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Gynaec Issues

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Menstrual Problems (Painful, Irregular, Heavy)

What happens during the menstrual cycle?

The menstrual cycle is a recurring process that takes place in females of reproductive age, generally starting between the ages of 11 and 16. This cycle involves hormonal changes that occur roughly once a month, preparing the body for a potential pregnancy. The word “menstruation” is derived from “mensis,” meaning month, hence the term menstrual cycle. Menstruation is also called the periodic shedding of the uterine lining, commonly referred to as a “period.”
On average, the menstrual cycle lasts upto 28 days and is divided into three phases:
  1. Follicular Phase: Egg development occurs
  2. Ovulatory Phase: Eggs get released
  3. Luteal Phase: Hormones decrease if no pregnancy occurs

Follicular Phase

This phase begins during the first day of the menstrual period. During this stage, two hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH), are produced by the brain and travel to the ovaries through the bloodstream. These hormones help stimulate the development of approximately 15 to 20 eggs inside the ovaries, each housed within a structure called a follicle.
As FSH and LH promote follicle growth, they also trigger a rise in estrogen production. When estrogen levels increase, it stops the production of FSH, ensuring that only one follicle matures. As the cycle progresses, one dominant follicle comes, while the rest stop developing. This dominant follicle continues to produce estrogen as it prepares for the next phase.

Ovulatory Phase

Ovulation typically causes around 14 days after the follicular phase begins, though this can vary. During this phase, the dominant follicle’s estrogen production causes a surge in LH levels, leading to the release of the egg from the ovary, known as ovulation. The fimbriae then capture the egg, the finger-like projections at the present at the end of the fallopian tubes, where it waits to get fertilized.
Some women will notice an increase in clear, stretchy cervical mucus a few days before ovulation. This mucus aids in capturing and nourishing sperm, helping them reach the egg for potential fertilization.

Luteal Phase

Following ovulation, the empty follicle transforms into the corpus luteum, which produces estrogen and progesterone. Progesterone helps in the preparation of the uterine lining for the implantation of fertilized eggs.
If fertilization occurs, the embryo travels through the fallopian tube and implants in the uterus, marking the beginning of pregnancy. If no fertilization occurs, the corpus luteum disintegrates, hormone levels will decrease, and also the uterine lining sheds, leading to the next menstrual period.

Heavy Bleeding

Menstrual cycles can vary significantly between women and throughout a woman’s life. A typical cycle occurs every 28 days, with menstruation lasting an average of five to seven days. When bleeding happens more frequently or lasts longer than this duration, it is considered abnormal or heavy bleeding.
Approximately one in five women will experience heavy vaginal bleeding at some point in their lives. Other symptoms, such as severe cramps, headaches, and fatigue, may accompany this condition. In fact, 80% of women with heavy bleeding report avoiding intimacy, while 60% have missed social activities, athletic events, or even work due to the issue.
Fortunately, there are several treatment options available for heavy menstrual bleeding. For women who have completed their families, a minimally invasive outpatient procedure called endometrial ablation has been available for the last two decades. This procedure, which removes the uterine lining using an energy source, is performed under anaesthesia and typically allows for a speedy recovery, with most women resuming normal activities within one to two days.
The procedure is fast and requires no incisions, offering significant benefits to many women. Around 90% of women who undergo endometrial ablation experience lighter periods, and about 40% have no further bleeding at all. This method is an excellent option for those seeking relief from heavy bleeding without needing a hysterectomy.

Irregular Periods

A typical menstrual period lasts between four and seven days and occurs roughly every 28 days. However, irregular periods are relatively common and can still be considered “normal” even if they don’t happen on the same exact day each cycle.
Examples of irregular periods are:
  • Periods occur either less than 21 days or more than 35 days apart.
  • Missing three or more periods continuously.
  • Menstrual flow is significantly heavier or lighter than usual.
  • Periods lasting longer than seven days.
  • Significant variability in cycle length, such as having one cycle last 28 days, another last 37 days, and the next 29 days.
  • Periods accompanied by extreme pain, cramping, nausea, or vomiting.

Conditions Associated with Irregular Periods

  • Amenorrhea: This occurs when periods stop entirely for at least 90 days, outside of pregnancy, breastfeeding, or menopause (which typically occurs between the ages of 45 and 55). If menstruation hasn’t started by age 15 or within three years of breast development, amenorrhea may also be present.
  • Oligomenorrhea is characterized by infrequent periods, with more than 35 days between cycles or fewer than six to eight periods per year.
  • Dysmenorrhea: Refers to painful periods and severe menstrual cramps, which, although common, can be more intense in some instances.
  • Abnormal Uterine Bleeding: This term describes bleeding between periods, prolonged bleeding, or extremely heavy periods.

What is the cause of my irregular periods?

Irregular periods can stem from various factors, including hormonal fluctuations, stress, certain health conditions, medications, and lifestyle changes.
Medical conditions and irregular periods
  • Endometriosis: In this condition, the tissue that normally lines the uterus grows outside of it, often attaching to the ovaries or fallopian tubes, leading to abnormal bleeding and pain.
  • Pelvic Inflammatory Disease (PID): A bacterial infection, often resulting from untreated sexually transmitted infections (STIs), PID will lead to irregular periods, pelvic pain, and abnormal vaginal discharge.
  • Polycystic Ovary Syndrome (PCOS): This condition causes the ovaries to produce high levels of androgens, which can prevent ovulation and result in irregular or absent periods.
  • Primary Ovarian Insufficiency: This occurs when the ovaries stop functioning properly before age 40, leading to irregular or missed periods. It is caused by chemotherapy, radiation, or autoimmune disorders.
  • Thyroid and Pituitary Gland Disorders: Issues with the thyroid or pituitary glands, such as hypothyroidism or hyperthyroidism, can disrupt hormone levels and lead to irregular menstruation.
  • Bleeding Disorders: Conditions affecting blood clotting can cause heavier-than-normal periods.
  • Uterine or Ovarian Cancer: Some cancers may present symptoms of heavier-than-usual bleeding or missed periods.
Lifestyle factors and irregular periods
Changes in daily routine and lifestyle can also impact menstruation. Examples include:
  • Stress
  • Significant weight gain or loss
  • Intense exercise, especially in athletes like long-distance runners or dancers
  • Illnesses or viral infections
Other causes of abnormal menstruation
Medications and certain life events, such as pregnancy or breastfeeding, can also affect menstrual regularity. Additional causes include:
  • Birth Control Pills: Hormonal birth control can delay or prevent ovulation, leading to missed or irregular periods for up to six months after stopping the medication.
  • Medications: Some drugs, such as steroids or anticoagulants, can impact menstrual cycles.
  • Miscarriage or Ectopic Pregnancy: Pregnancy complications can cause changes in the menstrual cycle.
  • Surgery or Blockages: Uterine, ovarian, or fallopian tube surgery, as well as scarring or blockages, can disrupt normal menstruation.
By understanding the causes and conditions related to irregular periods and heavy bleeding, women can work with their healthcare providers to find effective solutions and treatments.

Diagnosis and Tests

How are irregular periods diagnosed?

If you have noticed any changes in your menstrual cycle, it’s important to start tracking your periods. Record when they begin and end, and note the intensity of the flow, any cramping, bleeding between periods, or large clots you pass. This information will be helpful when you discuss your symptoms with your healthcare provider.
To diagnose irregular periods, your provider will inquire about your menstrual cycle and medical history and conduct a physical tests, including a pelvic exam. They may also order tests such as:
  • Pelvic ultrasound: This test helps identify irregular bleeding due to fibroids, polyps, or ovarian cysts.
  • Endometrial biopsy: A small tissue sample is extracted from the uterine lining to examine for conditions such as endometriosis, hormonal imbalances and precancerous cells.
  • Hysteroscopy: A procedure that helps your provider to examine the inside of your uterus, which can help identify and treat causes of abnormal bleeding.

Management and Treatment

How are irregular periods treated?
Treatment for irregular periods depends on the underlying cause.
Medications for Irregular Periods
Medications are often the first line of treatment. If they are ineffective, surgery might be recommended. Medications may include:
  • Hormonal birth control: Hormonal contraception can help manage irregular or heavy periods caused by conditions like PCOS, fibroids, or endometriosis. These options include pills, injections, IUDs, or vaginal rings containing estrogen and progestin, or just progestin.
  • Tranexamic acid: This medication helps reduce heavy menstrual bleeding when taken at the start of your period.
  • Pain relievers: Over-the-counter pain killers like ibuprofen or acetaminophen can help alleviate pain from cramps.
  • Hormone therapy: Hormone therapy may help if the irregular periods are related to perimenopause and can also alleviate other symptoms like hot flashes. However, there are risks, so discussing them with your healthcare provider is essential.
  • Antibiotics: Antibiotics are prescribed if an infection is causing irregular bleeding.
  • Gonadotropin-releasing hormone agonists: These medications help shrink fibroids and control heavy bleeding by temporarily halting menstrual periods.
Surgery for irregular periods
If medications don’t resolve the issue, your provider may suggest surgery, depending on your condition, age, and desire for future pregnancy. Surgical treatments include:
  • Endometrial ablation: A procedure that removes the uterine lining, reducing bleeding. It’s not suitable for those wanting future pregnancies.
  • Myomectomy: A surgery to remove fibroids, which can cause irregular bleeding.
  • Uterine artery embolization: This procedure cuts off the blood supply to fibroids to stop their growth and reduce bleeding.
  • Hysterectomy: In severe cases, especially if your uterus is damaged or other treatments fail, removing the uterus might be necessary.

