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Painful periods in the covid 19 pandemic era

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.

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Abnormal period in Covid 19 pandemic

Abnormally heavy or prolonged menstrual bleeding is also called ‘abnormal uterine bleeding’. It can be scanty, delayed or prolonged bleeding. We sometimes use this general term to describe bleeding that does not follow a normal pattern, such as spotting between periods. It used to be referred to as menorrhagia, but this term is no longer used medically.

On average, a typical woman passes around 40 ml of blood during her menstrual period, which lasts around four to seven days. For some women, however, bleeding may be excessively heavy or go on for longer than normal.

A woman may have ‘chronic’ heavy or prolonged bleeding (for more than six months) or it may be ‘acute’ (sudden and severe). In most cases, the causes of abnormal menstrual bleeding are unknown. See your Gynecologist about any abnormal menstrual bleeding.

Symptoms of abnormal periods

Symptoms include:

  • bleeding for more than eight days
  • heavy blood loss during the menstrual period – for example, soaking through one or more sanitary pads or tampons every hour for several hours in a row
  • needing to change your pad or tampon during the night
  • have to change or restrict your daily activities due to your heavy bleeding
  • bleeding or spotting between periods (intermenstrual bleeding)
  • cramping and pain in the lower abdomen
  • fatigue
  • any vaginal bleeding after menopause.

Causes of abnormal periods

While in many cases it is not possible to determine the exact cause, there are a number of reasons a woman may experience abnormal uterine bleeding. Some of the known causes of abnormal uterine bleeding include:

  • spontaneous miscarriage in pregnancy
  • Ectopic pregnancy – lodgement of the fertilised egg in the slender fallopian tube instead of the uterine lining
  • hormonal disorders – conditions such as hypothyroidism (low levels of thyroxine), polycystic ovarian syndrome (PCOS) and hyperprolactinemia can disrupt the menstrual cycle
  • ovulatory dysfunction – this is when the ovary does not release an egg each month. Most commonly, this occurs at either end of a woman’s reproductive years, either during puberty or at menopause
  • Endometriosis – the cells lining the uterus (endometrial cells) can travel to, attach and grow elsewhere in the body, most commonly within the peritoneal cavity (including on the outside of the uterus or on the ovarian surface)
  • infection – including Chlamydia or pelvic inflammatory disease
  • medication – may include anticoagulants, which hinder the clotting ability of the blood; phenothiazides, which are antipsychotic tranquilisers; and tricyclic antidepressants, which affect serotonin uptake
  • Intrauterine device ( IUD) – is a contraceptive device that acts as a foreign body inside the uterus and prompts heavier periods
  • hormonal contraceptives – may include the combined oral contraceptive pill, injections of a long-acting synthetic progesterone, a rod containing slow-release progesterone (implanted in the upper arm), or intrauterine system devices (progesterone-releasing contraceptive devices inserted into the uterus). The progesterone-only treatments commonly cause spotting
  • hormone replacement therapy – used as a treatment for menopausal symptoms
  • Fibroids – benign tumours that develop inside the uterus
  • Polyps – small, stalk-like projections that grow out of the uterus lining (endometrium). Polyps may be associated with fibroids
  • bleeding disorders – may include leukemia and von Willebrand disease
  • cancer – most uterine cancers develop in the lining of the uterus, though some cancers grow in the muscle layers of the uterus. They are most common after menopause.

Diagnosis of abnormal periods

The diagnosis and identification of potential causes of abnormal uterine bleeding involves a number of tests including:

  • general examination
  • medical history
  • menstrual history
  • physical examination
  • Cervical screening test
  • blood tests
  • vaginal ultrasound
  • endometrial biopsy.

Dr. Ruchi Tandon is a Gynecologist, practicing in leading hospitals in South Delhi, namely, max panscheel, max smart superspeciality hospital saket, Apollo hospitals, Delhi. She has over 13 years of clinical experience in handling abnormal periods.

