1,50,000 to 2,00,000 rupees. In Vitro, Fertilization cost differs from one place to another. Therefore, these are a few treatments to cure Infertility in women. 

Fertility clinic 

Check for a fertility clinic near your place, do thorough research about the clinic and get yourself diagnosed and treated. 

Self-management 

If you are having Infertility issues and want to become pregnant soon, then you need to take the below steps: 

• Quit smoking and avoid alcohol
• Reduce stress by doing stress-relieving activities of your choice
• Maintain a healthy body weight
• Limit the intake of caffeine to 200-300 milligrams per day 

Understanding Sexual Dysfunction 

Difficulty faced by a woman at any stage of sexual intercourse is called female Sexual Dysfunction. This prevents you and your partner from having successful intercourse and from enjoying the sexual act. Do not worry as Sexual Dysfunction in women is common; many other women just like you face some sort of Sexual Dysfunction at some point in their life. It may be during their early days or later in their life after having a successful period of sex life. 

Causes 

Sexual Dysfunction may begin at any stage of your life, it may develop gradually or it may show itself suddenly, you may either have a partial or complete inability to participate in sexual acts. Sexual Dysfunction may be caused either due to physical inability due to psychological problems or both in many. 

Physical factors responsible for Sexual Dysfunction are 

• Urinary or Bowel Disease
• Previous Pelvic Surgery
• Arthritis
• Fatigue
• Headache
• Neurological Disorders such as Multiple Sclerosis (MS)
• Taking medicines such as antidepressants, Blood Pressure medicine, an antihistamine for any allergies and Chemotherapy drugs for Cancer
• Diseases such as Diabetes, Blood Pressure
• Consuming excessive alcohol
• Vaginal infection
• Thinning of the Vaginal wall
• Loss of Vaginal elasticity
• Lack of Vaginal lubrication
• After Menopause, childbirth, during pregnancy and Breastfeeding 

Psychological factors causing Sexual Dysfunction include 

• Untreated anxiety and depression may lead to stress and reduced sexual desire
• Fear that sex may hurt
• Concern about negative outcomes such as unwanted pregnancy or transmission of sexual diseases
• Relationship problems
• Sexual abuse
• Stressful day
• Tired after a day’s long work 

Symptoms 

A female is said to have Sexual Dysfunction if she possesses one or more of the symptoms listed below; 

• Lack of the desire to have sex
• Experience pain during or after intercourse
• Lack of arousal
• Lack of orgasm or pain during orgasm 

Diagnosis 

If you are experiencing one or more of the above-said symptoms, then it is better that you contact your doctor at the earliest, as many Sexual Dysfunction problems are curable. Don’t be reluctant, leave your hesitations behind talk to your doctor and explain to him about the way you feel during or after sexual intercourse. 

Diagnosis includes your physician asking for a detailed medical history, defining the dysfunction, identifying the cause, confounding medical conditions, and identifying psychological issues. During physical examination, your physician might conduct a detailed pelvic examination to check for the presence of any infection or physical problems that are keeping you from enjoying sex. He will check for Vaginal thinning, Vaginal elasticity, genital tissue, scar or pain in the genitals. Further tests will be based on the physical examination and the type of Sexual Dysfunction you are experiencing. Although there is no specific laboratory test for diagnosing Sexual Dysfunction in women, a routine pap smear will be done. 

Tests for checking the level of Thyroid-stimulating hormone, Follicle-stimulating hormone, Luteinizing hormone, Estradiol and Prolactin will be done. He will look into the fact that which one of them, orgasm, arousal, pain or low desire is the cause. He would also like to know your psychological status. 

 Treatment 

Your treatment procedure depends on the diagnostic results. If Diabetes, Blood Pressure or hormone levels are the problem then your treatment procedure will focus on treating the underlying cause of Sexual Dysfunction. 

Treating low desire: Treating women with low desire is difficult. In many cases, low desire is because of getting bored with daily routine. In that case, your doctor might recommend a change in your daily routine, try changing your timing of having sex, or change your position during sex, try involving yourself and enjoy the moment. If the diagnostic procedure shows no underlying cause or hormone abnormality then counseling may help. Estrogen therapy may help post-menopausal women. 

Treating arousal problem: Arousal problems can often be treated by using Vaginal cream and lubrications to avoid Vaginal dryness. If you have undergone Menopause, then consult your physician about using an estrogen cream or pills. Taking a warm bath may increase arousal. You can try a few arousal stimulant pills, but only with your doctor’s approval. 

Treating orgasm: Anorgasmia is responsive to therapy. Lack of orgasm may be due to psychological problems, chronic disease, or the result of medication. If the problem is with a lack of orgasm, which is due to not enough foreplay before intercourse, using a vibrator as a stimulator may be helpful. Stimulating an hour before intercourse might be needed in some. 

Treating sex pain disorder: Pain during sex may be caused due to several factors. It may be superficial, Vaginal or deep inside. If you suffer from pain during intercourse, you may try different positions as being on top gives you more control over penetration. Use sex lubrication or take a warm bath before having sex. Identifying the underlying cause is very important in treating painful sex. 

Talk to your partner 

Talking to your partner is very important to have a successful relationship going on. Tell him what feels good to you and what hurts. Sometimes your partner wants to try something that you are not comfortable with or you might want him to try something which he is not pleased with, Learn to manage such situations and make him understand your problem. Try to respect each other’s feelings, and know each other’s comforts and discomforts. Practising this will help you have a healthy relationship with your partner. For further help, you can consult your physician or counsellor. 

Conclusion 

The complexity of Sexual Dysfunction in women makes it very difficult to diagnose the dysfunctional disorder. The success of the treatment depends on the cause of Sexual Dysfunction. Treating women with low sexual desire is very difficult whereas treating other underlying problems like Vaginismus or orgasm disorder is quite effective. Occasional sexual problems are common and need no treatment but if the problem persists then you may need immediate medical or psychological help. 

Understanding Gonorrhoea 

Gonorrhoea is a very common Sexually Transmitted Infection caused by the bacteria Neisseria Gonorrhoeae. 

In men and women, the bacteria infect the urethra (urine canal) and in women, mostly warm and moist areas of the reproductive tract including the Cervix (opening to the womb), Uterus (womb), and Fallopian Tubes (egg canals). 

The bacteria can also infect the mouth, throat, eyes, and anus. In the US, more than 700,000 new cases of Gonorrhoea are reported every year. 

Gonorrhoea (Gonococcus infection) is commonly transmitted by an infected person through Vaginal, anal and oral sex. If the pregnant woman is already infected with Gonorrhoea, then it may be transmitted to her baby during delivery. 

Symptoms 

It is possible to be infected with Gonorrhoea and have no symptoms. In men, symptoms of Gonorrhoea are more visible. Half of the women infected with Gonorrhoea exhibit no signs at all. In men, symptoms may appear within two to five days and in some men, it may take as long as 30 days. 

Symptoms of Gonorrhoea in men are as follows: 

• White, pale yellow or greenish discharge from the penis
• Burning or painful urination
• Discharge from rectum and or irritation of anus
• Painful or swollen testicles 

Symptoms of Gonorrhoea in women are as follows: 

• Painful and burning sensation when passing urine
• Increased Vaginal secretions which can change to yellow or greenish discharge
• Foul odour
• Bleeding between periods
• Anal discharge
• Itching
• Painful bowel movements
• Soreness of the rectum
• Rectal bleeding 

Diagnosis 

The diagnosis of Gonorrhoea is carried out through physical examination of the genital areas and culture tests. 

The healthcare provider may take samples of the swabs of the affected areas. 

In women, a pelvic examination may be undertaken and smear tests may be carried out. Sometimes, samples of the urine may also be taken for testing. 

If the patient had anal sex, swabs from the rectum may also be taken. In the case of oral sex, similar swabs from the mouth may also be taken. These samples are sent to the lab for a culture test and examined under a microscope for the presence of bacteria. The doctor can prescribe appropriate treatment based on the confirmation by the culture test. 

Treatment of Gonorrhoea 

If the infection is diagnosed at early stages, the treatment for Gonorrhoea is simple and effective. Gonorrhoea is generally treated with antibiotics (medicines that can kill or inhibit the growth of the disease-causing bacteria) namely floroquinolones which include Ciprofloxacin, Levofloxacin, Ofloxacin etc. which are given orally in single doses per day. 

As Gonorrhoea has become resistant to these fluoroquinolones, other types of antibiotics namely cephalosporins such as cefotaxime, cephalexin, cefaclor, ceftazidime, cefixime etc. are recommended. 

If Gonorrhoea is not treated, the bacteria can spread up to the Reproductive Organs and into the blood and may cause the following complications: 

• In women: The infection can spread into Uterus (womb) and Fallopian Tubes (tubes that transport the egg from the ovary to the womb) causing Pelvic Inflammatory Disease (PID) leading to scarring of the tubes, pregnancy complications and Infertility. PID can result in abdominal pain, irregular menstruation, back pain and pain during intercourse.
• In men: The infection can cause inflammation of the sperm ducts (epididymitis) a painful condition of the testicles resulting in Infertility.
• Joints: The infection can spread to the joints and other parts of the body through the blood resulting in joint pain, swelling, stiffness, fever, rash and skin sores.
• HIV/AIDS risk: Untreated Gonorrhoea increases the risk of being more susceptible to Human Immunodeficiency Virus (HIV).
• Complications in infants: Babies infected with Gonorrhoea from their mothers at the time of birth can develop loss of vision, scalp sores, joint and other infections. 