Prevention

How can I reduce the risk of irregular periods?
Here are some strategies for maintaining regular periods:
  • Aim for a healthy lifestyle with balanced nutrition and moderate exercise.
  • Manage weight loss gradually and avoid extreme dieting.
  • Prioritize rest and practice relaxation techniques to manage stress.
  • Avoid overly intense or prolonged exercise routines.
  • Follow the directions for contraceptive use carefully.
  • Change tampons or pads every four to six hours to prevent infections and reduce the risk of toxic shock syndrome.

Period Pain

Also called: Dysmenorrhea, Menstrual cramps, Menstrual pain
What are painful periods?
Many women experience painful periods, medically known as dysmenorrhea. These painful cramps, often felt in the lower abdomen, can be accompanied by other symptoms like back pain, nausea, diarrhoea, or headaches. Painful periods differ from premenstrual syndrome (PMS) and can be categorized as primary or secondary dysmenorrhea.

Causes of Period Pain

  • Primary dysmenorrhea: This is one of the most common types of menstrual pain, caused by excessive prostaglandins, which trigger uterine contractions. Pain may start a day or two before the period and can last for several days.
  • Secondary dysmenorrhea: This type of pain is due to underlying conditions like endometriosis or fibroids. It often worsens over time and may persist even after the period ends.
What can you do to ease period pain?
To help ease your period pain, you can try:
  • Use either a heating pad or hot water bottle on your lower abdomen.
  • Take a warm bath or shower.
  • Exercise or stretch lightly.
  • Practice relaxation techniques, including yoga or meditation.
Over-the-counter painkillers, like ibuprofen or acetaminophen, can also help. They relieve pain and reduce the production of prostaglandins, which contribute to cramping. Be sure to follow the recommended dosage and avoid them if you have certain health conditions, like ulcers or liver disease.
When should you contact a doctor for period pain?
While some discomfort is common, you should seek medical advice if:
  • Pain disrupts your daily life and over-the-counter remedies aren’t helping.
  • The pain suddenly intensifies.
  • You experience severe cramps for the first time after age 25.
  • You have a fever alongside period pain.
  • You experience pain outside your menstrual cycle.
What are treatments for severe period pain?
If your pain is due to primary dysmenorrhea, your doctor might suggest hormonal birth control (pills, patch, ring, or IUD) or prescription pain relievers. If secondary dysmenorrhea is the cause, treatment will depend on the specific condition and include medication or surgery.
By managing a healthy lifestyle, managing stress, and seeking appropriate treatment when necessary, you can better manage irregular periods and painful menstruation.

Menopause

Menopause is a common and natural phase in a woman’s life, much like menstruation or childbirth. Typically, a woman is considered to be in menopause if she hasn’t had her period for 12 consecutive months. Most commonly, menopause occurs between the ages of 40 and 60, with the average starting point being around 50 years old.
All women will eventually go through menopause, although the timing can vary. Some women may experience it earlier, especially those who have had their ovaries removed during a hysterectomy. In these cases, menopause occurs immediately following the surgery due to the loss of hormone production. Similarly, cancer treatments like chemotherapy or radiation, as well as medical conditions such as primary ovarian insufficiency, may cause early menopause by disrupting hormone production in the ovaries.
Menopause signals during the end of a woman’s reproductive years. Once menopause begins, the body no longer produces estrogen on a monthly cycle, and menstruation ceases. Along with the absence of periods, women may notice symptoms linked to hormonal changes, including hot flashes, night sweats, vaginal dryness, weight gain, and thinning hair.

Common Symptoms of Menopause

The period leading up to menopause, known as perimenopause, often brings symptoms of its own, including irregular menstrual cycles. The experience of menopause varies from woman to woman, but some of the more common symptoms include:
  • Dry skin
  • Hot flashes
  • Night sweats
  • Thinning hair
  • Vaginal dryness
  • Painful intercourse
  • Urinary incontinence
  • Weight gain and slower metabolism
  • Loss of breast fullness
  • Disrupted sleep and poor sleep quality
Treatment to face Menopause:
Hormone Replacement Therapy (HRT) is a popular and effective treatment for managing severe menopause symptoms caused by reduced estrogen production. During menopause, the body’s estrogen levels drop, leading to symptoms likely hot flashes, night sweats, mood swings, weight gain, and vaginal dryness.
HRT works by introducing medications that contain estrogen, progesterone, or both, helping to relieve these symptoms.
Some benefits of HRT include:

  • Relief from menopause symptoms
  • Improved heart health
  • Mood stabilization
  • Prevention of bone loss
  • Preservation of muscle mass
  • Protection against dementia
  • Reduced risk of vaginal atrophy
  • Potential protection against certain cancers
For women going through menopause, understanding available treatments and lifestyle adjustments can significantly improve their comfort and well-being during this natural transition.

Polycystic Ovarian
Syndrome or
Disorder
(PCOS/PCOD)

PCOS Diagnosis Tests

Overview: Polycystic Ovarian Syndrome (PCOS) is defined as a common hormonal disorder among women of reproductive age. It often results in irregular menstrual cycles, increased levels of androgen (male hormone), and the development of numerous small cysts on the ovaries. These factors will affect a woman’s fertility and overall health.
Symptoms: PCOS symptoms usually start around puberty, though it can develop later, particularly in relation to weight gain. Symptoms vary between individuals, but a diagnosis typically requires the presence of at least two of the following:
  • Irregular Periods: This includes infrequent, prolonged, or abnormally heavy menstrual cycles, with lesser than nine periods a year or exceeding 35 days between periods occuring.
  • Excess Androgen: Elevated male hormone levels may cause excess facial and body hair (hirsutism), more acne, and male-pattern baldness symptoms.
  • Polycystic Ovaries: The ovaries will be enlarged and develop numerous small fluid-filled follicles, which can interfere with their normal function.

Causes

The exact cause of PCOS remains unclear, but several factors may contribute to its development:
  • Insulin Resistance: Insulin helps regulate sugar levels in the blood. When body cells become resistant to insulin, the body produces more insulin, which may increase androgen production and disrupt ovulation.
  • Low-Grade Inflammation: Research indicates that women with PCOS often have chronic, low-grade inflammation, which prompts the ovaries to produce excess androgens. This can increase the risk of heart and blood vessel issues.
  • Genetic Factors: Some studies suggest a hereditary link, with certain genes contributing to the likelihood of developing PCOS.
  • Excess Androgen: Overproduction of androgen by the ovaries will lead to symptoms such as acne and hirsutism.

Complications

PCOS can lead to several long-term health complications, including:
  • Infertility
  • Gestational diabetes or excess blood pressure during pregnancy
  • Miscarriage or premature birth
  • Nonalcoholic steatohepatitis (liver inflammation due to fat buildup)
  • Metabolic syndrome (a group of conditions that increase the risk of cardiovascular disease)
  • Type 2 diabetes or prediabetes
  • Sleep apnea
  • Mental health disorders especially depression, anxiety, and eating disorders
  • Abnormal uterine bleeding
  • Endometrial cancer (cancer of the uterine lining)
  • Obesity, which may worsen these complications

Diagnosis

Transvaginal ultrasound

There’s no test to definitively diagnose PCOS. Your doctor is likely to start with a discussion of your medical history, including your menstrual periods and weight changes. A physical exam will include checking for signs of excess hair growth, insulin resistance and acne.

Your doctor might then recommend

Pelvic Exam

The doctor examines the reproductive organs for any abnormalities.

Blood Tests

These are used to measure hormone levels and exclude other conditions that could mimic PCOS. Additional tests might include checking glucose tolerance and cholesterol levels.

Ultrasound

A transvaginal ultrasound is performed to check the ovaries' appearance and the uterine lining's thickness.

Additional Tests for Complications If diagnosed with PCOS, your doctor may recommend periodic monitoring for potential complications. This could include regular checks of blood pressure, glucose tolerance, and cholesterol levels and screening for mental health issues like depression or anxiety.

Periodic checks of blood pressure, glucose tolerance, and cholesterol and triglyceride levels

Screening for depression and anxiety

Screening for obstructive sleep apnea

Lifestyle Changes

An essential part of managing PCOS involves lifestyle modifications, particularly weight loss through a low-calorie diet and regular exercise. Even a 5% reduction in body weight will significantly improve the effectiveness of treatments.

