Month: September 2020

Menopause occurs when a woman has not had her menstrual period for a year. This occurrence is the result of a natural decline in hormones that a woman will experience usually in her 40s or 50s.

When a woman has gone through menopause, she normally does not expect to have any further bleeding. However, women may sometimes experience additional vaginal bleeding. If she has gone through menopause, doctors consider the bleeding abnormal, and a woman should contact her Gynecologist.

Examples of bleeding symptoms that could indicate that she needs to call her doctor include bleeding after sex or bleeding that is very heavy and more than “spotting.” Most commonly, the bleeding is unrelated to an issue with menstruation and may be due to another cause that should be identified.

Postmenopausal bleeding can be due to a number of causes. Examples of some of the most common causes include:

• Endometrial atrophy: When the hormone estrogen stops being produced due to menopause, a woman’s endometrial lining may start to become thinner. As a result, the lining of the endometrium may be more likely to bleed.

• Endometrial hyperplasia: This condition causes the uterine lining to become thicker instead of thinner, giving rise to heavy or irregular bleeding. The cause of this condition is most commonly excess estrogen without the hormone progesterone to offset it. Endometrial hyperplasia can sometimes lead to the development of endometrial cancer.

• Endometrial cancer: This is cancer of the endometrial lining. An estimated 10 percent of postmenopausal women with uterine bleeding experience the bleeding due to endometrial cancer.

• Polyps: Polyps are growths that can develop on the lining of the uterus. They are usually noncancerous but can cause unusual or heavy bleeding. Polyps can sometimes grow inside the cervical canal. When this occurs, a woman may experience bleeding when she has sex.

Other potential, but less likely, causes of postmenopausal bleeding include:

• clotting problems
• infection of the uterine lining, which is known as endometritis
• trauma to the pelvis
• bleeding from the urinary tract
• thyroid disorders

Hormone medications, such as tamoxifen, may also cause postmenopausal bleeding as a side effect. Many women will experience breakthrough bleeding as a result of taking hormone replacement therapy in the first 6 months.

Regardless of the potential underlying cause, it is important that a woman sees her doctor when she has vaginal bleeding.

Diagnosis

A Gynecologist will start an exam for postmenopausal bleeding by asking the woman about the symptoms she may be experiencing. A Gynecologist will likely ask:

• when she first noticed her symptoms
• how much she bleeds
• if she has any family history of postmenopausal bleeding

Depending upon a woman’s symptoms, a doctor may recommend one or more of a number of tests.

Examples of tests used to diagnose the cause of postmenopausal bleeding include:

Examples of tests used to diagnose the cause of postmenopausal bleeding include:

• Dilation and curettage (D&C): This procedure involves dilating or widening the cervix to obtain a larger tissue sample. It also involves using a special tool called a hysteroscope to see inside the uterus to identify any potential growths.

• Endometrial biopsy: This procedure involves inserting a small, thin tube into the vagina to reach the cervix to take a sample of tissue lining from the uterus. This tissue can then be tested for the presence of abnormal cells, such as cancerous cells.

• Hysteroscopy: This procedure involves a doctor inserting a tool with a thin, lighted camera on the end to examine the inside of the uterus and its lining. The approach can help a doctor to identify polyps or abnormal growths.

• Sonohysterography: This procedure involves injecting fluid through the vagina and into the uterus. A doctor will then use an ultrasound machine – which uses sound waves to identify differences in tissues – to visualize the uterus. This is known as a transabdominal ultrasound. The process can allow a doctor to determine whether the uterine lining is thicker or thinner than expected.

• Transvaginal ultrasound: This procedure involves inserting a special ultrasound probe into the vagina to allow a doctor to visualize the uterus from the bottom of the uterus, instead of from the lower abdomen.

While most of these tests can be performed at a doctor’s office, others, such as a D&C, are often performed at a hospital or surgery center.

Dr. Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals, with over 14 years of experience in handling all kinds of Gynecological conditions.

The spread of COVID-19 and the consequent lockdown has been having the most significant effect on people already dealing with persisting medical conditions – such as pregnant women. Life for them has taken an especially unprecedented swerve, since visits to the doctor, routine checkups, or sanitizing surfaces for the baby are not ordinary anymore. Schedules have been disrupted, throwing the work-life-mom nexus off-balance.

