Tag: pregnancy doctor in south delhi

Irregular periods are very common, especially in a girl’s first few years of getting her period.

What Are Regular Periods?

Most girls get their first period between the ages of 10 and 15, but some get it earlier and some later. The first period is known as menarche.

A girl’s monthly cycle is the number of days from the start of her period to the start of the next time she gets her period. You often hear this is a 28-day cycle. But 28 is just an average figure that doctors use. Cycle lengths vary — some are 24 days, some are 34 days. And a girl may notice that her cycles are different lengths each month — especially for the few years after she first starts getting her period.

Early in a girl’s cycle, her ovaries start preparing one egg. At the same time, the lining of the uterus becomes thick to prepare a nesting place for a fertilized egg in the event that the girl becomes pregnant.

About 2 weeks before a girl gets her period, the egg is released from the ovary (this is called ovulation). The egg travels through the fallopian tube into the uterus. If the egg isn’t fertilized by sperm, it starts to fall apart. Then the lining and egg leave a girl’s body as her period and the whole thing starts all over again — that’s why we use the word “cycle.” The first day a girl’s period comes is Day 1 of her cycle.

A girl’s body may not follow an exact schedule. It’s common, especially in the first 2 years after a girl starts getting her period, to skip periods or to have irregular periods. Illness, rapid weight change, or stress can also make things more unpredictable. That’s because the part of the brain that regulates periods is influenced by events like these. Going on a trip or having a major change in schedule can also make your period come at a different time than expected. All of this is perfectly normal.

It’s also normal for the number of days a girl has her period to vary. Sometimes a girl may bleed for 2 days, sometimes it may last a week. That’s because the level of hormones the body makes can be different from one cycle to the next, and this affects the amount and length of bleeding.

If My Period Is Irregular, How Do I Know When I Will Get It?

If your cycle is not regular, you’ll want to pay attention to the clues your body may give you that your period is coming soon. These may include:

• back cramps or stiffness
• heavier breasts or breast soreness
• headaches
• acne breakouts
• disturbed sleep patterns
• mood swings
• bloating
• loose stools

How Can I Be Prepared?

Keep some pads or tampons in your backpack or purse, just so you’ll have them handy in case your period comes when you’re not expecting it. You may even want to carry an extra pair of underwear.

What Causes Irregular Periods?

Most of the time, irregular periods are part of the normal changes that can happen when you’re a teen. As you get older, your cycle will probably settle into a recognizable pattern.

Sometimes, irregular periods can be caused by some medicines, exercising too much, having a very low or high body weight, or not eating enough calories.

Hormone imbalances can also cause irregular periods. For example, thyroid hormone levels that are too low or too high can cause problems with periods. Some girls have extra androgen, a hormone that can cause hair growth on the face, chin, chest, and abdomen. Extra androgen can also makes girls gain weight and have irregular periods.

Girls who are pregnant also will not get their periods.

Should I Worry About Irregular Periods?

Talk to your doctor if you have had sex and have missed a period because you could be pregnant. Also let the doctor know if:

• You were having regular periods that then become irregular.
• You stop getting your period.
• You have extra hair growth on the face, chin, chest, or abdomen.
• You start having periods that last longer than 7 days, are heavy, or are coming more often than every 21 days.
• Your period comes less often than every 45 days.
• You have severe cramping or abdominal pain.
• You have bleeding in between your periods.
• Your periods are irregular for 3 years or more.

The doctor may prescribe hormone pills or other medicines, or recommend lifestyle changes that can help you to have regular periods.

Dr. Ruchi Tandon is a reputed Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 14 years of clinical experience in handling all gynecological cases including irregular periods in teenage .

Benign or malignant neoplasms of the vagina are uncommon. The frequency of benign lesions ranges from rare to very rare. Neoplasms that may develop in other locations within the genital tract may also be found in the vagina. Most vaginal tumors produce no symptoms until significant size is reached. Symptoms and signs may include a sensation of pressure, dyspareunia, obstruction of the vagina or urethra, or vaginal bleeding. However, most lesions will be detected during a routine exam in the asymptomatic patient. Vaginal neoplasms may be divided into cystic or solid lesions and a third category best described as related conditions. As is true for any neoplasm, biopsy provides a definitive diagnosis.

