MENSTRUAL DISORDER
Menstrual disorders are a very common problem in women in their reproductive age. Disturbances of menstruation are one of the most common reasons for women to attend their gynaecologist. A woman’s menstrual periods start with the menarche (first menstrual period) and ends with the menopause( last menstrual period). In general, a woman will experience a period every 21-35 days with 3-7 days of menstrual flow. Nowadays, women are experiencing more menstrual periods than ever before and this is because women are having less children and are not breastfeeding as much as their mothers or grandmothers before them and are also living much longer.
What causes menstrual cycle irregularities?
- Stress and Emotional changes
- Weight changes-overweight or underweight(anorexia, bulimia)
- Strenuous exercise
- Hormone imbalances-PCOS
- Endocrine-thyroid, prolactin,adrenal
- Pregnancy related
- IMB -Polyp fibroid cyst
- PCB-cervix
Investigations and treatments
Tests for abnormal bleeding include hormonal profile, ultrasound scan, hysteroscopy and biopsy of the lining of the womb.
Treatment depends on the abnormality detected and the options are hormonal treatment, hysteroscopic resection/ablation and hysterectomy.
POLYCYSTIC OVARIAN SYNDROME PCOS
First described by Stein Leventhal in 1935, PCOS is a problem in which a woman’s hormones are out of balance. It is a syndrome-collection of signs and symptons, therefore the clinical presentations can be highly variable. Some of the clinical syndromes include:
- Irregular menses
- Hyperandrogenism
- Insulin Resistance and Obesity
- Infertility
- Long term consequences
It can cause problems with your periods and make it difficult to get pregnant. If it isn’t treated, over time it can lead to serious health problems, such as diabetes and heart disease.
What causes PCOS?
The cause of PCOS is not fully understood, but genetics may be a factor. PCOS seems to run in families, so your chance of having it is higher if other women in your family have it or have irregular periods or diabetes. PCOS can be passed down from either your mother’s or father’s side. Some of the other causes can be high Luteinizing hormone, high level of insulin, high androgens and obesity.
How is PCOS treated?
Regular exercise, healthy foods, and weight control are the key treatments for PCOS. Treatment can reduce unpleasant symptoms and help prevent long-term health problems.
It is important to see your doctor for follow-up to make sure that treatment is working and to adjust it if needed. You may also need regular tests to check for diabetes, high blood pressure, and other possible problems.
ENDOMETRIOSIS
Endometriosis is a condition where the tissues that line the inside of the womb (endometrium) are found outside the womb, in muscle layer of the womb (adenomyosis), ovary, bladder and bowel.
What are the symptoms of endometriosis?
- Abdominal cramps or back pain during menstruation.
- Severe menstrual cramps.
- Painful bowel movements or urination, especially during menstruation.
- Abnormal or heavy bleeding during periods.
- Painful sex.
- Difficulty becoming pregnant.
How is endometriosis treated?
The gold standard for diagnosing endometriosis is by having a laparoscopy, a small operation. There are many options to manage and treat endometriosis including a healthy lifestyle, pain-relief medications, hormone therapy such as the oral contraceptive pill and progestins. Different types of surgery including laparoscopy, laparotomy and hysterectomy are also discussed.
FIBROIDS & OVARIAN CYST
Fibroids
Uterine fibroids are benign (non-cancerous) overgrowths of fibrous and smooth muscle tissue of the womb. They are very common in women of reproductive age and rarely cancerous. Most women with fibroids are asymptomatic but some may have heavy menstrual bleeding, cramps or abdominal discomfort. Treatment options include observation, medication for symptom control or surgery.
What are the symptoms?
- Asymptomatic and incidental finding in vast majority
- Symptoms depends on size, site and number
- Heavy prolonged bleeding and anaemia
- Abdominal swelling and pressure symptoms
Ovarian Cyst
Ovarian cysts are fluid filled sacs. Most ovarian cysts are benign but some are cancerous, or may become cancerous over time. Ovarian cysts can vary in. They may be related to a woman’s periods (functional cysts) or may be due to pathology. Most ovarian cysts are do not cause symptoms. However some ovarian cysts may cause problems such as abdominal swelling, lower abdominal pain (constant or intermittent), pain during intercourse, irregular or heavy periods. Sometimes a cyst may bleed into itself, burst or even twist (torsion). This can cause a sudden severe pain in the lower abdomen. Treatment depends on symptoms, size and nature of the cyst and may involve medication, surgery or close observation depending on its severity.