Higher risk of severe disease, ICU admission

A recent study by the Centers of Disease Control and Prevention, USA, indicates that pregnant women are more likely to get severe COVID-19 and are at a high risk of being hospitalized or admitted in the intensive care unit (ICU) with need for mechanical ventilation when compared to non-pregnant women.

Higher risk of blood clots

Another study, published in the journal Endocrinology, indicated that pregnant women are at a higher risk of developing blood clots due to COVID-19 than non-pregnant women. Now, experts suggest that pregnant women are already 5 times more likely than non-pregnant women to develop a blood clot. This happens due to various changes that occur in the bodies of women during pregnancy; the blood clots more easily to prevent excessive bleeding during labour and not being active during pregnancy may reduce blood flow to legs, further increasing the risk of clotting. SARS-CoV-2, the COVID-19 causing virus, has also shown to cause blood clotting in patients. So, experts suggest that for pregnant women, this risk may increase further.

Placenta damage and vertical transmission

A study including 16 COVID-19 positive pregnant women found that blood clots were formed in the placenta leading to restriction of blood flow to the baby. Even though all the babies in the study were born in good health, it was suggested that pregnant women should be watched more carefully during the pandemic.

In two other cases, children born to COVID-19 positive women were found to have antibodies against the virus and clinical signs of the infection. However, in the latter, it was not exactly apparent if the infant got the disease while in the womb or during delivery.

Preterm birth

Even though no cases of preterm birth or miscarriage has been seen in COVID-19 positive pregnant women, on the basis of the data from SARS and MERS, experts suggest that the novel coronavirus may induce both of these conditions.

Despite all the current evidence, it is worth mentioning that the research is still ongoing and nothing can be said for sure yet. It is highly likely that new things would be found about the virus and its effects on pregnancy in the coming months.

Do pregnant women face greater risk from COVID-19?

So far, the data on COVID-19 does not suggest pregnant women are at higher risk of getting the virus, according to the American College of Obstetricians and Gynecologists. However, as we have seen from the flu they are at greater risk of harm if they get respiratory infections. Pregnancy causes a variety of changes in the body and results in a slight immunocompromised state which can lead to infections causing more injury and damage.

Does having the coronavirus create a greater risk of miscarriage or preterm labor?

Studies have not yet been done to show if having COVID-19 during pregnancy increases the chance of miscarriage, but there is some evidence from other illnesses. During the SARS coronavirus epidemic in 2002-2003, women with the virus were found to have a slightly higher risk of miscarriage, but only those who were severely ill.

Having respiratory viral infections during pregnancy, such as the flu, has been associated with problems like low birth weight and preterm birth. Additionally, having a high fever early in pregnancy may increase the risk of certain birth defects, although the overall occurrence of those defects is still low.

Can a mother with COVID-19 pass the virus to her baby in the womb?

This data is evolving fast. Two papers published March 26 describe finding coronavirus antibodies in three newborns of mothers with COVID-19. That could suggest they had been exposed to the virus in the womb, though the virus itself was not detected in their umbilical cord blood and researchers have raised questions about the type of test used. Researchers in an earlier study found no evidence of COVID-19 in the amniotic fluid or cord blood of six other infants born to infected women. While the research papers include only a small number of cases, a lack of vertical transmission – from the mother to child in utero – would be consistent with what is seen with other common respiratory viral illnesses in pregnancy, such as influenza.

There have been a few reports of newborns as young as a few days old with infection. But in those cases, it is believed that the mother or a family member transmitted the infection to the infant through close contact after delivery. The virus can be transmitted through a cough or sneeze, which could spread virus-laden droplets on a newborn.

How are prenatal checkups changing?

Prenatal care may look different for a while to control the spread of COVID-19 among patients, caregivers and medical staff.

Typically, a pregnant woman has about 14 prenatal visits. That may be reduced by approximately half, with telemedicine playing a larger role. Telemedicine is already endorsed by the American College of Obstetricians and Gynecologists for patients in rural settings. Now, the pandemic is making virtual care solutions an indispensable tool. Pregnant women are able to do some at-home monitoring, such as for high blood pressure, diabetes and contractions, and telemedicine can even be used by pregnancy consultants, such as endocrinologists and genetic counselors.