Gartner’s Duct Cyst

Gartner’s duct cysts develop as a result of incomplete regression of the mesonephric or wolffian duct during fetal development . In the male, these ducts form the epididymis. When present, these cysts may be multiple, and are located submucosally along the lateral aspects of the upper vagina. Histologic evaluation reveals nonsecretory, columnar epithelium. If these cysts are small, asymptomatic, and located in the lateral aspects of the upper vagina, no treatment is indicated. If the diagnosis is in question, or there is a history of antenatal exposure to synthetic hormones, adenosis of the vagina must be considered. The presence of mucosa, which stains normally with Lugol’s solution, helps to exclude the diagnosis of adenosis. Regardless of size, biopsies should be performed on symptomatic cysts or they should be excised. Larger cysts in the vaginal fornix may extend to the lateral aspects of the cervix and require excision in the operating room.

Paramesonephric Duct Cyst

In contrast to Gartner’s duct cysts, paramesonephric duct cysts are lined with secretory epithelium resembling endocervix or fallopian tube, suggesting müllerian origin. These cysts may be found anywhere in the vagina and frequently contain mucus. Vaginal adenosis is excluded by staining with Lugol’s solution. The diagnosis is established with an excisional biopsy if the cyst is large, symptomatic, or only recently identified.

Inclusion Cyst

Inclusion cysts of the vagina result from mucosa trapped in the submucosal area by surgical procedures such as episiotomy, colporrhaphy, or trauma including childbirth. As the cysts enlarge, symptoms may develop. These cysts are lined with squamous epithelium and contain keratin and squamous debris. Foreign-body reaction and inflammation surround the cyst. Treatment involves excision of the intact cyst and approximation of normal epithelium.

Endometriosis

Endometriosis in the vagina may develop at the site of a previous operation or as primary implants. Nodularity of the posterior vaginal fornix may represent endometriotic implants of the posterior cul-de-sac and may eventually erode or grow into the vaginal mucosa. When visualized colposcopically, these implants may appear dark blue or brown. If associated with fibrosis, the submucosal implants may appear white. Biopsy may yield chocolate-colored material representing old hemorrhage and dense fibrosis. Endometrial glands and stroma are usually identified histologically although the presence of both are not required to make the diagnosis. The diagnosis is made by biopsy unless endometriosis is identified in other parts of the pelvis. Small, symptomatic lesions are treated by excision or laser vaporization. Large lesions arising in the posterior cul-de-sac and extending into the posterior vaginal fornix may require laparotomy to accomplish excision. Preoperative therapy with gonadotropin releasing hormone analogs may greatly reduce the size of the implants, therefore, reducing the extent of excision or vaporization. We recommend outpatient mechanical bowel preparation prior to surgery. For the symptomatic patient who does not wish surgical excision of the lesion, gonadotropin releasing hormone analog therapy followed by suppression with oral contraceptives may be beneficial.

Leiomyoma

Vaginal leiomyomas or fibromyomas are rare lesions usually located in the anterior vaginal wall . Between 250 and 300 cases have been reported in the world literature. These lesions are benign smooth muscle neoplasms, usually solitary and in many cases asymptomatic. Histologically, they resemble leiomyoma of other origins. Proposed sites of origin include vaginal smooth muscle, local arterial musculature, or smooth muscle of the bladder or urethra. As is true of uterine leiomyomata, the vaginal lesions are estrogen dependent. Malignant conversion is extremely rare. When large, symptoms can include vaginal discharge or bleeding, dyspareunia, or urinary retention. The differential diagnosis of a midline anterior vaginal mass includes urethral diverticulum, fibroepithelial polyp, cystocele, Skene duct abscess, or vaginal malignancy. Therapy involves excision in the symptomatic patient. Recurrence is uncommon but reported.

