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PCOS in your 30’s, how it can affect you?

Polycystic ovary syndrome (PCOS) is a common condition that affects how a woman’s ovaries work.

The 3 main features of PCOS are:

  • Irregular periods – which means your ovaries do not regularly release eggs (anovulation)
  • excess androgen – high levels of “male” hormones in your body, which may cause physical signs such as excess facial or body hair
  • polycystic ovaries – your ovaries become enlarged and contain many fluid-filled sacs (follicles) that surround the eggs (but despite the name, you do not actually have cysts if you have PCOS)

If you have at least 2 of these features, you may be diagnosed with PCOS.

What are polycystic ovaries?

Polycystic ovaries contain a large number of harmless follicles that are up to 8mm (approximately 0.3in) in size. 

The follicles are under-developed sacs in which eggs develop. In PCOS, these sacs are often unable to release an egg, which means ovulation does not take place.

It’s difficult to know exactly how many women have PCOS, but it’s thought to be very common, affecting about 1 in every 5 women in the UK.

More than half of these women do not have any symptoms.

Symptoms of polycystic ovary syndrome (PCOS)

If you have symptoms of PCOS, they’ll usually become apparent during your late teens or early 20s.

They can include:

  • irregular periods or absent periods
  • difficulty getting pregnant as a result of irregular ovulation or failure to ovulate
  • The excessive hair growth or hirsutism – usually on the face, chest, back or buttocks
  • weight gain
  • thinning hair and hair loss from the head
  • oily skin or acne

PCOS is also associated with an increased risk of developing health problems in later life, such as type 2 diabetes and high cholesterol levels.

What causes polycystic ovary syndrome (PCOS)?

The exact cause of PCOS is unknown, but it often runs in families.

It’s related to abnormal hormone levels in the body, including high levels of insulin.

Insulin is a hormone that controls sugar levels in the body.

Many women with PCOS are resistant to the action of insulin in their bodies and produce higher levels of insulin to overcome this.

This contributes to the increased production and activity of hormones like testosterone.

Being overweight or obese also increases the amount of insulin your body produces.

What causes it?

Doctors don’t know exactly what causes PCOS. They believe that high levels of male hormones prevent the ovaries from producing hormones and making eggs normally.

Genes, insulin resistance, and inflammation have all been linked to excess androgen production.

Genes

Studies show that PCOS runs in families.

It’s likely that many genes — not just one — contribute to the condition.

Insulin resistance

Up to 70 percent of women with PCOS have insulin resistance, meaning that their cells can’t use insulin properly.

Insulin is a hormone the pancreas produces to help the body use sugar from foods for energy.

When cells can’t use insulin properly, the body’s demand for insulin increases. The pancreas makes more insulin to compensate. Extra insulin triggers the ovaries to produce more male hormones.

Obesity is a major cause of insulin resistance. Both obesity and insulin resistance can increase your risk for type 2 Diabetes.

Inflammation

Women with PCOS often have increased levels of inflammation in their bodies. Being overweight can also contribute to inflammation. Studies have linked excess inflammation to higher androgen levels.

How PCOS affects your body

Having higher-than-normal androgen levels can affect your fertility and other aspects of your health.

Infertility

To get pregnant, you have to ovulate. Women who don’t ovulate regularly don’t release as many eggs to be fertilized. PCOS is one of the leading causes of infertility in women.

Metabolic syndrome

Up to 80 percent of women with PCOS are overweight or obese. Both obesity and PCOS increase your risk for high blood sugar, high BP, low HDL (“good”) cholesterol, and high LDL (“bad”) cholesterol.

Together, these factors are called metabolic syndrome, and they increase the risk for heart disease, diabetes, stroke.

Sleep apnea

This condition causes repeated pauses in breathing during the night, which interrupts sleep.

Sleep apnea is more common in women who are overweight — especially if they also have PCOS. The risk for sleep apnea is 5 to 10 times higher in obese women with PCOS than in those without PCOS.

Endometrial cancer

During ovulation, the uterine lining sheds. If you don’t ovulate every month, the lining can build up.

A thickened uterine lining can increase your risk for endometrial cancer. 

Depression

Both hormonal changes and symptoms like unwanted hair growth can negatively affect your emotions. Many with PCOS end up experiencing depression and anxiety.