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Lactation and breast care post pregnancy

Although breast development begins around puberty, development of mammary function is only completed in pregnancy. During the first half of pregnancy, the mammary ducts proliferate and group together to form large lobules. During the second half of pregnancy, secretory activity increases and the alveoli become distended by accumulating colostrum. After 16 weeks of pregnancy, lactation occurs even if the pregnancy does not progress.

The ability of the mammary gland to secrete milk during later pregnancy is called lactogenesis, stage 1. During this time, breast size increases and fat droplets accumulate in the secretory cells. The onset of copious milk secretions after birth is lactogenesis, stage 2, and usually occurs from day two or three to eight days postpartum. During this time, the milk goes through a maturation process to match the infant’s needs. Without the hormone prolactin, lactation would not occur.

During pregnancy, prolactin helps to increase breast mass but does not cause lactation because it is inhibited by the hormone progesterone, which is made by the placenta. The inhibiting influence of progesterone is so strong that lactation is delayed if any of the placenta is retained after birth. Prolactin levels rise and fall in direct proportion to the frequency, intensity, and duration of nipple stimulation from the infant’s suckling. During the first week after birth, prolactin levels in breastfeeding women fall about 50 percent. If a mother does not breastfeed, prolactin levels usually reach the levels of the nonpregnant state by seven days postpartum. After milk “comes in” or rapidly increases in volume, lactation is no longer driven by the hormone prolactin. It shifts control to a milk removal driven process, i.e., sucking stimulus. Thus, the initiation of lactation is not driven by breastfeeding, but breastfeeding is necessary for the continuation of lactation.

Colostrum is thick and creamy yellow as compared with mature milk, which is thin and bluish-white. Compared with mature milk, colostrum is richer in protein and minerals and lower in carbohydrates, fat, and some vitamins. The high concentration of total protein and minerals in colostrum gradually changes to meet the infant’s needs over the first two to three weeks until lactation is established. The key component in colostrum and breast milk is immunoglobulins or antibodies that serve to protect the infant against infections or viruses. Breast milk also facilitates the development of the infant’s own immune system to mature faster. As a result, breast-fed babies have fewer ear infections, diarrhoea, rashes, allergies, and other medical problems than bottle-fed babies. Human milk is rich in proteins, lipids, carbohydrates, vitamins, minerals, hormones, enzymes, growth factors, and many types of protective agents. It contains about 10 percent solids for energy and growth and the rest is water, which is essential to maintain hydration. This is also why a breastfed baby does not need additional water. Infants can digest breast milk much more rapidly than formula and, therefore, do not get constipated. On average, it takes about 30 minutes longer to digest formula as opposed to breast milk. Breastfed babies have better cheekbone development and better jaw alignment.

Besides the benefits of the contracting uterus, the process of producing milk burns calories, which helps the mother to lose excess weight gained during pregnancy. After all, that is why pregnant women put on extra fat during pregnancy—energy storage for milk production. Breastfeeding is also related to a lower risk of breast cancer and ovarian cancer. For every year of life spent breastfeeding, a woman’s risk of developing breast cancer drops by 4.3 percent and this is on top of the 7 percent reduction she enjoys for every baby to whom she gives birth.

Additionally, there is the convenience. Breast milk is always with the mother. Mothers do not have to store it. It is always at the right temperature. It is free. It does not require sterilization. In fact, it prevents diseases and has protective factors resulting in healthier babies and decreased healthcare costs. It saves money as there is no need to buy formula, bottles, and nipples.

Procedure

It is best to begin breastfeeding immediately after birth as it is an infant’s natural instinct to nurse then. Regardless of the baby’s initial suckling behavior, this interaction stimulates uterine contractions, promotes colonization of harmless bacteria on the nipple, and helps to protect the infant from pathogenic bacteria. It is an important time to nuzzle. Women breastfeed for a longer duration if feedings are started early. The first several feedings have an imprinting effect. It is recommended to continue feeding about every two to three hours. It is important to remember that all babies are different; some need to nurse almost constantly at first, while others can go much longer between feedings. There are babies and mothers who have no trouble breastfeeding, while others may need some assistance. Once the baby begins to suck, the mother makes sure that the entire dark area around the nipple (areola) is in the baby’s mouth. This helps stimulate milk flow and allows the baby to get enough milk. Nipple soreness can be a result of the infant not getting a good grasp of the entire areola. A newborn needs to be fed at least eight to 12 times in 24 hours. Since breast milk is so easily digested, a baby may be hungry again as soon as one and one-half hours after the last feeding.

