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Apr04
HIGH-RISK PREGNANCY: What to Do and What to Expect? Why to Worry?
High-risk pregnancies sound daunting. It is common in women with a medical history, a chronic illness, substance addiction, and other mental or physical health conditions that put the mother at a higher risk of miscarriage or pre-term labor. So, what exactly is a high-risk pregnancy? Does it mean you are supposed to seek help from the best obstetrician-Gynecologist in Thane West? Does it mean your child is at risk of abnormalities after birth?
Causes of High-risk Pregnancy
Pregnancy is the most beautiful yet unpredictable phase in a woman’s life. But, things get pretty complicated for those diagnosed with a high-risk pregnancy. To protect yourself and the child, you need to be extra careful with your medication, diet, health, and lifestyle. But, what exactly causes high-risk pregnancy, and who is at a higher risk?
â—Ź Women above 35 years
â—Ź Alcohol or drug addiction, smoking, and sedentary lifestyle
â—Ź Chronic diseases, such as diabetes, hypertension, epilepsy, irregular thyroid levels, kidney diseases, heart diseases, asthma, or an existing infection
â—Ź Complications during pregnancy, such as abnormal placenta position
â—Ź Women carrying twins
â—Ź Prior pregnancy complications, such as a history of miscarriage or premature birth
Some women might have a healthy pregnancy in the first trimester but may experience complications later. So, it is important to stay in touch with the gynecologist to monitor your blood sugar level, blood pressure, and thyroid levels. In addition, regular health checkups every few weeks are highly recommended for pregnant women.
How Can You manage High-risk Pregnancy?
High-risk pregnancy doesn’t mean you cannot have a healthy pregnancy or a healthy child. It, generally, implies you need special care and regular health monitoring. Here are a few things to consider to manage high-risk pregnancies.
Plan Your Pregnancy: A planned pregnancy can save you and your child from many pregnancy complications. It isn’t only for women exposed to high-risk pregnancy, but every couple trying to conceive should visit the maternity care in Thane to discuss their health with the gynecologist before getting pregnant. The doctor will recommend health supplements, especially folic acid, so you can gain weight before you get pregnant.
Get Regular Prenatal Care: Prenatal care is important for pregnant women, in general. But, it is a necessity for women with a high-risk pregnancy. Your gynecologist may refer you to a specialist to monitor your and the fetus’s health.
Avoid any Harmful Substance: Alcohol, drugs, and smoking increase your risk of miscarriage and pose a health risk for your child. Your gynecologist will give you a list of the items you need to avoid during and after the pregnancy to keep your baby safe. These mainly include alcohol and drugs. You should also aim to follow a healthy lifestyle with a nutritious and balanced diet.
Are Special Tests Necessary?
The doctor recommends additional tests for women with a high-risk pregnancy. It includes:
â—Ź Targeted ultrasound
â—Ź Prenatal screening
â—Ź An ultrasound for cervical length
â—Ź Lab tests
â—Ź Invasive genetic screening
â—Ź Biophysical profile
Note that certain pregnancy tests, like amniocentesis, should be taken only if prescribed by a gynecologist.


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May17
Gyneza Menstruation Problems In Female
Menstruation Problems In Female
Amenorrhea
The absence of menstrual period in women is called Amenorrhea. It is of two types.

1. Primary Amenorrhea
The failure of menses in women even after turning up to 16 years of age, is called as primary amenorrhea.

Causes
• Chromosomal or genetic abnormalities and mainly Turner syndrome. • Uterus structural defects. • Uterus infection. • Cystic fibrosis. • Cushing’s syndrome. • Imbalance in hormones. • Mainly adrenal gland problems. • Intake of Medicines for Cancer disease treatment and anti-depressive.

2. Secondary Amenorrhea
The stop of regular and normal menstrual cycles after the pregnancy for 3 months or more is called as Secondary amenorrhea.

Causes
• Pregnancy. • Breastfeeding and menopause. • Pituitary gland. • Thyroid problems. • Intake of contraception medicines and few antidepressants medicines. • PCOD (Polycystic Ovary Disease). • Strenuous exercise. • Uterus related operations.

Oligomenorrhea
It occurs in women of childbearing age. Some variation in menstruation is normal. A woman who regularly goes over 35 to 40 days without menstruating may be diagnosed with Oligomenorrhea. Light or infrequent menstrual periods less than 35 to 40 milli is also called as Oligomenorrhea.

Causes
• PCOD. • Formation of pituitary glands tumours. • The cause of Oligomenorrhea is mainly seen during the end of menstruation period.

Metrorrhagia
The occurrence of menses period between two menstruation cycles is called as metrorrhagia. Mainly during the release of egg this metrorrhagia problem is seen.

Causes
• Adenomas. • Endometriosis. • Ectopic pregnancy. • Hormones imbalance. • Intake of contraception medicines. • Usage of contraception equipment (IUD).

