The trend towards later maternity is strongest among women with better educational qualifications, as they increasingly postpone child rearing to pursue their careers.
On the whole, babies are more likely to be planned and wanted by women in their thirties. There is evidence that older women express greater satisfaction and feel they are ready to have a child because they have been fulfilled in their lives before that time. The notion of sacrifice is more often talked about in younger mothers. Older mothers may want to spend more time with their children."

Most of the degenerative changes, pre menopausal problems and metabolic diseases, thyroid dysfunction, cancers of breast and genital organs and deteriorating vision start from mid thirties, let us say around 35 years only. For preventive and optimal healthcare, we have to start early from the mid thirties, while later comes curative and palliative stage. The most common problem faced by the females over age 35 is menopause. Lets learn what to expect and ways to stay strong and healthy in the years around menopause.

Menopause

Menopause is a natural process that occurs as a woman’s ovaries stop producing eggs and the production of female hormones (estrogen and progesterone) declines. Menopause can also occur if a woman’s ovaries are damaged by certain diseases or cancer treatments, or if they are surgically removed. Menopause usually happens gradually between the ages of 45 - 55. The average age that women reach menopause is 51 years although it can occur as early as age 40 to as late as the early 60s. Women now have a life expectancy of more than 80 years. Currently, women can expect to live some 30 or 40 years of their life in the postmenopausal state.

Menopause does not occur suddenly. A period called perimenopause usually begins a few years before the last menstrual cycle. There are two stages in the transition:

1) Early Stage. Pre menopause can begin in some women in their 30s, but most often it starts in women ages 40 - 44. It is marked by changes in menstrual flow and in the length of the cycle. There may be sudden surges in estrogen.

2) Late Stage. The late stages of pre menopause usually occur when a woman is in her late 40s or early 50s. In the late stages of the menopausal transition, women begin missing the periods until they finally stop. About 6 months before menopause, estrogen levels drop significantly. The fall in estrogen triggers the typical symptoms of vaginal dryness and hot flashes (which can last from half a year to more than 5 years after onset of menopause).

Menopause is considered to have occurred after a woman has gone a full 12 months without a period. Menopause marks the end of menstruation and a women’s fertility.
Menopause is not a disease. However, many conditions are associated with estrogen depletion, including heart disease, osteoporosis, and other complications. Fortunately, effective treatments are available for these conditions.

Many women experience some physical and emotional symptoms during menopause, caused by hormonal imbalance. Typically, a woman will begin to experience menopause symptoms around her mid-40's as her body's reproductive capability comes to the end. This prolonged stage of gradually falling and fluctuating hormone levels is called per menopause, which can last upwards of two years before a woman's final period. For most women, symptoms end at menopause; however, some women will experience symptoms into postmenopausal life. The first symptom is usually a change in the pattern of your monthly periods. The start of the menopause is known as the pre menopausal stage. During this time, you may have light or heavy periods.The frequency of your periods may also be affected. You may have a period every two-three weeks, or you may not have one for months at a time. Other prominent symptoms of the transition to menopause include:

1) Hot flashes and night sweats . Women often feel hot flashes as an intense build-up in body heat, followed by sweating and chills. Some women report accompanying anxiety as the sensation builds. In most cases, hot flashes last for 3 - 5 years, although they may linger in some women for years after menopause. Women who have surgical removal of both ovaries, and who do not receive hormone replacement therapy, may have more severe hot flashes than women who enter menopause naturally.

2) Heart pounding or racing can occur, with or without hot flashes.

3) Difficulty sleeping . Insomnia is common during perimenopause. It may be caused by the hot flashes, or it may be an independent symptom of hormonal changes.

4) Mood changes . Mood changes are most likely to be a combination of sleeplessness, hormonal swings, and psychological factors as a woman undergoes this intense passage in her life. Once a woman has reached a menopausal state, however, depression is no more common than before, and women with a history of premenstrual depression often have significant mood improvement.

5) Sexuality . Sexual responsiveness tends to decline in most women after menopause, although other aspects of sexual function, including interest, frequency, and vaginal dryness vary. It is useful to remember that most symptoms of menopause eventually go away.