Preventing Gonorrhoea 

Presently there is no vaccine to prevent Gonorrhoea. However, precautions may be adopted to prevent Gonorrhoea. 

The surest way to prevent Gonorrhoea is by avoiding sex. If it cannot be avoided, then make sure that you and or your partner use condoms. 

Ensure that your partner is free from Gonorrhoea. If not sure, then insist on your partner to get checked. 

Do not indulge in sex with an infected partner.  

If your partner has unusual symptoms of Sexually Transmitted Disease, such as a burning sensation during urination or a rash on the genitals and unusual discharge, avoid sex with the partner. 

If you have multiple sex partners or had Gonorrhoea or any other STD in the past, consult your doctor to have regular screening. 

Knowing more about Menopause 

Menopause is a time when the menstrual cycle ceases permanently. It happens because the gonads called Ovaries are no longer producing eggs. Women in Menopause are no longer fertile. 

Menopause is said to have occurred if the periods cease for 12 consecutive months. Thus, Menopause is diagnosed in retrospect. 

Menopause may set in anytime in the early forties or late fifties, usually after 45 years of age. The age for Menopause is different for different women. The average age is said to be 51 years. 

Signs and symptoms of Menopause 

Menopause leads to hormonal changes in the body that cause symptoms like: 

• Hot flashes
• Night sweats
• Dry skin and Vagina
• Irritability
• Depression
• Mood swings
• Fatigue
• Sleep disturbances
• Weight gain
• Hair thins and becomes scanty
• Facial hair growth
• Burning sensation while passing urine
• The desire for sex decreases
• Intercourse may become painful
• Irregular periods
• Light, heave, frequent or infrequent flow 

These Menopause symptoms may precede for several years. This phase of transition to Menopause is called Perimenopause. There is a higher risk of Heart Disease, weak bones, and some Cancers like Cancer of the Breast and womb. 

Help for hot flashes 

Hot flushes are a feeling of sudden gush of heat felt in the face and upper body which then blush. It is an imbalance of hormones that leads to excessive local blood flow in these regions. It is best to identify and avoid triggers of a hot flush like heat, alcohol, or caffeine. 

• Wear comfortable and light clothing, and practice slow and deep breathing.
• Exercise can work wonders. Walk for at least 30 minutes each day. Yoga and meditation offer benefits.
• Hormone Therapy, which aims to replenish the falling hormone levels, is commonly used.
• Antidepressant medicines like venlafaxine, gabapentin, and fluoxetine are also used.
• Vitamin E and soy isoflavones are said to relieve symptoms effectively. Alternative approaches include acupuncture and herbal remedies.
• Weight loss and smoking cessation help. 

Emotional symptoms 

• Menopause affects the psyche and mood
• Irritability
• Feelings of sadness
• Depression
• Lack of motivation
• Concentration
• Anxiety
• Aggressiveness
• Tension
• Mood swings
• Fatigue
• Negative feelings 

Things to follow: 

• It is good to socialize
• Avoid isolation
• Engage in creative activities
• Exercise and eat healthy food
• Yoga
• Meditation
• Relaxing activities can help 

In severe cases, medicines to treat depression and counselling to develop motivation are required. 

Diagnosis 

Usually, the signs and symptoms are enough to treat Menopause in a woman. In some cases, the doctor may recommend a few diagnostic tests to treat Menopause. They are: 

• Follicle Stimulating Hormone (FSH) and estrogen are checked as FSH levels increase and estrogen levels decrease.
• Thyroid Stimulating Hormone (TSH) should be checked as a non-active Thyroid shows symptoms similar to those of Menopause. 

Calling your doctor 

Menopause though is a natural biological event, yet may need medical help if the symptoms are very severe. Remember, your periods can get irregular. So, do not assume Menopause if you have missed one or few of your periods or have experienced a scantier flow. 

Talk to your doctor and rule out any other causes of Vaginal bleeding like Cancer in the genital tract. The symptoms may make your life miserable. 

You may need to undergo a few blood tests to confirm the nearing of Menopause. It is better to be informed, aware and prepared to meet Menopause. 

If possible, schedule regular visits to your doctor and have your healthcare provider help you to make Menopause a smooth transition. 

Hormone Replacement Therapy 

Hormone Replacement Therapy (HRT) is the substitution of the lost hormones. It consists of estrogen and progesterone replacement. Normally, these two hormones are produced in the body and help to regulate the menstrual cycle. 

During Menopause, when the levels of these hormones fall, these need to be substituted from outside to maintain a state as close to natural as possible. Hormones may be given in the form of pills, Vaginal rings, or patches placed on the skin. 

For local symptoms in Vagina, estrogen creams and tablets can be used inside the Vagina. HRT can dramatically reduce hot flashes, urinary problems, bone loss, and other mood changes. However, HRT is not free from risks. 

Estrogen in HRT increases the risk of Cancer in the womb, called the Uterus; HRT also increases the risk of Breast Cancer. 

It causes changes in the clotting mechanisms of the blood and increases the tendency to form blood clots. It is known to increase Blood Pressure, Heart Disease, and Cholesterol. 

Depending upon your age, medical problems, and severity of menopausal symptoms, varying doses of HRT may be advised. 

Other treatments 

• The first step towards easy Menopause is to exercise and eat a healthy balanced diet.
• Some women may be prescribed antidepressant medicines. Medicines called bisphosphonates like alendronate, risedronate, and ibandronate are used to prevent and treat Osteoporosis.
• Selective Estrogen Receptor Modulators (SERMs) like raloxifene have beneficial effects on bone health.
• Local therapy has fewer side effects and can be used to treat local symptoms in the Vagina. This comprises Vaginal rings, creams, or tablets of estrogen for insertion into Vagina.
• Soy foods are proven to work well in relieving the symptoms and also in lowering the risks of Cancer.
• A supplement of 1,000 - 1,500 mg of elemental calcium per day through diet and tablets, and vitamin D are good for bones.
• Fish oil rich in omega-3 fatty acids is good for the heart and Cholesterol.
• Several herbs like black cohosh, ginseng, sage, and red clover are believed to be beneficial.
• Acupuncture and Homoeopathy are alternative treatments.
• Slow deep breathing and relaxation techniques like yoga and meditation also help. 

Bring about a healthy Menopause 

Menopause may be a different experience for each woman. Every woman should be prepared to beat the blues, build the bones, and do her best to make Menopause less distressing. A change in lifestyle and timely medical help can make a huge difference. Let the dawn of Menopause not deter your life. 

Signs and Symptoms 

The signs and symptoms of Menorrhagia include: 

• Constant pelvic or lower abdominal pain
• Saturation of sanitary pads or tampons every hour
• Requirement of double sanitary protection
• Need for change of sanitary protection during the night
• Bleeding lasting for more than a week
• Blood clots during menstrual flow for more than one day
• Symptoms of Anaemia, such as fatigue or shortness of breath
• Inability to perform regular activities due to heavy menstrual flow 

Causes 

Menorrhagia can be caused by several underlying conditions. The common causes of Menorrhagia include: 

• Hormonal imbalances
• Intrauterine devices
• Uterine Cancer
• Dysfunctioning of Ovaries
• Uterine Fibroids
• Uterine Polyps
• Ovarian Cancer
• Miscarriage of pregnancy
• Ectopic pregnancy
• Cervical Cancer
• Von Willebrand's Disease
• Platelet Function Disorder
• Pelvic Inflammatory Disease
• Thyroid Disorders
• Endometriosis
• Liver or Kidney Disease
• Anti-inflammatory and anticoagulants 

 Risk factors 

Menorrhagia is more common in two age groups of women, they are: 

• Girls who have recently started menstruating
• Older women approaching the Menopause stage 

Complications 

Menorrhagia can lead to the following medical conditions: 

• Iron deficiency Anaemia characterized by fatigue and pale skin
• Severe pain during menstruation 

Diagnosis 

The diagnosis of Menorrhagia includes a physical examination along with the following tests. 

Blood Tests: A sample of blood will be withdrawn, to evaluate deficiency of iron and other conditions such as blood-clotting abnormalities or thyroid disorders. 

Endometrial Biopsy: A sample of tissue from the Uterus will be taken to perform laboratory tests. 

Pap Test: The cells from the Cervix are collected and tested for infection or inflammation. This test also helps to identify the changes that may be cancerous or may lead to Cancer. 

Ultrasound Scan: High-frequency sound waves are used to produce images of the Uterus, Ovaries, and pelvis. It helps in identifying abnormalities. 

Sonohysterogram: In this test, a fluid is injected through a tube into the Uterus through Vagina and Cervix. An ultrasound will be used by the doctor to look for problems in the lining of the Uterus. 

Hysteroscopy: It involves the insertion of a tiny camera through the Vagina and Cervix into the Uterus. It helps to view the inside of the Uterus and identify abnormalities. 

Treatment 

The treatment for Menorrhagia is based on several factors such as medical history and overall health, cause, and severity of the condition, future childbearing plans, and effect of the condition on your lifestyle. The drug therapy for Menorrhagia includes: 

• Tranexamic acid
• Iron supplements
• Oral progesterone
• Oral contraceptives
• Nonsteroidal anti-inflammatory drugs (NSAIDs) 

The Hormonal IUD: This is an intrauterine device, that releases a type of progestin called levonorgestrel, which tins the uterine lining and decreases menstrual blood flow and cramping. 