Menorrhagia
The abnormally heavy bleeding at menstruation for more than normal 5 days is called as Menorrhagia.

Causes
• Uterine fibroids. • PCOD problems. • Thyroid problems. • Endometriosis. • Cancer in the Uterus.

Dysmenorrhea
The Painful menstruation, typically involving abdominal cramps that effect daily activities of women is called as Dysmenorrhea. It is mainly seen either before the few days of the menstruation periods or during the first three days of menstruation period.

Causes
• Endometriosis. • Tumors in hysterectomy. • Ovarian water cysts. • Hormones imbalance.

GENERAL SYMPTOMS OF THE DISEASE
Menopausal Symptoms Peri-menopausal and menopausal symptoms can appear at any time of life, although usually their onset begins in a woman’s late forties or early fifties. Menopausal symptoms are clearly delineated in most women, and consist of one or more of the following problems - some patients even present with all of the below symptoms. • Anemia, Weakness,* Feeling of intense heat in your body on some occasions • Profuse sweating at night • Excessive falling of hair, • Irregular menstrual periods with excessive or scanty bleeding, • Burning and increased frequency of micturation, • Vaginal dryness and itching • Joint pain, • Edema, • Irritable nature, • Sleeplessness Lassitude.

INDICATION
• Leucorrhoea • Dysmenorrhea • Amenorrhoea • Metrorrhagia • Oligomenorrhea • Menorrhagia • Low Back Pain

Benefits Of Gyneza
• it is helpful in dealing with health of female reproductive system • Increase fertility in females • Releases stress • Enhances immunity which helps to optimize overall health • Helpful in leucorrhoea • Increase Stamina • scanty menstruation • menopause

COMPOSITION
Ashoka, Dashmoola, Lodhra, Guduchi, Punarnava, Shatavari, Musta, Anantmoola, Triphala, Jatamansi, Pippalimoola, Trikatu, Aal, Methika, Ashwagandha

Ashoka
Ashoka bark is considered as the uterine tonic and uterine sedative as it helps in reducing the pain and bleeding during periods.

Dashmoola
These magic herbs and spices soothe the digestive process. It is used in the treatment of anemia, .

Lodhra
• Lodhra is considered useful in managing female disorders such as leucorrhea (excessive vaginal discharge) which is caused by vaginal infections as it has antimicrobial and anti-inflammatory properties. • It is a well known coagulant (coagulation is a process by which the blood forms clots to block and then heal a wound/cut to stop the bleeding). It is therefore used in the treatment of bleeding disorders . Lodhra is especially helpful in inflammation of the uterus.

Punarnava
Thus traditional herbs are used in gynecological disorders Ovulation problems due to polycystic ovarian syndrome.

Shatavari
Shatavari might be beneficial in the management of uterine bleeding or heavy menstrual bleeding. It acts as a primary uterine tonic. It helps to balance and strengthen the menstrual system.

Musta
Musta is great for your digestive and urinary system. Motha (nutgrass) in Ayurveda used to treat various female disorders.

Anantmool
It is used for the management of many gynecological problems in females such as menorrhagia.

Triphala
Triphala is a herbal medicine that has been widely used for treating a variety of ailments. This study aims to systematically analyze the antitumor effects of Triphala on gynecological cancers.

Jatamansi
It is recommended for gynecological problems especially in frequent abortions.

Pippalimoola
It is used to treat semen defects and gynecological problems.

Trikatu
Trikatu gives strength to the reproductive system, used to treat obesity as it keeps a check on food cravings, works as anti-inflammatory and analgesic due to the presence of Sunthi in it which works as Vata Shamaka, that is, it balances the aggravated Vata Dosha which is mainly responsible for all kind of pains.

Trikatu
Trikatu gives strength to the reproductive system, used to treat obesity as it keeps a check on food cravings, works as anti-inflammatory and analgesic due to the presence of Sunthi in it which works as Vata Shamaka, that is, it balances the aggravated Vata Dosha which is mainly responsible for all kind of pains.

Aal (Noni)
Noni (Morinda citrifolia) has been used for many years as an anti-inflammatory agent. & gynecological problem that a?ects adolescents and is reported to have many beneficial properties

Methika
Reduces pain in women with painful menstrual periods.

Ashwagandha
Ashwagandha is considered one ... as a blood tonic, especially in gynecological disorders including anemia.

Dosage
2 teaspoon diluted with 100ml water twice a day for 15 days to 3 months.


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Feb04
Laser hair removal cost in India
Firstly I discuss some laser treatment features then I explain to search for your topic.

You know if your hair grows permanently then you face many problems and you do not feel comfortable. so you decide your unwanted hair reduce uses by a method.

And You decide this method laser hair removal method. because this laser treatment gives the service the best.