Fibroepithelial Polyp

Fibroepithelial polyps of the vagina are uncommon and usually asymptomatic. In infants and young girls, sarcoma botryoides must be ruled out. Fibroepithelial polyps of the vagina are usually small and may be multiple. During pregnancy, these lesions may become enlarged, very edematous, and bizarre in appearance. Histologically, the polyps are composed of a squamous epithelial surface with a fibrovascular stalk and edematous stroma. Proposed etiologies include stromal proliferation or granulation tissue reaction as a result of local injury. Therapy involves excision of the polyp and stalk in the symptomatic patient or the patient with a large polyp.

Condyloma Acuminatum

Condyloma acuminatum represents the clinical manifestation of human papillomavirus infection.There are currently more than 120 human papillomavirus types identified. These lesions may be associated with condylomata of the cervix and vulva or appear only as vaginal lesions. Histologic evaluation confirms the diagnosis and rules out a dysplastic lesion. The microscopic description is similar to that for condyloma in other locations. Hybridization techniques to identify high-risk DNA type are currently of little help to the clinician in the face of obvious condyloma. Clinical management includes topical therapy with carefully applied bichloroacetic or trichloroacetic acid. For large or multiple lesions, excision, cauterization, laser vaporization, or loop electrical excision may be required. Cryotherapy may be helpful for small lesions; however, depth of thermal injury may be difficult to control. The entire genital tract should be evaluated and any obvious lesions treated simultaneously. Overly aggressive treatment, especially with laser or cautery may result in significant distortion and scarring of the vagina and should be avoided.

Urethral Caruncle

Urethral caruncles present as localized, red, friable lesions at the urethral meatus . They are generally seen in the postmenopausal woman and are thought to result from a localized area of prolapse of the urethral mucosa with secondary inflammatory changes. They can be confused with acute circumferential prolapse of the urethral mucosa, a condition usually seen in young girls. Urethral carcinoma must be excluded in patients with larger urethral caruncles. There may be pain, dysuria, and bleeding. Small asymptomatic urethral caruncles may not require any treatment. Larger or symptomatic lesions can be treated by topical application of estrogen. To establish the diagnosis, small biopsies may be performed under local anesthesia. Large or persistent lesions may require excision and reapproximation with fine absorbable suture.

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 tumors of the vagina and vulva.

The COVID-19 pandemic has everyone anxious and in fear. If you are pregnant, undoubtedly you have a lot of queries about whether coronavirus poses a threat to you and your baby. The answers are not crystal clear yet, due to the evolving nature of the disease. Knowledge from past epidemics due to similar respiratory illnesses help understand and manage viral infections during pregnancy. Here are the common queries among pregnant women answered.

What effect does coronavirus have on pregnant women?

Generally, pregnant women do not appear to be more risky than healthy adults to develop a more serious disease or any complications if affected by coronavirus. Mostly, they will only experience mild to moderate flu-like symptoms.

If you are pregnant and your flu-like symptoms are getting worse, it could mean that your chest infection is getting more severe, and you may require hospitalization. If you develop more severe symptoms or your recovery is getting delayed, contact a first response hospital near you immediately.

What effect will coronavirus have on my baby if I test positive for COVID-19?

As this is a very new virus, all the information and evidence is still not available to us. There is no evidence to suggest an increased risk of miscarriage if exposed to COVID-19. There is also no evidence of vertical transmission, which refers to the ability of the virus to pass to your unborn baby during pregnancy.
In a study of nine pregnant women in China who tested positive for COVID-19, all nine babies tested negative for the virus and were healthy overall. One pregnant lady in London tested positive for coronavirus and later her newborn also tested positive. However, it is unclear whether the baby contracted the viral infection in utero or shortly after birth. Expert opinion is that the baby is unlikely to be exposed during pregnancy, and it is unlikely for the baby to have any defects in development as a result. As of now, there isn’t any new evidence that says otherwise.

What are the effects of Coronavirus in the first trimester?

Pregnant women who were part of The Lancet study were all in their second or third trimesters. There is still no data on pregnant women who tested positive for the virus in their first trimester. Patients who may get infected with symptoms like high fever may increase the risk of birth defects, though there is no evidence for this yet.

Are pregnant women a vulnerable group for Coronavirus?