Dr.Ruch Tandon, the Gynecologist, specializes in PCOS and is available at leading hospitals in South Delhi

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Urinary leakage in women, why does it happen?

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.

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What could possibly be the cause of your miscarriage and how to avoid it?

A miscarriage, also called a spontaneous abortion, is the spontaneous ending of a pregnancy. About 1/3 to 1/2 of all pregnancies end in miscarriage before a woman misses a menstrual period or even knows she is pregnant. About 10 to 20% of women who know they are pregnant will miscarry , mostly in the first three months.

A miscarriage is most likely to occur within the first 3 months of pregnancy, before 20 weeks gestation. Very few of miscarriages occur after 20 weeks’ gestation. These are termed late miscarriages.

What causes miscarriage?

About half of all miscarriages that occur in the first trimester are caused by chromosomal abnormalities, which might be hereditary or spontaneous , in the father’s sperm or the mother’s egg. Chromosomes are tiny structures inside the cells of the body that carry many genes, the basic units of heredity.

Genes determine all of a person’s physical attributes, such as sex, hair and eye color and blood type. Most chromosomal problems occur by chance and are not related to the mother’s or father’s health.

Miscarriages are also caused by a variety of unknown and known factors, such as:

  1. Infection
  2. Exposure to environmental and workplace hazards such as high levels of radiation or toxic agents.
  3. Hormonal irregularities.
  4. Improper inplantation of fertilized egg in the uterine lining.
  5. Maternal age.
  6. Uterine abnormalities.
  7. Incompetent cervix. (The cervix begins to widen and open too early, in the middle of pregnancy, without signs of pain or labor.)
  8. Lifestyle factors such as smoking, drinking alcohol, or using illegal drugs.
  9. Disorders of the immune system including lupus, an autoimmune disease.
  10. Severe kidney disease.
  11. Congenital heart disease.
  12. Diabetes that is not controlled.
  13. Thyroid disease.
  14. Radiation
  15. Certain medicines, such as the acne drug isotretinoin .
  16. Severe malnutrition.
  17. Infections

What are the symptoms of a miscarriage?

Symptoms of a miscarriage include:

If you are experiencing the symptoms listed above, contact your Gynecologist right away. She will tell you to come in to the office or go to the labor room.

How Is a Miscarriage Diagnosed and Treated?

Your Gynecologist will perform a pelvic exam, an ultrasound test and bloodwork to confirm a miscarriage. If the miscarriage is complete and the uterus is empty, then no further treatment is usually required. Occasionally, the uterus is not completely emptied, so a dilatation and curettage (D&C) procedure is performed. During this procedure, the cervix is dilated and any remaining fetal or placental tissue is gently removed from the uterus. As an alternative to a D&C, certain medicines can be given to cause your body to expel the contents in the uterus. This option may be more ideal in someone who wants to avoid surgery and whose condition is otherwise stable.

Blood work to determine the amount of a pregnancy hormone (hCG) is checked to monitor the progress of the miscarriage.

When the bleeding stops, usually you will be able to continue with your normal activities. If the cervix is dilated, you may be diagnosed with an incompetent cervix and a procedure to close the cervix (called cerclage) may be performed if the pregnancy is still viable. If your blood group is Rh negative, your doctor may give you a blood product called Rh immune globulin (Rhogam). This prevents you from developing antibodies that could harm your baby as well as any of your future pregnancies.

Blood tests, genetic tests, or medication may be necessary if a woman has more than two miscarriages in a row (called recurrent miscarriage). Some diagnostic procedures used to evaluate the cause of repeated miscarriage include ultrasound, hysterosalpingogram (an X-ray of the uterus and fallopian tubes), and hysteroscopy (a test in which the doctor views the inside of the uterus with a thin, telescope-like device inserted through the vagina and cervix).

Can I Get Pregnant Following a Miscarriage?

Yes. At least 85% of women who have miscarriages have subsequent normal pregnancies and births. Having a miscarriage does not necessarily mean you have a fertility problem. On the other hand, about 1%-2% of women may have repeated miscarriages (three or more). Some researchers believe this is related to an autoimmune response.

If you’ve had two miscarriages in a row, you should stop trying to conceive, use a form of birth control, and ask your Gynecologist to perform diagnostic tests to determine the cause of the miscarriages.

