About dysmenorrhea

Menstruation occurs when the uterus sheds its lining once a month. Some pain, cramping, and discomfort during menstrual periods is normal. Excessive pain that causes you to miss work or school is not.

Painful menstruation is also called dysmenorrhea. There are two types of dysmenorrhea: primary and secondary.

Primary dysmenorrhea occurs in people who experience pain before and during menstruation. If you’ve had normal periods that become painful later in life, it may be secondary dysmenorrhea. A condition affecting the uterus or other pelvic organs, such as endometriosis or uterine fibroids, can cause this.

What are the causes?

It’s not always possible to identify the cause of painful menstrual periods. Some people are just at a higher risk of having painful periods.

These risks include:

• being under age 20
• having a family history of painful periods
• smoking
• having heavy bleeding with periods
• having irregular periods
• never having had a baby
• reaching puberty before age 11

A hormone called prostaglandin triggers muscle contractions in your uterus that expel the lining. These contractions can cause pain and inflammation. The level of prostaglandin rises right before menstruation begins.

Painful menstrual periods can also be the result of an underlying medical condition, such as:

• Premenstrual syndrome or PMS is a common condition that’s caused by hormonal changes in the body occurring 1 to 2 weeks before menstruation begins. Symptoms typically go away after bleeding begins.
• Endometriosis .This is a painful medical condition in which cells from the lining of the uterus grow in other parts of the body, usually on the fallopian tubes, ovaries, or tissue lining the pelvis.
• Fibroids are noncancerous tumors that can put pressure on the uterus or cause abnormal menstruation and pain, though they often don’t cause symptoms.
• Pelvic inflammatory disease. PID is an infection of the uterus, fallopian tubes, or ovaries often caused by sexually transmitted bacteria that cause inflammation of the reproductive organs and pain.
• This is a rare condition in which the uterine lining grows into the muscular wall of the uterus, causing inflammation, pressure, and pain. It can also cause longer or heavier periods.
• Cervical stenosis. Cervical stenosis is a rare condition in which the cervix is so small or narrow that it slows menstrual flow, causing an increase of pressure inside the uterus that causes pain.

Home treatment

At-home treatments can be helpful in relieving painful menstrual periods. Types of things to try at home include:

using a heating pad on your pelvic area or back

massaging your abdomen

taking a warm bath

doing regular physical exercise

eating light, nutritious meals

practicing relaxation techniques or yoga

taking anti-inflammatory medications such as ibuprofen several days before you expect your period

taking vitamins and supplements such as:

• Vitamin B6
• Vitamin B1
• Vitamin E
• Omega 3 fatty acid
• Calcium
• Magnesium
• raising your legs or lying with your knees bent
• reducing your intake of salt, alcohol, caffeine, and sugar to prevent bloating

Dr. Ruchi Tandon, is a specialist Gynecologist , practicing in leading hospitals in South Delhi namely Max Smart superspeciality hospital ,saket, Apollo hospitals , with over 13 years experience in handling all kinds of period problems.

The vulva (Latin for womb or covering) consists of several layers that cover and protect the sexual organs and urinary opening. The fleshy outer lips of the vulva — the labia majora — are covered with pubic hair and contain fat that helps cushion the area. Inside the labia majora are the thinner, more pigmented and delicate flaps of skin called the labia minora. The labia minora join at the top to enclose the clitoris. The labia majora, labia minora, and clitoris are made up of erectile tissue, that is, tissue that can become engorged with blood.

The area between the labia minora, the vestibule, contains the openings to the urethra and the vagina, as well as the Bartholin’s glands, which are located on either side of the vaginal opening and produce lubricant for the vestibule. The flesh between the vaginal opening and the anus (not part of the vulva but often involved in vulvar skin problems) is the perineum. This is where the incision called an episiotomy is sometimes made during childbirth.

Getting a diagnosis for vulva skin conditionsVulvar skin conditions are highly treatable, but the treatment depends on the specific cause. And identifying the underlying diagnosis can be very challenging.