If you reduce your hair use by other methods then you not get permanent service.

#Laser hair removal means
Laser hair removal means if you remove your unwanted hair uses by any method suppose waxing, shaving, plucking, and other methods then you do not get quality treatment but if you choose laser hair removal treatment then you get quality service.

Laser target our pigment hair follicles areas in which unwanted hair does not grow for a long time.

#Laser hair removal benefits
Hi if you uses laser reduce your hair then you get many benefits like –

Permanent service – laser remove your hair permanently
Safe – laser give safe treatment which you do not get uses other methods
Very fast – if you reduce your unwanted hair uses laser then your reduce hair areas you get very fast service
Painless – laser treatment is not painful
Not creat side effects – if you reduce your hair uses laser then your bodyes areas do not look side effects.
#Laser treatment cost in India
Hi, you know Indian many people are not using laser hair removal service but some educated male and female persons are used laser treatment reduces her unwanted hair. If you think laser treatment costs in India very high then you think wrong. if you reduce your unwanted hair use laser then her cost in India 35000 to 30000(full body).


laser hair removal price in india
#Laser hair removal price list
Hi if you want to reduce your bodyes unwanted hair use by laser then you choose the best methods because this treatment is very popular in the USA country. now I presented some bodyes areas cost you read and if you want more areas price list then comment me.

Bodyes area maximum minimum

Legs hair – 20000 to 17000
Chest – 8000 to 6000
The stomach is – 8000 to 5000
Bikini line- 6000 to 5000
Hands – 6000 to 5000
Upper lip – 3500 to 1500
Face – 8000 to 6000
Underarms – 3500 to 3000
Lower lip – 3000 to 2000
Back – 20000 to 15000
Full body – 35000 to 30000
Hi, I keep saying this price list may be variable. your area clinic decides which price to take her treatment because they know how much will it cost ?.


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Apr24
Effects of PCOS
What is polycystic ovary syndrome (PCOS)?

PCOS is hormonal disorder where there are irregular periods, excessive hair growth on face or body (“hirsutism”), loss of hair on head, oily skin, acne and weight gain along with polycystic ovaries found in ultrasound.

The symptoms vary from woman to woman. Some women have very few mild symptoms, while others are affected more severely by a wider range of symptoms.

Polycystic ovaries have more number of follicles (fluid-filled spaces containing the eggs), which appear like cysts. However, the “cysts” in PCOS are not tumours. The main problem in PCOS is not the “cysts”, rather cysts are arising because of hormonal problems.

Presence of polycystic ovaries does not always mean PCOS.

A diagnosis is made when you have any two of the following:

1. Irregular, infrequent periods or no periods at all

2. An increase in facial or body hair and/or blood tests that show higher testosterone levels

3. An ultrasound scan that shows polycystic ovaries.

It is a quite common condition, affecting 2 to 26 in every 100 women.

What causes PCOS?

The exact cause of PCOS is not yet known but it often runs in families.

The symptoms are related to abnormal hormone levels:

1. Testosterone is a hormone that is produced in small amounts by the ovaries in all women. Women with PCOS have slightly higher than normal levels of testosterone

2. Insulin is a hormone that controls the level of glucose (a type of sugar) in the blood. If you have PCOS, your body may not respond to insulin (“insulin resistance”), so the level of glucose is higher. To try to prevent the glucose levels becoming higher, your body produces even more insulin. High levels of insulin can lead to weight gain, irregular periods, fertility problems and higher levels of testosterone.

Effects of PCOS

Is PCOS related to other diseases?

Effect of PCOS is not limited to the ovaries. Women with PCOS are more prone to develop diabetes, high blood pressure, heart disease, stroke, depression and mood swings, snoring and daytime drowsiness and sometimes, cancer in the lining of the uterus (endometrium).

The risks are higher for obese women.

How PCOS is related to the infertility?

Women with PCOS have good number of eggs inside the follicles but they cannot be released (Ovulation). As a result, sperms cannot meet the eggs, leading to infertility. Additionally, obesity, diabetes, high testosterone and insulin level all can be risk factors for infertility.


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Apr24
Fallopian Tube Block - Causes
What is Fallopian Tube(s)?
Fallopian tubes (commonly called “the tubes”) are the structures that are connected to the both sides of the uterus. Inside the tube, the sperms and the egg meet (“fertilization”) to form the embryo, which then travels down the tubes into the uterus and then the pregnancy starts. Tubal factor accounts for 20-25% cases of female infertility. It’s more common in secondary infertility (women who conceived earlier).