6) Forgetfulness . This appears to be one of the few symptoms that are common across most cultural and ethnic groups.

7) Urinary symptoms. During the menopause, you are more likely to experience recurrent lower urinary tract infections, such as cystitis. You may also feel an urgent and frequent need to pass urine.

8) vaginal dryness and pain, itching or discomfort during sex.

9) Joint stiffness .

10) Skin, Hair and Other Tissue Changes. With the increase in the age, you will experience changes in your skin and hair. Loss of fatty tissue and collagen will make your skin drier and thinner and will affect the elasticity and lubrication of the skin near your vagina and urinary tract. Reduced estrogen production may contribute to hair loss or cause your hair to feel brittle and dry.

Women from different countries and states have different menopausal symptoms. Menopause is not a disease. However, many conditions are associated with estrogen depletion, including heart disease, osteoporosis, and other complications. Fortunately, effective treatments are available for these conditions. After the menopause it is common for the following complications to appear.

Cardiovascular disease - a drop in estrogen levels often goes hand-in-hand with an increased risk of cardiovascular disease. Women who experience early menopause are almost twice as likely as the general population to have a heart attack, stroke, or other cardiovascular disease later in life. In order to reduce the risk of developing cardiovascular disease a woman should quit smoking, try to keep her cholesterol, blood sugar, and blood pressure within normal, healthy levels, do plenty of regular exercise, sleep at least 7 hours each night, and eat a well-balanced healthy diet.

Osteoporosis - Bone density may be lost at a fast rate for the first few years after menopause because estrogen plays a role in building new bone. The risk of fractures to the hip, wrist, and spine are especially pronounced in postmenopausal women.

Urinary incontinence - the menopause causes the tissues of the vagina and urethra to lose their elasticity, which can result in frequent, sudden, strong urges to urinate, followed by urge incontinence (involuntary loss of urine). Stress incontinence may also become a problem - urinating involuntarily after coughing, sneezing, laughing, lifting something, or suddenly jerking the body.

Urinary Tract Infections - Because of vaginal drying, women are at increased risk for recurrent urinary tract infections after menopause.

Low libido - this is probably linked to disturbed sleep, depression symptoms, and night sweats.

Overweight/obesity - during the menopausal transition women are much more susceptible to weight gain because metabolism slows. Experts say women may need to consume about 200 to 400 fewer calories each day just to prevent weight gain - or burn of that number of calories each day with extra exercise. The chances of becoming obese rises significantly after the menopause.

Breast cancer - women are at a higher risk of breast cancer after the menopause. Regular exercise and check ups after menopause significantly reduces breast cancer risk.

Skin and Hair Changes - Estrogen loss can contribute to slackness and dryness in the skin and wrinkles. Many women experience thinning of their hair and some have temporary hair loss.

Lifestyle Changes Changing and improving lifestyle is the basic factor in preventing 50% of ageing and metabolic diseases. Making lifestyle changes may help ease the discomfort of menopause symptoms. Simple changes in lifestyle and diet can help control menopausal symptoms such as hot flashes. Avoid hot flash triggers like spicy foods, hot beverages, caffeine, and alcohol. Dress in layers so that clothes can be removed when a hot flash occurs. For vaginal dryness, moisturizers, and non-estrogen lubricants are available. Quit smoking, get enough sleep, and make a conscious effort to eat healthily and exercise more to keep symptoms of menopause under wrap and keep yourself fit and healthy. One of the keys to enjoying menopause is to try to keep up a happy and healthy lifestyle. The right diet, open communication with your partner, and stress relief are examples of ways to make life the most easy in menopause.

How long will the phases of menopause lasts in women is completely individual. Most women experience the majority of their symptoms over a 2-year period of time’, but that will just annoy those women who find themselves still up to the eyeballs in hot flushes after 5 years. The average age when menopause is on is around 52 years old, but many women start in their 40s and some not until their late 50s, so really you just have to see what happens for you.

