Heavy and painful periods

Heavy flows and achy cramps can be common experiences when many women have their periods. Periods that prevent you from doing everyday activities aren’t normal.

Each woman’s menstrual flow and cycle are different. It may be hard to know if your period is normal, light, or heavy unless you talk with your doctor.

Women lose an average of 30-40 ml of blood during a period. Women with heavy bleeding may potentially lose up to 80 mL.

Women who do experience abnormally heavy menstrual bleeding may have a condition called menorrhagia.

This condition causes flows so heavy you need to change your tampon or pad every hour. You may also use more than six or seven tampons a day.

This condition can cause anemia and severe cramps. You may also pass blood clots larger than a quarter during your period.

Because measuring your total blood loss is impractical, the best way to know if your period is unusually heavy is to talk with your doctor.

What causes a heavy period?

Several conditions can cause heavy periods. These heavy periods may occur frequently, or they may be more sporadic.

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A period that’s suddenly very heavy one month
Ectopic pregnancy

The signs and symptoms of an ectopic pregnancy may be confused with a heavy menstrual period.

This type of pregnancy develops outside your uterus and isn’t sustainable. It can cause severe health issues, including heavy bleeding and severe cramping. Left untreated, an ectopic pregnancy is life threatening.

Miscarriage

During and surrounding a miscarriage, heavy bleeding is common and may be mistaken for a very heavy period.

Non-hormonal intrauterine device (IUD)

Heavy menstrual bleeding is a common side effect of a non-hormonal IUD. After a few months with your IUD, you may find that bleeding becomes less severe.

Medications

Blood thinners can lead to blood flow problems and heavier menstrual flow.

A period that’s heavy on the first day

Many women experience heavier bleeding on the first day of a period and lighter bleeding on the last days. A heavy flow that might get in the way of your normal activities is unusual.

Birth control changes

If you recently stopped using hormonal birth control, your periods may be very heavy in the first days as your cycle adjusts to the hormone changes.

Medication changes

Like birth control, medications you take may interfere with your cycle and lead to heavy bleeding on the first day of your period.

A recurring period that’s heavy and painful

If every period is heavy, painful, and difficult to work around, you may have underlying, long-term issues.

Hormone problem

Your body typically balances progesterone and estrogen, the two hormones that play the biggest roles in menstruation.

Too much estrogen, however, can lead to a thickened uterine lining. This can cause heavy bleeding as the lining is eliminated during your period.

An underactive thyroid gland (hypothyroidism) may also cause heavy or irregular menstrual bleeding

Bleeding disorder

Roughly 10-30% of women with heavy periods have a bleeding disorder, such as von Willebrand disease. These disorders can make it difficult to stop your bleeding.

Uterine polyps

These small growths on the lining of the uterus can make periods heavier.

Uterine fibroids

Fibroids are noncancerous growths of the muscle tissue of the uterus. They can develop on the outside of the uterus, within the wall, or protrude into the cavity or some combination of these.

Certain cancers

Cancer in your uterus, cervix, and ovaries is rarely the sole cause of heavy bleeding, but a heavier period may be a symptom.

Perimenopause

During this transition before menopause, you may experience hormonal changes and unusually heavy bleeding during your period.

Childbirth recovery

After you have a baby, heavy periods aren’t uncommon. These changes may be permanent, or your period may return to a flow similar to what you had before getting pregnant.

Adenomyosis

Adenomyosis is a condition where endometrial tissue encroaches into the muscles of the uterus, causing thickening of the uterine wall and increased pain and bleeding.

Endometriosis

Endometriosis is a disorder in which tissue similar to your endometrial tissue grows outside of your uterine cavity. Symptoms include:

  • painful periods
  • lower back pain
  • heavy menstrual bleeding
When to see your Gynecologist?

If bleeding is so heavy that you must replace a pad or tampon every hour, talk with your doctor.

Likewise, if your period prevents you from doing normal activities because of pain, cramping, and heavy bleeding, it’s time to see your doctor.

During a visit, your doctor may:

  • conduct a physical exam
  • request your health history
  • request that your symptoms be recorded

They may also order a biopsy or imaging tests to look more closely at your uterus.

It’s difficult to know if your period is considered normal or heavy without your doctor’s help. They’ll be your guide in the process of figuring out if an underlying issue is the reason for your heavy periods.