Dr.Ruchi Tandon is a reputed Gynecologist practicing in leading hospitals in South Delhi , namely, max and apollo hospitals.

Periods, they’re painful and messy, and unpredictable. But while you might not be looking forward to getting your periods every month, realizing you’re late for no apparent reason is probably a worse feeling. Turns out, the stress caused by a deadly pandemic can do that to your body.

As the world struggles to come to terms with the deadly coronavirus outbreak, our mental health has gone for a toss. Along with that, your menstrual cycles may also have been affected – you’re locked indoors for days at a stretch, your sleep patterns have been adversely affected, you’re probably not eating healthy and your physical activities have been reduced to a minimum.

The COVID-19 pandemic has meant that many governments have advised people to remain inside, most services and facilities are closed and you may be having to contact loved ones over video call. Not knowing when you’ll next see your friends and family is scary and finding the perfect balance between staying up-to-date with the COVID-19 updates without becoming overwhelmed is tough. The World Health Organization has noted that the main psychological impact of COVID-19 to date is elevated rates of stress or anxiety. Being stressed isn’t just a mental experience. Your body reacts to it in certain ways and your menstrual cycle can become longer or shorter and your periods may stop altogether. This isn’t something to be too alarmed about but you should seek out either a close one or a medical professional if you’re struggling to cope. 

A great way to alleviate stress is to exercise. When you’re only allowed outside for emergency groceries and to exercise then the gym is off-limits. That doesn’t mean you can’t get moving at home. However, be mindful of any changes to your weight. According to the NHS, the stress that intense physical activity places on your body can affect the hormones responsible for your periods. Losing too much body fat through intense exercise can also stop you ovulating. Similarly, if you put on a lot of weight your body may produce an excess amount of estrogen which can cause your periods to stop.  

The contraceptive pill is the most form of contraception and if you’re taking hormonal contraception it may be the reason you miss a period. The coil, implant and injection may also change your cycle. Some forms of contraception such as the progesterone-only pill, injection and Mirena coil may stop your periods altogether. 

You shouldn’t worry if you miss a period, especially if you’re on hormonal birth control and going through a stressful period, such as the COVID-19 pandemic. However, ruling out more serious reasons why you might have missed a period will give you peace of mind. Polycystic ovary syndrome (PCOS) is a condition where your body produces more of the male hormone androgen. As a result of the hormonal imbalance, cysts form on the ovaries. This can cause your periods to become irregular or to stop completely. Other symptoms include weight gain, hair loss from the head and excessive body hair growth.

Another reason you may miss a period is if you’re pregnant. Other early signs of pregnancy are nausea, tender breasts and fatigue. If you think there’s a serious possibility you could be pregnant wait to take a test until a week after your period was due to start. By taking one any sooner you could get a false negative.  

The COVID-19 pandemic and lockdown is stressful and your body will react in different ways to the pressure. It’s hard not to jump to conclusions when you miss a period, especially if your cycle is usually very regular. However, a change in exercise regime, birth control and mental health could all be contributing factors as to why you might miss a period. If you think you are suffering from PCOS or are pregnant you should get in touch with your clinician.

For those of you who haven’t experienced the aforementioned symptoms yet, you’re probably blessed with a more cooperative uterus. But that doesn’t mean you’re not at risk for developing complications in the long run.

To be honest, there is little one can do to reduce stress or stay calm during such tense circumstances, with the threat of a pandemic hanging above our heads like a time bomb. Yet, having a fixed routine for the day, exercising, eating healthy and just trying to take it easy may just trick your bodies into believing things are normal, thereby reducing stress levels as much as possible.

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

Experiencing an unplanned pregnancy can be one of the most challenging times in your life. It can bring about feelings of doubt, stress, and a lot of undue anxiety.

Navigating life through social distancing, closures, quarantines, and constant COVID-19 updates can cause worry, uncertainty, and even panic.

A combination of the two? It can make anyone feel completely overwhelmed, and understandably so. Even if your pregnancy was planned, you may be wondering if you should continue your pregnancy or if abortion or the abortion pill is a safe option for you.