If drug therapy is unsuccessful, the doctors may suggest surgery. The treatment options include: 

Dilation and Curettage (D&C): In this procedure, the cervix will be dilated, and the tissues of the Uterus lining will be suctioned or scraped. It reduces menstrual bleeding. 

Uterine Artery Embolization: It is used for Menorrhagia that is caused by Fibroids. In this procedure, the Fibroids in the Uterus are minimized by blocking the uterine arteries and cutting off their blood supply. During uterine artery embolization, a catheter is passed through the large artery in the thigh and guided into the uterine arteries. Microspheres made of plastic are injected into the arteries. 

Focused Ultrasound Ablation: A focused ultrasound ablation is used to treat bleeding caused by Fibroids. This procedure uses ultrasound waves to shrink and destroy the fibroid tissue. No incisions are required for this procedure. 

Myomectomy: In this procedure, uterine Fibroids are removed surgically. This procedure can be done as an open abdominal surgery by making several small incisions (laparoscopic), or through the Vagina and Cervix (Hysteroscopic) depending on the size, number, and location of the Fibroids. 

Endometrial Ablation: The endometrial (Uterus) lining is destroyed by this technique. 

Endometrial Resection: In this procedure, an electrosurgical wire loop is used to remove the lining of the Uterus. 

Hysterectomy: It is a surgical procedure performed to remove Uterus and Cervix. This procedure ends menstrual periods permanently. It is performed under anaesthesia and requires hospitalization. 

Dysmenorrhea - Painful cramps during menstruation 

Dysmenorrhea is the medical term for the severe and frequent menstrual cramps and pain associated with menstruation. 

As the Uterus contracts more strongly during menstruation, it presses against the nearby blood vessels and cuts off the supply of oxygen to the uterine muscle tissue. Brief loss of oxygen to the muscle results in pain. 

It is classified into primary and secondary Dysmenorrhea based on the time of onset and underlying cause. 

A woman is probably suffering from primary Dysmenorrhea if she has been experiencing menstrual cramps from the time she first got her periods. 

This usually persists for life and is seen to be a result of severe and abnormal uterine contractions caused by chemical imbalances in the body (especially prostaglandin and arachidonic acid that control the contractions of the Uterus). 

Dysmenorrhea that is seen to develop in later life is termed secondary Dysmenorrhea and is usually caused by the presence of an underlying disease condition. 

A few of the medical conditions that can cause secondary Dysmenorrhea are: 

• Endometriosis (a condition in the inner tissue of the Uterus becomes implanted outside the Uterus usually on other reproductive Organs inside the pelvis or in the abdominal cavity often resulting in internal bleeding, infection, and pelvic pain).
• Pelvic Inflammatory Disease (infection of the pelvic Organs)
• Uterine Fibroids (Tumour-like growths in the uterine muscle wall or the uterine cavity)
• Abnormal pregnancy (i.e., miscarriage, ectopic),
• Tumours of the Uterus or Ovaries
• Ovarian Cysts (fluid-filled sacs in the ovary)
• Polyps (abnormal growths in the uterine cavity) 

At-risk individuals 

Menstrual cramps are seen to affect over 50% of women with about 15% of them experiencing severe cramps. It is more common in adolescent girls affecting up to 90% of them. 

A woman is at increased risk of suffering from painful menstrual cramps if she has started menstruating before the age of 11, her age is below 20 years, she has heavy bleeding during her periods, is overweight, or has never delivered a baby. 

While any particular underlying reason is not clear period pain is seen to be prolonged in females who smoke, drink alcohol, or suffer from depression. 

Symptoms 

A woman suffering from Dysmenorrhea may experience the following symptoms: 

• Cramping and pain in the lower abdomen radiating down the legs
• Nausea
• Vomiting
• Fatigue
• Weakness
• Fainting
• Headaches
• Painful period cramps
• Constant ache 

The pain may begin 1 to 3 days before or during the menstrual period with a peak at 24 hours and will later subside after 2 to 3 days. 

When to Seek Help 

• It is necessary to seek an appointment with the doctor if the cramps and discomfort are not relieved by over-the-counter medicines such as ibuprofen or naproxen, or lifestyle modifications (cutting down on sugar and caffeine, using of heating pad over the abdomen, hot water bath, etc.)
• Maintaining a record of the monthly periods and symptom tracker (time of occurrence and severity of symptoms) for 2 to 3 months can help the doctor figure out the best treatment option.
• A minor surgical procedure called a Laparoscopy (involves making a small cut in your abdomen to look inside your pelvis) may be done to diagnose the presence of abnormal masses/ growths, Fibroids, Endometriosis, Cysts in the ovary, etc.
• A woman also needs to see the doctor if she has started experiencing painful periods later in life, if there is pain at times other than the first two days of the period, or pain during sex.
• If the pain is accompanied by unusual Vaginal bleeding or discharges, it is safer to consult the doctor to rule out any serious problem involving the Uterus or Ovaries. 

Diagnosis 

Evaluation at the doctor’s clinic will cover a detailed history and a complete physical examination including a pelvic examination. 

A diagnosis of Dysmenorrhea shall be arrived at after ruling out other menstrual disorders such as Fibroids, Endometriosis, Uterine Polyps, medical conditions, or medications causing or aggravating the condition. 

Diagnostic procedures such as; 

• Blood tests
• Urine analysis
• Ultrasound imaging of the pelvis
• MRI
• Laparoscopy
• Hysteroscopy (video-assisted procedure to visualize the uterine and cervical cavity for the presence of internal Fibroids or Polyps) 

All these tests are performed to confirm the diagnosis. 

Management 

A few measures that can help in managing Dysmenorrhea are regular exercise, increased protein intake, cutting down on sugar and caffeine, taking a hot water bath or shower, using a heating pad across the abdomen, or getting an abdominal massage done. 

Eating healthy foods, drinking lots of fluids and getting plenty of rest are necessary during the menstrual cycle. 

Over-the-counter medications called anti-prostaglandins (slow down prostaglandin production) may help relieve the pain and discomfort, making the flow lighter, and causing the Uterus to cramp less. 

Medicines containing ibuprofen, acetaminophen, or naproxen sodium which are anti-inflammatory agents and also reduce pain can help. These medicines need to be taken with food when you first start feeling the symptoms for maximum benefit. 

Oral contraceptive pills are another treatment option as they prevent ovulation and reduce the severity of menstrual cramps. 

Other treatment options include vitamin supplements of vitamin B1 or vitamin E, magnesium supplements, fish oils, or acupuncture. 

All these are the procedures opted to manage the pain and to obtain menstrual pain relief. 

Surgical intervention is done if the menstrual cramps are followed by menstrual pain which is caused by Endometriosis or Fibroids in which the abnormal tissue needs to be removed to reduce symptoms. 

Causes 

The exact cause of Ovarian Cancer is unknown. Usually, it is believed that any type of Cancer may occur as a result of genetic mutations in the cells. The Cancer cells multiply rapidly and form a mass called a Tumour. They can also invade the nearby tissues and may spread to other Organs of the body. The different types of Ovarian Cancer include the following: 

• Epithelial tumours occur when abnormal cells form in the outer layer that lines your Ovaries.
• Stromal Tumours occur in the cells that produce hormones.
• Germ cell tumours occur when Cancer begins in the egg-producing cells. 

Symptoms 

The patients with early Ovarian Cancer usually do not report any symptoms. However, they may have pain in the abdomen or side, and bloating. In severe stages, the patients experience symptoms such as: 

• Severe abdominal pain and back pain
• Difficulty eating
• Increased urination and an urge to urinate
• Fatigue
• Indigestion and Heartburn
• Constipation
• Back pain
• Menstrual irregularities
• Painful intercourse 

Consult your doctor immediately if you experience any of these symptoms and if the symptoms do not go away. 

Risk factors 

The factors that increase your risk of Ovarian Cancer are listed below: 

• Family history of Ovarian Cancer
• Genetic mutations of genes, such as BRCA1 or BRCA2
• Medical history of Breast, Uterine, or Colon Cancer
• Being obese
• Use of fertility drugs or hormone therapies
• No history of pregnancy
• History of Endometriosis
• Older age 

 Diagnosis 

Your doctor begins the diagnosis with a pelvic examination that includes inspecting the outer parts of your genitals and detecting the abnormalities by using a speculum that is inserted into your Vagina. Your doctor might order the following tests to confirm the diagnosis. 

• Imaging tests: Computerized Tomography Scans and Ultrasound provide detailed images of your Ovaries and help to identify any abnormalities.
• Blood tests: Your doctor might order a blood test to detect the presence of protein (CA 125) which is present on the surface of Ovarian Cancer cells.
• Biopsy: A small piece of ovarian tissue is removed and examined under the microscope. The test helps to identify the presence of Cancer cells. 

Staging of Ovarian Cancer 

Your doctor determines the stage of your Cancer which is crucial for planning the treatment strategies. The stages of Ovarian Cancer include: 

Treatment 

The Ovarian Cancer treatment depends on the extent or severity of the condition. Your doctor might recommend any or a combination of the following therapies. 

Surgery: Surgical removal of affected Ovaries is the first line of choice to treat Ovarian Cancer. Chemotherapy often follows the surgery. Your doctor may remove Ovaries, the Fallopian Tubes, the Uterus and the nearby lymph nodes. The surgery is limited to only the affected parts if the condition is diagnosed in the early stages. 