The ultimate aim is to give healthy lives in later age, to compressor illness in to short period of time, to reduce morbidity and disability of ageing women passing more than one third of their life in the menopausal age.

Rupal Hospital for Women is a premiere leader in women's healthcare since 45 long years. The doctors are committed to providing women with the highest quality and most advanced healthcare throughout all stages of their lives, from adolescence through menopause. Rupal clinic for women is providing special care to women around 35 years, Premenopausal, Menopausal and post menopausal ageing women. Dr. Malti Shah senior Gynecologist and obstetrician, qualified for Menopause Practice gives her services to the clinic. Rupal Hospital Menopause Clinic offers care for women with concerns about the menopause, including women with early menopause or menopause caused by surgery or illness. Rupal Hospital understands and meets all the health needs of a woman and fosters the understanding of how advanced health care can improve the lives of women and their families.

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Fibroids Treatment – Shrink your fibroids by angiography methods (Uterine Fibroid Embolisation) - No Surgery, Quick Recovery and Affordable Treatment.
Fibroids in uterus with symptoms can be treated without surgery by procedure called Uterine Fibroid Embolisation (UFE).
Advantages of Uterine Fibroid Embolisation (UFE)
1. It is performed under Local anaesthesia. Not General anaesthesia.
2. Requires only a needle puncture in skin (No surgical incision of abdomen).
3. Recovery is much shorter than from hysterectomy or open myomectomy.
4. You can walk after rest for 4 hrs. Within 3 days you can carry out routine activities.
5. No complications associated with surgical opening.
6. All fibroids are treated at once, which is not the case with myomectomy.
7. Uterine fibroid embolization involves virtually no blood loss or risk of blood transfusion.
8. Many women resume light activities in a few days and the majority of women are able to return to normal activities (including exercise) within a week. If the presenting complaint was excess vaginal bleeding, 87-90% of cases experience resolution within 24hours.
9. Emotionally, financially and physically benign procedure -embolization can have an overall advantage over other procedures as the uterus is not removed.


FAQ's
Q. What are the conditions that can be treated?
A.
1. Single / multiple Uterine Fibroids with symptoms.



Q. What are typical symptoms?
A.
1. Heavy, prolonged menstrual periods and unusual bleeding, sometime with clots.

2 .Lower abdomen pressure or heaviness


Q. Who is most likely to have uterine fibroids?
A. Uterine fibroids are very common, although, often they are very small and cause no problem. From 20% to 40 % of women aged 35 and older have uterine fibroids of a significant size.

Q. How are uterine fibroids diagnosed?
A. Sonography
Q. What is fibroid embolization?
A. UFE is performed by an interventional radiologist, a physician who is specially trained to perform this and other minimally invasive procedures. The doctor makes a needle puncture in the groin and inserts a catheter into an artery. The catheter is guided through the artery to the uterus while the interventional radiologist guide’s the progress of the procedure using X-ray. The interventional radiologist injects tiny particles the size of grains of sand into the artery that is supplying blood to the fibroid tumor. This cut off the blood flow and causes the fibroid to shrink. The artery on the other side of the uterus is then treated. This procedure is available at few hospitals.
Q. Which patient can go for fibroid embolization?
A. Patients who have single / multiple fibroids which are causing symptoms
Q. How successful is the fibroid embolization procedure?
A. Studies show that up to 94% of women who have the procedure experience significant or total relief of heavy bleeding, pain and other symptoms. The procedure also is effective for multiple fibroids. No re-growth of treated fibroids is observed.
Q. Are there risks associated with the treatment of fibroid tumors?
A. There are some associated risks, as there are with almost any medical procedure. Most women experience moderate pain and cramping in the first several hours following the fibroid embolization procedure. Some experience nausea and fever. These symptoms are controlled with antibiotics and pain medication. Less than 1% of the patients need myomectomy or hysterectomy to complete the removal of a persisting fibroid.
Q. What are the risks of Surgery for fibroids
A. Hysterectomy and myomectomy carry risks, including infection, bleeding leads to blood transfusion. Patients who undergo myomectomy may develop adhesions causing tissue and organs in abdomen to fuse together, which can lead to other problems. In addition, the recovery time is much longer generally one to two month.