Medications

Treatment options vary depending on symptoms and health goals, such as regulating menstrual cycles, managing symptoms, or improving fertility.
To Regulate Menstrual Cycles:

  • Combination Birth Control Pills: These pills, containing estrogen and progestin, regulate hormones, reduce androgen production, and lower the risk of endometrial cancer. Alternatives include skin patches or vaginal rings with the same hormone combination.
  • Progestin Therapy: Progestin taken for 10-14 days every 1-2 months can regulate menstrual cycles and protect against endometrial cancer, though it doesn’t reduce androgen levels or serve as a contraceptive.

To Induce Ovulation

  • Clomiphene: This anti-estrogen medication is often prescribed for women trying to conceive.
  • Letrozole (Femara): Originally used for breast cancer, Letrozole can also stimulate ovulation.
  • Metformin: Most commonly used medication to treat type 2 diabetes, metformin will increase insulin resistance and help with weight loss.
  • In some cases, it is combined with Clomiphene for infertility treatment.

To Reduce Excess Hair Growth

  • Birth Control Pills: These decrease androgen production, which may help manage hirsutism.
  • Spironolactone (Aldactone): This medication blocks androgen’s effects on the skin. However, it is not recommended during pregnancy or for women planning to become pregnant, as it may cause birth defects.
  • Eflornithine (Vaniqa): A cream that can slow facial hair growth.
  • Electrolysis: This involves using a small electric current to damage and destroy hair follicles, which may require multiple treatments.

Premenstrual Syndrome (PMS)

What is premenstrual syndrome (PMS)?
A lot of women experience emotional or physical changes in the days leading up to their periods. Premenstrual syndrome (PMS) is a term that explains a set of symptoms that a woman has every month that interferes with her regular activities.
Emotional symptoms include
  • depression
  • angry outbursts
  • irritability
  • crying spells
  • anxiety
  • confusion
  • social withdrawal
  • poor concentration
  • insomnia
  • increased sleeping
  • changes in sexual desire
Physical symptoms include
  • thirst and appetite changes (food cravings)
  • breast tenderness
  • bloating and weight gain
  • headache
  • swelling of the hands or feet
  • aches and pains
  • fatigue
  • skin problems
  • gastrointestinal symptoms
  • abdominal pain

How is PMS diagnosed?

A gynecologist must verify a pattern of symptoms in order to diagnose PMS. The symptoms must interfere with certain regular activities and be present in the five days prior to the start of a woman’s menstruation for at least three menstrual cycles. They also need to end within four days of the period beginning.

Maintaining a log of your symptoms can assist your ob-gyn in determining if you are experiencing PMS. For a minimum of two to three months, list and rank any symptoms you experience on a daily basis. Additionally, note the dates of your periods.

Can PMS be treated?

Modest to severe symptoms are frequently alleviated by dietary or lifestyle adjustments. You may choose to seek medical attention if your PMS symptoms start to negatively impact your life. Your symptoms will decide how you are treated. In cases that are more serious, your doctor might advise medication.
  • Exercise: Frequent cardiovascular activity helps many women have fewer PMS symptoms. It might lessen melancholy and exhaustion. Your heart rate and lung function will increase with aerobic exercise, which includes brisk walking, jogging, cycling, and swimming. Engage in regular exercise, not just on symptom-filled days. Getting in at least thirty minutes of exercise most days of the week is a healthy goal.
  • Relaxation techniques: Women with PMS can benefit from learning how to de-stress and unwind. Your ob-gyn may recommend relaxation training as a means of reducing PMS symptoms. Yoga, meditation, and breathing techniques are a few examples of relaxation therapy. Another type of relaxation therapy you might wish to try is massage therapy. Some women find that self-hypnosis and biofeedback are useful therapy. Sleeping sufficiently is a crucial thing. Establishing regular sleep schedules, which involve waking up and going to bed at the same times every day, even on weekends, may help reduce fatigue and mood swings.
  • Dietary changes:
    • Consume enough complex carbohydrates in your diet. Diets high in complex carbohydrates may help lessen cravings for food and mood disorders. Whole wheat bread, pasta, and cereals are examples of foods prepared with whole grains and include complex carbohydrates. Barley, brown rice, beans, and lentils are a few more examples.
    • Cut back on the fat, salt, and sugar you consume.
    • Stop Using caffeine as well as alcohol.
    • Modify the time you eat. Instead of having three substantial meals a day, have six small ones, or reduce your intake at each meal and add three light snacks. Sustaining a steady blood sugar level will alleviate symptoms.
  • Drugs: Hormonal birth control pills and other drugs that stop ovulation can reduce physical symptoms. However, not all may help with PMS’s mood issues. It might be required to experiment with several of these drugs before determining which one is effective.
  • For some women, antidepressants may be useful in the treatment of PMS. These medicines have the ability to reduce mood symptoms. They can be taken for the duration of the menstrual cycle or two weeks prior to the commencement of symptoms.
  • Antidepressants come in different types of forms. Should one not suit your needs, your ob-gyn might recommend an alternative.
  • If you find that anxiety is a significant PMS symptom and other therapies are not working, you may consider trying an anti anxiety medication. You take antianxiety medications as needed to treat your symptoms.

Pelvic Organ
Prolapse

When one or more pelvic organs slide out of their natural place and protrude into the vagina, this condition is known as pelvic organ prolapse. It could be the top of the vagina, the bladder, the bowel, or the uterus. Prolapses can hurt and create discomfort, but they are not life-threatening.
Pelvic floor exercises and lifestyle modifications can typically alleviate symptoms; however, medical intervention is required in certain cases.

Pelvic organ prolapse
symptoms

  • Symptoms of pelvic organ prolapse include feeling heave around the genitals and lower abdomen.
  • A pulling pain inside your vagina that feels like something is entering it; it could feel like you’re sitting on a tiny ball.
  • a bulge or lump inside or coming out of your vagina.
  • numbness or discomfort during intercourse issues urinating—such as having the sensation that your bladder is not emptying completely, needing to use the restroom more frequently, or dripping a little bit of urine during coughing, sneezing, or exercise (stress incontinence)

Causes of pelvic organ
prolapse

Pelvic organ prolapse occurs when the pelvic floor—a network of muscles and tissues that normally supports the pelvic organs—becomes weaker and is unable to maintain the organs’ position.
Your risk of getting pelvic organ prolapse might be increased by a variety of factors that weaken your pelvic floor.
Among them are:

  • pregnancy and childbirth—particularly if it was a protracted, challenging birth, or if you gave birth to several small infants or large babies—ageing and going through menopause—being overweight—having chronic constipation or a chronic illness that makes you cough and strain
  • carrying out a hysterectomy is a physically demanding job.
  • a job that needs a lot of heavy lifting
Consult your gynecologist if you experience any prolapse symptoms or find a lump in or near your vagina. To feel for any lumps inside your vagina and in your pelvic region, your doctor will do an internal pelvic examination. To check for a prolapse, they could carefully insert a device called a speculum in your vagina to hold the walls open.

Treatment for pelvic
organ prolapse

Treatment options for pelvic organ prolapse include
  • cutting back on excess weight,
  • avoiding heavy lifting,
  • Treatment or prevention of constipation
There are a few more therapy alternatives to think about if the prolapse is more severe or if your symptoms are interfering with your day-to-day activities.
  • exercise for the pelvic floor
  • hormone therapy
  • surgery
  • vaginal pessaries
The kind and extent of the prolapse, your symptoms, and your general health will all influence the suggested course of action.

Types of prolapse

  • the anterior prolapse, or bladder protruding into the vaginal wall
  • Uterine prolapse is the bulging or hanging down of the womb into the vagina.
  • the bowel protruding forward into the rear wall of the vagina (posterior wall prolapse) the top of the vagina sinking down—this occurs to certain women following womb removal surgery
You can have more than one of these active at once.
A scale of 1 to 4 is typically used to classify pelvic organ prolapse, with 4 denoting a severe prolapse.

Uterine Fibroids

Non-cancerous uterine growths known as uterine fibroids frequently develop throughout the childbearing years. Uterine fibroids, also known as leiomyomas (lie-o-my-O-muhs) or myomas, which are not linked to an increased risk of uterine cancer and rarely ever turn cancerous.
Numerous females with fibroids are asymptomatic. Uterine fibroids are a common condition for women. However, since uterine fibroids frequently don’t create any symptoms, you might not be aware that you have them. Fibroids may be unintentionally discovered by your doctor when performing a pregnancy ultrasound or pelvic check. Numerous females with fibroids are asymptomatic. The most common signs and symptoms of uterine fibroids include
  • Heavy menstrual bleeding
  • Menstrual periods lasting more than a week
  • Pelvic pressure or pain
  • Frequent urination
  • Difficulty emptying the bladder
  • Constipation
  • Backache or leg pains
Uterine fibroids are a common condition for women. However, since uterine fibroids frequently don’t create any symptoms, you might not be aware that you have them. Fibroids may be unintentionally discovered by your doctor when performing a pregnancy ultrasound or pelvic check.
A fibroid that is starting to die and overrun its blood supply very seldom causes excruciating discomfort.
Generally, fibroids are categorized according to where they are. Intramural fibroids develop inside the uterine wall’s muscle. Submucosal fibroids protrude through the uterus. Subserosal fibroids protrude beyond the uterine wall.