It is not yet known if pregnant women are more susceptible to be infected by COVID-19 when compared to the normal population. Despite this, pregnant women are advised to reduce social contact by social distancing. It is an established fact that in some women, pregnancy alters how the body fights some viral infections. Though evidence for coronavirus is still insufficient, it is for this reason that pregnant women are advised to be extra cautious during this pandemic.

Will I be able to breastfeed my baby if I have suspected or confirmed coronavirus?

Yes. The benefits of breastfeeding your infant far outweigh the risk of transmission of coronavirus through breastmilk. The main risk of breastfeeding is due to the close contact between you and your baby which can pose a risk of droplet infection that can spread to the baby while breathing. Discuss the risks and benefits with your treating doctor and family before you make a decision.

Here are some steps to follow to minimize the risk of transmission:

• Wash your hands before feeding or touching the baby, breast pump or bottles
• Try to avoid coughing or sneezing while you feed
• Wear a face mask while feeding, if available.
• If you are using a breast pump, follow instructions for cleaning and sterilizing properly.
• Consider asking one of your healthy family members to feed your baby if you are expressing milk.

Precautions for pregnant women against Coronavirus

Here are some actions you can take to prevent getting the disease during pregnancy:

• Wash your hands frequently. Hand hygiene can really protect you from exposure to COVID-19. You may hear this over and over but with good reason.
• Practice social distancing. Always maintain a distance of at least 2 metres or 6 feet from others when you are in a public place. Avoid contact with others as much as possible.
• Get your flu vaccination on time. Though the flu vaccine does not protect you from exposure to COVID-19, it does make you less susceptible to influenza, which can cause complications during pregnancy.
• Use a tissue when you cough or sneeze, throw the tissue in the dustbin. Wash your hands right after.
• Do not ignore any respiratory symptoms. If you develop a cough or any respiratory distress, do not hesitate to call your doctor. After taking a detailed history, your doctor will decide if you need to get tested for COVID-19.
• Go virtual. As much as possible, consider virtual consultations instead of prenatal visits to your gynecologist. Try to minimize or altogether avoid spending time in the doctors waiting room or in the hospital. However, some tests will require you to be there in person such as the ultrasound, blood tests and fetal testing.
• Work from home whenever possible.
• Stay safe. Symptoms such as high fever with or without continuous cough may indicate a possible coronavirus infection. Avoid coming in close contact with anyone showing these symptoms & take the time to look for support from your family and friends. Keep in touch via emails, messages or video chats. Consider taking up a new hobby or acquiring a new skill. Do things that make you happy and put your mind at ease such as taking a long shower, meditating or reading a book. Exercise as per your doctor’s advice and regularly do your Kegels and squats as recommended.

Do not stress too much if your due date is nearing, as hospitals have a system in place for safe deliveries and to ensure minimal risk of exposure for newborns.

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 pregnancies. She is known for her bedside manners and etiquette towards pregnant women.

Medical abortion, also known as non-surgical abortion, is one way to terminate an early pregnancy using medications. Medical abortion is provided by trained health care providers in private office settings, family planning clinics and hospitals.

A medical abortion can be performed from the time a woman suspects and confirms she is pregnant up until nine weeks from her last menstrual period. However, some insurance companies limit medical abortion to pregnancies of seven weeks or less.
In clinical practice, medical abortion is about 95 percent to 98 percent effective, causing a woman to completely pass the pregnancy without the use of surgery. In comparison, early surgical abortion is effective 98 percent of the time.

Medication abortion procedure

Medication abortion involves using the medications mifepristone and misoprostol instead of surgery to end a pregnancy. It can be done as soon as a pregnancy can be seen in an ultrasound. In India, medication abortion is performed up to five weeks of pregnancy.

A pregnancy needs high levels of the hormone progesterone to continue. Mifepristone works by blocking the action of progesterone to cause the pregnancy to stop progressing. Misoprostol causes the cervix to soften and the uterus to contract to allow the pregnancy to be expelled from the uterus.

The process and number of appointments for having a medication abortion varies depending on the type of clinic setting you attend, and whether certain tests you need (such as ultrasound and blood tests) are available on site or require separate appointments. A number of clinics are able to offer necessary tests and medication abortion in a single initial appointment.