SPIDER VEINS
What are spider veins?
Spider veins are tiny prominent blood vessels seen on the skin of legs. These are 0.5-1mm in size. Veins 1-3mm in size are called reticular veins. These veins occur in patches. Usually they do not cause any problems. Sometimes these veins can bleed, cause pain and irritation.

What investigations are done?
If you have too many spider veins doctor may do sonography of veins

What are the reasons for seeking treatment?
1. Bleeding from spider veins.
2. Pain and irritation
3. Itching
4. For cosmetic reasons if they are prominent

What is done for treatment?
Treatment is called “Sclerotherapy”. It is done on OPD basis. Doctor can give injections into these veins. They veins will swell up after treatment and then collapse over few days and then disappear.

What are the side effects of treatment?
The common side effect is pigmentation along the treated veins. This will fade away with creams most of the times.

Dear Friends,

An ancient Sanskrit saying says, woman is the home and the home is the basis of society. It is as we build our homes that we can build our country. If the home is inadequate–either inadequate in material goods and necessities or inadequate in the sort of friendly, loving atmosphere that every child needs to grow and develop–then that country cannot have harm ony and no country which does not have harmony can grow in any direction at all.
That is why women’s education is almost more important than the education of boys and men. We–and by “we” I do not mean only we in India but all the world–have neglected women education. It is fairly recent. Of course, not to you but when I was a child, the story of early days of women’s education in England, for instance, was very current. Everybody remembered what had happened in the early days.

Now, we have got education and there is a debate all over the country whether this education is adequate to the needs of society or the needs of our young people. I am one of those who always believe that education needs a thorough overhauling. But at the same time, I think that everything in our education is not bad, that even the present education has produced very fine men and women, specially scientists and experts in different fields, who are in great demand all over the world and even in the most affluent countries. Many of our young people leave us and go abroad because they get higher salaries, they get better conditions of work.

But it is not all a one-sided business because there are many who are persuaded and cajoled to go even when they are reluctant. We know of first class students, especially in medicine or nuclear energy for instance, they are approached long before they have passed out and offered all kinds of inducements to go out. Now, that shows that people do consider that they have a standard of knowledge and capability which will be useful any where in the world.

So, that is why I say that there is something worthwhile. It also shows that our own ancient philosophy has taught us that nothing in life is entirely bad or entirely good. Everything is somewhat of a mixture and it depends on us and our capability how we can extract the good, how we can make use of what is around us. There are people who through observation can learn from anything that is around them. There are others who can be surrounded by the most fascinating people, the most wonderful books, and other things and who yet remain quite closed in and they are unable to take anything from this wealth around them.
Our country is a very rich country. It is rich in culture, it is rich in many old traditions–old and even modern tradition. Of course, it has a lot of bad things too and some of the bad things are in the society–superstition, which has grown over the years and which sometimes clouds over the shining brightness of ancient thought and values, eternal values. Then, of course, there is the physical poverty of large numbers of our people. That is something which is ugly and that hampers the growth of millions of young boys and girls. Now, all these bad things we have to fight against and that is what we are doing since Independence.

But, we must not allow this dark side of the picture which, by the way, exists in every country in the world. Even the most rich country in the world has its dark side, but usually other people hide their dark sides and they try to project the shining side or the side of achievement. Here in India, we seem to want to project the worst side of society. Before anybody does anything, he has to have, of course, knowledge and capability, but along with it he has to have a certain amount of pride in what he or she is doing. He has to have self-confidence in his own ability. If your teacher tells, “You cannot do this,” even if you are a very bright student I think every time you will find, it will be more and more difficult for you to do it. But if your teacher encourages saying, “Go along you have done very good work, now try a little harder,” then you will try a little harder and you will be able to do it. And it is the same with societies and with countries.