Chemotherapy: Surgery is followed by Chemotherapy. Chemotherapy uses the chemical to kill the Cancer cells in the ovary. The chemotherapeutic drugs are injected into a vein or directly into the abdominal cavity. In an advanced stage of Cancer, Chemotherapy is considered as the first-line drug treatment. 

 Coping and support 

You may find it very difficult to cope with the diagnosis of Ovarian Cancer. Initially, you are likely to get upset and confused. The following strategies may help you to deal with Ovarian Cancer: 

• Get thorough and complete information about your Cancer.
• Discuss your feelings with your friends and family members.
• Maintain a healthy diet and perform mild physical activity. 

Types of Ovarian Cysts 

Ovarian Cysts are of three types. Some are non-cancerous and harmless, while others may be a cause of concern. 

Functional Cysts are non-cancerous and occur due to the normal physiological process of release of ovum or egg from the ovary, a process known as ovulation. Due to functional Cysts, you may experience symptoms like irregular menstrual periods, vomiting, nausea, and abdominal pain. These Cysts shrink in 1 to 3 months on their own. 

These are of two types - Corpus Luteum Cysts and Follicular Cysts. If the sac (follicle that holds the egg) does not dissolve after the ovum or egg is released, then Corpus Luteum Cysts are formed. Following the release of the egg, the sac seals itself and fluid starts building up inside. These Cysts grow up to 4 inches and disappear in a few weeks. They are not cancerous, but they may twist and cause bleeding in the ovary causing pain. The risk of getting these Cysts increases when drugs such as serophene or clomid are taken. When the sac does not break open to release the egg, follicle Cysts are formed that disappear in 1-3 months. 

The other types of Ovarian Cysts are Dermoid Cysts, Cystadenomas, and Endometriomas. These are less common forms of Ovarian Cysts. Dermoid Cysts are formed from specialized cells that can grow and differentiate into other kinds of cells like hair, teeth or skin. These may be asymptomatic when small in size but can cause pain if enlarged. 

Cystadenomas develop from ovarian tissue and may be filled with watery fluid or sticky mucus. 

Endometriomas are a result of Endometriosis which means that cells of the Uterus grow on other Organs. All these Cysts have the potential to become large and cause twisting of the Ovaries, which is a very painful condition. 

Symptoms 

There are a few ovary Cyst symptoms: 

• Irregular menstrual cycle
• Pelvic pain during sexual intercourse
• Dull constant pelvic pain radiating to thighs and lower back, pain during and after periods
• Pressure and pain during bowel movements
• Breast tenderness
• Nausea
• Vomiting
• Heaviness in the abdomen
• Difficulty in emptying Bladder completely 

Diagnosis 

In addition to taking a complete medical history, the doctor may advise certain tests or procedures to determine the type of Ovarian Cyst present. 

The doctor uses the sonogram to check for any abnormalities in the ovary. In a sonogram, the sound waves are used to take pictures of the internal structures in the body. The sonogram of the Ovaries is taken through Vagina or abdomen and it lasts for 30 minutes duration. By studying the images of the ovary obtained through a sonogram, the doctor studies the appearance and size of the Cyst. 

A pregnancy test may be done. If the pregnancy test turns positive it is an indication of a Corpus Luteum Cyst which develops when the ruptured follicle is sealed with fluid after the release of an egg. 

Laparoscopy may be advised in some women. In this procedure, the doctor can not only view the Ovaries but also remove the Ovarian Cyst present on the Ovaries with the help of an instrument inserted through an abdominal incision. 

If the doctor wants to know if the Ovarian Cyst is Cancerous in nature, the CA 125 blood test will be conducted in which the levels of protein called Cancer antigen 125 (CA 125) are checked. If the levels are elevated then it suggests Ovarian Cancer. 

Treatment 

The Ovarian Cysts treatment depends on the type and size of the Cysts, symptoms experienced and your age. Since most of the Cysts disappear within 1 to 3 months, the doctor would wait and watch, and re-examine after 3 months. 

In post-menopausal women who have fluid-filled Cysts that are less than 2 cm, regular monitoring with ultrasound is done. 

To reduce the chance of new Cysts the doctor may prescribe oral contraceptive pills. These also reduce the risk of Ovarian Cancer. 

If the Cyst is large and growing in size, then surgery is recommended. In a procedure called Cystectomy, the Cyst is removed without removal of the Ovaries. 

If a single affected ovary needs to be removed, then the procedure is known as an Oophorectomy. 

In case of a Cancerous Cyst, the doctor may perform a Hysterectomy in which the Uterus and both the Ovaries are removed. This is generally recommended after Menopause (cessation of periods between 45 to 55 years of age). 

A laparotomy procedure is used to remove the entire affected Fallopian Tube and ovary. 

Mode of infection 

Pelvic Inflammatory Disease is an ascending infection, i.e., it is an infection where the germs travel way up the birth canal, called Vagina to affect the other upper reproductive Organs. The resultant inflammation in the Uterus is called Endometritis, one in the Fallopian Tubes is called salpingitis, and that in the Ovaries is called oophoritis. 

The Sexually Transmitted Diseases (STDs) that are notorious for causing PID are Gonorrhoea and Chlamydia. PID can develop anytime within a few days to months after a woman has suffered from an STD. 

Infections like Bacterial Vaginosis, which are not sexually transmitted, can also lead to PID. Many of these infections can be asymptomatic and hence may escape attention. 

Risk Factors 

PID occurs in sexually active women. The risks are higher if the woman is young, has multiple sex partners, does not use a barrier contraceptive like condoms or diaphragms, and comes from a lower socio-economic class. 

The risk is high even if the partner of a woman has multiple partners. Women who use an Intrauterine Device (IUD) for contraception have an increased risk for PID near insertion. The risk is high in women who are already suffering from a Sexually Transmitted Disease like Gonorrhoea, HIV, or any other sexual infection. One episode of PID increases the risk of another one in future if not treated well. 

Symptoms 

PID can be deceptively silent and may not cause any complaints. Some women may experience only mild or non-specific complaints. The commonest complaint in women suffering from PID is pain, which may vary in severity and type depending upon the extent of infection. Other common problems caused by PID are: 

• Abnormal menstrual bleeding
• Vaginal discharge
• Frequent and painful urination
• Fever
• Chills
• Nausea
• Pain during intercourse 

If you are a woman of childbearing age and experience any of these symptoms, you should seek medical help. 

As soon as you think you might be developing a PID, see a doctor without any further delay. Share proper details of your sexual activities preferences, and partners. 

Do not conceal anything or feel inhibitions to discuss openly what problems you have. Complete all the tests you are advised. Refrain from sex and talk to your sex partner(s) and have them investigated too. 

 Diagnosis 

The health care provider may examine your pelvis and advise you on some investigations. The pelvic examination may cause pain. 

The Vaginal secretions may be collected to examine the discharges for infection. Some blood tests may be done. 

You may need to undergo an ultrasound to help the doctor look at your internal reproductive Organs. Usually, it helps to diagnose a PID if pus is seen in the pelvis. If the diagnosis is not established with an ultrasound and a woman does not respond to treatment, the doctor may advise a Laparoscopy. A flexible tube with a mounted camera is inserted through a small incision in the abdomen and the Organs are viewed and samples of fluid (if any) are collected for laboratory examination. 

Treatment 

PID needs proper and immediate treatment. Antibiotics are prescribed depending upon the type of infection suspected. Two or more antibiotics may be prescribed for some infections. It is important to take medicines even if there are not many symptoms and complete the entire prescribed schedule for Pelvic Inflammatory Disease treatment even if the symptoms subside early with treatment. 

When the infection is difficult to diagnose, severe, or if a woman is pregnant, hospitalization may be required to undergo treatment. If the tests reveal a localized big abscess, it may be aspirated or drained by a surgical procedure. 

Surgery may be required if the Organs in the pelvis are found glued together on investigations. Treatment in PID usually yields good results. 

You should discuss this with your partner(s) and have them treated. A partner may need treatment even if there are no symptoms. Do not have sex with a partner who has not been treated. 

Complications 

PID if not treated well, can lead to complications. You may develop a constant ache in the abdomen. This can vary from mild to severe and can be distressing. The worst consequence of PID can be Infertility. You may not be able to conceive or bear children if PID is not treated well. 

One of the small openings of the Fallopian Tubes may be blocked. The lining of the Uterus or tubes or the Ovaries may be irreversibly damaged. PID increases the chances of ectopic pregnancy where the developing baby implants in the tubes or any other site outside the Uterus. This is a medical emergency and needs immediate surgery. 

The inflamed internal Organs in PID may get glued together due to sticky pus and over some time may get scarred. This leads to a condition called ‘frozen pelvis’ where it is not able to visualize and demarcate the internal Organs individually. 

Preventing PID through safe sex 

• Practice safe sex to avoid STDs.
• Have only one sex partner.
• Make sure your partner has sex with only you and nobody else.
• Use condoms every time you have sex. Use them even if you are using other birth control measures like pills.
• If you cannot limit your sex partners, you should undergo regular medical examinations for STDs.
• Simple urine and Vaginal tests can help to detect any sexual infections.
• Caution, consistent and correct use of condoms, and proper medical care can help to prevent STDs and PID. 

Causes 

Pain in the pelvic region is caused either by Gynaecological problems or due to other medical conditions. 