Mothers need to be comfortable when nursing; therefore, loose, front-opening clothes and a good nursing bra are essential. They need to explore different positions for breastfeeding to determine what is best for them. The cradle hold works well in bed or sitting in a comfortable chair. The football hold is excellent if the woman had a cesarean section.

  • Common problems in breastfeeding mothers.
  • Engorgement: Breasts that are too full can prevent the baby from suckling because they cannot be grasped. Expressing milk manually or with a breast pump can alleviate this problem.
    Sore nipples: Transient soreness can occur during the first week postpartum and is usually temporary. Air drying the nipples and rubbing colostrum or breast milk into them provides relief. Prolonged, abnormal soreness lasts longer than a week postpartum. Discontinuing use of soap on breasts while bathing and applying purified lanolin to nipples and air drying them helps.
    Infection: Soreness and inflammation on the breast surface or a fever in the mother may be an indication of breast infection (mastitis). If it is just starting, the mother should drink lots of water and nurse frequently on the affected breast. Antibiotics may be necessary if the infection persists.

Lactation consultants work at almost every hospital where babies are delivered. First-time mothers can request the lactation consultant to visit her. The mother should make a note of the lactation consultant’s phone number should problems be encountered after mother and infant go home.

There are no rules about when to stop breastfeeding. A baby needs breast milk for at least the first year of life and it is preferred that no solid food be given for at least the first six months to prevent allergies. As long as a baby eats age-appropriate solid food, the mother may nurse for several years.

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 experience in handling lactation and Pregnancy.

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Vulval and vaginal skin infections

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.

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Ovarian cyst in the times of covid 19 pandemic

What are ovarian cysts?

The ovaries are part of the female reproductive system. They’re located in the lower abdomen on both sides of the uterus. Women have two ovaries that produce eggs as well as the hormones estrogen and progesterone.

Sometimes, a fluid-filled sac called a cyst will develop on one of the ovaries. Many women will develop at least one cyst during their lifetime. In most cases, cysts are painless and cause no symptoms.

Types of ovarian cysts

There are various types of ovarian cysts, such as dermoid cysts and endometrioma cysts. However, functional cysts are the most common type. The two types of functional cysts include follicle and corpus luteum cysts.

Follicle cyst

During a woman’s menstrual cycle, an egg grows in a sac called a follicle. This sac is located inside the ovaries. In most cases, this follicle or sac breaks open and releases an egg. But if the follicle doesn’t break open, the fluid inside the follicle can form a cyst on the ovary.

Corpus luteum cysts

Follicle sacs typically dissolve after releasing an egg. But if the sac doesn’t dissolve and the opening of the follicle seals, additional fluid can develop inside the sac, and this accumulation of fluid causes a corpus luteum cyst.

Other types of ovarian cysts include:

  • dermoid cysts: sac-like growths on the ovaries that can contain hair, fat, and other tissue
  • cystadenomas: noncancerous growths that can develop on the outer surface of the ovaries
  • Endometriomas: tissues that normally grow inside the uterus can develop outside the uterus and attach to the ovaries, resulting in a cyst

Some women develop a condition called polycystic ovarian syndrome. This condition means the ovaries contain a large number of small cysts. It can cause the ovaries to enlarge. If left untreated, polycystic ovaries can cause infertility.