Tell your clinician about any other past or present medical conditions (including bladder and bowel issues) and any skin problems elsewhere on your body. For example, psoriasis anywhere on the body raises the risk of a vulvar condition known as lichen sclerosus. (This condition and others are described, below, in “Vulvar conditions and their treatment.”) Crohn’s disease, a chronic inflammatory intestinal disease, may cause abscesses or draining fistulas in the vulvar area, and vulvar skin problems are often one of its early symptoms. A mouth condition called lichen planus is another cause of vulvovaginal problems. (The term “lichen,” as applied to skin disorders, refers fancifully to skin lesions that resemble lichen on rocks.) Long-term treatment with oral steroids, immune suppressants, or antibiotics can affect vulvar skin and raise the risk infection.

Your clinician will want to know how you care for your vulvar skin, which can help identify possible sources of irritation. Even if you can’t pinpoint a change, that doesn’t mean your standard routine isn’t the culprit. Sometimes vulvar problems are the cumulative effect of long-term practices.

It’s often what you’ve done day after day, year after year, that causes the problem. If you wear abrasive clothing and engage in abrasive activities like bicycling or spinning class and wear tight workout clothes that expose your vulva to sweat or to detergent or soap residue, eventually it might catch up with you.

Report all the symptoms that concern you, including itching, burning, soreness, discharge, bumps, and any rashes the vulva. It will also help if you can provide a history of your symptoms and recall what seems to make them better or worse. Your clinician will examine the vulva, perhaps using a magnifying glass, and insert a speculum to inspect the vagina. She or he may test the pH (acid-base balance) of the vagina and take samples of secretions to examine under the microscope or culture for yeast. Remember, even if you’re seeing an experienced clinician, several visits may be needed to diagnose and improve certain vulvovaginal conditions.

The problem with self-treatment

When vaginal or vulvar itching occurs, women usually assume it’s a yeast infection and treat it with an over-the-counter antifungal cream. Often this does the trick, but not always. Instead, the cause of the symptoms might be dry skin, a sexually transmitted disease or bacterial infection, a less common strain of yeast that required special medication, or irritation by and allergic reactions to common products such as soaps, creams, and lotions.

If yeast isn’t the problem, an antifungal cream isn’t the solution. And if your skin is already irritated, you may exacerbate the problem by introducing preservatives (such as alcohol or propylene glycol) and other ingredients contained in many antifungal remedies. That’s why it’s important to see your gynecologist or dermatologist if a problem persists after you’ve tried a standard antifungal cream.

Another common response of women faced with a vaginal discharge or itch is to wash the vulvar skin vigorously, on the assumption that this will disinfect the area or remove irritants. But aggressive cleansing can add to the irritation. Until the problem is diagnosed, it’s best to follow a gentle skin care routine (see “Gentle vulvar care”). In fact, gentle cleansing applies whether you have a vulvar skin condition or not: Wash the area gently with your fingertips or a soft cloth and pat dry with a soft towel. Don’t use a rough washcloth, and don’t rub.

Vulvar skin conditions and their treatment

Several vulvar skin conditions are familiar from other areas of the body but may be difficult to recognize when they appear on the vulva. These include the following:

Eczema. This inflammatory skin condition disrupts the skin’s surface, causing red patches and thin cracks, weeping, and crust formation. On the vulva, crusts are less likely, but eczema may initiate a cycle of vulvar itching and scratching that leads to lichen simplex chronicus — thickened and intensely itchy skin. If eczema affects an area of the vulva called the vestibule, it may cause stinging and burning. Sometimes eczema appears in early childhood and its cause is unknown. More often, it begins with exposure to an irritant or allergen (see “How irritating”).

To diagnose vulvar ecz

Many things can cause an allergic reaction or irritate vulvar skin. Here are some of the leading suspects:

Irritants (on exposure, can cause immediate stinging or burning)

• Soap, bubble baths and salts, detergent, shampoo, conditioner
  Adult or baby wipes
  Panty liners and their adhesives
  Nylon underwear, chemically treated clothing
  Vaginal secretions, sweat, and urine
  Douches, yogurt
  Spermicides, lubricants
  Perfume, talcum powder, deodorants
  Alcohol and astringents

Allergens (symptoms may not appear until several days after exposure)

• Benzocaine
  Neomycin
  Chlorhexidine (in K-Y Jelly)
  Imidazole antifungal
  Propylene glycol (a preservative used in many products)
  Fragrances
  Tea tree oil
  Latex (in condoms and diaphragms)

Adapted from The V Book, by Elizabeth G. Stewart, M.D., and Paula Spencer (Bantam Books, 2002).

ema, the clinician will ask about your symptoms; your history of eczema, allergy, and related conditions; your vulvar cleansing habits; and any products the vulva has been exposed to. During the exam, she or he will look for redness, scaling, cracking, and thickening.