Gynaecological causes 

• Endometriosis: Endometrium is the tissue lining of your Uterus and Endometriosis is a disease of the endometrium. In Endometriosis the tissue from the Uterus lining invades the Fallopian Tube, Ovaries, pelvis, Bladder and other regions. During the normal menstrual cycle these tissues swell and bleed like your Uterus, as this happens outside the Uterus the blood and tissue cannot find their way out through the Vagina, they get collected in the abdomen resulting in painful Cyst
• Pelvic Inflammatory Disease: Infection in Uterus, Fallopian Tube, and Ovaries
• Fibroids: Non-cancerous muscle growth in the wall of the Uterus
• Ovarian remnant: During surgical removal of the Uterus and Ovaries called Hysterectomy, a small part of the Ovaries might be left behind, which later develops into a painful Cyst
• Ectopic pregnancy: Pregnancy outside the Uterus 

Non-Gynaecological causes 

• Gastrointestinal causes: Irritable Bowel Syndrome which means a problem in the Intestine, where the food is pushed too fast or too slow through the Intestine. Other Gastrointestinal problems that cause CPP are – Appendicitis, Constipation, Gastroenteritis (inflammation of the Stomach and Intestine), Hernia (protrusion of Organ or tissue), and Inflammatory Bowel Disease
• Interstitial Cystitis: Inflamed and irritated Bladder wall resulting in stiff, non-expandable Bladder. Other urological problems are Kidney Stones, Urethral Syndrome, Urinary Tract Infection
• Musculoskeletal: Joint pain, posture problems, Spinal Injury, and inflammation
• Psycho-social issues: Depression, sexual abuse, eating disorder, and substance abuse 

Symptoms 

There are a few Chronic Pelvic Pain symptoms mentioned below. They are: 

• Severe and steady pain
• Dull aching
• Cramps
• Sharp pains
• Pressure or heaviness deep within the pelvis
• Pain during intercourse
• Pain while urinating
• Pain while sitting for a long time 

Diagnosis 

Diagnosis of CPP begins with a detailed examination of your previous medical history. Your doctor would enquire you about the duration and frequency of your symptoms, severity and location of pain, situations that increase or decrease pain, and previous medicines and treatments that you have undergone. Your doctor would also ask you about any health-related issues in your family. He would also want to know information like 

• Is your pain related to bowel movement menstrual cycle or both?
• Does it pain during sexual activity and urination?
• Your previous pelvic surgeries
• Previous infections 

As CPP is caused by a variety of sources it is important that during a physical examination, your doctor gives attention to the screen for musculoskeletal causes your doctor will examine your posture, palpate (diagnosis by touch) your upper and lower back, check your leg-length, and ask you whether you often stand on one leg. He will ask you to lie down on your back and palpate your abdomen with your legs and head raised. 

Physical examination will also focus on urological and Gynaecological causes. He will palpate your Urethra and Bladder to detect specific tenderness or mass. 

A rectal examination will be done if a Gastrointestinal cause of CPP is suspected. 

Laboratory tests include a complete blood picture and erythrocyte sedimentation rate; urine analysis and urine culture; human chorionic gonadotropin hormone will be measured in sexually active individuals. A plain film of the abdomen will be taken if Constipation is suspected. 

An ultrasound examination of the abdomen, Vagina, and rectum will be done in patients with abnormal results of physical examination. 

Performing a safe and minimally invasive Laparoscopy in patients detected with abnormal physical examinations has become an important diagnostic tool in assessing CPP. Laparoscopic examination is done when 

• CPP doesn’t respond to oral contraceptives and anti-inflammatory drugs
• Chronic Pelvic Inflammatory Disease or Appendicitis is suspected
• Identifying a pelvic mass
• Irregular, painful Vaginal bleeding
• Progressive Dysmenorrhea (painful periods) 

Treatment 

The underlying cause of CPP will dictate the pelvic treatment procedure, it varies for each patient. CPP is not a single-cause disease, it is caused by various factors interacting together therefore you will need several treatment procedures for all these problems. Few treatment options are 

• Hormone Therapy for patients with Endometriosis and heavy menstrual bleeding
• Stopping ovulation (periods) with birth control pills or injections
• Non-steroid anti-inflammatory medicine for relieving pain
• Antibiotics in case of infection
• Relaxation exercise, physical therapy and biofeedback (controlling emotional state using electric shocks) for people with connective tissue or muscle pain
• Abdominal trigger point injection: giving shots in the trigger point region, in the lower wall of the abdomen, where the pain originates, actually subsides the pain
• Psychological counselling with or without anti-depressant medicines
• Meditation, yoga, and breath work for mind and body relaxation
• Rarely, surgery for patients with adhesion or remnant or Endometriosis 

Normal milieu 

Ovaries in girls produce the hormones estrogen, progesterone, and androgen that regulate the menstrual cycle and cause ovulation. While estrogen and progesterone are female sex hormones, androgens are termed male hormones and are usually produced only in small amounts in females. 

Syndrome Complex 

Polycystic Ovarian Syndrome commonly termed as PCOS is a common health problem among teenage girls and young women. It is named such because of the presence of numerous small and painless Cysts in the Ovaries of women affected. 

In PCOS, there is an excess production of androgen along with changes in other hormone levels such as luteinizing hormone (LH), estrogen, and progesterone. Higher levels of androgens interfere with the development and release of the egg from the ovary. 

The eggs do not mature and are not released during normal ovulation in each monthly cycle. Instead, they develop into Cysts (little sacs filled with liquid) and get enlarged. 

Causes 

There is no clear understanding of why or how the changes in the hormone levels occur if you have PCOS. 

You may suffer from PCOS if your Ovaries produce higher-than-normal levels of androgens. 

You are also seen to develop PCOS if your body produces too much insulin that in turn signals your Ovaries to produce an excess amount of male hormones. 

Another hormone implicated in PCOS is the excessive production of LH which stimulates the Ovaries to produce hormones. 

Symptoms 

The major symptoms you may experience are changes in your menstrual cycle and the development of male sex characteristics. 

• You may either suffer from absent periods for varying durations or irregular menstrual cycles that are more or less frequent and may range from light to very heavy.
• You may find difficulty in getting pregnant.
• You may be overweight, have acne, oily skin, dandruff, or patches of skin on the neck, arms, Breasts, or thighs that are thick and dark brown.
• You may also experience pelvic pain, sleep-related problems, and episodes of anxiety or depression.
• You may also show certain male sex characteristics such as decreased Breast size, deep voice, enlargement of your clitoris, increased body hair over your chest, abdomen, face and nipples, and thinning of hair on your head causing male pattern baldness. 

Diagnosis 

There is no single test to determine or diagnose if you have PCOS. 

Your evaluation at your doctor’s clinic will initially include a detailed medical history of your menstrual cycle, weight changes, and other physical symptoms. 

Physical examination will include an assessment of your body mass index, Blood Pressure measurement, and inspection for areas of increased hair growth. 

Your doctor will want to do a pelvic examination to check if your Ovaries are enlarged. 

Blood tests that your doctor would prescribe for you would include measurement of your sex hormone levels, glucose, and insulin levels. 

Your doctor will also perform a Vaginal Sonogram (a test that uses sound waves to take pictures of the pelvic area) to view your Ovaries for Cysts, and the endometrium/ the lining of your womb to check for hyperplasia/thickening. 

Treatment 

There is no cure for PCOS but the symptoms are treatable with varying degrees of success. The main reason why you should take treatment for PCOS is to ameliorate physical changes and prevent long-term risks to your health. 

Your doctor will decide on the treatment options for you based on your symptoms, whether or not you want to get pregnant, and as preventive management to lower your chances of getting Heart Disease and Diabetes in the future. 

For the monthly cycle 

If you do not want to get pregnant then your doctor may advise you on the use of birth control pills to regularize your menstrual cycle and reduce levels of the male sex hormone. However, you need to keep in mind that your cycles may get irregular again once you stop the pills and also the pills are not completely free of side effects if taken for a long duration. 

For fertility 

If you want to conceive, your treatment may include fertility medications such as clomiphene, metformin in combination with clomiphene, and gonadotropins. Metformin, the antidiabetic medication helps by affecting the way insulin controls blood sugar, lowers testosterone production, slows the growth of abnormal hair, restores ovulation, decreases body mass, and improves Cholesterol levels. 

You may opt for In Vitro Fertilization or IVF if medications fail although it is a costly option. Your doctor may advise you to undergo a surgical procedure called ovarian drilling (puncture the ovary and destroy a small portion of the ovary by Laparoscopy) to temporarily lower male hormone levels and help with ovulation. 

For the excess hair 

You may benefit from medicines called antiandrogens (spironolactone, finasteride) to reduce hair growth and acne. Do not take these medicines if you are planning to get pregnant, are pregnant, or are Breastfeeding. You may try other options such as local creams, laser treatment, electrolysis, or hormonal treatment to prevent new hair from growing. 

For the excess weight 

You may need to implement lifestyle measures such as eating a healthy diet (more whole grain products, fruits and vegetables; less processed foods and foods with added sugar) and exercising regularly. If you are morbidly obese with a BMI > 40 or a BMI between 35 – 40 and an obesity-related disorder then undergoing bariatric surgery for weight loss may be effective in managing your PCOS. 

Complications 

If you have PCOS you are at a greater risk of developing serious health conditions including life-threatening diseases. You are more likely to develop Diabetes before the age of 40. The increased likelihood of obesity, High Blood Pressure, high levels of LDL (bad) Cholesterol, and low levels of HDL (good) Cholesterol increases your risk of getting Heart Attacks by over 4 to 6 times as compared to women of your age. 

Sleep Apnea (cessation of breathing for short periods during sleep), depression, and anxiety are other complications that you may develop. 