What are the reasons for tubal blockage?
Often, the exact cause is not known. Infection is the commonest cause. The infections may be due to sexually transmitted infection (STI), particularly Chlamydia infection or infection from bowel or appendix. Tuberculosis is very common in our country and can affect the tubes, silently, without affecting any other parts (not even the lungs) of the body. Endometriosis is also a common reason for tubal blockage. Any pelvic surgery (surgery in ovaries, tubes, uterus, even appendix) can block the tubes by “adhesion”. This means the tube may be open but attached to the bowel or rotated on itself, so that the tube cannot pick up the eggs from the ovaries. Sometimes fibroid of uterus can compress the tube and cause blockage. Women, with previous history of ectopic pregnancy, are at risk. Uncommonly, some abnormalities, present since birth can block the tubes.


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Dec24
IVF in Punjab india
IVF India is one of the best surrogacy and male infertility treatments providers in Jalandhar, Punjab. We use cutting-edge technology with advance labs for patients better health. The cost of all the treatments are very reasonable at our SJS IVF Hospital. We also provide our patients with personalized care of doctors and nurses.


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May16
8 ways to avoid Irregular Menstruation
How to make your menstrual cycles regular- 8 simple ways
How to make your menstrual cycles regular?

In our clinics everyday some patients at different ages will come with complaint of irregular menstrual cycles. But there are other patients who feel embarrassed to seek doctor's help for this problem. While it seems to be a simple problem related to reproduction only, often it is associated with diseases that are matter s of concern.

First, you should know what is meant by the word "irregular"? In most women period movvurs at interval of 28 to 30 days. But it is said to be normal if it happens every 21-35 days. That means you should have periods not more frequently than every 3 weeks or not less frequently than every 5 weeks. But if you had previous cycles at interval of every 4 weeks but now you are having periods every 5 weeks, that is ABNORMAL, although it is occurring every 35 days. In other words change in interval upto 7 days is normal, nit beyond that. For example, if you had periods every 30 days previously and for ladt 2 months it is happening every 33 days or every 25 days, then it's normal. But if it happens at interval of more than 37 days (30 + 7) or les than 23 days (30- 7) then it's of course abnormal.

So what are the things you can do for regular periods.

1. Normal weight
Ideal weight varies according to the height. We express it in terms of BMI (Body Mass Index) that is the weight in Kg divided by square of the height in centimeters. Ideal BMI should be between 19 to 25. If it's more than 25, reduce weight by diet and exercise. IT can resume normal menstruation without any drugs. IF despite your sincere efforts, you are unable to lose weight or even after normalization of weight menstruation remains irregular, you must consult your gynaecologist for treatment.
On the other hand very low BMI can also cause irregular menses. Treatment is weight gain. Tjis is often seen in athletes and they are even at risk of losing bone calcium because if excessive exercise and strict diet control. If gaining weight does not help, you must consult your doctor for having regular periods.

2. Stress, Anxiety, Tension, Depression
These are inevitable part of modern lifestyle. These may noy only cause mental problems but will also cause physical problems by altering the hormone levels. The result is abnormal menstrual cycle. Try to avoid them by relaxation, counseling and if necessary by taking help of doctors.

3. Thyroid disorders
Problem of thyroid gland is common in females and causes abnormal weight and changes action of many hormone s. The result is irregular menstruation. So if you feel lethargy, extreme cold, weakness ir ibcreased weight, do not forget to check thyroid status after consulting doctor.

4. Pituitary disorders
Pituitary gland is a gland situated inside the brain that controls hormone of other gland s of the body. If there is soMe tumour or soNe abnormalities in its function, there will be high lebel of prolactin hormone secretion or there will be deficiency of hormones like FSH and LH. As a result ivaries cannot produce enough hormones and you will have irregular menstruation. So in case of abnormal menstruation, pkease Check your prolactin level.

5. PCOS
Polycystic Ovarian Syndrome is common nowadays. Apart from causing abno menstruation, it increases risk of infertility, high blood pressure, diabetes, heart disease and even cancer. It is diagnosed byclinical feature s, hor tests and ultrasonography. It may also xause weight gain, male like growth of hairs in body and oily skin. The treatment is weight control and drugs to regularize menses. This is particular ly important in young women an teenagers, in whom timiely treatment xan prevent many serious consequences.

6. Premature Ovarian Failure
In some women menopause can come earlier and irregular menstruation may be the early indication of this. This may be followed by permanent cessation if periods. So if you are planning for family expansion but have irregular menses, do not delay pregnancy.

7. Problems in uterus
Excessive trauma to uterus by repeated surgical abortion or infections lije STD r tuberculosis xan damage the lining of uterus. The result is irregular menses folliwed by total cessation of menses. But this problem can be easily treated if you consult your gynecologist in time.

8. Systemic diseases and drugs
Irregular menSes should never be ignored. Sometimes it may be because if so e undiagnosed diseases like diabetes, diseases if heart, liver, kidney, chest etc. Often it may be the side effect if the drugs you are taking- like antacids containing domperidone, psychiatric drugs, Steroid s or chemotherapy.