Symptoms of an ovarian cyst

Often times, ovarian cysts do not cause any symptoms. However, symptoms can appear as the cyst grows. Symptoms may include:

  • Abdominal bloating or swelling
  • painful bowel movements
  • pelvic pain before or during the menstrual cycle
  • Painful intercourse
  • pain in the lower back or thighs
  • Breast tenderness
  • Nausea and vomiting

Severe symptoms of an ovarian cyst that require immediate medical attention include:

  • severe or sharp pelvic pain
  • Fever
  • Fainting or dizziness
  • Rapid breathing

These symptoms can indicate a ruptured cyst or an ovarian torsion. Both complications can have serious consequences if not treated early.

Ovarian cyst complications

Most ovarian cysts are benign and naturally go away on their own without treatment. These cysts cause little, if any, symptoms. But in a rare case, your doctor may detect a cancerous ovarian mass during a routine examination.

Ovarian torsion is another rare complication of ovarian cysts. This is when a large cyst causes an ovary to twist or move from its original position. Blood supply to the ovary is cut off, and if not treated, it can cause damage or death to the ovarian tissue. Although uncommon, ovarian torsion accounts for nearly 3 percent of emergency gynecologic surgeries.

Ruptured cysts, which are also rare, can cause intense pain and internal bleeding. This complication increases your risk of an infection and can be life-threatening if left untreated.

Diagnosing an ovarian cyst

Your Gynecologist can detect an ovarian cyst during a routine pelvic examination. They may notice swelling on one of your ovaries and order an ultrasound test to confirm the presence of a cyst. An ultrasound test (ultrasonography) is an imaging test that uses high-frequency sound waves to produce an image of your internal organs. Ultrasound tests help determine the size, location, shape, and composition (solid or fluid filled) of a cyst.

Imaging tools used to diagnose ovarian cysts include:

  • CT scan: a body imaging device used to create cross-sectional images of internal organs
  • MRI: a test that uses magnetic fields to produce in-depth images of internal organs
  • Ultrasound: an imaging device used to visualize the ovary

If there aren’t any changes in your condition or if the cyst increases in size, your doctor will request additional tests to determine other causes of your symptoms.

These include:

  • Pregnancy test to make sure you’re not pregnant
  • hormone level test to check for hormone-related issues, such as 
  • CA 125 to screen for ovarian cancer

In covid pandemic era, a complete assessment of ovarian cyst is done. Surgery is done only in cases of emergency and anticipated complications.

Dr. Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi , namely, max smart superspeciality hospital, saket, Apollo hospitals , with clinical experience of over 13 years.

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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.

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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.

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Abortion in the times of the corona virus pandemic

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.

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How To Deal With Pregnancy In The Time Of Coronavirus

Unlike the Severe acute respiratory syndrome or SARS pandemic of 2003-2004, which was also caused by a Corona virus, pregnant mothers are not in the higher risk bracket from COVID-19.

Stressful, even during normal times, pregnancy can be deeply disturbing during a pandemic induced lockdown. Even more so if you or someone close to you has tested positive for the coronavirus.  Here’s a few do’s and don’ts for expectant mothers during these troubled times, based on what we know so far about the virus.

Don’t Fret

Unlike the Severe acute respiratory syndrome or SARS pandemic of 2003-2004, which was also caused by a Corona virus, pregnant mothers are not in the higher risk bracket from COVID-19. During the SARS outbreak, pregnant women had a fatality risk of 25 per cent compared to 10 per cent of the general population. This is mostly based on a report on 9 pregnant women from Wuhan, China, the epicenter of the COVID-19 outbreak, who had COVID-induced pneumonia. The report, published in the Lancet, said none of the women, who were in their third trimester, developed severe illness, and all their babies were born healthy and Corona virus free. The World Health Organization (WHO) published a report on February 28 of 147 pregnant women, of whom, 64 were confirmed to have coronavirus, 82 were suspected to have the virus and one showed no symptoms. According to the report, only 8% of these women developed a severe condition and only 1% fell critically ill.

Immunity Matters

This does not mean pregnant women can afford to be complacent as the immunity system tends to dip during pregnancy, making the women vulnerable to various infections and diseases, including COVID-19. So, ensure that the diet contains immunity boosting and iron rich food, including fruits, leafy vegetables and nuts. You should also continue to take all the vitamin supplements the doctor may have prescribed.