You are also at an increased risk of developing Endometrial Cancer  (Cancer of the lining of the womb) due to the persistent elevated levels of the hormone estrogen and low or almost absent levels of progesterone due to PCOS that causes the lining of the womb to grow too much. 

Causes 

The cause of uterine Fibroids is still unclear. However, the experts believe that the following factors may cause uterine Fibroids. 

• Genetic mutations: In most cases, Fibroids may occur as a result of genetic alterations in the healthy uterine muscle cells.
• Hormonal changes: The hormones, estrogen and progesterone, cause the regeneration of the uterine lining during each menstrual cycle. These hormones stimulate the growth of the Fibroids in the Uterus.
• Pregnancy: Due to an increase in the levels of estrogen and progesterone during pregnancy, most of the pregnant women develop Fibroids in the Uterus which may shrink off after the pregnancy.
• Other causes: The factors that help to maintain normal body mechanisms, such as insulin-like growth factors may also cause uterine Fibroids. 

 Symptoms 

In most of the cases, uterine Fibroids do not cause any symptoms. The symptoms may occur depending on the location, size, and number of Fibroids. The most common symptoms of uterine Fibroids are listed below: 

• Heavy menstrual bleeding
• Increased urination
• Menstruation lasting more than a week
• Pelvic pressure or pain
• Difficulty emptying the Bladder
• Constipation
• Swelling of the abdomen
• Increased menstrual cramping
• Backache or leg pains 

Risk factors 

The factors that increase the risk of uterine Fibroids include the following: 

• Being a woman of reproductive age
• Family history of uterine Fibroids
• The onset of menstruation at an early age
• A diet high in red meat and lower in green leafy vegetables
• Vitamin D deficiency
• Consumption of alcohol
• Being obese
• Use of birth control pills 

Complications 

Uterine Fibroids may not lead to life-threatening complications; however, they may cause discomfort. The presence of Fibroids in the Uterus may cause heavy blood loss during menstruation, and this may lead to iron deficiency anaemia. In pregnant women, uterine Fibroids may increase the risk of placental abruption, preterm delivery, and inadequate development of the fetus. 

 Diagnosis 

In most cases, uterine fibroid remains unnoticed and is discovered incidentally during a routine check-up. If your doctor suspects uterine Fibroids, any of the following tests might be ordered to confirm the diagnosis. 

• Ultrasound of the pelvis: The test provides detailed images of the internal organs and helps to identify the abnormal structures in the pelvis.
• Imaging tests: If ultrasound doesn’t identify the condition, your doctor might order other imaging tests such as pelvic MRI (magnetic resonance imaging), hysterosonography, hysterosalpingography, and hysteroscopy.
• Blood tests: Your doctor might order a complete blood count if you have menstruation for longer periods. The test identifies the presence of anaemia and helps to prevent complications. 

Treatment 

The treatment for uterine Fibroids depends on your age, the size of the fibroid, and the extent or severity of the condition. Your doctor might order a combination of the following treatments. 

Medications: The medications are used to relieve symptoms such as discomfort, pelvic pain, and massive blood loss (menstrual cycle). Your doctor might prescribe the drugs that shrink the Fibroids. The drugs include: 

• Gonadotropin-releasing hormone (Gn-RH) agonists - to block the production of estrogen and progesterone
• Progestin-releasing intrauterine device (IUD) - to relieve from heavy blood loss due to menstruation
• Other drugs such as tranexamic acid, Nonsteroidal anti-inflammatory drugs (NSAIDs), and vitamin supplements. 

Minimally invasive procedures: Your doctor might suggest certain procedures to destroy the uterine Fibroids including: 

• Uterine Artery Embolization: During the procedure, your doctor injects certain medications that stop the blood flow to the Fibroids allowing them to shrink.
• Myolysis: It is performed using a Laparoscope. During the procedure, a high-energy electric current is passed that destroys the Fibroids.
• Laparoscopic Myomectomy: The procedure involves the removal of Fibroids using a laparoscope. During the procedure, the Fibroids are broken into small pieces and then removed.
• Other procedures include hysteroscopic myomectomy and endometrial ablation. 

Signs and symptoms 

In most women, Uterine Polyps do not show any signs and symptoms, but a few women may experience light bleeding or spotting. 

Uterine Polyps are sometimes manifested with the signs and symptoms which include: 

• Irregular menstrual bleeding
• Mid-cycle bleeding
• Excessively heavy menstrual periods
• Vaginal bleeding after Menopause
• Infertility 

Causes 

The exact cause for the formation of Uterine Polyps is unclear. However, changes in the hormone levels such as estrogen may be a factor. 

Risk factors 

You may be at risk of developing Uterine Polyps if you are: 

• In the perimenopausal or postmenopausal phase
• Having High Blood Pressure
• Overweight or obese
• On tamoxifen medication, a treatment for Breast Cancer 

Complications 

Infertility is the major complication associated with Uterine Polyps. Removal of Uterine Polyps may sometimes help you in becoming fertile. 

Diagnosis 

You need to tell your doctor about the details of your menstrual cycle and about the unusual symptoms you experience and also mention your difficulty in getting pregnant. Your doctor will perform a Gynaecological examination before ordering any other additional tests or procedures. 

These tests used to diagnose Uterine Polyps may include: 

• Transvaginal Ultrasound - Produces images of the interior of the Uterus which helps in determining the abnormalities in the Uterus.
• Sonohysterography - This test is usually performed after transvaginal ultrasound. Clearer images of any growth within the uterine cavity can be known by this test.
• Hysteroscopy - Hysteroscope is inserted into the Uterus to examine the inside of the Uterus
• Endometrial Biopsy - Through a hysteroscope, the doctor collects a tissue from the inner wall of the Uterus and sends it to the laboratory to check the presence of abnormalities.
• Curettage - This technique can diagnose and treat Uterine Polyps. While using a hysteroscope, the doctor uses a curette to scrape the tissue which is sent to the laboratory to detect the abnormalities. 

Treatment 

Uterine Polyps are treated with different methods, which include: 

Medications: Medicines such as (progestins or gonadotropin-releasing hormone agonists) are prescribed to regulate the hormonal balance to relieve the symptoms. This is only a temporary treatment for the symptoms; the condition may revert once the medications are stopped. 

Hysteroscopy: This procedure is used as a treatment method as well as a diagnostic method for the condition of Uterine Polyps. Your doctor may perform hysteroscopy in combination with surgery to remove the Polyps. 

Curettage: This technique is effective for smaller Polyps. A curette is performed by scraping the lining of the Uterus to remove the Polyps. This technique is used both for diagnosing as well as treatment. 

Additional surgery: This procedure may be necessary if the Polyps cannot be removed using other methods, or if they are Cancerous. In such cases, a Hysterectomy, the surgical procedure to remove the entire Uterus may be necessary to prevent the spread of Cancer cells from the Polyps. 

 Self-management 

You cannot prevent this condition. The only way of self-management is to have regular Gynaecological checkups. Have a regular check on your risk factors such as obesity, High Blood Pressure, or taking tamoxifen to minimize the appearance of Uterine Polyps. 

Vaginal Cancer is a rare or uncommon condition. Only one out of every 1,100 women may develop Vaginal Cancer. It is of the following types: 

• Squamous Cell Carcinoma – Cancer forms in the flat, squamous cells of the Vagina. It is the most common type of Vaginal Cancer. It spreads slowly and stays within the Vagina in most cases
• Adenocarcinoma – Cancer forms in the glandular cells. It spreads quickly when compared to the Squamous Cell Carcinoma
• Melanoma – Cancer forms in the pigment-forming cells (melanocytes) of the Vagina
• Sarcoma – Cancer forms in the cells of the connective tissue present in the walls of the Vagina 

Symptoms 

Symptoms of Vaginal Cancer are not seen during the initial stages. The symptoms appear as the disease progresses. The symptoms include: 

• Abnormal bleeding
• Pelvic pain
• Watery discharge from Vagina
• A lump or mass
• Painful and frequent urination
• Pain during sexual intercourse 

 Causes 

The causes of Vaginal Cancer are not clear. In general, Cancer occurs due to a mutation in the DNA leading to an abnormal growth of cells. These abnormal cells undergo cell division rapidly and form a mass called the tumour. 

Risk factors 

Elderly women are at more risk for Vaginal Cancer. Use of diethylstilbesterol during pregnancy, smoking, multiple sexual partners, Human Papillomavirus (HPV) infection, history of Cervical Cancer, history of previous Radiation Therapy, and Hysterectomy increases the risk of Vaginal Cancer. 

Diagnosis 

Your doctor performs a physical examination and reviews your medical history. Other tests include: 

• A pelvic exam is also performed to examine the reproductive system (Vagina, Uterus, Fallopian Tubes, Ovaries, and rectum). This exam is done by inserting lubricated and gloved fingers of one hand into the Vagina and the other hand into the abdomen to examine the shape and position of the Uterus and Ovaries.
• A Pap test is performed by collecting the cells from the surface of the Vagina and Cervix for microscopical examination.
• A Colposcopy is performed using a Colposcope to check Vagina and Cervix for abnormalities.
• A biopsy is performed to examine the cells and tissues of Vagina and Cervix.
• Imaging tests such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and Positron-emission Tomography (PET) Scans are performed for staging Cancer. 