Dr. Ruchi Tandon is a Gynecologist practicing in South Delhi, in leading hospitals, namely, Max Smart superspeciality hospital and Apollo hospitals. She has over 13 years of clinical experience in handling painful and heavy periods.

Vaginal infections – how to diagnose and treat

Vaginitis describes a few conditions that can cause infection or inflammation of your vagina. vulvovaginitis describes inflammation of both your vagina and your vulva. Your vulva is the external part of your genitals.

Read on to learn more about what causes different types of vaginal infections and what you can do about it.

What should I look for with a vaginal infection?

Some vaginal infections may not produce any symptoms. If you do develop symptoms, the most common are:

  • Vaginal itching
  • a change in the amount of discharge from your vagina
  • a change in the colour of your vaginal discharge
  • Pain or burning during mictutition
  • Pain during intercourse
  • Vaginal bleeding or spotting

The symptoms of vaginal infections will also vary based on the cause of your infection:

  • Bacterial infections typically cause grayish-white or yellow discharge. This discharge may have a fish-like odor that’s easily noticed after sex.
  • Yeast infections typically produce itching. If discharge is present, it may be thick and white and look like cottage cheese.
  • Trichomoniasis is a condition that can produce vaginal itching and odor. Discharge from this infection is typically greenish-yellow and may be frothy.

Vaginal infections aren’t life-threatening conditions. However, you should make an appointment to see your doctor if you:

  • have never had a vaginal infection before
  • have had a vaginal infection but are experiencing new symptoms
  • have had different or new sexual partners
  • develop a fever
  • believe you may be pregnant
  • have symptoms that return after treatment

If you experience vaginal irritation and have been diagnosed with yeast infections in the past, you may not need to see your doctor.

Yeast infections can be treated at home with over-the-counter vaginal antifungal medications. However, if you’re not sure that you have a yeast infection, it’s always wise to check with your doctor.

What causes vaginal infections?

Vaginal infections can have several causes. If you develop a vaginal infection, your doctor will diagnose and treat your infection based on its cause.

Common causes of vaginal infections include:

  • Bacterial infections. Certain bacteria are commonly found in your vagina. An overgrowth of these bacteria can cause bacterial vaginosis.
  • Yeast infections. Yeast infections are usually caused by a fungus called Candida albicans. Many things, including antibiotics, can reduce the number of antifungal bacteria in your vagina. This reduction can lead to an overgrowth of fungi and cause an infection.
  • Trichomoniasis. This vaginal infection is caused by a protozoan parasite that can be contracted through sexual intercourse.
  • Vaginal atrophy. This condition commonly occurs after menopause. It can also develop during other times in your life when your estrogen levels decline, such as while breastfeeding. Reduced hormone levels can cause vaginal thinning and dryness. These can lead to vaginal inflammation.
  • Irritants. Soaps, body washes, perfumes, and vaginal contraceptives can all irritate your vagina. This can cause inflammation. Tight-fitting clothes may also cause heat rashes that irritate your vagina.

In some cases, your doctor may not be able to determine the cause of your vaginal infection. This condition is known as nonspecific vulvovaginitis. It can occur in women of any age, but it’s more common in young girls that haven’t entered .

How are vaginal infections diagnosed?

To diagnose a vaginal infection, your doctor will ask you about your health history. They’ll also typically ask about your sexual health such as your current number of sexual partners and your history of past vaginal infections sexually transmitted infections ( STD).

Your doctor may also perform a pelvic exam. During this exam, your doctor may collect a sample of vaginal discharge. They’ll send this sample to a laboratory for analysis. This can help your doctor learn what’s causing your infection.

How are vaginal infections treated?

Treatment for vaginal infections will depend on what’s causing your infection. For example:

  • Metronidazole tablets, cream, or gel, or clindamycin cream or gel may be prescribed for a bacterial infection.
  • Antifungal creams or suppositories may be prescribed for a yeast infection.
  • Metronidazole or tinidazole tablets may be prescribed for trichomoniasis.
  • Estrogen creams or tablets may be prescribed for vaginal atrophy.

If your infection is caused by an irritant, such as soap, your doctor will recommend a different product to reduce irritation.

How can you prevent vaginal infections?