The process of having a medication abortion generally involves the following steps:

• You will have a medical consultation with a Gynecologist and often a nurse as well, which involves a clinical assessment of medical and other relevant information, and arrangements for you to have an ultrasound and blood tests.
• You will be given information about the methods of abortion to help you to make an informed decision about the best method for you.
• If you decide to have a medication abortion, you will be asked to sign a consent form and will be given all the relevant information about what to expect, the steps you will need to take, and about pre- and post-abortion care.
• You will discuss what sort of pain relief, and any other appropriate medication you may require, and how to obtain it, in preparation for the abortion.
• If you have an intrauterine device, it will need to be removed before you take the first medication (mifepristone).
• You will take a tablet of mifepristone either at the clinic or at home and obtain the other appropriate medications.
• You will take a tablet of misoprostol 24 to 48 hours later. This softens the cervix and helps the uterus push out the pregnancy. This stage nearly always occurs at home. (If you need to travel after taking misoprostol and before the abortion is complete, it is recommended that you have a responsible adult who can drive you.)
• The abortion is usually completed some hours later, although it may take longer. You will usually need a day or two of rest or reduced activity.
• You will be encouraged to have telephone contact with the clinic you attended or another source of expert support in case you have any questions or concerns at any time during and after the procedure.

What to expect during and after a medication abortion

After taking the second medication abortion tablet at home, you may experience the following:

• nausea, vomiting, diarrhoea, dizziness, headache and fever
• pain – usually within half an hour and generally much stronger than period pain
• bleeding one to four hours later – heavier than a period and there may be large clots
• after two to six hours the bleeding usually settles to the level of your normal period
• bleeding is usually similar to a normal period for another three to seven days
• unpredictable, irregular or prolonged bleeding can last for up to four weeks after a medication abortion.

Note: The timing of the pain and bleeding is unpredictable. It occasionally starts before taking the second medication, but may take up to 24 hours to start.

Follow-up after a medication abortion

It is important to have a follow-up appointment to make sure the procedure is complete and the pregnancy has ended. Many doctors order a blood test to check that the pregnancy hormone level has dropped. You will be given an appointment for review in two weeks’ time.
Medication abortion does not work in around one percent of cases. Around two to five per cent of women will have some pregnancy tissue remaining in the uterus (womb) and will need further treatment such as additional tablets or a small surgical procedure to complete the abortion. Your Gynecologist will discuss this with you.

Advantages and disadvantages of medication abortion

Advantages of medication abortion include:

• For around 95 to 98 per cent of pregnancies up to five weeks, no further treatment is needed after taking the two doses of abortion medication.
• Unlike surgical abortion, medication abortion does not need to take place in a hospital or day surgery unit as it does not require a surgeon, anaesthetist or other medical staff to be present during the later stage of the procedure. This makes it a suitable alternative for those living in remote areas provided they have access to emergency care.
• It is a less clinical and non-surgical procedure, which some women may prefer.
• Some women feel it is a more natural process.
• It happens in a home environment.

Disadvantages of medication abortion include:

• Medication abortions are generally more time consuming than surgical abortions, and there may be more doctor visits and tests.
• In a small percentage of cases the medication needs to be repeated, and sometimes a surgical procedure is needed.
• Pain and bleeding generally last longer than following a surgical abortion.
• It is difficult to predict the time it will take for a medication abortion to complete – it may take longer than the expected four to eight hours, after taking the second medication.
• A separate appointment is needed if you would like an IUD inserted.
• Mifepristone is not suitable for some women.

Mifepristone may not be recommended for you if you:

• have certain medical conditions such as bleeding problems, adrenal failure or high blood pressure
• are taking long-term steroid or blood-thinning medication
• have had allergic reactions to medication containing mifepristone.

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

What should you know about vaginal bleeding during pregnancy?

Vaginal bleeding or spotting during the first trimester of pregnancy is relatively common. Some amount of light bleeding or spotting during pregnancy occurs in about 20% of pregnancies, and most of these women go on to have a healthy pregnancy.

What is implantation bleeding?

Implantation bleeding is bleeding that occurs when the fertilized egg implants in the lining of the uterus. This happens around the time of the expected menstrual period. Implantation bleeding may occur before a woman realizes she is pregnant. What are the serious causes of vaginal bleeding in the first trimester of pregnancy?