In conclusion, irregular menstruation may sometimes warn you about serious disease s and may be associated with infertility and early menopause. Stay health y, have health y diet and lifestyle, maintain normal weight, get rid of tension and attend your doctor's clinics in time.


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Feb04
Gynaecological cancers
Today is the WORLD CANCER DAY and the theme of this year is "We can, I can".... Yes we all can battle the cancer. But the irony is that majority of women ignore early signs and symptoms of cancer and do not consult doctors in time. And even some of these cancers are preventable if proper action is taken.

Ovarian Cancer-

What will you do if you feel gaseous distension (gas, bloating), acidity, constipation, change in bowel habit, decreased appetite, feeling of full stomach, weight loss and abdominal swellling? Majority of the women ignore these symptoms and take antacids before it is too late. But these are often symptoms of early ovarian cancer and thus if you ignore these symptoms, you are harming yourself. Ovarian cancer is difficult to treat if detected at late stage. But in early stage, it is curable. So, don't ignore these symptoms.
Who are the women at risk of ovarian cancer- women who are not having baby, who themselves or close relatives (sister/ mother/ daughter) had history of cancer in breast/ ovary/ bowel/ uterus etc. But some women are at lower risk like those using Oral Contraceptive Pills- OCP(- the birth control pills can reduce the risk by 50%) and who had tubal ligation (permanent family lanning methods).
If you had such risk factors, you must not avoid any such above mentioned symptoms. Rather you should consult gynecologist early. Ovarian cancer can be detected by ultrasound, CT scan, some blood tests (CA 125) and some cases biopsy may be needed. And remember, majority of the ovarian diseases are NOT cancer but you must be sure that it's not cancer causing your problem.
If ovarian cancer is diagnosed, the treatment is surgery (to be done by expert personnels) and most of the women need chemotherapy.
Ovarian cancer is common in elderly women but it can afect younger women also. So, all the women should take care of the above mentioned symptoms


Cancer of Cervix: Cervix is the mouth of the terus. In our country, this is the COMMONEST CANCER in GYNAECOLOGY affecting women whereas it is uncommon in the Western countries. The irony is that women die of this disease whereas it is TOTALLY PREVENTABLE

It is caused by a virus (human papilloma virus- HPV) that is sexually transmitted (so afects sexually active women). But it has a peculiar feature that before cancer actually occurs, there is precancerous stage- when the cells of cervix shows some changes that we can detect and treat. So, if women regularly consult doctor (WHEN THEY DO NOT HAVE PROBLEMS), we can check if she is at risk of cervical cancer or not, by some simple tests (Pap Smear, HPV testing etc). Is such changes are found (that is not cancer) we can treat her so that she does not develop cancer. These method of detection, before disease occurs or before an individual feels that she is having disease, is called "Screening".
Another method of preventing it is vaccination of HPV, that should be given to the adolescent girls before they become sexually active. Even it can be given in older women (who are sexually active), although the response is somehow lower than if given at early age. But vaccination is not alternative to screening. SO, both screening and vaccination should be done to prevent this cancer.
Even if detected at early stage, it is totally curable. So, women should not ignore symptoms of excessive vaginal discharge (remember, all excessive discharges are not due to cancer), abnormal or heavy menstrual bleeding, bleeding occuring unredictably in between menstrualtion, bleeding after intercourse etc.
It is treated by surgery and some cases may need radiation also.


Cancer of uterus

Cancer of uterus is common after 50 years of age (although can occur at early years also). It is the commonest gynaecological cancer in the Western World. It mainly occurs in women who are obese (excessive weight), having diabetes or hypertension (high blood pressure), not having any baby, who are having personal or family history of cancer in uterus/ breast/ ovary/ bowel.
It can be prevented by taking OCP (birth control pils) and controlling weight. In many cases, it is also preceeded by some precancerous changes (hyperplasia) that can be detected by ultrasonography and if needed small biopsy procedure.
The common symptoms are abnormal heavy bleeding and bleeding after attaining menopause (after totall stoppage of menses). So, any abnormal menstrual bleeding must be properly investigated.
It is usually well curable if treated early- by surgery and in few cases, may need radiation, chemo or hormone therapy.


Cancer of Vulva: The external genitalia of female is known as vulva. Cancer in vulva is relatively uncommon but still it can happen, especially those who are having diabetes, HIV positive or those having poor hygiene.

Never ignore any symptoms of excessive itching in your private parts. It may be the early symptom of vulval cancer. Some cases, patient may have ulcer or tumour or bleeding.
It can be detected easily by examination by doctor and then taking biopsy. It is treated well with surgery and some cases, radiation may be needed.


Sumary: Majority of the gynaecological cacers are preventable. They can be diagnosed early if women consult doctor at early stage. Majority of them respond to treatment.