Treatment 

Your doctor chooses the treatment based on your age, physical condition, stage of Cancer, and extent of spread of the disease. Treatment of Vaginal Cancer includes: 

Surgery: Surgery involves the removal of small Tumours, Vaginectomy, or pelvic exenteration (removal of a majority of pelvic Organs) depending on the extent of your Cancer. Your doctor recommends pelvic exenteration if your Cancer has spread to a majority of the pelvic area or Cancer has recurred. 

If Vaginectomy is performed, you may undergo a surgery called Vaginal Reconstruction. In this procedure, your surgeon constructs a new Vagina using the flaps of muscle or sections of the Intestine. 

Radiation Therapy: Radiation Therapy involves killing Cancer cells using laser beams or high-energy X-rays. Your doctor chooses either external radiation or internal radiation (brachytherapy). External radiation is performed by positioning you on a table and directing the radiation machine to the target area. Internal radiation is given by placing radioactive devices such as wires, cylinders, or other materials in your Vagina and removing these devices after a certain amount of time. 

Generally, internal radiation is given after external radiation. However, individuals who are in the early stages of Cancer receive only internal radiation. 

In a few cases, Chemotherapy is given the following radiation to enhance the effectiveness of the therapy. 

Coping and support 

Before initiating the treatment, talk with your doctor and clearly, explain your expectations from the therapy. Take help from your healthcare team and family members to identify and implement coping strategies. Discuss the possible side effects that you may experience during and after treatment. 

Prevention 

The following few tips can help to prevent Vaginal Cancer: 

• Undergoing Gynaecological examination annually
• Avoiding multiple sexual partners
• Practicing safe sex
• Quitting smoking 

Understanding Cancer of the vulva 

The Cancer that affects the two skin folds or lips around the Vagina is called Vulvar Cancer. Vulva is the area that extends from the area of the anus to an inch below the hairline of the pubic area. 

Vulvar Cancer is a rare form of Cancer seen in women between the age group of 65 years to 75 years. It may be related to Genital Warts (sexually transmitted) which are caused by the Human Papilloma Virus (HPV). 

Vulvar Cancer may manifest as a lump in the vulva, pain and itching in the affected area, bleeding from the vulva other than menstrual bleeding, and a mole on the vulva that shows changes in colour, size and texture. 

Symptoms 

Signs and symptoms of Vulva Cancer may include: 

• Persistent itching
• Pain and tenderness
• Bleeding but not because of menstruation
• Discolouration
• Skin thickening
• Lump or sores
• Abnormal bleeding
• Burning 

Diagnosis 

To diagnose the condition the doctor may do a physical examination. 

Any abnormality of the vulva can be detected by an examination called a Colposcopy. In this procedure, a device that works like a magnifying glass is used to check for abnormalities. 

A procedure called biopsy is done to check for Cancer cells in the area. In this procedure, local anaesthesia is given in the area and with the help of a scalpel a part of the affected area is removed for testing. You may need stitches depending on the amount of area removed. 

Staging tests are done to determine the stage or extent of your Cancer spread. In the staging tests, the doctor examines the pelvis for the spread of Cancer. 

Imaging tests that are done to check the chest and abdomen for Cancer spread are Computerized Tomography (CT) by which 2D and 3D images of areas are created, X-ray, Magnetic Resonance Imaging (MRI) which uses a magnetic field to produce clear images of Organs and Ultrasound that use high-frequency sound waves with help of which images of Organs are created. 

Stages of Vulvar Cancer 

The stages of Vulvar Cancer are: 

Stage I - In this stage, the Tumour is present on the vulva and there is no spread of Cancer to the other parts of the body and lymph nodes. 

Stage II - In this stage, the Tumours spread to the nearby areas like the urethra, anus and Vagina. 

Stage III - Lymph nodes are affected by Cancer spread. 

Stage IV A- In this stage, Cancer spreads to Lymph Nodes, Bladder, Urethra, Vagina, Rectum and pelvic bone. 

Stage IV B- In this stage, distant parts of the body are affected by Cancer spread. 

Treatment 

The treatment of Vulva Cancer depends on the stage of Cancer and the general health of the patient. A procedure involving excision or removal of tissue affected with Cancer along with a little of normal tissue is done to make sure all Cancer cells are removed. 

In a surgical procedure called a Partial Vulvectomy, the affected part of the vulva is removed. 

In another surgical procedure known as Radical Vulvectomy, the entire vulva with clitoris and tissues surrounding it are surgically removed. 

For severe Cancer that has spread to the Organs beyond the vulva, a surgical procedure called Pelvic exenteration is done in which the entire vulva and all Organs affected are surgically removed. 

If the removal of skin is extensive, reconstructive surgery is done. 

The affected lymph nodes are also removed surgically. 

Radiation Therapy is used in which high-power X-rays are used to kill Cancer cells. 

Chemotherapy is also used in combination with Radiation Therapy in which chemical drugs are given orally or intravenously (through a vein). 

After treatment, regular checkups are a must. The doctor recommends follow-up examination twice every year for the first 5 years after treatment. 

Prevention 

To prevent Vulvar Cancer you must practice safe sex. The Human Papillomavirus that spreads through sexual transmission can cause Vulvar Cancer. Hence it is essential to use a condom for protection against the HPV virus. 

Limiting your sexual partners is also important to reduce exposure to HPV. 

Having sex at an early age also increases the risk of HPV infection. It is recommended that you undergo pelvic exams in which the vulva is examined for any abnormalities. 

Gardasil and Cervarix are two vaccinations that have been developed to give protection against HPV. 

About ectopic pregnancy 

In a normal pregnancy, the fertilized egg gets attached to the inner lining of the uterus, and the fetus develops in the uterus of a woman, but this is not the case with ectopic pregnancy. The word ectopic means “outside”, the fertilized egg fails to attach itself in the uterus and gets attached somewhere else. 

In 95% of women, the fertilized egg attaches itself to the fallopian tube resulting in tubal pregnancy. Other than the fallopian tube the egg can also implant itself in the ovary, cervix, and abdomen. None of these regions have sufficient space and nutrient supply, like the uterus, for the development of the fetus. Moreover, these organs cannot expand like the uterus; therefore the organ may eventually burst after some time. resulting in severe bleeding and risking the mother’s life. An ectopic pregnancy never results in a successful live birth. 

Symptoms 

The early signs and symptoms of an ectopic pregnancy are similar to those of a normal pregnancy; therefore many times it is difficult to diagnose an ectopic pregnancy. You will have normal symptoms like: 

• Missed periods
• Nausea
• Vomiting
• Morning sickness
• Breast tenderness 

A pregnancy test at home may show a positive result. However, you should be concerned if you have the following signs: 

• Vaginal spotting or bleeding
• Pain in the pelvis, abdomen, shoulder, and neck
• Sharp stabbing pain in one side of the pelvis that comes and goes
• Fainting due to low blood pressure and blood loss
• The feeling of pressure on the rectum 

Chances of a normal second pregnancy 

If you once had an ectopic pregnancy, then the risk of developing a second ectopic pregnancy for sure increases. But many women have a normal pregnancy after an ectopic one. About 1/3rd of women will have a repeated episode of ectopic pregnancy. Some women will have difficulty conceiving for the second time. The likelihood of becoming pregnant after an ectopic pregnancy depends on 

• Your age
• Whether you had fertility problems before your previous ectopic pregnancy
• Whether your fallopian tubes were removed due to a previous ectopic pregnancy, if yes, then it again reduces your chance for a second pregnancy 

Treatment 

There are many treatment options but your doctor will carefully choose one depending on how physically stable you are, and the size and location of the ectopic pregnancy. 

If an ectopic pregnancy is detected at the early stage, then the growth of the embryo can be stopped by giving an injection of methotrexate. If the pregnancy has developed further, then surgery, involving a pelvic cut, may be required to remove the fetus developing in an abnormal position. A laparoscopic removal of the developing fetus can also be done by making a small incision in the lower abdomen. A tiny video camera and an instrument is inserted using which the abnormal pregnancy is removed. 

In case of ruptured and bleeding fallopian tubes, all parts of the fallopian tube must be removed by emergency surgery. 

Whatever the treatment procedure you have undergone your doctor will ask you to visit him often to check the amount of hCG until it reaches zero. If the hCG level doesn’t come down after treatment then it means that some of the tissues of ectopic pregnancy were left behind, which require further treatment by methotrexate or by surgery. 

Women at risk for Ectopic pregnancy 

An ectopic pregnancy can happen in any woman. However, few circumstances increase the risk of ectopic pregnancy. Few such risk factors are 

• Presence of pelvic inflammatory disease (PID)
• Sexually transmitted infection like chlamydia & and gonorrhoea, which usually affects your fallopian tube
• Age above 35
• Previous episode of ectopic pregnancy
• Endometriosis (problem with the tissue lining the uterus)
• Previous history of several induced abortions
• Any fallopian tube and pelvic surgery
• Consuming medications for stimulating ovulation
• Infertility problem & and infertility treatment
• Smoking
• Any previous history of the uterus being exposed to diethylstilbestrol
• Pregnancy after tubal ligation (permanent birth control surgery)
• Pregnancy with any intra-uterine device in place 

 Diagnosis 

If you know that you are pregnant and you are suffering from any of the symptoms of an ectopic pregnancy, then it’s best to contact your doctor at the earliest. Initially, you will be recommended to do a urine pregnancy test to confirm pregnancy. Once confirmed, the next test will be a blood test for measuring human chronic gonadotropin (hCG) hormone, which is produced during pregnancy by the placenta as early as 8-10 days of conception. The level increases as pregnancy proceeds but if you have an ectopic pregnancy the level of hCG decreases as days go by. Serum progesterone level in the blood will be measured, as it is related to pregnancy. 