Dr. Ruchi Tandon, is a Gynecologist with over 13 years experience in obstetrics and Gynecology, practicing in leading hospitals in South Delhi. She is approachable, experienced and highly competent in handling all types of pregnancies.

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Endometrial polyp in your 40’s

Uterine or endometrial polyps are growths attached to the inner wall of the uterus that extend into the uterine cavity. Overgrowth of cells in the lining of the uterus (endometrium) leads to the formation of ensdometrial polyps, also known as uterine polyps. These polyps are usually noncancerous (benign), although some can be cancerous or can eventually turn into cancer. They can range from few millimetres to few centimeters and can be endometrial, endocervical or cervical polyps depending on the origin of the tissue.

Symptoms

Signs and symptoms of uterine polyps include:

  • Irregular menstrual bleeding — for example, having continuous, unpredictable periods of variable length and heaviness
  • Bleeding between 2 menstrual periods
  • Excessively heavy menstrual periods
  • Vaginal bleeding after menopause
  • Infertility

Some women have only light bleeding or spotting; others are without symptoms.

Causes

Doctors don’t know exactly why women get uterine polyps, but it may be related to changes in hormone levels. Each month, your estrogen levels rise and fall, directing the lining of the uterus to thicken and then shed during your period. It’s an overgrowth of that uterine lining that makes a polyp.

Some things make you more likely to have polyps. One is age ,they’re more common in your 40s or 50s. That may be due to the changes in estrogen levels that happen right before and during your menopause.

Obesity, high blood pressure and taking the breast cancer drug tamoxifene can also raise your chances for uterine polyps.

Diagnosis

Transvaginal ultrasound

Hysteroscopy

Endometrial biopsy

Treatment modalities

Watch and wait

Medication :Some studies have shown polyps less than 5 mm can be treated with course of progesterones for upto 3 cycles, polys might regress or be she’d out in next  menstrual cycle.

Hysteroscopy:

Hysteroscopy had been accepted as the gold standard in diagnosis and treatment of all types of polyps. It is usually done as a daycare procedure and the obtained tissue is sent for histopathology diagnosis.

What to expect with hysteroscopic removal of endometrial polyp

Prior to surgery

  • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), Clopidogrel (Plavix), warfarin (Coumadin), and other blood thinners.
  • You will be scheduled to undergo the procedure after menstrual bleeding has ended and before ovulation (if you are still ovulating).
  • Ask your doctor which drugs you should still take on the day of the surgery.
  • Discuss any possible bleeding disorders or other medical conditions that you may have.
  • You will have blood samples taken in case you need a blood transfusion.
  • Do not smoke. This will help you to recover quicker.

On the Day of the Surgery

  • If you are to have general anesthesia, you will usually be asked not to drink or eat anything after midnight the night before the surgery.
  • Take the drugs your doctor told you to take with a small sip of water.
  • Your doctor or nurse will tell you when to arrive at the hospital.

After Surgery

  • Most patients can go home the same day.
  • You may have increased cramping and vaginal bleeding for a day or two after the procedure.
  • You may experience gas pains for about a day or so due to gas administered during the procedure. This may extend into your upper abdomen and shoulder. Walking will help relieve this pressure.
  • This surgery has a quick recovery with most patients feeling much better within the first few days.

Recovery: what to expect in the next few weeks

  • Some women have some water discharge with some blood for a few weeks expect the flow to be heavy at first and then diminishing over time.
  • Most women feel better within the first week following surgery; however, do not lift, push or pull any heavy objects for a couple of weeks.
  • Do not resume sexual intercourse or douche until your doctor says it is OK.
  • Full recovery takes about two weeks to allow for internal healing.

Dr.Ruchi Tandon is a trained hysteroscopic surgeon with over 13 years of clinical experience. At present, she is providing her services in leading hospitals in South Delhi namely, Apollo Spectra, Apollo Cradle Royale and Max Smart super speciality hospital, Saket.

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High Risk Pregnancy – How to manage it

Any pregnancy that poses a risk to the mother or baby, or is different from normal is considered as high-risk pregnancy.

What are the risk factors for high-risk pregnancies?

Sometimes a high-risk pregnancy is the result of a medical condition or disease present before pregnancy. In other cases, a medical condition that develops during pregnancy for either you or your baby causes a pregnancy to become high risk pregnancy.