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Oct18
MENOPAUSE- How to tackle
Today 18th October is World Menopause Day....
Aging is an inevitable phenomenon in our lives. Often our parents or grand-parents say “we are aged now, so it’s just a matter of few years”. But is it really so? French author Jules Renard said “It`s not how old you are, it`s how you are old”. Scientific studies has shown that “we can expect to become old”. There are mainly two reasons for it. One is our life style changes, leading to faster aging of the general population. The second thing is profound improvement in medical care that made it possible to conquer death even at the age of 80 years.In 1000 BC, the life expectancy was only 18 years. By 100 BC, the time of Julius Caesar, it had reached 25 years. In 2005, it was 80 years for women and 75 years for men. And today, you can expect to reach 82 years if you are a male and 85 years if you are a female. Men and women population need to be addressed differently from social, economic and biological points of view. Half of men at 85 and above live with their wives, but only 10% of elderly women live with their husbands. Aging is nothing but a sign of maturity. There are three signs of maturity in each sex. Two of them are common in both men and women; graying of hair and cataract in eye. The third one is unique to each sex. In men, it’s increased size of prostate gland (prostatism) and in female, it’s menopause.

Menopause is unavoidable in a woman’s life. In simplest term, it is the cessation of menstruation permanently at the end of reproductive life. The ovaries stop secreting female sex hormones- mainly estrogen and progesterone. In medical terminology, menstruation should be absent for 12 consecutive cycles to define it as menopause. Though menopause is the stoppage of reproductive function, it has profound effect in almost every organ of the body. Despite our socio-economic improvement, the age of menopause remains relatively the same; average 51 years with range of 45 to 55 years. However, there are some causes that may cause early menopause. If it occurs before 40 years, it’s called premature menopause. This needs medical consultation because it is caused by some serious diseases like genetic causes (may have family history of premature menopause- in elder sisters and mother), smoking, autoimmune disorders (body makes destructive substances against itself) etc. Sometimes premature menopause is the side-effect of some treatments like drugs (especially anti-cancer drugs), radiation and removal of ovaries by surgery. On the other hand, if menstruation continues to occur after 55 years, it’s called delayed menopause. It also deserves consultation with gynaecologists, as it is often caused by diabetes, some tumours and even some cancers. So, if menopause occurs too early or too late, it should never be ignored.

But if menopause occurs in time, do the women should consult gynaecologists? Well. You can find the answers from this article. Most of the women have some common problems after menopause; they become irritable or depressed and sometimes very much emotional and moody. Even suicidal tendency is not uncommon. Often they complain of sudden sensation of excessive warmth, the hot sensation, as if there is something burning on the head, the ears or other parts of the body. This is called “hot flush”, which is often associated with excessive sweating at night, palpitation and anxiety. This happens due to absence of estrogen hormone. These problems can be solved by hormonal drugs. Even non-hormonal drugs also work well. So, timely treatment can give them good quality of life and you don’t have to say “my mother has become intolerable these days”.

Frequently our mothers and grand-mothers complain of having back-pain or pain in the bones. This is due to osteoporosis; the destruction of components of bones and joints. They often get fracture with minor trauma. Again, this is due to deficiency of estrogen and also inadequate calcium intake. So, the treatment of this problem is exercise (at least 30 minutes per day), avoidance of smoking and the drugs that inhibits bone formation and adequate calcium and vitamin D intake. Hormone therapy is also effective and there are many non-hormonal drugs that can prevent destruction of bone. Thus timely medical consultation may stop our mothers saying “I cannot go outside for pain in my knees”.

Cardiovascular disease is the leading cause of death in elderly. Before the age of 40 years, males are more likely to die, than females, due to heart attacks. After 40, the sex difference is lost. This is because of absence of estrogen in women after menopause that alters the composition of fat (especially cholesterol) in blood. Cholesterol get deposited in the wall of blood vessels. Such problems can be avoided by dietary control, control of high blood pressure and diabetes and regular medical checkup.

The worst problemof the menopause is faced by the urinary and reproductive systems, i.e., the private parts of the body. In medical terminology, this is called “pelvic atrophy”. Our women remain very silent of it; most of them do not consult doctors for such problems. There is feeling of increased frequency of urination (women has go to the toilets frequently), burning sensation during urination and sometimes inability to hold the urine until they can reach the toilet or leakage of urine during coughing and sneezing (medically called “urinary incontinence”). The incontinence is not only a medical problem but also a social and hygienic embarrassment, for which many women avoid participation in social activities and even do not want to go outside. Sexuality is a thing that is often ignored both by the elderly people as well as the doctors. Menopause does not mean end of the conjugal life. Often the women may feel decreased libido (the desire) because of low hormone levels. And again there is difficulty in keeping intimacy for problems in the concerned area (due to decreased blood supply), again due to deficiency of estrogens. This may even lead to damage to the private parts and bleeding, while leading the conjugal life. For this, the couples should not suffer silently. There are many treatments that can avoid such urinary and sexual problems. Sometimes, simple counselling and some special exercises may prove to be adequate. Otherwise hormonal drugs (estrogens) can be used. And for this purpose, even we don’t need to take the hormones orally or by injection; simple local use of some creams or jellies help a lot. You will be surprised to know that testosterone may also help some women, because testosterone is not only found in male but is also an important female hormone. Those who want to avoid hormones, can try other non-hormonal agents. Even pregnancy is possible after menopause. There have been many examples of conception, either naturally or by test-tube baby (in vitro fertilization), after menopause. The recent socio-economic trend of delaying the age of marriage and child-birth is making this issue of pregnancy after menopause very much relevant.