A transvaginal or pregnancy ultrasound examination may show whether the fetus develops in the uterus or elsewhere. However, ultrasound examination may not be able to detect every ectopic pregnancy. A culdocentesis procedure may be done that allows your physician to check for any bleeding in the region behind the uterus and in front of the rectum by inserting a small needle. The presence of blood indicates a ruptured fallopian tube. 

A pelvic examination may be done to detect the exact location of pain, and enlarged uterus, and to find out any masses. A “D and C test” (dilation and curettage test) is done as a confirmatory test, where the tissues from the endometrium are scraped and collected to check for endometriosis. A laparoscopy will also be done where your doctor will be able to look into your pelvis, abdomen, fallopian tubes, ovaries, and uterus. 

Even with sophisticated equipment, it is very difficult to diagnose a pregnancy that is less than 5 weeks. If the above-mentioned test doesn’t give clear diagnostic results then your doctor may ask you to come back every 2-3 days to check the level of hCG. If the hCG levels decrease then your doctor will monitor you continuously until an ultrasound shows the location of your pregnancy. 

Conclusion 

After an ectopic pregnancy, it is pretty obvious that you and your partner will be emotionally down. It is important that you take time and heal emotionally before planning or worrying about a second pregnancy. Although it is known that ectopic pregnancy can threaten your health and future well-being it is important that you get prompt treatment and follow-up care from your doctor. 

Alcohol during pregnancy 

Alcohol consumption in pregnancy is dangerous as it can have deleterious effects on the developing baby. No amount of alcohol in pregnancy is safe. Abstain. Alcohol can affect the baby even before you know you are pregnant. Give up on drinking even if you are not planning to conceive. The earlier you stop the better. 

There isn’t any safe amount or type of alcohol. Even wines and beer are harmful. Different women tolerate alcohol differently. So the effects on the mother and baby may vary from one woman to another. Even occasional drinking is harmful to the baby. The best safeguard is to resolve to abstain from alcohol. 

To give up on alcohol may not be easy. But it isn’t difficult as well. How tough it is for you to give up alcohol is determined by how addicted are you to drinking. If you can’t stop drinking, you need help. Consult your healthcare provider. Seek help from friends and family. Join a support group to help you in this process. Remember! You alone will need to decide the fate of your baby. 

Causes 

Alcohol in early pregnancy can cause physical deformities. The baby’s brain develops throughout pregnancy and consumption of alcohol by the mother at any stage of pregnancy can adversely affect the baby’s mental capabilities. The growth of the baby can be affected at any stage. 

Consumption of alcohol is not good for the health of the baby as it readily diffuses in the blood and reaches the baby in the womb. The developing baby is not capable of eliminating alcohol. So, even a minor amount may persist long in a baby. This may be harmful to the developing organs of the baby. 

About fetal alcohol syndrome 

Fetal alcohol syndrome (FAS) is a constellation of signs and symptoms caused in a developing baby as a result of the consumption of alcohol by the pregnant mother. It is a spectrum of physical, mental, and behavioural disorders. 

Fetal alcohol syndrome is a common problem. Every year around 40,000 babies in the US are born with some type of alcohol-related damage. The prevalence of fetal alcohol syndrome has been reported to be around 0.5 to 2 cases per 1,000 births or even more in the US. 

Once fetal alcohol syndrome has occurred, it cannot be treated or reversed. There isn’t any cure. The best is to prevent it by totally giving up on drinking. 

Remember these things 

• Fetal alcohol syndrome is 100% preventable
• Fetal alcohol syndrome has no cure
• If you are trying to get pregnant or are pregnant, totally abstain from alcohol.
• No type or amount of alcohol is safe in pregnancy.
• Seek help from family, friends and your doctor and give up alcohol to ensure that you have a healthy baby. 

Symptoms 

A list of fetal alcohol syndrome symptoms has been mentioned below: 

• The baby may be low in weight when born
• Small head and shorter than average weight
• Flat philtrum
• Ridge between the nose and upper lip
• Sleep and sucking problems
• Problems with the heart, kidneys, bones
• Poor vision and hearing
• Learning disabilities
• Poor memory
• Lack of concentration
• Low IQ, speech
• Delay in language
• Weak coordination
• Hyperactive
• Poor judgment
• Poor reasoning 

The worst part is that these disorders and disabilities are not reversible. 

Treatment 

There is no particular medication or treatment for fetal alcohol syndrome. The only things to follow are: 

• Regular exercise
• Yoga
• Enrolling in healing activities
• Counselling
• Following a healthy diet
• Opting for a healthy lifestyle
• Avoid consumption of alcohol
• Alcohol intoxication 

Prevention 

Fetal alcohol syndrome can be prevented and you have to do it. You can prevent your baby from being born with a handicap and developing a mental incapability later in life. If you have been drinking, you need to give it up if you are planning a pregnancy. 

If you are not using any measures of birth control, it is ideal to refrain from alcohol for the period that you are sexually active. Many conceptions are unplanned. Accidental and brief exposure of your developing baby to alcohol can be harmful as the organs of the baby develop in the early weeks of pregnancy. Irreparable harm may occur even before you realize that you are pregnant. 

It is never too late to give up. Anytime you feel or confirm that you are pregnant, give up on alcohol. Do not drink at any stage of pregnancy. If you are dependent on alcohol, you need to seek medical help and social support to give it up so that you can plan and start a family for yourself. 

Symptoms 

Some of the symptoms that indicate fetal macrosomia are: 

Large Fundal Height: The doctors measure the distance between the top of the uterus to the pubic bone. A larger distance indicates large fundal height, which is an indication of fetal macrosomia. 
Excessive Amniotic Fluid (Polyhydramnios): Amniotic fluid surrounds the baby in the uterus. The amniotic fluid reflects the baby’s urine output; more urine is produced if the baby is large. Too much amniotic fluid may be an indication of excessive weight of the baby. 

Maternal Risks 

Delivery Problems: The delivery of a macrosomic baby is difficult as the baby cannot pass through the birth canal easily, so a vacuum or c-section is required. 

Uterine Rupture: If a prior c- c-section was performed in the first delivery, the fetal macrosomia can be a serious complication as the uterus tears open from the scar of the c-section line. 

Lacerations of Genital Tract: Fetal Macrosomia can injure the birth canal by tearing the vaginal tissues and muscles, sometimes anal muscles are also. 

Bleeding: Fetal macrosomia can lead to uterine atony which may result in excessive bleeding after delivery of the baby. 

Causes 

Several factors contribute to a macrosomic baby. Genetics is the most significant factor that is involved in the growth and development of the baby. So, the genes may also be the reason for a macrosomic baby. Other factors that contribute to fetal macrosomia are: 

• Gestational diabetes or diabetes mellitus during pregnancy
• Extra weight gain during pregnancy
• Carrying the baby more than past due date
• Gender of the baby (Most males are macrosomic)
• High body mass index (BMI) during the first few months of pregnancy
• Macrosomic baby in first pregnancy
• Weight gain in between pregnancies or no weight loss after first pregnancy 

Sometimes these conditions may not affect the delivery; the macrosomic baby can be delivered easily without complications. In some cases, macrosomic babies are also born to mothers with none of the risks mentioned above. 

Complications 

Fetal macrosomia can pose health risks for both the mother and the baby. 

Newborn Risks 

Obesity: Macrosomic infants may have an increased risk for childhood obesity. 

Low Blood Sugar Levels: Babies with macrosomia are more likely to have lower blood sugar levels than normal. 

Metabolic Syndrome: Metabolic syndrome includes a cluster of conditions such as increased blood pressure, increased sugar levels, excessive body fat and cholesterol, and increased risk of heart disease, stroke, and diabetes. The infant of a diabetic mother is more likely to experience metabolic syndrome. 

Diagnosis 

Prediction of the weight of the baby is difficult before birth. It is possible and accurate only after the birth. Your doctor would suggest the following tests if he or she suspects fetal macrosomia. 

Ultrasound: The doctors may suggest an ultrasound at the end of the third trimester, to measure the parts of the baby such as the head, abdomen, and femur. The measurements of these body parts will be used to determine the weight of the baby. However, this weight may not be accurate. 
Antenatal Testing: Some doctors may suggest antenatal testing to identify fetal macrosomia. The antenatal testing includes a nonstress test or a fetal biophysical profile. 

In a nonstress test, the heart rate of the baby is measured, based on the movement of the baby. 

In the fetal biophysical test, a nonstress test is performed with ultrasound, to monitor the movement of the baby, breathing, and volume of the amniotic fluid. 

Treatment 

There is no treatment for fetal macrosomia. If the diagnosis indicates fetal macrosomia, the doctors may suggest vacuum-assisted vaginal delivery or a c-section based on the condition of the mother. Mostly the doctors suggest a c-section if the mother has gestational diabetes or the baby’s weight is more than 500 g. It is also suggested in cases where the first delivery resulted in shoulder dystocia of the baby. 

Prevention 

You may not prevent fetal macrosomia, but you need to make some lifestyle changes to promote a healthy pregnancy: 

• If you are planning for pregnancy, talk to your doctor or dietician and take a proper diet to reach a healthy weight
• Control your blood sugar levels to avoid gestational diabetes
• Follow your doctor’s instructions and exercise daily
• Monitor your weight by gaining a healthy amount of weight