Ultimately, before you make any decisions, coronavirus pandemic or not, the best thing you can do for yourself is to take your time and learn about all your options. At your consultation, you can learn more about side-effects, current precautions, and the long-term impact on your health.

COVID-19 and Abortion

If you are considering an abortion because you are unsure of the future, you are one of the millions of Americans affected financially by COVID-19, or you just are experiencing an unintended pregnancy and looking for a solution – we are here for you.

The abortion pill and surgical abortions always carry risks and side-effects to your health. Right now, elective surgical procedures are cautioned due to the unnecessary risk of spreading the virus. The good news is that time is on your side. We can walk through how the abortion pill works, different types of abortion procedures, and answer any questions you may have.

It’s important to know that as of this date, there has been no evidence of transmission from mom to baby in-utero. Fetuses and babies have remained healthy even in cases where the woman has been diagnosed with COVID-19.
In the first three months of the Covid-19 lockdown, March 25 to June 24, 47% of the estimated 3.9 million abortions that would have likely taken place in India in this span under normal circumstances were possibly compromised. This means that 1.85 million Indian women could not terminate an unwanted pregnancy, concluded a May 2020 modelling study conducted by the Ipas Development Foundation, India, a non-profit dedicated to preventing and managing unwanted pregnancies. Of these 1.85 million women, 80% or 1.5 million compromised abortions were due to the lack of availability of medical abortion drugs at pharmacy stores, the study found.

The estimation builds on data from telephone surveys of 509 public-sector facilities across eight states, 52 private-sector providers, expert opinion of members of the Federation of Obstetric and Gynecological Societies of India, sales data on medical abortion drugs, and trend estimation by pharmaceutical industry experts.

How did the lockdown restrict women’s access to their choice of contraceptives, an essential?

In many ways, factors affecting women’s access to contraceptives during the lockdown were similar to that of abortion:

• Public health facilities were converted to Covid-19 care centers, limiting the availability of sexual and reproductive health [or SRH] services
• Clinical staff occupied with the Covid-19 response may not have had time to provide services or may have lacked personal protective equipment to provide services safely
• Private health facilities were either closed or limited their service provision due to provider unavailability, inadequate protective gear, or lack of mandatory Covid-19 testing arrangements
• Supply chain disruptions limited availability of contraceptives and stock-outs of many contraceptive methods
• Suspension of public transport facilities and curbs on movement restricted women’s mobility.

In addition, some specific reasons include:

• Temporary suspension of the provision of sterilisations and IUCDs in line with the Ministry of Health and Family Welfare’s advisory till about mid-May, when revised guidelines were released. This meant that women were unable to use their preferred method of contraception especially if they needed long-term contraception.
• Involvement of ASHA workers in Covid-related surveillance work impacted the community-level distribution of contraceptives.
• Women refrained from visiting health facilities due to fear of Covid-19 exposure.

What are the likely choices for a woman who could not access contraception and discovers her pregnancy during the lockdown?

Possible choices for such a woman include:

• continuation of her pregnancy even though it may be unplanned or unintended;
• attempting an abortion during the lockdown through safe or unsafe methods [there are chances she may attempt medical abortion pills from a chemist outlet or visit a backstreet provider]; or
• waiting until the lockdown restrictions are relaxed and then undergo most probably a second-trimester abortion in a health facility [since it is likely that due to the lockdown she may have crossed the 12-week gestation limit of medical abortion].

For women, what are the long- and short-term impacts of being denied contraceptives?

Women who are unable to access contraceptives are likely to make decisions that may not be as per their preference – whether it be the continuation of their unintended pregnancy or second trimester or unsafe abortion. All of these are likely to have profound consequences for their overall health and well-being, including physical health since the unintended pregnancy may not ensure adequate spacing with the previous childbirth, as well as mental health [beyond the lockdown’s own impact]. Unsafe abortion may lead to morbidities with long-term consequences on health and in the worst case, result in mortality among women.

Dr. Ruchi Tandon, is a reputed Gynecologist, practicing in leading hospitals in South Delhi for last 13 years and has experience in handling all kinds of pregnancies and abortions.