Not all vaginal infections can be prevented. Using a condom during sexual intercourse will help prevent the spread of STIs. It will also lower your risk of contracting them.

Proper hygiene can also help prevent some vaginal infections.

When possible, you should wear cotton underwear and pantyhose with a cotton crotch. This can lower your risk of developing vaginal inflammation and irritation. Some women develop inflammation and irritation from wearing less breathable fabrics.

Dr. Ruchi Tandon is a Gynecologist practicing in South Delhi , in leading hospitals , Max Smart superspeciality hospital and Apollo hospitals. She has experience of over 13 years in treatment of vaginal infections.

Fibroids in the time of covid pandemic

What are fibroids?

Fibroids are abnormal growths that develop in or on a woman’s uterus. Sometimes these tumors become quite large and cause severe abdominal pain and heavy periods. In other cases, they cause no signs or symptoms at all. The growths are typically benign, or noncancerous. The cause of fibroids is unknown.

Fibroids are also known by the following names:

  • leiomyomas
  • myomas
  • uterine myomas
  • fibromas
What are the different types of fibroids?

The type of fibroid a woman develops depends on its location in or on the uterus.

Intramural fibroids

Intramural fibroids are the most common type of fibroid. These types appear within the muscular wall of the uterus. Intramural fibroids may grow larger and can stretch your womb.

Subserosal fibroids

Subserosal fibroids form on the outside of your uterus, which is called the serosa. They may grow large enough to make your womb appear bigger on one side.

Pedunculated fibroids

Subserosal tumors can develop a stem, a slender base that supports the tumor. When they do, they’re known as pedunculated fibroids.

Submucosal fibroids

These types of tumors develop in the middle muscle layer, or myometrium, of your uterus. Submucosal tumors aren’t as common as the other types.

What causes fibroids?

It’s unclear why fibroids develop, but several factors may influence their formation.

Hormones

Estrogen and progesterone are the hormones produced by the ovaries. They cause the uterine lining to regenerate during each menstrual cycle and may stimulate the growth of fibroids.

Family history

Fibroids may run in the family. If your mother, sister, or grandmother has a history of this condition, you may develop it as well.

Pregnancy

Pregnancy increases the production of estrogen and progesterone in your body. Fibroids may develop and grow rapidly while you’re Pregnant..

Who gets fibroids?

Fibroids are common, with around 1 in 3 women developing them at some point in their life. They most often occur in women aged 30 to 50.

Fibroids are thought to develop more frequently in women of African-Caribbean origin.

It’s also thought they occur more often in overweight or obese women because being overweight increases the level of oestrogen in the body.

Women who have had children have a lower risk of developing fibroids, and the risk decreases further the more children you have.

What are the symptoms of uterine fibroids?

Most women with fibroids will experience no symptoms at all. However, large or numerous fibroids can cause the following symptoms:  

  • Heavy or prolonged periods
  • Bleeding between periods
  • Pelvic pain and pressure
  • Frequent urination
  • Low back pain
  • Pain during intercourse
  • Difficulty getting pregnant
How are uterine fibroids diagnosed?

Fibroids are most often found during a physical exam. Your health care provider may feel a firm, irregular (often painless) lump during an abdominal or pelvic exam.

Scans can confirm a diagnosis. These tests are the two main options:

  • Ultrasound: Ultrasound is the most commonly used scan for fibroids. It uses sound waves to diagnose fibroids and involves frequencies (pitch) much higher than what you can hear. A doctor or technician places an ultrasound probe on the abdomen or inside the vagina to help scan the uterus and ovaries. It is quick, simple and generally accurate. However, it relies on the experience and skill of the doctor or technician to produce good results.  Other tests such as MRI may be better for other conditions, such as adenomyosis.
  • MRI: This imaging test uses magnets and radio waves to produce images. It allows your provider to gain a road map of the size, number and location of the fibroids. We can also distinguish between fibroids and adenomyosis, which sometimes gets misdiagnosed. We use MRI to confirm a diagnosis and help determine which treatments are best for you. MRI may also provide a better option for related conditions such as adenomyosis.

 How to manage fibroids in covid pandemic times?

Laparoscopy and open myomectomy are both options in covid pandemic depending on the extent of symptoms and position of the fibroid.