Specific factors that might contribute to a high-risk pregnancy include:

  • Advanced maternal age.Pregnancy risks are higher for mothers older than age 35 years.
  • Lifestyle choices. Smoking cigarettes, drinking alcohol and using certain drugs can put a pregnancy at risk.
  • Medical history. A history of hypertension, diabetes, heart disorders, breathing problems such as poorly controlled asthma, infections, and blood-clotting disorders such as deep vein thrombosis can increase pregnancy risks.
  • Surgical history. A history of surgery on your uterus, including  C-sections, multiple abdominal surgeries or surgery for uterine tumors (fibroids), can increase pregnancy risks.
  • Pregnancy complications. Various complications that develop during pregnancy can pose risks. Examples include an abnormal placenta position, bleeding during pregnancy, fetal growth less than the 10th percentile for gestational age (fetal growth restriction) and Rh (rhesus) sensitization — a potentially serious condition that can occur when your blood group is Rh negative and your baby’s blood group is Rh-positive.
  • Multiple pregnancy. Pregnancy risks are higher for women carrying twins or higher-order multiple fetuses.

What steps can you take to promote a healthy pregnancy?

Whether you know ahead of time that you’ll have a high-risk pregnancy or you simply want to do whatever you can to prevent a high-risk pregnancy, follow the instructions by your Gynecologist. For example:

  • Schedule a preconception appointment.If you’re thinking about becoming pregnant, consult your Gynecologist. She might counsel you to start taking a daily prenatal vitamin with folic acid and reach a healthy weight before you become pregnant. If you have a medical condition, your treatment might need to be adjusted to prepare for pregnancy. Your health care provider might also discuss your risk of having a baby with a genetic condition.
  • Seek regular prenatal care. Prenatal visits can help your health care provider monitor your health and your baby’s health. Depending on the circumstances, you might be referred to a specialist in maternal-fetal medicine, genetics, pediatrics or other areas.
  • Eat a healthy diet. During pregnancy, you’ll need more folic acid, protein, calcium and iron. A daily prenatal vitamin can help fill any gaps. Talk to your Gynecologist if you have special nutrition needs due to a health condition, such as diabetes.
  • Gain weight wisely. Gaining the right amount of weight can support your baby’s health — and make it easier to shed the extra pounds after delivery. Work with your Gynecologist to determine what’s right for you.
  • Avoid risky substances. If you smoke, quit. Alcohol and illegal drugs are off-limits, too. Get your health care provider’s OK before you start — or stop — taking any medications or supplements.

Do you need special tests?

If you have a high-risk pregnancy, you might consider various tests or procedures in addition to routine prenatal screening tests. Depending on the circumstances, your Gynecologist might recommend:

  • Specialized or targeted ultrasound.This type of fetal ultrasound, an imaging technique that uses high-frequency sound waves to produce images of a baby in the uterus  targets a suspected problem, such as abnormal development.
  • During this procedure, a sample of the fluid that surrounds and protects a baby during pregnancy (amniotic fluid) is withdrawn from the uterus. Typically done after week 14 of pregnancy, amniocentesis can identify certain genetic conditions, as well as neural tube defects — serious abnormalities of the brain or spinal cord.
  • Chorionic villus sampling (CVS).During this procedure, a sample of cells is removed from the placenta. Usually done between weeks 10 and 12 of pregnancy, CVS can identify certain genetic conditions.
  • Also known as percutaneous umbilical blood sampling, this is a diagnostic prenatal test in which a sample of the baby’s blood is removed from the umbilical cord for testing. The test can identify certain genetic disorders,  conditions and infections.
  • Ultrasound for cervical length. Your health care provider might use an ultrasound to measure the length of your cervix at prenatal appointments to determine if you are at risk of preterm labor.
  • Laboratory tests. Your health care provider will test your urine for urinary tract infections and screen you for infectious diseases such as HIV and syphilis.
  • Biophysical profile. 2This prenatal test is used to check on a baby’s well-being. It might involve only an ultrasound to evaluate fetal well-being or, depending on the results of the ultrasound, also fetal heart rate monitoring (nonstress test).

Some prenatal diagnostic tests — such as amniocentesis and chorionic villus sampling — carry a small risk of pregnancy loss. The decision to pursue prenatal testing is up to you and your partner. Discuss the risks and benefits with your Gynecologist.