Causes

The exact etiology of uterine fibroids is unknown to medical professionals, while potential contributors include genetic alterations, hormone fluctuations, and other growth factors. The smooth muscle tissue in the uterus, known as the myometrium, is thought to be the source of uterine fibroids, according to medical professionals. One cell eventually divides several times to form a solid, rubbery mass that is different from the surrounding tissue.
Uterine fibroids grow in many ways: they might expand gradually or quickly, or they can stay the same size. While some fibroids decrease on their own, others experience growth surges. After pregnancy, as the uterus comes back to its normal size, many fibroids that were present throughout the pregnancy diminish or vanish.

Complications

Uterine fibroids usually are not considered a danger, but they can be uncomfortable and can end up in consequences, including anemia or a decrease in red blood cells.

Pregnancy and fibroids

Usually, fibroids are not what prevents a woman from becoming pregnant. On the other hand, fibroids, primarily submucosal fibroids, may result in infertility or miscarriage. Additionally, fibroids may increase the chance of specific pregnancy issues such as preterm delivery, fetal growth restriction, and placental abruption.

Prevention

Uterine fibroids can’t always be prevented, although only a tiny portion of these tumors need to be treated.However, you may be able to lower your risk of fibroid by adopting healthy lifestyle habits including eating fruits and vegetables and keeping a healthy weight. Usually, fibroids are not what prevents a woman from becoming pregnant. On the other hand, fibroids, primarily submucosal fibroids, may result in infertility or miscarriage. Additionally, fibroids may increase the chance of specific pregnancy issues such as preterm delivery, fetal growth restriction, and placental abruption.

Hormonal
Imbalance &
Hormone
Replacement
Therapy

Hormones are your body’s chemical messengers, and an imbalance occurs when you have too much or too little of any one of them. It’s a general phrase that can refer to a wide range of disorders associated with hormones.
What are hormones?
Hormones are essential chemicals which communicate with your organs, skin, muscles, and other tissues via your bloodstream to regulate various bodily activities. Your body receives these messages and knows what to do and when. Your health and life depend on hormones.
The human body contains more than 50 hormones that have been discovered thus far. Your endocrine system is composed of hormones and the majority of the tissues (mostly glands) that produce and release them. Hormones control a wide range of physiological functions, such as
  • metabolism.
  • metabolism.
  • expansion and progress.
  • sexual activity.
  • Procreation.
  • Cycle of sleep and wakefulness.
  • Feeling.

What is a hormonal
imbalance?

When you have excessive amounts of one or more hormones, you have an imbalance in your hormone levels. It’s a common phrase that can refer to a wide range of disorders associated with hormones.
Hormones are potent messengers. Many hormones can have significant effects on your body and result in problems that need to be treated, even if you have somewhat too much or too little of them.
Hormonal abnormalities can range in severity from transient to chronic (long-term). Furthermore, while certain hormone imbalances may not directly damage your health, they can nevertheless have a detrimental effect on your quality of life and necessitate therapy in order to maintain your physical health.

What conditions are
caused by hormonal
imbalances?

Hormone problems are the primary cause of numerous illnesses, such as irregular menstruation, infertility, acne, diabetes, thyroid disease, and obesity. Some of these imbalances can be transient and may resolve on their own, but many of them need medical attention.

What causes hormonal
imbalances?

Your hormone levels naturally rise and decrease throughout your life, and even during the course of a day.
Hormone swings and shifts can be more pronounced at specific life stages, such as
  • puberty
  • Maternity
  • Menopause
Other reasons include Stress, certain medications such as steroids.

Diagnosis and Tests

Since hormones are released directly into your circulation by your endocrine glands, doctors usually request blood tests to measure hormone levels. Doctors may prescribe additional tests, such as an insulin or glucose tolerance test, to evaluate your hormone levels because some hormone levels fluctuate significantly during the day.

Management and
Treatment:
Hormone
Replacement
Therapy

Hormone replacement therapy is an essential treatment for low-than-normal hormone levels. You can take oral (pill) or injectable treatment, depending on which hormone is lacking.
For instance, your doctor may recommend synthetic thyroid hormone supplements if you have hypothyroidism or low thyroid hormone levels. You’ll probably need to have shots of synthetic growth hormone if you don’t have enough of the hormone.

Depending on the cause, you have a wide range of therapeutic choices if your hormone levels are higher than usual. Medication, surgery, radiation therapy, or a mix of any of these are available options.

How do you fix
hormonal imbalance?

Many health conditions that involve hormonal imbalances, likely diabetes and thyroid disease, require medical treatment.

Prevention

Although many hormonal imbalances are unavoidable, you can take certain steps to improve your general health, which may assist maintain a balanced level of hormones. These steps include:
  • keeping a healthy weight in mind.
  • maintaining a healthy, balanced diet.
  • engaging in regular exercise.
  • Controlling your level of stress.
  • obtaining a sufficient amount of good sleep.
  • Taking good care of your long-term medical conditions (if appropriate).
  • If you smoke, give up smoking and stop using tobacco products.

Hormone therapy: Is it
right for you?

Medication that contains female hormones is known as hormone replacement treatment. When you undergo menopause, your body stops producing estrogen, so you take medication to replace it. The most frequent menopausal symptoms that are treated with hormone treatment are hot flashes and vaginal discomfort.
In postmenopausal women, hormone therapy has also been demonstrated to lower fracture risk and stop bone loss. Hormone treatment does come with certain hazards, though. The kind of hormone therapy, the dosage, the length of time the drug is used, and the specific health concerns you face all affect these risks. Hormone therapy should be personalized for each patient and periodically reevaluated to ensure that the benefits still exceed the hazards in order to achieve the optimum results.
There are two main types of estrogen therapy:
Hormonal treatment administered systemically. A larger dosage of estrogen that is absorbed throughout the body is usually found in systemic estrogen, which is available as pills, skin patches, rings, gel, cream, or sprays. Any of the typical menopausal symptoms can be treated with it.
low-concentration vaginal goods. The quantity of estrogen absorbed by the body is reduced by low-dose vaginal formulations of estrogen, which are available as cream, tablets, or rings. As a result, low-dose vaginal preparations are typically limited to treating menopausal symptoms pertaining to the vagina and urine.
Your doctor will usually prescribe estrogen in addition to progesterone or progestin (progesterone-like medication) if you haven’t had your uterus removed. This is due to the fact that progesterone, when left unbalanced by estrogen, can promote uterine lining growth, which raises the risk of endometrial cancer. You might not need to take progestin if you underwent a hysterectomy, which involves removing your uterus.

What are the risks of
hormone therapy?

Risks include heart disease, blood clots and breast cancer, which are also influenced by age, type of therapy and patient’s health industry. Your gynaecologist will suggest the right type of therapy after considering the above.

Endometriosis -
What is it?

One usual gynecological condition impacting women is endometriosis, which is caused by uterine lining cells growing in other parts of the body. The presence of “ectopic” (misplaced) endometrial (uterine lining) tissue characterizes this chronic, benign (non-cancerous) inflammatory condition.
Stated in different ways, they are uterine lining cells found outside the uterus, for example, in the bladder, cervix, intestines, vagina, and parts of the pelvis near to the uterus; they are also frequently seen in more distant parts of the body. Similar to the endometrium from the uterus, these tissues develop, thicken, break down, and bleed; yet, because they are external, this cycle may irritate or inflame nearby organs or even result in the production of scar tissue, or “adhesions,” which may cause organs to adhere to one another.
Experts say that it affects at least 10% of reproductive-age women.

Symptoms of Endometriosis

  • Pelvic pain, which usually gets worse over the course of the month painful times
  • discomfort during or during sexual activity
  • discomfort during bowel motions
  • Cramps or pain prior to and during menstruation
  • lower back pain throughout the menstrual period
Endometriosis is typically examined between ages 25 – 35,

Although the condition probably starts about the time that regular menstruation starts.

What happens exactly?

The ovaries of a woman generate hormones each month that instruct the uterine lining cells to thicken and bulge. Every month when you have your period, these excess cells are eliminated from the lining of your uterus.
If these cells, also known as endometrial cells, proliferate and implant beyond the uterus, the result is endometriosis. These growths are usually found on the bladder, ovaries, rectum, colon, and the lining of the pelvic area in women who have endometriosis. They may also appear in other bodily parts.
The tissue implants outside the uterus do not move when you receive your period, in contrast to the endometrial cells present inside the uterus. They may bleed a little. When your next period arrives, they start to grow new.
Adhesions, which are nothing but bands or sheets of scar tissue that can grow around your fallopian tubes, ovaries, uterus, bladder, or bowels, are a result of this continuous process and can cause discomfort as well as other endometriosis symptoms. Pelvic pain can result from adhesions, which can also impair fertility or cause infertility if they fully block one or both fallopian tubes or obstruct an egg’s ability to enter. If they disrupt your tubes’ normal function and put you at risk of an ectopic pregnancy, they become extremely dangerous.