All eczema requires gentle skin care. In simple cases, patients use topical corticosteroid ointments twice a day for two to four weeks and then gradually reduce the frequency until the symptoms are gone. Severe cases may require a short course of a potent corticosteroid ointment.

During treatment, you must stop scratching, so your clinician may prescribe an antihistamine (usually taken at night to prevent daytime drowsiness). A cold pack can also help relieve itching.

Dr. Ruchi Tandon is a Gynecologist, practicing in leading hospitals in South Delhi namely, Max Smart superspeciality hospital, saket and Apollo hospitals. She has experience of over 13 years in handling all vulval skin lesions.

The COVID-19 crisis has starkly revealed the patchy and precarious provision of abortion in India, deepening existing inequalities in access.

What was already an expensive procedure may be even less attainable for many women facing financial strain during the pandemic.

Meanwhile, a shortage of staff and resources is likely to be affecting access for many women seeking an abortion – particularly those in regional and rural areas.

This all comes at a time when advocates predict unwanted pregnancies could rise due to increased rates of domestic violence, reproductive coercion and financial stress.

A shortage of resources

In April, suppliers cancelled orders of personal protective equipment (PPE) to abortion clinics on the basis these supplies were reserved for “health professionals”.

Suppliers might be forgiven for assuming medical procedures relegated to the private sector are elective.

While the federal government confirmed abortion was “essential” during the halt on elective procedures, they didn’t offer much support. Instead they told clinics to source PPE supplies from Chemist Warehouse.

Although the supply of PPE to abortion clinics is no longer under immediate threat, the industry continues to face resource constraints.

This includes a shortage of providers.

Lack of access in regional and rural areas

Abortion is one of the most commonly performed Gynecological procedures, and early medical abortion should be readily available in primary care settings.

But abortion care is not integrated into medical education or training. The shortage of Gynecologists trained and willing to provide surgical abortion, and the failure of governments to require public hospitals to take responsibility for local provision, means abortion is virtually inaccessible in much of rural and regional India.

The few clinics that offer surgical abortion outside urban centers often depend on general practitioners, who rely on domestic air travel to deliver abortion care.

The provision of second trimester abortions is in such short supply in India that this single private clinic services women from across the country.

Women may require abortion after 20 weeks for a range of reasons, including maternal health, fetal abnormalities, and delayed diagnosis of pregnancy.

Many of these women, we can assume, are also affected by travel restrictions.

We could be doing more via telehealth

Early medical abortion can be delivered via telehealth. In this scenario, medications are mailed to the patient after some local tests and a remote consultation with a doctor via phone or video call. This method is especially appropriate now as we continue to practice social distancing.

India says it has protected abortion as an essential service in the coronavirus lockdown but experts say women are struggling to get medical help and may resort to risky alternatives or end up with babies they do not want.

With no transport services, limited healthcare and movement restricted, campaigners predict the Covid-19 crisis could push women to take abortion drugs without supervision or seek help from people who lack training.

In life after lockdown, experts fear a lasting legacy. “Unsafe practices such as women taking herbs or inserting rods and sticks has reduced drastically and that situation will never come back in India,” said researchers. “But it will have to be researched post lockdown if the number of unwanted births go up.”

Dr. Ruchi Tandon is a trained and certified Gynecologist, practicing in leading hospitals in South Delhi namely Max Smart superspeciality hospital saket and Apollo hospitals.She has over 13 years experience in handling pregnancies and abortions and is doing telephonic consultantions as well.

What is menorrhagia?

Menorrhagia is a heavy or prolonged menstrual bleeding. Many women have this type of abnormal uterine bleeding. It can be related to a number of conditions including problems with the uterus, hormone problems, or other rare conditions. While heavy bleeding can make it tough to take part in normal daily life at times, there are treatments to help.

What causes menorrhagia?

During your menstrual cycle, if an egg is not fertilized, the uterine lining breaks down, and bleeds. The egg and the uterine lining are then shed during your period.

Hormone problems or conditions that affect the uterus can result in heavy bleeding. Other diseases or bleeding disorders can also cause it.