Cancer is the second leading cause of death in elderly, after heart attack. Lung cancer is increasing day by day in women and even non-smokers can also have lung cancers. Discharge of blood with cough or vomiting, long-standing cough, chest pain and weight loss needs consultation with chest physician. Breast cancer is a major cause of death in women. This can be avoided by monthly self-breast examination and consultation; if any abnormal swelling or discharge is found. Colo-rectal cancer (cancer of lower part of our digestive tract), recently showed increased incidence in all the age groups. So, if there is any bleeding with stool or passage of black coloured stool, it should never be ignored. Ovarian cancer is showing increased incidences all over the world. Despite significant improvement in cancer management, ovarian cancer is a nightmare of the gynaecologists. Often, even after best possible treatment, patients of ovarian cancer don’t survive beyond one year of diagnosis. So, if you have any problems in digestion, abdominal discomfort, pain and swelling, please don’t just go to medicine shop to take antacids; instead go to your doctor. Post-menopausal bleeding is a medical term, used to describe the condition where there is bleeding through vagina, after menopause. Even if the bleeding is only one drop, it should never be ignored. Though, most causes of such bleeding are not worrisome (due to drugs and ‘’pelvic atrophy”- as mentioned earlier), some cancers may present in this way. Cancer of endometrium (the inner lining of uterus) almost always present with post-menopausal bleeding. Cancer of cervix (the mouth of uterus) is the commonest cancer of reproductive system in our country, which is totally preventable by timely diagnosis by screening (even before actual cancer occurs) and timely HPV vaccination.

“What cannot be cured, must be endured”. We cannot cure the menopause, nor can we avoid it. But definitely we can give our older generation a better quality of life. The first step is obviously making them aware of the menopause and its aftermaths. Second issue is regular health checkup by physicians and gynaecologists, even if they feel no problems as such. But the most important issue is managing their problems. As mentioned above, life-style modifications (like diet, exercise) and non-hormonal drugs play important role. But if we consider the basic problem is menopause, it’s simply deficiency of secretion of female sex hormones from the ovaries. So, if we can artificially introduce those hormones in women, menopausal symptoms can be reduced. This led to emergence of a treatment modality, called HRT (Hormone Replacement Therapy).

Clearly, as discussed earlier, HRT is required in women complaining of menopausal symptoms like “hot flush”, urinary and sexual problems, osteoporosis, and mood depression and also for young women having premature menopause. HRT does not only help to improve these problems, but also has some added advantage like preventing excessive weight gain, problems in oral cavity, eyes and ears and even colorectal cancer. Majority of the women report feeling better and having improved quality of life (social, personal, biological and conjugal) after start of HRT. There are multiple ways to give HRT to a woman. Those include injections (one in 1-3 month), oral tablets, local creams or jellies, skin patches etc. And the drugs include estrogen only, estrogen plus progesterone, tibolone etc.

Now the million-dollar question is, “is HRT absolutely safe?” The answer is difficult to give in one word. After the publication of the reports of the WHI (Women’s Health Initiative) and the MWS (Million Women Study), there have been a great hue and cry regarding safety of HRT. Those study found out many serious side effects of HRT and concluded that HRT should not be used in all the menopausal women. However, subsequently, many flaws of those studies were found out and subsequent review of the WHI study proved that HRT has few side effects. Thrombosis (increased tendency of blood to form clots) is a known side effect of hormonal drugs, but the problem occurs only to those who are at risk of thrombosis due to other causes (like obesity). Breast cancer is definitely a risk factor but the risk is small. So, the women need to continue self-breast examination and yearly checkup by their consultants. Blood fat concentration (cholesterol) may be altered, which needs regular lipid profile checkup. And finally there is increased risk of heart attacks and stroke. But possibility of heart attack is there only if HRT is started in very elderly women (after 60 years) and those who are already have some risks (obesity, smokers, and hypertensive). Even, timely initiation of HRT (before 60 years) can protect the heart and brain against stroke.

