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Can Pelvic or uterine adhesions cause infertility?

Pelvic adhesions, sometimes referred to as “scar tissue”, are a common cause of both infertility and pelvic pain.

Pelvic adhesions can occur as a result of a variety of different conditions including endometriosis, pelvic infection, and previous abdominal or pelvic surgery. It is well known that pelvic adhesions develop over 90% of the time following major abdominal surgery. The most common types of surgery that predispose to the development of pelvic adhesions include the removal of uterine fibroids (myomectomy), treatment of endometriosis, removal of ovarian cysts, and the repair of obstructed fallopian tubes.

Many complications can occur as a result of pelvic adhesions. For example, it is thought that adhesions may be a significant factor in as much as 40% of cases of infertility. They are also thought to be responsible for up to 50% of cases of chronic pelvic pain. In addition, adhesions are typically responsible for 50-75% of cases of bowel obstruction. Although more recent data are lacking, the treatment of pelvic adhesions accounted for 3% of all surgical procedures performed in the United States in 1998, as well as 1% of all hospital admissions and 2% of all patients admitted for surgeries around that time.

How do pelvic adhesions occur?

Adhesions typically develop in response to injury, as part of the normal healing process. Immediately following injury, cells that cause healing (inflammatory cells) migrate to the site of the injury. Within seven days following injury, the scaffold for healing or adhesion formation has already developed. As a result, it appears that no new adhesions form more than seven days after an injury. Rather, the character of the adhesion changes, progressing from thin, filmy adhesions to more dense, vascular adhesions. The earlier in this process that adhesions can be removed, the less likely it is that they will recur and cause long-term problems.

Adhesion formation that occurs following surgery can be of two types; de novo adhesion formation or adhesion reformation. De novo adhesion formation means the formation of adhesions at a site that did not have any adhesions affecting it prior to surgery. This would include the formation of adhesions around the uterus following the removal of a fibroid tumor or the formation of adhesions around an ovary following removal of an ovarian cyst.

Adhesion reformation refers to the recurrence of adhesions following a procedure designed to remove pre-existing pelvic adhesions. This difference is important, as the techniques described below may be very effective at preventing de novo adhesion formation, while they appear to be somewhat less effective at preventing adhesion reformation

What types of surgeries can increase my risk of adhesions?

In most cases of adhesions, they form in the majority of women after gynaecologic pelvic surgery. Studies have shown that adhesions formed in 55-100% of patients who had reproductive pelvic surgery, whether open or laparoscopic.

For example:

• myomectomy (surgery to remove fibroids)
• tubal surgery (to remove an ectopic pregnancy)
• surgery on the ovary (to remove cysts)
• surgery for endometriosis
Even surgery to remove adhesions can lead to new adhesions. It can be a vicious cycle.
• Laparoscopic surgery (surgery done through several small incisions using a camera) has been known to cause less adhesion formation than laparotomy (surgery through one larger incision without use of a camera).
• Microsurgery (surgery using a microscope or magnifying glass, and special surgical technique) leads to less tissue damage and has a lower incidence of adhesion development than the traditional approach.
• Diagnostic procedures, which only involve a visual inspection of the organ(s), such as a diagnostic hysteroscopy or diagnostic laparoscopy, rarely lead to adhesions.

How can I reduce my risk of adhesions?

It starts with talking to your doctor and explaining your concerns about adhesions. There are techniques which can be used at the time of surgery to reduce the risk of developing adhesions. In addition to using microsurgery or laparoscopic techniques, prevention of infection is essential.

During surgery, various products are used to inhibit adhesion formation, known as adhesion barriers. These include gauze-like materials placed over the tissue which dissolve to become a gelatinous layer to reduce the incidence of post-operative adhesions. This material is eventually absorbed by the body.

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

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How to manage endometriosis and endometriotic ovarian cyst

Endometriosis causes chocolate cysts. Endometrial tissue lines the uterus, and endometriosis causes this tissue to grow outside the uterus as well.

Endometrial tissue can attach to the ovaries, fallopian tubes, and nearby organs, such as the bladder. This can cause painful, heavy periods, and it can also damage the organs that it affects.

Doctors divide endometriosis into stages, according to how far the endometrial tissue has spread to other areas of the body. Stages 3 and 4 are the most severe, and they are the most likely to cause endometriomas.
If a person with endometriosis does not receive treatment, it can grow more severe, and chocolate cysts may develop.

Chocolate cysts are sacs containing old blood. They attach to the ovaries and can affect ovarian function. In some cases, chocolate cysts can stop the ovaries from working and so prevent pregnancy.

Doctors do not know what causes endometriosis. Most research suggests that estrogen plays a key role,researchers are unsure why the hormone causes the condition in some people and not others.