Avoid These

Apart from following the standard guidelines like avoiding crowds and sick people, frequently washing hands and not touching the face, doctors recommend scrupulously maintaining social distancing, avoiding public areas and wearing a mask whenever you are outdoors.

Be Prepared

Given the stress on the healthcare system, and the possibility of infections from hospitals, you should check whether your doctor or hospital offers tele-medicine facilities. Don’t visit the hospital unless it is absolutely necessary, or for critical checkups. Never go without a clear appointment. Always keep your records handy, and insist that the doctor mail you any advice or medicine prescribed, so that you don’t make mistakes. Make sure you inform your doctor/health provider if you have any symptoms like fever, respiratory symptoms or even diarrhea, or if you have been in contact with someone who has tested positive for COVID-19. Avoid over the counter medications to treat cough and cold.

Deliver With Care

Because of the corona restrictions, many hospitals do not allow more than one visitor during your delivery. So, ensure that your spouse or partner is prepared for that, and have a backup in place in case he cannot be present there. Explain this to other members of your family and friends so that they do not arrive at the hospital. After the delivery, make sure that you have a backup support to take care of you and the baby, particularly if the original support system involved elders of the family.

What If You Test Positive?

If you have tested positive for COVID-19 during your pregnancy or just before delivery, don’t worry. Initial studies indicate that the virus does not transmit to uterus, or through breastmilk. However, it is important to ensure that the newborn does not get infected through contact with someone who has tested positive for the disease. In that case, doctors will usually isolate the baby, which will be looked after by healthy caregivers in protective gear. This can be traumatic, so be prepared for it. Your partner might be allowed to spend time with the child if he tests negative. If you want to give milk to your child using a breast pump, do ensure proper hygiene, and wear a mask while using the pump. Direct breastfeeding might be allowed if the infected mother wears a mask, but do you really want to take the risk?

Dr. Ruchi Tandon is a Gynecologist with over 13 years experience in handling pregnancies and is currently practicing in Max smart superspeciality hospital , Saket and Apollo Cradle Royale , Nehru place, both in South Delhi.

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PCOD- irregular periods and other things

What Is PCOS?

Polycystic ovarian syndrome, or PCOS, is a hormonal condition that women can get during their childbearing years. It can affect your ability to have a child . It can also:

  • Stop your periods or make them hard to predict
  • Cause acne and unwanted body and facial hair
  • Raise your risk of other health problems, including diabetes and high blood pressure

You can get treatments for the symptoms. And you could be able to get pregnant, although you may need to take medicines to improve your fertility.

So what are polycystic ovaries?

Polycystic ovaries are slightly larger than normal ovaries that have twice the number of follicles (fluid-filled spaces within the ovary that release the eggs when you ovulate).

However, having polycystic ovaries need not necessarily mean that you have polycystic ovarian disease (also called poly cystic ovarian syndrome). But if there are two or more following symptoms present, it can be PCOD.

Irregular, infrequent periods or no periods at all

An increase in facial or body hair and/or blood tests that show higher testosterone levels than normal

Ultrasounds scan that shows polycystic ovaries.

How does PCOD affect you?

PCOD is a condition that can affect your periods, fertility, hormones and appearance. It can also affect your overall health across time. It is estimated that this disease affects 2 – 26 among 100 women.

What are the usual symptoms?

Irregular/no periods

Excess hair growth on the face, chest, abdomen, or upper thighs – a condition called hirsutism

Loss of hair on head

Becoming overweight – experiencing a rapid increase in weight/ having difficulty in losing weight

Oily skin and acne

Reduced fertility – difficulty getting pregnant

Patches of thickened, velvety, darkened skin (acanthosis nigricans)

Depression and psychological problems

What are the causes of PCOD?

Though the exact cause of PCOD is unknown, it is often hereditary. Most of the PCOD symptoms presented are due to abnormal/ change in hormonal levels. Though Testosterone is considered a male hormone, it is also produced in small amounts by ovaries, in all women. Women with PCOD have elevated levels of testosterone, which causes most of the symptoms.