Dr. Ruchi Tandon is a Gynecologist, practicing in leading hospitals of South Delhi , max smart superspeciality hospital and Apollo Cradle Royale , with over 14 years experience in handling all kinds of fibroids and complications.

Endometriotic or chocolate cyst of the ovary

Chocolate cysts are noncancerous, fluid-filled cysts that typically form deep within the ovaries. They get their name from their brown, tar-like appearance, looking something like melted chocolate. They’re also called ovarian endometriomas.

The color comes from old menstrual blood and tissue that fills the cavity of the cyst. A chocolate cyst can affect one or both ovaries, and may occur in multiples or singularly.

Chocolate cysts occur in 20-40 percent of women who have endometriosis, estimates the Endometriosis Foundation of America.

Endometriosis is a common disorder in which the lining of the uterus, known as the endometrium, grows outside the uterus and onto the ovaries, fallopian tubes, and other areas of the reproductive tract. The overgrowth of this lining causes severe pain and sometimes infertility.

Chocolate cysts are a subgroup of endometriosis. They’re often associated with more severe forms of the disorder.

What are the symptoms?

Chocolate cysts may cause symptoms in some women. Other women may not experience any symptoms.

The size of the cyst also doesn’t necessarily affect the severity or presence of symptoms. This means a woman with a small cyst may experience symptoms, while someone with a large one may not. Cysts can range from 2 to 20 centimeters (cm) in size.

When symptoms do occur, they’re similar to those of endometriosis. They can include:

  • painful, crampy periods
  • Pelvic pain not related to your menstrual cycle
  • Irregular periods
  • Pain during sex
  • infertility for some women

If a chocolate cyst ruptures, it can cause severe, sudden abdominal pain on the side of the body where the cyst is located. A ruptured cyst can be a medical emergency. Seek immediate medical attention if you suspect you have a ruptured cyst.

What causes chocolate cysts?

There’s a lot of debate as to how and why chocolate cysts form. One theory is that they may be a result of endometriosis.

The lining of these cysts acts much the way the lining of the uterus does. It grows and is then shed in response to the monthly rise and fall of female hormones.

Instead of leaving the body, this tissue becomes trapped within the cavity of the cyst. Here it can produce inflammation and disrupt the ovaries.

How are chocolate cysts diagnosed?

Your doctor may order a pelvic ultrasound if:

  • they feel a cyst during a pelvic exam
  • they suspect you have endometriosis based on your symptoms
  • you’re experiencing unexplained infertility

An ultrasound can identify if a cyst is present. But it can’t necessarily determine what type of cyst it is.

To definitively diagnose a chocolate cyst, your doctor will extract fluid and debris from inside the cyst. This is usually done with a needle biopsy.

During a needle biopsy, your doctor will use ultrasound to help them insert a needle through the vagina into the ovarian cyst. The extracted fluid is then examined under a microscope. Your doctor can diagnose the type of cyst using the results from the needle biopsy.

How are chocolate cysts treated?

Treatment will depend on several factors, including:

  1. your age
  2. your symptoms
  3. whether one or both ovaries are affected
  4. whether or not you want to have children

If the cyst is small and not producing symptoms, your doctor may advise a watch-and-wait approach. They may also recommend medication that inhibits ovulation, such as the birth control pill. This can help control pain and slow the growth of cysts, but it can’t cure them.

Surgery to remove the cysts, called an ovarian cystectomy, is often recommended for women who have:

  1. painful symptoms
  2. cysts larger than 4 cm
  3. cysts that may be cancerous (but a 2006 review estimates less than 1 percent of cysts are cancerous)
  4. infertility

The surgery is generally done via a laparoscope. A laparoscope is a thin, long tube with a light and camera on the end that helps doctors perform the procedure. It’s inserted through a small incision.

The surgery is controversial in terms of whether it hurts or helps fertility.

Even when the surgeon is highly skilled, healthy ovarian tissue can be removed along with the cyst. That may negatively affect ovarian function. However, the inflammation and toxic environment a chocolate cyst can produce may do more harm to fertility than surgery.

Discuss all of your options and concerns with your Gynecologist before beginning treatment.

Dr. Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi, namely, Max Smart superspeciality hospital, saket, Apollo cradle Royale and is skilled in handling endometriotic or chocolate cysts.