Dr. Ruchi Tandon is a gynecologist specialising in high risk pregnancy, with over 14 years of clinical experience. She is currently associated with leading hospitals of South Delhi such as Max Smart Superspeciality Hospital, saket, Apollo Cradle Royale, Nehru Place and Apollo Spectra, Kailash Colony.

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Post menopausal bleeding – what can it possibly be?

What is postmenopausal bleeding?

Postmenopausal bleeding is any bleeding that occurs in a woman’s vagina after she has undergone menopause. Once a woman has gone 12 months without a period, she’s considered to be menopausal.

In order to rule out serious medical problems, women with postmenopausal bleeding should always see a gynecologist.

What is vaginal bleeding?

Vaginal bleeding can have a variety of causes. These include normal menstrual cycles and postmenopausal bleeding. Other causes of vaginal bleeding include:

  • trauma or assault
  • cervical cancer
  • infections, including urinary tract infections
  • Polyps
  • Endometrial hyperplasia
  • Fibroids

If you’re experiencing vaginal bleeding and are postmenopausal, your Gynecologist will ask about the duration of the bleed, the amount of blood, any additional pain, or other symptoms that may be relevant.

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Because abnormal vaginal bleeding can be a symptom of cervical, uterine, or endometrial cancer, you should get any abnormal bleeding evaluated by a gynecologist immediately .

What causes postmenopausal bleeding?

Bleeding can occur in postmenopausal women for several pathological reasons. For example, women who take hormone replacement therapy for menopause may have vaginal bleeding for a few months after starting the hormones. It’s also possible for a woman who thought she was in menopause to begin ovulating. If this occurs, bleeding may also occur.

There are a variety of other conditions that can cause postmenopausal bleeding such as polyps, endometrial hyperplasia, and endometrial atrophy.

Uterine polyps

Uterine polyps are noncancerous growths. Though benign, some polyps may eventually become cancerous. The only symptom most patients with polyps will experience is irregular bleeding.

Uterine polyps are particularly common in women who have gone through menopause. However, younger women can also get them.

Endometrial hyperplasia

Endometrial hyperplasia is the thickening of the endometrium. It is a potential cause for postmenopausal bleeding. It is often caused when there is an excess of estrogen without enough progesterone. It occurs frequently in women after menopause.

Long-term use of estrogen can lead to increased risk of endometrial hyperplasia. It can ultimately lead to cancer of the uterus if not treated.

Endometrial cancer

Endometrial cancer begins in the uterus. The endometrium is a layer of the uterus. In addition to abnormal bleeding, patients may experience pelvic pain.

This condition is often detected early. It causes abnormal bleeding, which is easily noticed. The uterus can be removed to treat cancer in many cases. Less than 10% of women who have postmenopausal bleeding have endometrial cancer.

Endometrial atrophy

This condition results in the endometrial lining becoming too thin. It can occur in postmenopausal women. As the lining thins, bleeding may occur.

Cervical cancer

Bleeding after menopause is often harmless. However, it can also be a rare sign of cervical cancer. Cervical cancer tends to progress slowly. Gynecologists can sometimes identify these cells during a regular exam.

Annual visits to the gynecologist can help with early detection and even prevention of cervical cancer. This can be done by monitoring for abnormal Pap smears.

Other symptoms of cervical cancer can include pain during sex or abnormal vaginal discharge, including in women who are postmenopausal.

Symptoms of postmenopausal bleeding

Many women who experience postmenopausal bleeding may not have other symptoms. But symptoms may be present. This can depend on the cause of bleeding.

Many symptoms that occur during menopause, like hot flashes, often begin to decrease during the postmenopausal time period. There are, however, other symptoms that postmenopausal women may experience.

Symptoms postmenopausal women may experience include:

  • vaginal dryness
  • decreased libido
  • insomnia
  • stress incontinence
  • increased urinary tract infections
  • weight gain

Why Dr. Ruchi Tandon is the best choice?

Dr. Ruchi Tandon is a gynecologist with over 13 years of experience in clinical menopause and is a trained Hysteroscopy surgeon, practicing in leading hospitals of South Delhi such as Max smart super specialty hospital, Saket, Apollo Cradle Royale, Nehru Place. She specializes in hormone replacement therapy and recommended the management of menopausal symptoms.