Abnormal levels of androgens can prevent the ovaries from releasing an egg every month (ovulation), cause the unwanted hair growth and acne.

Those with PCOD may not respond to insulin –the hormone that controls blood glucose levels. High levels of insulin can lead to weight gain, irregular periods, fertility issues and also elevate levels of testosterone.

What are the long-term health risks of PCOD?

PCOD not only affects the reproductive system, but the entire body.

It increases the of serious health conditions including heart ailments, diabetes and hypertension.

The risk of developing diabetes is higher if one is:

Over 40 years of age

Have family history of diabetes

Developed diabetes during pregnancy (gestational diabetes)

Is obese (a body mass index (BMI) of over 30)

Another condition that is associated with PCOS is metabolic syndrome, which leads to both diabetes and heart diseases.

Besides, if the number of periods is less than a year, the lining of the womb (endometrium) can thicken too much, leading to a condition called endometrial hyperplasia. This condition can subsequently lead to endometrial cancer or cancer of uterine lining. However, PCOD does not increase the chances of breast or ovarian cancer.

What are the treatment options for PCOD?

There is no cure for PCOD. However, it can be managed very efficiently with positive changes lifestyle and medicine, if required.

Many women with PCOD manage symptoms and long-term health risks without medical intervention, by adopting a healthy diet, exercising regularly and maintaining a healthy lifestyle.

Treatment for PCOD is personalised as symptoms and health problems, vary. Special treatment is given in case the patient wants to have a baby.

For overweight women, losing weight itself can help regulate the menstrual cycle. Even a loss of 5- 10 kg can be helpful in making menstrual periods regular. Weight loss can also improve cholesterol and insulin levels and relieve symptoms such as excess hair growth and acne.

Combined hormonal – birth control pills can be used for long-term treatment in women with PCOD (in those who do not wish to become pregnant). These pills regulate the menstrual cycle and reduce symptoms like hirsutism and acne by decreasing the androgen levels. They also decrease the risk of endometrial cancer.

Insulin-sensitizing drugs used to treat diabetes are used in the treatment of PCOD. These drugs help the body respond to insulin and decrease the androgen levels, which in turn improves ovulation. Restoring ovulation helps make menstrual periods regular and more predictable.

There are various ways to protect the lining of the womb using the hormone progestogen. This can be a five-day course of progestogen tablets (every three or four months)/ taking a contraceptive pill/ using the intrauterine contraceptive system (Mirena).

What can be done to increase the chances of pregnancy in women with PCOD?

Successful ovulation is the first step toward pregnancy. For overweight women, this can be achieved through weight loss. Medications can also be used to induce ovulation. Surgery on the ovaries can be opted for only medical management does not work. Such procedures are performed only if there is no other option.

How can long-term health risks of PCOD be managed?

Lead a healthy lifestyle

Change to healthy balanced diet: include fruits, vegetables, whole grain products, lean meat, fish and fibre. Avoid high sugar, high fat foods and alcoholic drinks.

Eat meals on time, especially breakfast.

Exercise regularly for at least 30 minutes a day – brisk walking is the best and easiest option.

Losing weight helps:

Manage insulin resistance/ developing diabetes

Lowers risk of heart problems

Lowers risk of uterine cancer

Regularises periods

Reduces acne

Decrease in excess hair growth

Improved mood and self-esteem

Do regular health checks

Women with PCOD and over the age of 40 should do regular blood sugar tests.

Women with PCOD and over the age of 40 should do regular blood sugar tests.

If you have had no periods/ have irregular bleeding, see a doctor immediately for uterine disorder/ cancer assessment.

Dr.Ruchi Tandon, is a Gynecologist doctor, practicing in leading hospitals in South Delhi, namely, Max Smart superspeciality hospital , saket , Apollo hospitals . She has over 13 years clinical experience in PCOD, irregular periods and other hormonal issues.