Obstetrics & Gynaecology hospital in Chennai

Why does it happens?

Endometriosis’s etiology is uncertain. According to one idea, endometrial cells shed after a menstrual cycle make their way back down the fallopian tubes and through the pelvis, in which they implant and proliferate. We refer to this as retrograde menstruation. Most women have this backward menstrual flow, but individuals with endometriosis may have a distinct immune system, according to experts.

Diagnosis of Endometriosis

The diagnosis is mostly dependent on the presence of concurrent ovarian dysfunction. Some women with endometriosis in the early stages report minimal to no pelvic pain and no problems getting pregnant. When these women had laparoscopies to tie their tubes, we used to diagnose them (albeit there are now less invasive procedures to block the tubes in women who are done having children).
The ‘gold standard’ for diagnosis is a diagnostic/operative laparoscopy, an outpatient procedure done under anesthesia in which a tiny incision below your belly button allows us to insert a surgical telescope into your abdomen and pelvis to search for endometriosis and, if detected, often remove or destroy it. A pelvic ultrasonography, which is best done with a transvaginal probe, may reveal more advanced endometriosis, but it will not reveal endometriosis in its early stages. When undergoing an IUI, a hysterosalpingogram (HSG) searches for scar tissue or blocked tubes, which can occur in endometriosis-affected women, as well as for other causes, including previous infections. It does not see’ endometriosis.
Regardless of your age or the length of time you have tried, it is advised that you contact a fertility doctor if you have recently received an endometriosis diagnosis and are ready to become pregnant. We will assess your ovarian reserve (the quantity of eggs remaining in your ovaries) even if the endometriosis was identified through laparoscopy and treated concurrently. Some endometriosis sufferers who are in their early 20s even have significantly decreased ovarian reserve. Antral Follicle Count, an ultrasound of your ovaries that counts the size of the follicles that contain tiny eggs, and blood tests like as the Clomid Challenge Test, FSH, and Antimullerian Hormone (AMH) can be used to test this. Even though you might seem fantastic on these tests, it’s better to know in any case than to try for a year and then discover there’s an issue.
Your doctor may have performed a chromotubation dye test on you if you had a laparoscopy and were told you have endometriosis. This test checks for adhesions, or scar tissue, around your ovaries and tubes, which can make it more difficult to conceive. If not, your tubes should undergo a hysterosalpingogram, or HSG, X-ray dye test.

Endometriosis and
Infertility Treatment

While many endometriosis-afflicted women will become pregnant, others will struggle more than others. The severity of the endometriosis will determine whether or not it has resulted in a decreased ovarian reserve, scar tissue surrounding your tubes or ovaries, or blocked tubes. Some women experience issues with their tubes and limited egg production.
Some endometriosis sufferers have no trouble becoming pregnant (a woman with three children undergoing a laparoscopy to have her tubes tied may have a few spots of endometriosis inside her pelvis), while other endometriosis sufferers have severe difficulty becoming pregnant and may require more intensive fertility therapies than women of similar age without endometriosis.

Osteoporosis

Since osteoporosis is a complicated condition, its causes have yet to be entirely understood. However, if bone loss is identified early on, this condition can be avoided. Osteoporosis makes bones brittle and more possibilities to breaking.

If treatment is not received, it can proceed painlessly until a bone breaks. Fractures, another name for these damaged bones, usually affect the hip, wrist, and spine.

Although fractures of the hip and spine are particularly concerning, any bone can be impacted. Major surgery and hospitalization are almost usually necessary after a hip fracture.
It may result in long-term or permanent impairment, even death, and can make it difficult for a person to walk without assistance. Serious side effects from spinal fractures include deformity, excruciating back pain, and height loss.
You can strengthen yourself and your bone density if it’s lower than usual. Exercise, weightlifting, and weight machines are among the options. Additionally, you can make sure you receive adequate vitamin D and calcium. Some females require an injection every two years.

Ovarian/Vaginal Cyst

A fluid-filled sac that makes on an ovary is called an ovarian cyst. They are highly prevalent and typically symptomless.
The majority of ovarian cysts spontaneously disappear within a few months and don’t require medical intervention.
Two almond-shaped structures that are a component of the female reproductive system are called ovaries. One is located in the uterus on either side of the womb.One ovary may be affected by ovarian cysts, or both may be affected simultaneously.
The two primary functions of the ovaries are:

  • Produce an egg during the menstrual cycle, which typically occurs every 28 days, and also release progesterone and estrogen.
  • Sex hormones that are important for reproduction.

Symptoms of an
ovarian cyst

Generally speaking, an ovarian cyst only becomes noticeable if it divides (ruptures), grows to a great size, or stops the ovaries’ blood flow.Endometriosis is one example of an underlying disorder that can occasionally also generate ovarian cysts.
While a small percentage of ovarian cysts are dangerous, the majority are non-cancerous. If you have gone through menopause, you are more likely to develop cancerous cysts.
  • Pelvic pain can range in intensity, from a heavy, dull sensation to a sharp, sudden, and severe discomfort. Other symptoms can include
  • discomfort during sexual activity,
  • trouble passing gas,
  • a frequent urge to urinate,
  • menstrual issues,
  • feeling extremely full
  • experiencing bloating after eating a small amount, and difficulty becoming pregnant, even though ovarian cysts often have no effect on fertility.

Diagnosing ovarian cysts

If you suspect you may have an ovarian cyst, consult a gynaecologist. In the event that she believes you could have an ovarian cyst, you will likely be referred for an ultrasound scan, which uses a vaginal probe.
In addition, the doctor will schedule blood tests to check for elevated chemical levels that may be a sign of ovarian cancer if there is any reason to believe that your cyst may be cancerous. However, having elevated levels of these substances does not always indicate the presence of cancer, as elevated levels can also result from non-cancerous ailments such as fibroids, endometriosis, and pelvic infections.

Treating ovarian cysts

Depending on the size, appearance, symptoms, and menopausal status of the ovarian cyst, you may need to decide whether to treat it. Usually, the cyst goes away in a matter of months. To verify this, a further ultrasound scan could be performed. The risk of ovarian cancer is gradually increased in postmenopausal women. For a year or more, routine blood tests and ultrasound scans are typically advised to monitor the cyst. If the cysts are large, causing symptoms, or possibly dangerous, surgery may be required to remove them.
Ovarian cysts can sometimes make it more challenging to conceive, but they typically do not prevent pregnancy.

Vaginal Cyst

Cysts are often sac-shaped lumps that can form anywhere on the body, including delicate areas like the vagina, and are filled with air, fluid, or other substances. A vaginal cyst may develop on top of or beneath the vaginal lining. Many factors, including childbirth, trauma, injury, or accumulation of fluid in the vagina, can result in the development of vaginal cysts. Cysts typically cause no symptoms and are not dangerous. They might, however, occasionally make you uncomfortable. Cysts can range in size from little enough to be invisible to large enough to cause pain, irritation, or an increased risk of infection.

Symptoms

Due to their small size and benign nature, vaginal cysts typically show no symptoms. But occasionally, you might feel a lump or mass close to your vagina. You should be aware of certain symptoms, such as pain during sexual activity, discomfort when walking or sitting, difficulties urinating or defecating, and a sore lump near the vaginal opening.

Causes of Vaginal Cysts

Vaginal cysts typically develop from clogged glands or ducts. This causes liquid and other things to build up inside the vaginal glands and tissues, which causes cysts to form. Depending on the type, cysts have different causes. Thus, the risk of developing inclusion cysts is increased, for instance, if you had an episiotomy performed prior to childbirth in order to broaden the vaginal opening. Similarly, fluid collection results in Bartholin’s gland cysts, which are brought on by a blocked Bartholin’s gland (perhaps as a result of a skin flap).

Diagnosis for Vaginal
Cysts

Typically, vaginal cysts are found during a standard pelvic exam. The vaginal cysts are then identified by the doctor using either a physical examination or an ultrasound. In certain circumstances, a biopsy may be required to rule out vaginal cancer.

Vaginal Cysts Treatment

Vaginal cysts usually don’t require treatment because they stay small and don’t create any issues. But if it persists for a long time, causes you discomfort, or spreads to other areas, your doctor might suggest antibiotics, surgical drainage, warm water soaking, or marsupialization—a successful treatment for recurrent cysts. During the operation, the doctor removes Bartholin’s gland or stitches together both sides of a drainage incision to create a permanently open pocket.

Uterine Polyps

Growths in the endometrium, the inner lining of your uterus, are called uterine polyps. They expand inside into your uterus and are connected to the endometrium by a narrow stalk or a large base. Although uterine polyps are typically not malignant, if they are not removed, they may result in issues with menstruation or fertility. Golf ball-sized uterine polyps are possible to develop.