Risk factors for endometriosis and chocolate cysts can include:

• Genetics: People with a family history of endometriosis are more likely to get the condition.
• Retrograde menstrual flow: This happens when period blood travels in the reverse direction, going up the fallopian tubes instead of out of the vagina.
• Immune disorders: Certain immune system issues, especially autoimmune disorders, may cause endometriosis.
• Injuries: Damage to the uterus or surrounding structures correlate with an increased risk of endometriosis. These injuries can occur, for example, during cesarean delivery.

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

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

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

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

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

What are the symptoms?

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

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

When symptoms do occur, they’re similar to those of endometriosis. They can include:
• painful, crampy periods
• pelvic pain not related to your menstrual cycle
• irregular periods
• pain during sex
• infertility for some women

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

How are chocolate cysts diagnosed?

Your doctor may order a pelvic ultrasound if:

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

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

To definitively diagnose a chocolate cyst, your doctor will extract fluid and debris from inside the cyst. This is usually done with a needle biopsy.
During a needle biopsy, your Gynecologist will use ultrasound to help them insert a needle through the vagina into the ovarian cyst. The extracted fluid is then examined under a microscope. Your Gynecologist can diagnose the type of cyst using the results from the needle biopsy.

Dr. Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi, namely Max and Apollo hospitals, she has over 13 years experience in handling endometriosis and all kinds of ovarian cysts.

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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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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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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.

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What is Infertility and causes in females

Definition of Infertility

As per WHO, Infertility in females is defined as an inability to achieve pregnancy after 1 year of regular sexual intercourse & no predisposing cause such as lactation, Contraception etc. 

Male Infertility is responsible for 20–35% of infertility cases, while 35% are due to female infertility, and 25–40% are due to combined problems in both parts.  In 10–20% of cases, no cause is present. The most common cause of female infertility is ovulatory problems, which generally manifest themselves by sparse or absent periods. Male infertility is most commonly due to deficiencies in the semen.

Women who are fertile experience a natural period of fertility before and during ovulation, and they are naturally infertile for the rest of the cycle.

Causes of infertility in females

 Ovulation disorders

Ovulation disorders, meaning you ovulate irregularly or not at all. Problems with the regulation of reproductive hormones by the hypothalamus and pituitary gland, or problems in the ovary, can cause ovulation disorders.

Polycystic ovary syndrome or PCOS causes a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face and body and acne. It’s the most common cause of female infertility, especially females in their 30’s.

Hypothalamic dysfunction:

Excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight gain or loss can disrupt the production of the female hormones and affect ovulation. Irregular or absent periods are the most common signs.

Premature ovarian failure:

Also called primary ovarian insufficiency, this disorder is usually caused by an autoimmune response or by premature loss of eggs from your ovary. The ovary no longer produces eggs, and it lowers estrogen production in women under the age of 40.

Too much prolactin/hyperprolactinemia

The pituitary gland may cause excess production of prolactin (hyperprolactinemia), which reduces estrogen production(E2) and may cause infertility. Usually related to a pituitary gland problem, this can also be caused by medications you’re taking for another disease.

Damage to fallopian tubes (tubal blockage)

Damaged or blocked fallopian tubes keep sperm from getting to the egg or block the passage of the fertilized egg into the uterus. Causes of fallopian tube damage or blockage can include:

Pelvic inflammatory disease, an infection of the uterus and fallopian tubes due to chlamydia, other sexually transmitted infections like gonorrhea.

Previous surgery in the abdomen or pelvis, including surgery for ectopic pregnancy, in which a fertilized egg implants and develops in a fallopian tube instead of the uterus

Pelvic tuberculosis, a major cause of tubal infertility worldwide, especially India.

Endometriosis

Endometriosis occurs when tissue that normally grows in the uterus implants and grows in other locations. This extra tissue growth — and the surgical removal of it — can cause scarring, which may block fallopian tubes and keep an egg and sperm from uniting.

Endometriosis can also affect the lining of the uterus or endometrium, disrupting the implantation of the fertilized egg. The condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg.

Uterine or cervical causes

Several uterine or cervical causes can impact fertility by interfering with implantation or increasing the likelihood of a miscarriage:

Benign polyps or tumors (fibroids or myomas) are common in the uterus. Some can block fallopian tubes or interfere with implantation, affecting fertility. However, many women who have fibroids or polyps do become pregnant.

Endometriosis scarring or inflammation within the uterus can disrupt implantation.

Uterine abnormalities present from birth, such as an abnormally shaped uterus, can cause problems becoming or remaining pregnant.

Cervical stenosis

Unexplained infertility

Sometimes, the cause of infertility is never found, this accounts for almost 30 %of cases.

Infertility treatment by Laparoscopy

Laparoscopy is being done in all the leading hospitals in South Delhi. Dr Ruchi Tandon has received extensive training in laparoscopy from best hospitals in Delhi and Mumbai, such as Max hospital, Dr Ruchi Tandon is one of the best gynecologists, based in greater Kailash and doing all sorts of daycare and operative laparoscopic procedures. Infertility surgeries, Myomectomy, hysterectomy, Hysteroscopy are some of the procedures to name a few.