MENOPAUSE
Menopause cannot be scheduled. It arrives later for some, earlier for others. It affects each woman differently – bringing changes that range from minor to profound. The impact of menopause is as individual as each woman.We at The Women’s Specialist OB•GYNAE Centre can help you better cope with this sometimes challenging period of life with a variety of treatment options.
Perimenopause
Perimenopause, or menopause transition, is the stage of a woman’s reproductive life that begin several years before menopause, when the ovaries gradually begin to produce less estrogen. It usualy starts in a woman’s 40s, but can start in the 30s as well. Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last one to two years of perimenopause, the reduction of estrogen accelerates. At this stage, many women experience menopausal symptoms.The transition into the menopause begins when a women begins experiencing a variety of symptoms including hot flushes, night sweats, difficulty sleeping, breast tenderness, mood swings, reduced sex drive, irregular periods, vaginal dryness, urinary problems just to name a few.
Perimenopausal bleeding
Irregular periods are common and normal during perimenopause. But, other conditions can cause abnormalities in menstrual bleeding during the menopause transition. Potential causes of abnormal bleeding include hormonal imbalances, hormonal contraception, pregnancy, fibroids, blood clotting problems or, rarely, cancer.Post Menopausal bleeding
Post Menopausal Bleeding is bleeding form the genital tract one or more years following the cessation of menses. This symptom is always abnormal and must be taken seriously. Most cases are benign in nature but it is important to exclude cancer of the genital tract in every women who complains of PMB.
SEX IN THE CITY
Vaginal Discharge
Vaginal yeast infections (vulvovaginal candidiasis) is one of the commoner reasons for vaginal discharge and can occur frequently in many women. Yeast infections are due to a variety of causes including pregnancy, birth control, antibiotics, swimming, certain type of clothing and diabetics. In most instances no obvious cause is determined. It is not dangerous, but just inconvenient, irritating, and uncomfortable. It is not a sexually transmitted disease. The infection usually has an itching and or burning sensation associated with a discharge. The discharge can be white, yellow, or greenish yellow. It frequently has the appearance of cottage cheese.The treatments available are quite simple and effective. Anti-yeast medication you should always be used with a cream. If after 24 to 48 hours no improvement occurs with these methods another problem may exist and a doctor should be consulted.
STDs(Chlamydiae and Gonorrhoea) and Pelvic Inflammatory Disease (PID)
Sexually transmitted diseases (STDs, or infections STIs) are diseases passed on through intimate sexual contact. These infections can be passed on during vaginal, anal or oral sex as well as just through genital contact with an infected partner. The incidence of such infections is increasing with most of those affected being between the ages of 16 and 24 years.Chlamydia
Chlamydia is the commonest STI and is caused by Chlamydia trachomatis, a bacteria. Most people who get this infection do not have any symptoms and many cases remain ‘silent’ and undiagnosed. It can be easily diagnosed through a simple vaginal swab or urine test. Undiagnosed Chlamydia can lead to more serious long term problems and infertility.PID is an infection of the upper reproductive organs. It occurs when bacteria move upward from the vagina and cervix to the uterus, ovaries, or fallopian tubes. Most cases stem from sexually transmitted diseases (STDs), generally gonorrhea and chlamydia. When the STD goes untreated, the bacteria that caused it can lead to PID. PID can cause serious long-term problems like infertility, ectopic pregnancy, and chronic pelvic pain.
Genital Warts
Genital warts are caused by a viral skin infection as a result of infection with the human papilloma virus (HPV). Small fleshy lumps are seen around the genital area. It is possible to pass on the infection without penetrative sex as HPV is spread by skin to skin contact. Genital warts are most common amongst young adults. Several treatments are available including, creams and cryotherapy (freezing).Genital Herpes
Genital herpes is caused by the herpes simplex virus (HSV) type 1 or 2. It causes painful blisters to appear on and around the genitals. HSV is very infectious passes easily between people by direct contact. Genital herpes is transmitted from one person to another by having sex. It is possible for an individual with no symptoms to pass the condition onto a sexual partner. Once infected the virus stays dormant most of the time with 80% of people unaware they have been infected as there are no symptoms initially. Genital herpes is especially common amongst young people aged 20-24years.There is no cure for herpes but the symptoms can be relieved by antiviral medicines and with time the frequency and severity of attacks reduces.