Who is affected by
uterine polyps?

One important predictor of polyps is age. Uterine polyps are most likely to appear in women in their 40s and 50s, right before menopause. Although they hardly ever affect those under the age of 20, uterine polyps can also develop after menopause.

Symptoms and Causes

Unusual bleeding is uterine polyps’ most typical sign. Vaginal bleeding with menopause and irregular menstrual cycles are examples of abnormal bleeding. The menstrual cycle is erratic in many persons with uterine polyps.
Similar to menstruation cramps, large polyps can occasionally induce dull pain in the lower back or abdomen. However, pain is not usually a sign of uterine polyps.
What causes uterine polyps?
Although the exact cause of polyp formation is unknown, hormone levels may play a role. The endometrium thickens every month during your menstrual cycle in part due to estrogen. This thickening probably encourages the formation of uterine polyps. Elevated estrogen exposure is one of the main risk factors for uterine polyps.

Diagnosis and Tests

Your doctor will carry out a gynaecological checkup, which will include a Pap smear test and a pelvic exam. They might recommend more tests or interventions if they doubt the growths being polyps. These tests may include:
  • Transvaginal ultrasound: Your doctor will place an ultrasound transducer, a small, handheld device, into your vagina. Using sound waves, the gadget creates an image of your uterus’ interior, along with any potential anomalies.
  • Sonohysterography: Following your first transvaginal ultrasound, your doctor might insert a thin catheter-like tube filled with sterile fluid into your uterus. Your uterus expands as a result of the fluid, making any growth inside your uterine cavity easier to see during the ultrasound scan.
  • Hysteroscopy: Your doctor will pass a long, thin tube through your cervix and vagina into your uterus that is equipped with a lit telescope or hysteroscope. Your doctor will look inside your uterus using the hysteroscope. Sometimes, surgery is combined with hysteroscopy to remove uterine polyps.

Management and Treatment

Your symptoms and other variables that raise your risk of uterine cancer will determine how you are treated. Your doctor can decide to monitor the polyp rather than treat it if it isn’t causing any symptoms and you are still within the reproductive age range. The polyp might disappear by itself. You could require therapy if you have undergone menopause or if polyps are causing symptoms.
Methods of treatment include medications and/or uterine Polypectomy.

Prevention

It is impossible to avoid uterine polyps. To prevent problems or uncomfortable symptoms, you can take action to identify them early. Regular gynaecological exams might help your doctor identify polyps early on.

Outlook / Prognosis

The results of removing uterine polyps are perfect. Studies indicate that 75% to 100% of people had symptom relief after polyp removal. Polyps seldom regrow (occur) following excision.

What percentage of uterine polyps are cancerous?

The percentage of malignant uterine polyps is only 5%. If you are having abnormal bleeding or are postmenopausal, your chances of a polyp being malignant are higher.
Unusual bleeding could indicate the presence of uterine polyps, particularly in postmenopausal women. Unusual bleeding can be concerning, however most bleeding sources (such as polyps) are not connected to uterine cancer. To be sure, however, confirm with your provider. Your doctor can safely remove a polyp if they are worried that it could develop into cancer or if it is producing bothersome symptoms.

Uro-gynecology

It can be very embarrassing to have conditions like pelvic organ prolapse, overactive bladder, and incontinence. The NPHL urogynecology specialists apply their knowledge to deliver optimal care. Together, you and our team of the top urogynecologists will choose the best course of action for you, including treatments, biofeedback, and non-surgical and surgical procedures. Our goal is to keep you out of pain and embarrassed while assisting in the restoration of a healthy quality of life.
The top urogynecology physicians at NPHL offer a wide variety of surgical and non-surgical alternatives, such as:
  • Training in behavioral modification
  • minimally invasive surgery, such as laparoscopic, robotic, and vaginal techniques
  • Botox
  • Sacral neuromodulation for the management of certain bowel and bladder issues
  • Tibial nerve percutaneous stimulation
  • Urinary incontinence can be treated in offices with urethral bulking agents.
  • Pessary: (In women who have prolapsed, inserting a device into the vagina to support the uterus)
  • Pelvic floor manual treatment
  • Drugs for vaginal atrophy, such as topical estrogen

Urinary Tract
Infections (UTI)

UTIs, or urinary tract infections, are prevalent infections. At some point in their lives, many women experience these. Some women may get recurrent infections on a regular basis. However, most UTIs are not dangerous. Antibiotics are a treatment option for these infections, and most patients experience rapid symptom relief.
There is an upper and a lower portion of the urinary tract. The kidneys and ureters prepare the upper urinary system. The bladder and urethra make up the lower tract. The following are the ways in which the organs cooperate:
  • The kidneys both generate urine
  • Two tubes known as ureters carry urine from the kidneys to the bladder.
  • Within the bladder is stored urine.
  • Urine from the bladder is expelled from the body through the urethra.
Most of the UTIs start in the lower urinary tract via the urethra, bacteria enter and ascend to the bladder. This may result in a bladder infection called cystitis. Urethritis, an infection of the urethra, may occasionally occur concurrently.
  • How does an infection of the kidneys begin?
  • Bacteria from the bladder can ascend the ureters and reach the kidneys. Pyelonephritis, or kidney infection, may result from this. A higher tract infection has the potential to cause a more serious sickness than a lower tract infection..

Possible Causes

It’s common for intestinal bacteria to reside in the vagina or on the skin close to the anus. These germs can occasionally spread to the urethral region. They can infect the bladder and occasionally other areas of the urinary tract if they go up the urethra.

Are UTIs more common in women than in men?

Indeed, studies indicate that women experience UTIs at a higher rate than men. This is a result of a woman’s urethra being shorter and situated closer to the anus than a man’s. This indicates an easier path for bacteria to enter the bladder.

Can I get a UTI from sex?

Women are more likely than males to suffer urinary tract infections (UTTIs) following sexual activity. The vagina is in front of the urethral entrance. Bacteria near the vagina can enter the urethra during intercourse through touch with the penis, fingers, or sex toys.
When you first start having sex or start having it more frequently, UTIs usually happen. Frequent UTIs can also result from using spermicide or a diaphragm as birth control methods.
What else might result in UTIs?
  • Failure to completely empty the bladder can also result in infections. The following could be the reason for this.
    • A blockage in the urine flows through the urinary tract caused by a stone in the bladder, kidneys, or ureters.
    • When minerals in pee adhere to one another and are not sufficiently flushed out, stones can form.
    • a constricted urinary tract tube that reduces urine flow.
    • an issue involving the pelvic muscles or nerves.
    • possess diabetes mellitus, have experienced a UTI in the past, have had multiple children, are undergoing menopause, and are expecting
Give your obstetrician-gynecologist (ob-gyn) a call as soon as possible if you suspect you may develop a UTI while you are pregnant. Treating UTIs early is crucial because severe infections can have negative effects on both you and your developing fetus.

Symptoms

UTI symptoms might appear suddenly. An intense need to urinate that is uncontrollable (urgency) is one indicator. Urine flow may cause a scorching or severe pain in the urethra. Minutes later, the urge to urinate reappears (frequency). One may experience pain in the sides, back, or lower abdomen.
Urine with a UTI may

  • seem hazy,
  • strong odor,
  • have blood stains in it.

What are the symptoms of a kidney infection?

  • Back discomfort,
  • chills
  • fever
  • nausea
  • vomiting
These may be signs if the bacteria enter the ureters and proceed to the kidneys. Make an immediate call to your ob-gyn if you have any of these symptoms. Kidney infections can be dangerous. They require immediate medical attention.

Diagnosis

A UTI is frequently diagnosed based on symptoms, such as pain during urinating or frequent urine.
A quick test called a urinalysis could determine whether you have a UTI. You need to supply a urine sample for this test. In a lab, this sample is examined to search for germs, red blood cells, and white blood cells. To find out which bacteria are present, the urine sample can also be cultivated in a culture, which is a medium that encourages the growth of bacteria.
If your infection does not go away with therapy,

  • you have had multiple UTIs in a short period of time,
  • you have discomfort, fever, and chills, you
  • your ob-gyn may talk about having an examination of your urinary tract.
An upper urinary tract computed tomography (CT) scan or ultrasonography examination may be advised by your ob-gyn.

Treatment and Prevention

UTIs are treated with antibiotics. The kind of bacteria causing the infection and the details of your medical history determine the kind, dosage, and duration of antibiotic treatment. Upper urinary tract infections are unusual outcomes of uncomplicated UTIs.
The majority of the time, the very successful treatment just takes a few days. Most symptoms disappear after a day or two. It is imperative that you take the entire course of treatment prescribed for a UTI, even if your symptoms disappear.
You might need to stay in the hospital if the infection is more serious, like a kidney infection. Treatment for severe infections is more time-consuming, and you could require intravenous (IV) medicine.
There are numerous strategies to stop UTIs:

  • Cleanse the skin in the vaginal and anus regions.
  • Water is one of the many fluids you should consume to help your urinary system rid itself of bacteria.
  • When the desire strikes, or around every two to three hours, let your bladder go.