Hormone problems include:

• Imbalance of estrogen and progesterone or other hormones

Problems with the uterus include:

• Fibroids (non cancerous)
• Cancer
• Pregnancy problems (such as a miscarriage or ectopic pregnancy)
• Use of an intrauterine device (IUD)

Other conditions such as thyroid, kidney or liver disease, cancer or bleeding disorders can also cause heavy bleeding.

What are the symptoms of menorrhagia?

If you have to change your pad or tampon every 1 to 2 hours because it is soaked, or bleed longer than 7 days, see your doctor. Spotting or bleeding between periods is also a sign of a problem.

The symptoms of menorrhagia may look like other conditions or medical problems. Always consult your healthcare provider for a diagnosis.

How is menorrhagia diagnosed?

Your healthcare provider will ask you about your medical history and about your periods. You will also have a physical exam including a pelvic exam. You may be asked to keep track of your periods and how many pads or tampons you use for a few months if you haven’t already done so.

• Blood tests. These check for anemia and test how fast your blood clots.
• Pap test. For this test, cells are collected from the cervix and examined. It’s used to check for cancerous changes, infection, or inflammation.
• Ultrasound. Using sound waves and a computer, your healthcare provider can check for fibroids or other problems inside the uterus.
• Biopsy. Examining a tissue sample from the uterine lining can help your healthcare provider find cancer or other abnormal tissue.

Other tests include:

• Hysteroscopy. Using a viewing instrument inserted through the vagina, your healthcare provider can see the cervix and the inside of the uterus.
• Dilation and curettage (D&C).This procedure involves scraping and then examining the uterine cavity.

Treatment

Treatment of menorrhagia depends on the individual case.

Drug therapy includes:

• Iron supplements to treat anemia
• Tranexamic acid, or Lysteda, taken at the time of bleeding to help reduce blood loss
• Oral contraceptives to regulate the menstrual cycle and decrease bleeding duration and quantity
• Oral progesterone to treat hormonal imbalance and reduce bleeding
• Hormonal IUD to thin the lining of the uterus, reducing bleeding and cramping

In women who have a bleeding disorder, such as von Willebrand’s disease or mild hemophilia, Desmopressin nasal spray, or Stimate can boost the levels of blood-clotting proteins.

Nonsteroidal anti-inflammatories, such as ibuprofen, or Advil, can be used to treat dysmenorrhea, or painful menstrual cramps, and they can help reduce blood loss. However, NSAIDS can also increase the risk of bleeding.

Surgical interventions

A number of surgical procedures are available to treat or relieve the symptoms of menorrhagia.

• Dilation and curettage (D&C) is a surgical procedure for scraping the lining of the uterus
• Uterine artery embolization treats fibroids, a cause of menorrhagia, by blocking arteries that feed them
• Hysteroscopy involves inserting a camera into the uterus to evaluate the lining, assisting in the removal of fibroids, polyps, and the uterine lining.
• Focused ultrasound ablation uses ultrasonic waves to kill fibroid tissue.
• Myomectomy is a surgical intervention to remove uterine fibroids through several small abdominal incisions, an open abdominal incision, or through the vagina.
• Endometrial ablation permanently destroys the lining of the uterus.
• Endometrial resection uses an electrosurgical wire loop to remove the uterine lining.
• Hysterectomy removes the uterus and cervix, and, sometimes, the ovaries.

The choice of intervention will take into account the cause and extent of the condition, the age and health of the patient, and their personal preference and expectations.

Dr.Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi and Greater Kailash.

What is stress incontinence?

Stress incontinence is the inability to control your urge to urinate in certain circumstances. It’s a serious and embarrassing disorder and can lead to social isolation. Any pressure placed on the abdomen and bladder can lead to the involuntary loss of urine.

It’s important to remember that the term “stress” is used in a strictly physical sense when describing stress incontinence. It refers to excessive pressure on the bladder and not emotional stress.

An overactive bladder is a separate condition. In some cases, both overactive bladder and stress incontinence can occur, which is called mixed incontinence. Your Gynecologist can do tests to determine which is causing your incontinence.

Anatomy of the bladder

Your bladder is supported by a varied system of muscles:

• The sphincter encircles the urethra, the tube that carries urine outside of your body.
• The detrusor is the muscle of the bladder wall, which allows it to expand.
• The pelvic floor muscles help support the bladder and the urethra.