Thus HRT is found to have very minimum side-effects and that too at the expense of so many benefits. There are very few women who should not use HRT; those having thrombosis, heart disease or liver disease at present and very high blood fat level (high triglyceride). If the woman has any mass in the breast or post-menopausal bleeding, then HRT should be used only when the diagnosis of the mass or the bleeding is certain. To be on the safe side, before start of HRT, details examination by the consultant doctor is required. This includes checkup of blood pressure, heart, breast, liver and the pelvic organs. The best time to start HRT is as early as after menopause. For premature menopause, the women are relatively younger (before 40, even before 30). So, they should start HRT soon after consultation with doctors, if HRT is suitable for them. For women with natural menopause, HRT should be started before 60 years. Annual visit to the doctor is necessary to detect any side effects and to find whether HRT is needed further or not. HRT need not be continued lifelong. Most of the women can stop it after 5 years. Very few women have to continue it beyond 10 years. Actually, after 2-3 years of HRT, most of the menopausal problems subside and women do not require to continue HRT. However, before stoppage, doctor consultation is required.

In a nutshell, elderly people deserve special care. But that does not mean they should always be in the bed. They should continue their day to day activities. They have the full right to enjoy their life by themselves. What we can do is be supportive to boost up their confidence and self-esteem. That needs social as well as medical attention. Regular touch with physician and gynaecologist cannot be overemphasized. Most of the symptoms can be taken care by life style modifications and drugs. HRT should be used as necessary. HRT is very safe and cost-effective modality. “Not everyone grows to be old, but everyone has been younger than he is now”.


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Jul18
FEMALE SEXUAL DYSFUNCTION
Low Libido in Women, Decreased Sex Drive - Female, Sexual Dissatisfaction in Women, Lack of Sexual Desire in Women.

Female sexual dysfunction occurs when a woman is not able to fully, healthily, and pleasurably experience some or all of the various physical stages the body normally experiences during sexual activity. These stages can be broadly thought of as the desire phase, the arousal phase, and the orgasm phase. Sexual dysfunction also includes painful intercourse.

In women, sexual dysfunction takes many forms and has numerous causes. It is important to address all the aspects of a woman's sexuality - whether physical, psychological, physiological , or interpersonal - in order to resolve the problems. Female sexual dysfunction is actually quite common. It has been estimated that about 40% of women are affected by sexual dysfunction to some degree, and approximately 1 in 4 women are unable to achieve orgasm.
Causes of Female Sexual Dysfunction
Female sexual dysfunction may be related to physical factors, psychological factors, or a mixture of both. It can also be a matter of problems with technique: Some women never fully experience sexual arousal and orgasm because they or their partners lack sexual knowledge. They may not understand how female sex organs respond or are stimulated, or don't use appropriate arousal techniques.

At the same time, sexual dysfunction has a strong interpersonal component. A person's view of their own sexuality is largely influenced by culture, society, and personal experience. It may be intimately connected to their own or society's ideas about the appropriate or inappropriate expression of sexual behaviour. These feelings may cause anxiety because of a personal or cultural association of sexual experience and pleasure with immorality and bad behaviour. Anxiety is then expressed physically by the body in a way that prevents normal sexual function. Anxiety can do this, for example, by stopping or slowing the state of sexual excitement that allows for the lubrication or moistening of the female genitalia - an important step towards fulfilling forms of sexual activity.

Personal character, disposition, and life experience play a role in sexual dysfunction. Fear of intimacy can be a factor in arousal problems. Experiences of abuse, either in childhood or in past or current relationships, can establish a cycle of associating sex with psychological or physical pain. Attempting sexual activity in these circumstances causes more psychological or physical pain. For example, if anxiety prevents lubrication, sexual intercourse can be painful.

Conflict, tension, and incompatibility with a sexual partner can cause sexual dysfunction. Depression may be a cause, and stress a contributing factor. Medications, including oral contraceptives, antihypertensives, antidepressants, and tranquilizers are very common causes of sexual dysfunction. Also, the use of oral contraceptives can decrease a woman's interest in sex. If you're taking any of these medications, talk to your doctor about its possible contribution to sexual problems.

Physical causes include disorders of the genitalia and the urinary system, such as endometriosis, cystitis, vaginal dryness, or vaginitis. Other conditions such as hypothyroidism, diabetes, multiple sclerosis, or muscular dystrophy can have an impact on sexual desire and ability. Surgical removal of the uterus or of a breast may contribute psychologically to sexual dysfunction if a woman feels her self-image has been damaged.

Certain prescription and over-the-counter medications as well as the use of illegal drugs or abuse of alcohol may contribute to sexual dysfunction. Cigarette smoking may have a negative effect on sexual arousal in women.

Although women can remain sexually active and experience orgasms throughout their lives, sexual activity often decreases after age 60. While part of this may be due to a lack of partners, changes such as dryness of the vagina caused by lack of estrogen after menopause may make intercourse painful and reduce desire. After menopause, about 15% of women feel a strong decrease in sexual desire.


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