Urinary Incontinence

Urinary incontinence means leakage of urine. A few drips of pee spilling or the bladder fully emptying are examples of incontinence. Since incontinence is a prevalent issue, there are numerous ways to manage it.
Urinary incontinence frequently coexists with the following symptoms:
  • Having a strong desire to urinate
  • Vaginating, commonly known as urinating, more regularly than is typical for you
  • nocturia-Arousing from slumber in order to void
  • Dysuria: Sedentary discomfort
  • Urinating as you sleep is known as nocturnal enuresis.
There are three primary forms of urinary incontinence in women:
Stress urinary incontinence, or SUAI, is urine leakage that occurs after sneezing, laughing, or coughing. Leaks can also happen while you work out, run, or saunter.
Urgency urine incontinence is defined as a strong, sudden, and difficult-to-resist urge to urinate. You may urinate on your way to the bathroom. Regarding “overactive bladder,” it describes symptoms of frequency and urgency that may or may not be associated with incontinence. Some of the reasons of urinary incontinence include the following:
  • UTIs (urinary tract infections): UTIs are treated with medication and can occasionally result in leaks.
  • Alcohol, coffee, or diuretic drugs-Substances that increase urine production in the body may produce incontinence as a side effect.
  • Pelvic floor disorders: These conditions, which include urine incontinence, inadvertent bowel leaks, and pelvic organ prolapse, are caused by a weakening of the pelvic floor muscles and tissues.
  • Constipation: Women with urine incontinence frequently experience chronic constipation, particularly older women. Urinary symptoms may improve with the treatment of constipation.
  • Neuromuscular issues: When nerve signals from the brain to those organs are interfered with, the muscles that control the bladder and urethra may malfunction, causing urine to leak.
  • Conditions like multiple sclerosis, diabetes mellitus, and stroke can cause issues with muscle control.
  • Anatomical issues: Bladder stones or other growths can obstruct the bladder’s exit into the urethra. Urine leaks or dribbles due to the development of an abnormal pouch termed a diverticulum in the urethra. A fistula is an irregular opening that permits urine to escape from the urinary tract into another area of the body, such as the vagina. A fistula may result from childbirth, radiation therapy, pelvic cancer, or pelvic surgery.

Diagnosis and Treatment

The steps in assessing urinary incontinence are usually a medical history as well as physical exam:

  • Medical history: Your ob-gyn (obstetrician-gynaecologist) should ask you to describe your symptoms in great detail. For a few days, you might be required to complete a bladder diary. You note the timing and volume of leaks and the frequency of urination in a bladder diary. You also record the amount of liquid you drank and your activities during the leak.
  • Physical examination: To check for additional anatomical issues and determine whether you have pelvic organ prolapse, a pelvic exam may be performed. During the exam, a “cough test” could be administered. You are instructed to cough while pressing down on a full bladder in order to check for urine leaks during a cough test. You might participate in a pad test when you wear a pad that collects pee leaks. Weighing the pad determines how much leaking there is. One may assess the urethra’s support.

Treatment recommended for urinary incontinence

Initially, your ob-gyn may suggest nonsurgical treatment. This can entail adopting different lifestyle practices, physical therapy, bladder training, and the use of specific bladder support devices. Medication may be part of the treatment for urgent urine incontinence. Some forms of incontinence may respond well to surgery. For optimal results, multiple treatments are frequently administered in tandem.
Lifestyle changes that can help decrease urine leakage:

  • Lowering body weight: Even a small amount of weight loss (less than 10% of total body weight) may reduce urine leakage in overweight women.
  • Controlling the amount of liquids you consume: If you experience leaks throughout the early morning or at night, you might wish to restrict your fluid consumption a few hours prior to bedtime. Reducing your daily fluid intake to no more than two litres may also be beneficial. You may be drinking too much if your pee is colourless or pale. Limiting caffeine and alcohol might also be helpful.
  • Training your bladder: The two main goals of bladder training are to learn how to control the urge to urinate and to extend the time between regular intervals (every 3 to 4 hours at day and every 4 to 8 hours at night). You might stop leaking pee as often after a few weeks of training.
Exercise and physical therapy that can help treat urinary incontinence

  • Kegel exercises are an excellent way to strengthen the pelvic muscles. These are valuable exercises for incontinence in all its forms. Suggesting that you visit a physical therapist with knowledge of pelvic health is an additional choice. The training technique known as biofeedback may help you pinpoint the appropriate muscles.
  • A pessary is a type of medical device that is inserted into the vagina and used to treat SUI and problems with pelvic support. Pessaries support the walls of your vagina, raising the bladder and urethra. They come in different forms and sizes.
  • Your obstetrician can fit you for a prosthesis to see which one will best relieve your problems. Most of the time, you can put in and take out a support device on your own. Surgery may not be necessary to relieve symptoms using pessaries.
  • Additionally, an over-the-counter product resembles a tampon and is made expressly to assist stop bladder leaks.
Medications can also help treat urgent urinary incontinence. Please consult your gynaecologist for a prescription of a suitable medication.
The following procedures may help treat SUI:

  • Slings: The urethra can be lifted or supported using a variety of slings, including ones composed of synthetic materials or your own tissue. The most popular kind of sling used to treat SUI is the synthetic midurethral sling. This sling is a thin, synthetic mesh strap that is positioned beneath the urethra.

Contraception
Management /
Birth Control

  • Implant insertion
  • IUD insertion
  • Contraceptive Pills
  • Birth control shot / injection
  • Tubal Ligation

Implant Insertion

An effective long-term birth control option is contraceptive implants. Another name for them is LARCs, or long-acting reversible contraception.
A flexible plastic rod, roughly the size of a matchstick, is inserted beneath the upper arm’s skin as a contraceptive implant. The implant releases a little, consistent dose of the progestin hormone.
Progesterone prevents conception by delaying ovulation. Additionally, it thickens the cervix’s mucus, making it difficult for sperm to reach an egg. Additionally, progestin thins the uterine lining, making it more difficult for the fertilized egg to adhere to the uterus if sperm manage to get to the egg.
  • One of the implant’s advantages is that it can be reversed.
  • If you wish to become pregnant or decide it’s not suitable for you, a healthcare expert can remove the implant.
There’s no need for you to consider it.

  • Every three years, it will need to be replaced. However, unlike other ways, you won’t have to worry about it every day or every month.
  • You are in charge of your birth control. Get your partner’s approval before using birth control, or cease having sex. It doesn’t include estrogen. The use of estrogen-containing methods may increase the risk of blood clot formation. Therefore, if you’re looking for a less risky option, the implant can be a better fit for you
  • It enables a prompt restoration of fertility. As soon as the implant is removed, you can begin trying to conceive.
Yet, not everyone is a good candidate for contraceptive implants. If you have: Your care provider may recommend another birth control technique.

  • Allergies to any component of the device.
  • A history of heart attacks, strokes, or dangerous blood clots.
  • Liver illness or tumors.
  • A personal history of breast cancer or a possible diagnosis of breast cancer.
  • Bleeding that hasn’t been checked by a caregiver but occurs outside of your regular period.

Intrauterine Device (IUD) or Copper -T

An IUD is a tiny, T-shaped plastic and copper device that a doctor inserts into your uterus. It releases copper to prevent conception and provides five to ten years of contraception protection. At times, it’s called a “coil” or “copper coil.”

Facts about the IUD

  • IUDs are more than 99% effective when placed properly.
  • Depending on the kind, an IUD can function immediately after implantation and last for five to ten years.
  • As long as you are not pregnant, you can take it anytime you choose throughout your menstrual cycle.
  • It can be removed at any moment by a medical expert with the necessary training. It’s possible to become pregnant immediately after that.
  • For the first three to six months following IUD implantation, you may experience heavier, longer, or more painful periods.
  • In between periods, you can get spotting or bleeding.
  • There is a very small risk of infection following installation. It’s unlikely that your body will move and force the IUD out. Your physician or nurse will show you how to ensure that it is in place.
  • Although the IUD surgery can be difficult, you can take medication after if needed.
  • It might not be the ideal choice if you’ve previously had pelvic infections.
  • It does not provide STD protection, so using condoms may also be required.

How it works

The IUD and Implants are comparable, however the IUD delivers copper into the womb rather than the hormone progestogen.
Because copper changes cervical mucus, sperm have a harder time reaching and surviving on an egg. Additionally, it may stop a fertilized egg from self-implantation. When an IUD is implanted, if you are 40 years of age or older, it can be kept in place until menopause or until you are no longer in need of a contraception process.