To hold urine inside your bladder without leakage, you need to be able to contract your sphincter. When your sphincter and pelvic muscles are weak, it’s more difficult to contract these muscles and the result is called as stress incontinence.

Stress incontinence symptoms

The main symptom of stress incontinence is the loss of bladder control during physical activity. You may experience a few drops of urine or a large, involuntary flow. This can happen while you are:

• laughing
• sneezing
• coughing
• jumping
• exercising
• doing heavy lifting
• engaging in sexual intercourse

Sometimes even standing up from a seated or reclining position can put additional pressure on your bladder and cause a leakage. Stress incontinence is unique for every individual. You may not show symptoms every time you participate in an activity, and the same activities that cause leakage for you may not affect another person with stress incontinence.

Who suffers from stress incontinence?

Women are twice as likely as men to suffer from involuntary leakage. The most common causes of stress incontinence among women are pregnancy and childbirth, especially having multiple vaginal deliveries. During pregnancy and childbirth, the sphincter and pelvic muscles stretch out and are weakened.

Older age and conditions that cause a chronic cough can also cause stress incontinence. This condition can also be a side effect of pelvic surgery.

Some women only suffer from stress incontinence during the week before they get their period. Various studies explain that estrogen drops during this phase of the menstrual cycle, which can weaken the urethra. This is not common though.

Other risk factors for stress incontinence include:

• smoking due to chronic cough
• any other condition associated with chronic cough
• excessive caffeine and alcohol use
• obesity
• constipation
• long-term participation in high-impact activities

Treatment

Your Gynecologist may recommend a combination of treatment strategies to end or lessen the number of incontinence episodes. If an underlying cause or contributing factor, such as a urinary tract infection, is identified, you’ll also receive treatment for the condition.

Behavior therapies

Behavior therapies may help you eliminate or lessen episodes of stress incontinence. The treatments your doctor recommends may include:

• Pelvic floor muscle exercises. Called Kegel exercises, these movements strengthen your pelvic floor muscles and urinary sphincter. Your doctor or a physical therapist can help you learn how to do them correctly. Just like any other exercise routine, how well Kegel exercises work for you depends on whether you perform them regularly.

A technique called biofeedback can be used along with Kegel exercises to make them more effective. Biofeedback involves the use of pressure sensors or electrical stimulation to reinforce the proper muscle contractions.

• Fluid consumption.Your doctor might recommend the amount and timing of fluids you consume during the day and evening. However, don’t limit what you drink so much that you become dehydrated.

Your Gynecologist may also suggest that you avoid caffeinated and alcoholic beverages because it’s believed that in some people these dietary irritants affect your bladder function. But, new research suggests that coffee and caffeine may not increase stress incontinence. If you find that using fluid schedules and avoiding dietary irritants significantly improves leakage, you’ll have to decide whether these changes are worth the improvement in leakage.

• Healthy lifestyle changes.Quitting smoking, losing excess weight or treating a chronic cough will lessen your risk of stress incontinence as well as improve your symptoms.
• Bladder training.Your doctor might recommend a schedule for toileting (bladder training) if you have mixed incontinence. More frequent voiding of the bladder may reduce the number or severity of urge incontinence episodes.

Medications

There are various approved medications to specifically treat stress incontinence.The antidepressant duloxetine (Cymbalta) is used for the treatment of stress incontinence.

Devices

Certain devices designed for women may help control stress incontinence, including:

• Vaginal pessary. A specialized urinary incontinence pessary, shaped like a ring with two bumps that sit on each side of the urethra, is fitted and put into place by your doctor or nurse. It helps support your bladder base to prevent urine leakage during activity, especially if your bladder has dropped (prolapsed).

This is a good choice if you wish to avoid surgery. A pessary will require routine removal and cleaning. Pessaries are used mostly in people who also have pelvic organ prolapse.

Surgeries

Laparoscopic bladder neck repair, Kelly’s repair, sling operations,  burch colposuspensipn, TVT tape colposuspensipn are some of the surgical options.

Recently transvaginal RF LASER treatment is giving good results in stress and mixed incontinence.

Dr.Ruchi Tandon is a Gynecologist with 13 years experience in all cases of urinary leakage and urinary incontinence. She is practicing in leading hospitals in South Delhi.