This country, India, has had remarkable achievements to its credit, of course in ancient times, but even in modern times, I think there are a few modern stories, success stories, which are as fascinating as the success story of our country. It is true that we have not banished poverty, we have not banished many of our social ills, but if you compare us to what we were just about 60 years ago, I think that you will not find a single other country that has been able to achieve so much under the most difficult circumstances.

Today, we are passing through specially dark days. But these are not dark days for India alone. Except for the countries which call themselves socialist and about which we do not really know very much, every other country has the same sort of economic problems, which we have. Only a few countries, which have very small populations, have no unemployment. Otherwise, the rich countries also today have unemployment. They have shortages of essential articles. They have shortages even of food.

As I said, we do have many shortcomings, whether it is the government, whether it is the society. Some are due to our traditions because, as I said, not all tradition is good. And one of the biggest responsibilities of the educated women today is how to synthesise what has been valuable and timeless in our ancient traditions with what is good and valuable in modern thought. All that is modern is not good just as all that is old is neither all good nor all bad. We have to decide, not once and for all but almost every week, every month what is coming out that is good and useful to our country and what of the old we can keep and enshrine in our society. To be modern, most people think that it is something of a manner of dress or a manner of speaking or certain habits and customs, but that is not really being modern. It is a very superficial part of modernity.

Sometimes, I am very sad that even people who do science are quite unscientific in their thinking and in their other actions–not what they are doing in the laboratories but how they live at home or their attitudes towards other people. Now, for India to become what we want it to become with a modern, rational society and firmly based on what is good in our ancient tradition and in our soil, for this we have to have a thinking public, thinking young women who are not content to accept what comes from any part of the world but are willing to listen to it, to analyse it and to decide whether it is to be accepted or whether it is to be thrown out and this is the sort of education which we want, which enables our young people to adjust to this changing world and to be able to contribute to it.

Some people think that only by taking up very high jobs, you are doing something important or you are doing national service. But we all know that the most complex machinery will be ineffective if one small screw is not working as it should and that screw is just as important as any big part. It is the same in national life. There is no job that is too small; there is no person who is too small. Everybody has something to do. And if he or she does it well, then the country will run well.

In our superstition, we have thought that some work is dirty work. For instance, sweeping has been regarded as dirty. Only some people can do it; others should not do it. Now we find that manure is the most valuable thing that the world has today and many of the world’s economies are shaking because there is not enough fertilizer–and not just the chemical fertilizer but the ordinary manure, night-soil and all that sort of thing, things which were considered dirty.

Now it shows how beautifully balanced the world was with everything fitted in with something else. Everything, whether dirty or small, had a purpose. We, with our science and technology, have tried to–not purposely, but somehow, we have created an imbalance and that is what is troubling, on a big scale, the economies of the world and also people and individuals. They are feeling alienated from their societies, not only in India but almost in every country in the world, except in places where the whole purpose of education and government has to be to make the people conform to just one idea. We are told that people there are very happy in whatever they are doing. If they are told to clean the streets, well, if he is a professor he has to clean the streets, if he is a scientist he has to do it, and we were told that they are happy doing it. Well, if they are happy, it is alright.

But I do not think in India we can have that kind of society where people are forced to do things because we think that they can be forced maybe for 25 years, maybe for 50 years, but sometime or the other there will be an explosion. In our society, we allow lots of smaller explosions because we think that that will guard the basic stability and progress of society and prevent it from having the kind of chaotic explosion which can retard our progress and harmony in the country.

So, I hope that all of you who have this great advantage of education will not only do whatever work you are doing keeping the national interests in view, but you will make your own contribution to creating peace and harmony, to bringing beauty in the lives of our people and our country. I think this is the special responsibility of the women of India. We want to do a great deal for our country, but we have never regarded India as isolated from the rest of the world. What we want to do is to make a better world. So, we have to see India’s problems in the perspective of the larger world problems.

Jai Hind
Dr Sumit Dubey
New Delhi








* Courtesy Late Prime Minister Indira Gandhi ji

PUBLISHED IN OMAN MEDICAL JOURNAL, VOLUME 21, ISSUE 1 - MAY 2006