Exercises and physical activity for Pregnancy and normal delivery

Suitable activities during pregnancy are brisk walking, swimming, indoor stationary cycling, prenatal yoga, and low-impact aerobics, guided by a certified aerobics instructor.

Some special exercises can help prepare for labor.

These carry little risk of injury, they benefit the entire body, and they can continue until delivery.

  1. Brisk walking

If pre-pregnancy exercise levels were low, a quick stroll around the neighborhood is a good way to start.

This will provide a cardiovascular workout without too much impact on the knees and ankles. It can be done for free, almost anywhere, and at any time during pregnancy.

Safety tip: As pregnancy progresses, your center of gravity changes, and you can lose your sense of balance and coordination.

Choose smooth surfaces, avoid potholes, rocks, and other obstacles, and wear supportive footwear.

  1. Swimming

Swimming and exercising in water give a better range of motion without putting pressure on the joints. The buoyancy offered by the water may offer some relief from the extra weight.

Swimming, walking in water, and aqua aerobics offer health benefits throughout pregnancy.

Safety tip: Choose stroke feels comfortable, and that does not strain or hurt your neck, shoulders, or back muscles, for example, breaststroke. A kickboard can help strengthen the leg and buttock muscles.

Safety tips:

  • Use the railing for balance when entering the water, to prevent slipping.
  • Avoid diving or jumping, as this could impact the abdomen.
  • Avoid warm pools, steam rooms, hot tubs, and saunas, to minimize the risk of overheating.
  1. Stationary cycling

Cycling on a stationary bike, also called spinning, is normally safe even for first-time exercisers. It helps raise the heart rate without putting too much stress on the joints.

The bike helps support body weight, and, because it is stationary, the risk of falling is low.

Later in pregnancy, a higher handlebar may be more comfortable.

  1. Yoga

Prenatal yoga classes keep the joints limber and help maintain flexibility.

Yoga strengthens muscles, stimulates blood circulation, and enhances relaxation. These may contribute to a healthy blood pressure during pregnancy.

The techniques learnt in yoga class can also help you to stay calm and in control during labor.

Safety tip: As pregnancy progresses, skip positions that could cause you to overbalance.

From the second semester, it is better to avoid poses that involve lying on the abdomen or flat on the back.

Lying on the back can cause the weight of the fetus and the uterus to put pressure on major veins and arteries and decrease blood flow to the heart.

It can be tempting to overstretch, as the hormone relaxin increases flexibility and joint mobility during pregnancy. Overstretching could lead to injury.

  1. Low-impact aerobics

Aerobic exercise strengthens the heart and lungs and helps maintain muscle tone. Low-impact aerobics excludes jumping, high kicks, leaps, or fast running.

In low-impact exercise, one foot should stay on the ground at all times.

Compared with high-impact aerobics, the low-impact option:

  • limits stress on the joints
  • helps maintain balance
  • reduces the risk of weakening the pelvic floor muscles

A weak pelvic floor increases the chances of urine leakage.

Some aerobics classes are designed especially for pregnant women. This can be a good way to meet other pregnant women, as well as exercising with an instructor who is trained to meet your specific needs.

Women who already attend a regular aerobics class should let the instructor know that they are pregnant so they can modify exercises and advise about suitable movements.

  1. Preparing for labor: Squatting and pelvic tilts

Brisk walking instead of jogging can reduce pressure on the lower back.

The American Pregnancy Association recommends some exercises specifically for pregnancy, as they prepare the body for labor and delivery.

Squatting: During labor, squatting may help to open the pelvis, so it may be a good idea to practice during pregnancy.

  • Stand with the feet flat on the floor, shoulder-width apart, and the back straight.
  • Lower yourself slowly, keeping your feet flat and your knees no further forward than your feet.
  • Hold for 10 to 30 seconds, then slowly push up.

Pelvic tilts: These can strengthen the abdominal muscles and help reduce back pain.

  1. Go down on the hands and knees.
  2. Tilt the hips forward and pull the abdomen in, arching the back.
  3. Hold for a few seconds.
  4. Release, and let the back drop.
  5. Repeat this up to 10 times.

Dr.Ruchi Tandon is a Gynecologist and Obstetrician , with over 13 years of clinical experience in handling pregnancies and normal deliveries. She is practicing in Max Smart superspeciality hospital, saket and Apollo hospitals, Delhi.