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Ovarian cyst – laparoscopy is treatment of choice

Ovarian cysts are fluid-filled sacs or pockets in the ovary or on its surface. Women have two ovaries — each about the size and shape of an almond, 2-3cm in size— on each side of the uterus. Eggs, which develop and mature in the ovaries, are released in monthly cycles during the childbearing years.

Many women have ovarian cysts at some time. Most ovarian cysts present little or no discomfort and are harmless. The majority disappears without treatment within a few months.

However, ovarian cysts — especially those that have ruptured — can cause serious symptoms. To protect your health, get regular pelvic exams and know the symptoms that can signal a potentially serious problem.

Symptoms of ovarian cyst

Most cysts don’t cause symptoms and go away on their own spontaneously. However, a large ovarian cyst can cause:

  • Pelvic pain — a dull or sharp ache in the lower abdomen on the side of the cyst
  • Fullness or heaviness in your abdomen
  • Bloating

Complications of ovarian cyst

An ovarian cyst often causes no problems, but sometimes it can lead to complications.

  • Torsion: The stem of an ovary can become twisted if the cyst is growing on it. It can block the blood supply to the cyst and cause severe pain in the lower abdomen.
  • Burst cyst: If a cyst bursts, the patient will experience severe pain in the lower abdomen. If the cyst is infected, pain will be worse. There may also be bleeding. Symptoms may resemble those of appendicitis.
  • Cancer:less than 10 % of ovarian cysts can become malignant or cancerous.

Laparoscopy in ovarian cyst

A small incision will be made just below the navel. Next, a laparoscope will be inserted. This is a thin tube with a camera on the end. To allow the doctor to better view the organs, carbon dioxide gas will be pumped into the abdomen. The laparoscope will be used to locate the cyst. When it is found, 1 or 2 more incisions will be made. Surgical instruments will be inserted to remove the cyst. Tissue may be removed for testing. If cancer is found, both ovaries may need to be removed. After the cyst is removed, the instruments will be removed. The incision area will be closed with stitches or staples.

Immediately After Procedure

After the procedure, you will be given IV fluids and medications while recovering.

How Long Will It Take?

1-2 hours

Will It Hurt?

There will be pain after the surgery. You will be given pain medication.

Average Hospital Stay

You may stay overnight, or you may be able to leave the hospital the same day as your surgery.

Why Dr. Ruchi Tandon?

Dr. Ruchi Tandon is a trained laparoscopic Gynecological surgeon, practicing in best hospitals in South Delhi such as Max smart super speciality hospital, saket, Apollo Cradle Royale, Apollo Spectra Hospitals, Delhi. She has over 14 years of experience in the field of operative Gynecology and endoscopic procedures.

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What is abortion in pregnancy?

Abortion is the removal of pregnancy tissue, products of conception or the fetus and placenta (afterbirth) from the uterine cavity. In general, the terms fetus and placenta are used after eight weeks of intrauterine pregnancy. Pregnancy tissue and products of conception refer to tissue produced by the union of sperm with the ovum.

Other terms for an abortion include elective abortion, induced abortion, MTP, termination of pregnancy and therapeutic abortion.

Preparing for abortion

Your doctor will ask about your medical history and examine you internally as well. Even if you used a home pregnancy test, another pregnancy test often is needed to confirm that you are pregnant or not. In some cases, you will need an Ultrasound, may be transvaginal, to determine how many weeks into the pregnancy you are and the size of the fetus, and to make sure the pregnancy is not ectopic /tubal.

An ectopic pregnancy is one that is growing outside of the uterus, mostly in the tubes.

A blood test will determine your blood type and whether you are ABO Rh positive or negative. The Rh protein is made by the red blood cells of most women. These blood cells are considered Rh-positive. Some women have red blood cells that do not produce Rh protein; these blood cells are considered Rh-negative.

Pregnant women who have Rh-negative blood are at risk of reacting against fetal blood that is Rh-positive. Because a reaction can harm future pregnancies, Rh-negative women usually receive an injection of Rh immunoglobulin (RhIG) to prevent Rh-related problems after miscarriage or abortion.