Having an IUD fitted

As long as you are not pregnant, you can get an IUD fitted whenever you choose throughout your menstrual cycle. You will immediately be protected from becoming pregnant.
Before inserting your IUD, the doctor will measure the size and position of your womb inside your vagina. You might be given antibiotics and tested for illnesses, including STIs.
  • The entire procedure should take twenty to thirty minutes, and no more than five minutes should be needed to fit the IUD.
  • The vagina is held open during the operation, the same as it is for cervical screening, and the cervix is used to insert the IUD into the womb.
Although some people may find getting an IUD fitted painful, it can be uncomfortable. However, a local anesthetic can assist. Speak with a doctor or nurse about this in advance.
Period-like cramping will occur later, but medications can help with that. Additionally, bleeding may occur for a few days following IUD implantation.

How to tell if it's still in place

Two thin threads, which are attached to an IUD, extend from the top of your vagina into your womb.

You will learn how to feel for these threads and ensure that they are still in place from the physician who fits your IUD.

Several times throughout the first month, after every period, or on a regular basis, make sure your IUD is in place.
Although it’s unlikely that your IUD will come out, you might not be protected against pregnancy if you can’t feel the threads or believe it’s shifted.

During intercourse, your partner shouldn’t be able to feel your IUD. See a doctor or nurse for a check-up if at all possible.

Removing an IUD

Several times throughout the first month, after every period, or on a regular basis, make sure your IUD is in place. Although it’s unlikely that your IUD will come out, you might not be protected against pregnancy if you can’t feel the threads or believe it’s shifted. During intercourse, your partner shouldn’t be able to feel your IUD. See a doctor or nurse for a check-up if at all possible.

Who can use an IUD

The majority of women are able to use an IUD.
  • To determine whether an IUD is right for you, a doctor or nurse will inquire about your medical history.
  • An IUD might not be appropriate if you
  • Have a pelvic infection or an untreated STI and suspect pregnancy
Those who have cervix or womb issues have unexplained bleeding during your period or after sex. Before getting an IUD implanted, people with artificial heart valves or those who have experienced an ectopic pregnancy should speak with their physician.

Using an IUD after giving birth

Typically, an IUD can be inserted four weeks following a vaginal or cesarean delivery. From three weeks (21 days) following the birth until the IUD is implanted, you will need to utilize an alternate form of birth control.

Usage of an IUD after a miscarriage or abortion

A qualified physician or nurse can fit an IUD immediately following an abortion or miscarriage. You’ll be safeguarded against getting pregnant right now.

Advantages and disadvantages of the IUD

Despite being a reliable form of birth control, there are a few things to think about before getting an IUD inserted.
Advantages:
  • Depending on the kind, it offers five or ten years of contraception protection.
  • An IUD begins to function immediately once it is fitted.
  • Most women who are pregnant can use it.
  • Hormonal side symptoms such as headaches, breast soreness, or acne are absent.
  • It doesn’t stop sexual activity.
  • The use of an IUD during nursing is safe.
  • You can become pregnant right away after the IUD is taken out.
  • Not impacted by other medications.
  • There’s no proof that an IUD will make you heavier or raise your chance of developing cancer.
Disadvantages:
  • Though they may get better after a few months, your periods may get heavier, longer, or more painful.
  • It does not offer STI protection, so condom use may also be necessary.
  • If you don’t treat an infection you have after getting an IUD fitted, it could develop into a pelvic infection.
  • Though these adverse effects are rare, vaginal bleeding and pain are the main reasons why most women cease using an IUD.
Contraceptive Pills
When taken consistently every day, contraceptive tablets are 99% effective in preventing pregnancy. Hormones found in the pill control menstruation, reduce the risk of uterine and ovarian cancer, cure endometriosis, and improve acne.
How effective is the pill?
If you follow the recommended dosage exactly, without skipping even a day or two, the pill can avoid pregnancy up to 99% of the time. But taking the pill exactly right can be challenging, which is why nine out of every 100 women who take it will become pregnant unintentionally each year. When you take the pill at the same time every day, it is most dependable. Maintaining consistency aids in preventing fluctuations in hormone levels.
How does the birth control pill work?
  • If you follow the recommended dosage exactly, without skipping even a day or two, the pill can avoid pregnancy up to 99% of the time.
  • But taking the pill exactly right can be challenging, which is why nine out of every 100 women who take it will become pregnant unintentionally each year.
  • When you take the pill at the same time every day, it is most dependable. Maintaining consistency aids in preventing fluctuations in hormone levels.
There are two varieties of birth control tablets available. Hormones that hinder pregnancy are present in both varieties.

Progestin and estrogen are found in combination tablets.

  • “The mini pill” is another term for pills containing solely progestin.
  • Certain women benefit more from them than others, such as those who should not take estrogen and are nursing or have a history of blood clots or strokes.
Typically, you take hormone-free (inactive) pills for two to seven days after taking active pills for at least three weeks, depending on the type and dosage. We refer to this as cyclical dosing. The majority of women experience menstruation when using inactive tablets. Certain companies only deliver three weeks’ worth of active tablets; they don’t include any inactive pills in the bag.
A woman uses the 21-day packs, skipping a week’s worth of medication. You will experience your menstrual cycle at this time, much like when you take hormone-free, inactive tablets.
Certain formulations allow for continuous dosage, in which a woman takes an active pill every day, and there are no inert pills. As an alternative, extended cycle dosing involves only three or four-year pauses from the active pill regimen or inactive pills. Menstruation is prevented when the inactive pills are skipped.
Benefits of taking an oral contraceptive pill?
  • Control or lessen the menstrual cycle.
  • Reduce the length of or lighten your cycles to prevent anaemia.
  • Lessen the discomfort brought on by menstrual cramps.
  • Manage PMS and PCOD as much as you can
  • Treat endometriosis or uterine fibroids.
  • Cut down on the risk of ovarian, uterine, and colon cancer.
  • Alleviate acne.
  • Stop the growth of undesired hair.
  • Lessen the frequency of migraines.
  • Handle hot flashes during the transition to menopause.
Side effects:
  • Breast tenderness or swelling.
  • Headaches and nausea.
  • Irritability or moodiness.
  • Spotting between periods.
Are there any health risks to taking the pill?
For most women, birth control tablets are safe. There is a great deal of familiarity and experience with the pill’s use because it has been around for 60 years. A tiny proportion of women who use combination birth control pills (including estrogen) are more likely to experience these uncommon side effects, which include deep vein thrombosis, blood clots, heart attacks, etc.
What should I do if I miss a pill?
As soon as you remember, take the missed medication. Next, take your prescribed daily dosage as scheduled. Up to your menstruation, you should also utilize a backup method of birth control.
Birth Control Shot / Injection
An injectable method of birth control is the birth control shot. This method of birth control consists of a shot that is administered on a regular basis (every three months). When taken as directed by the schedule, it is quite effective and doesn’t require any daily action.
To avoid getting pregnant, this drug is injected into a woman’s arm or buttocks. Usually, the drug is administered once every twelve weeks.
The shot affects ovulation, the stage of the reproductive cycle in which a woman releases her egg from her ovary, and thickens the mucus in your cervical cavity, which keeps sperm from reaching the egg.
There are a few ways in which this injectable birth control differs from others. With a birth control shot, you don’t need to do anything every day, unlike with an oral contraceptive. You receive the shot from your physician every three months, and other than making sure you have your appointment with them on time, there are no additional steps you need to do to avoid getting pregnant.
Within the first seven days of the onset of your menstrual cycle, you will typically receive your first injection. If both you and your doctor are certain you are not pregnant, it can be administered later. There is nothing more you need to do to avoid getting pregnant after receiving the shot from your provider.
How soon does this work?
If you receive the first shot when you are menstruating, you are protected right away. You might have to wait a week to ten days before engaging in sexual activity without a condom in order to avoid getting pregnant if it is administered to you at a different point in your cycle.
Because the drug is 96% successful in preventing conception, around four unintended pregnancies will occur for every 100 women annually. Teens and younger women are most vulnerable to unintentional pregnancy when using birth control shots. Human mistakes are usually to blame for this, such as missing a shot or not getting your shot in time.
Most women can use the drug without risk. The birth control shot isn’t advised for everyone, though. Certain women may not be suitable candidates for the birth control shot, including those with heart or liver problems, breast cancer, and other diseases.
Side effects: The most frequent side effects that women encounter are modifications to their menstrual cycle. You can get sporadic bleeding or spotting. Approximately 50% of women will no longer receive their periods after a year of use. Monthly menstruation is not medically required for good health. Usually, periods resume after you stop using the medication.
Can I become pregnant after I stop using the shot?
As soon as 12 to 14 weeks following your last injection, you could get pregnant. Additionally, ceasing this kind of contraception could make it wait up to a year or two before getting pregnant. You might want to hold off on starting the birth control shot if you want to become pregnant within the next year.
There are several advantages of using shot, including:
  • You don’t have to remember to take it every day or immediately before bed.
  • It provides long-term protection as long as the injection is administered on time every three months.
  • It does not prevent having sex.
  • It functions pretty well.
Tubal Ligation
This is a surgical, permanent contraceptive procedure discussed under Gynaec surgeries.