How it is done

Doctors can use medicines, surgery or a combination of both to end a pregnancy. The method depends on how far along in the pregnancy you are, your medical history and your individual preference.

Abortions during early pregnancy, before 49 days, can be done safely with medications. Abortions between 6 and 14 weeks usually are done surgically, although medications may be used to help soften and open the cervix.

After 14 weeks, abortions can be done using labor-inducing medications that cause uterine contractions or by using these medicines in combination with surgery.

Medical abortion
Abortions completed with medication, called medical abortions, can be performed within 49  days of gestation. Days of gestation are the number of days beginning on the first day of your last menstrual period.

Most often doctors use a combination of mifepristone and misoprostol.

Surgical abortion

Suction or aspiration abortion

Sometimes called a suction D & E (for dilation and evacuation), this procedure can be done up to 14 weeks after the first day of the last menstrual period. Suction D & E is the procedure most commonly used to end a pregnancy. One dose of antibiotics is recommended prior to the procedure to prevent infection. The cervix is dilated (widened) and a rigid hollow tube is inserted into the uterus. An electric pump sucks out the contents of the uterus. The process takes about 15 minutes. Local anesthesia is usually applied to the cervix to minimize the pain of dilating the cervix. Medication given intravenously (into a vein) may help to decrease anxiety and relieve pain.

Why Dr. Ruchi Tandon is the best choice for your abortion?

Dr. Ruchi Tandon, is a gynecologist, based in South Delhi, practicing Obstetrics and Gynecology for over 14 years. She is proficient in all kinds of medical, surgical and high-risk abortions. She is available at her clinic in greater Kailash part 2, max smart super specialty hospital, Saket and Apollo Cradle Royale, Nehru Place, Delhi.

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Menopause in Indian women – An enigma

Menopause is the process through which a woman ceases to be fertile or menstruate completely. It is a normal part of life and is not considered a disease or a medical condition.

Symptoms may occur years before a woman’s final period also called as Perimenopause. Some women may experience symptoms for months or years afterward or before actual menopause.

In India, the average age for menopause is 47 years.

Despite being a natural process in the body of any woman, menopause can cause drastic changes that trigger a variety of symptoms.

While menopause is not a disease or disorder, it does trigger some profound changes in a woman’s body.

A diagnosis of menopause is confirmed when a woman has not had a menstrual period for one continuous year. However, the symptoms of menopause generally appear before the end of that one-year period.

Signs and symptoms

Irregular periods

Changes to the menstrual pattern are the first noticeable symptoms of menopause. Some women may experience a period every 2 to 3 weeks. Others will not menstruate for months at a time.

Lower fertility

Perimenopause is the 3-to-5-year period before menopause.

During the perimenopausal stage, a woman’s estrogen levels will drop significantly. This reduces her chances of becoming pregnant.

Vaginal dryness

Dryness, itching, and discomfort of the vagina tend to occur during perimenopause.

As a result, some women may experience Dysparenuia , or pain during sex. Women experience this pain due to lowering estrogen levels. These lower levels cause vaginal atrophy.

Vaginal atrophy is an inflammation of the vagina that happens as a result of the thinning and shrinking of the tissues, as well as decreased lubrication.

Hot flashes

A hot flash is a sudden sensation of heat in the upper body. It may start in the face, neck, or chest, and progress upward or downward.

The skin may become red and patchy, and a woman will typically start to sweat. Her heart rate may suddenly increase, strengthen, or become irregular. Hot flashes generally occur during the first year after a woman’s final period.

Night sweats

Hot flashes that occur during the sleep cycle are called night sweats. Most women say their hot flashes do not last more than a few minutes.

However, studies have confirmed that moderate-to-severe night sweats and hot flashes may pose a problem for 6-8 years before actual menopause.

Disturbed sleep

It can be difficult for women to fall asleep and stay asleep as they progress through menopause.

In some cases, night sweats can lead to discomfort during the night and difficulty sleeping. Sleep disturbance may also be caused by insomnia or anxiety.

Urinary problems

Menopause can disrupt a woman’s urinary cycle.

Women tend to be more susceptible to Urinary tract infections (UTIs) during menopause, such as cystitis. They may also find that they also need to visit the toilet more often.

Emotional changes

Women can experience depression and low mood during menopause.

Hormonal changes can often trigger depressed feelings and mood swings. In many cases, these emotional symptoms also go hand-in-hand with sleep disturbance.

Women may also experience low libido, or sex drive, as a result of these emotional changes.

Problems focusing and learning

Menopause can affect cognitive functions, such as concentration.

Some women may also experience short-term memory problems and difficulty focusing for long periods.

Other effects

Other symptoms of menopause include:

  • a buildup of fat in the abdomen, sometimes leading to overweight and Obesity.
  • Hair loss and thinning hair
  • breast shrinkage

Without treatment, symptoms usually taper off over a period of 2 to 5 years. However, symptoms can persist for longer. In some cases, vaginal dryness, itching, and discomfort can become chronic and eventually get worse without treatment.

Complications

Menopause can lead to the development of complications, including:

  • Cardiovascular disease: A drop in estrogen levels has been associated with an increased risk of cardiovascular disease.
  • Osteoporosis: A woman may lose bone density rapidly during the first few years after menopause. Low bone density leads to a higher risk of developing Osteoporosis.
  • Urinary incontinence: Menopause causes the tissues of the vagina and urethra to lose their elasticity. This can result in frequent, sudden, and overwhelming urges to urinate. These urges can be followed by an involuntary loss of urine. Women may involuntarily urinate after coughing, sneezing, laughing, or lifting during menopause.
  • Breast cancer: Women face a higher risk of breast cancer following menopause. Regular exercise can significantly reduce the risk.

Menopausal remedies at South Delhi

Dr. Ruchi Tandon is an exceptional  Gynecologist specializing in disorders such as menopause. She has over 14 years of experience in pregnancy, fibroids, fibroids, excessive bleeding, and hot flashes. She is a new generation doctor with a holistic approach towards her Perimenopausal and menopausal patients. She specializes in providing the best treatments for all patients.

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Why you should choose a specialized Laparoscopic Surgeon and Cosmetic Gynecologist?

Laparoscopy is a skilled profession that demands a high level of expertise and well-versed training. Gynecological Laparoscopy involves procedures such as

  • Laparoscopic Myomectomy
  • Laparoscopic hysterectomy
  • Laparoscopic Ovarian Cystectomy
  • Laparoscopic tubal evaluation and repairs
  • Laparoscopy and Hysteroscopy for Infertility
  • Hysteroscopic Polypectomy
  • Hysteroscopic septal resection
  • Hysteroscopic D&C

Gynecological expertise is of paramount importance in all of these procedures.

Reasons for gynecologic laparoscopy

Laparoscopy can be used for diagnosis, treatment, or both of them. A diagnostic procedure can sometimes very commonly turn into a treatment.

Some reasons for diagnostic laparoscopy are:

  • unexplained pelvic pain
  • unexplained infertility history of pelvic infection

Conditions that might be diagnosed using laparoscopy include:

  • Endometriosis
  • Uterine fibroids
  • Ovarian cysts or tumors
  • Ectopic pregnancy
  • Pelvic adhesions
  • Pelvic inflammatory disease

Some types of laparoscopic treatment include:

  • Hysterectomy or removal of the uterus
  • Removal of ovaries
  • removal of ovarian cysts
  • removal of fibroids
  • blocking blood flow to fibroids
  • adhesion removal
  • reversal of a contraceptive surgery called tubal ligation
  • Burch procedure for incontinence
  • vault suspension to treat a prolapsed uterus

Preparing for gynecologic laparoscopy

Preparation depends on the type of surgery. You may need imaging tests, or your doctor might order fasting or an enema.

Tell your doctor about any medication you take. This includes over-the-counter drugs and supplements. You may need to stop them before the procedure.

Ask a friend to come to pick you up after the surgery or schedule a car service. You will not be allowed to drive yourself.

Cosmetic Gynaecology

Cosmetic Gynaecology is one of the emerging areas of Gynecology and includes :

  • Non-surgical vaginal tightening
  • Surgical vaginoplasty
  • Hymenoplasty or restoration of virginity
  • Ovarian rejuvenation
  • Reversing menopause
  • Labiaplasty
  • Non-surgical treatments for painful intercourse

Dr. Ruchi Tandon, is a specialized gynecologist practicing in Greater Kailash, South Delhi with over 13 years of experience in operative laparoscopy, cosmetic Gynecology, and high-risk pregnancy cases.