What if I am pregnant and the bleeding severe?

Causes for severe bleeding during pregnancy include miscarriage, threatened miscarriage, and ectopic pregnancy. If you are pregnant and have vaginal bleeding, call 911 and go to the emergency department.

How much bleeding is normal during pregnancy?

Vaginal bleeding during the first three months of pregnancy is relatively common and usually is a cause of concern for the mother. Women wonder how much bleeding during early pregnancy is normal. While early bleeding may indicate the presence of a serious problem, this is frequently not the case. In fact, approximately 20% of pregnant women experience light bleeding or spotting during the first trimester of pregnancy. Most women go on to have uncomplicated pregnancies and ultimately deliver a healthy baby.

Spotting: Spotting usually refers to a few drops of blood that would not cover a pad or panty liner. Bleeding refers to blood flow that is heavy enough to require wearing a pad. If bleeding occurs during the first trimester, wear a panty liner or pad so that you are able to get an idea of the amount of bleeding that is occurring and can tell the health care professional. However, you should not use a tampon in the vagina or douche during pregnancy.

What other problems cause bleeding during early pregnancy (first trimester)?

Changes in the cervix: The normal hormone production during pregnancy can cause changes to the cervix, rendering it softer and more prone to bleeding. In addition, a cervical polyp (a benign overgrowth of tissue) may form, and this may bleed more easily during pregnancy. In both cases, spotting or light bleeding may be provoked following sexual intercourse or a pelvic examination.

Infection: A vaginal infection may cause spontaneous vaginal bleeding during pregnancy. The bleeding may be accompanied by abnormal vaginal discharge.

What causes heavy bleeding during early pregnancy (first trimester)?

Miscarriage

• Bleeding, abdominal pain, and back pain are common signs of miscarriage.
• An exam shows that the cervix is open.
• Tissue may be extruded through the cervix and vagina.
• A miscarriage occurs in an estimated 15% to 20% of pregnancies, usually during the first 12 weeks of gestation.
• A genetic defect confined to the specific embryo in question represents the most common cause of miscarriage.
• Few circumstances exist wherein a miscarriage in progress can be prevented.

Molar pregnancy

• Molar pregnancy, also known as gestational trophoblastic disease or hydatidiform mole, is an abnormality of fertilization that results in the growth of abnormal tissue within the uterus.
• Molar pregnancy is not a typical pregnancy, but the growth within the uterus leads to the typical symptoms of early pregnancy.
• In a complete hydatiform mole, there is only abnormal tissue in the uterus (and no fetus).
• In a so-called partial mole, there is abnormal tissue growth along with the presence of a fetus with severe birth defects.
• The fetus is typically consumed by the abnormal growth of tissue in the uterus, and a molar pregnancy cannot result in a normal fetus or delivery.
• Vaginal spotting or bleeding can be a symptom of molar pregnancy.
• A sonogram or ultrasound is used to diagnose a molar pregnancy.

Ectopic pregnancy

• Mild vaginal bleeding and increasing abdominal pain may indicate the presence of an ectopic pregnancy.
• An ectopic pregnancy occurs in approximately 1 out of 60 pregnancies.
• An ectopic pregnancy occurs when the fertilized egg implants outside of the uterus, where the blood supply is inadequate to sustain the growth of a normal pregnancy.
• In the majority of cases of ectopic pregnancy, the embryo is located within one of the Fallopian tubes; this sometimes is referred to as a tubal pregnancy. As the pregnancy grows and the tube distends, abdominal pain becomes increasingly severe.
• Sometimes these pregnancies can actually rupture the Fallopian tube, leading to significant blood loss.
• In some cases, a blood transfusion and emergency surgery are needed for prompt resolution of this potentially life-threatening condition.

Threatened miscarriage

• If a woman is bleeding during the first trimester of pregnancy, the possibility of a miscarriage must be ruled out.
• Symptoms of a threatened miscarriage are bleeding and mild cramping, but the cervix stays closed and the fetus is still viable.
• In many women, the bleeding stops and the pregnancy continues. For others, the bleeding continues, and they eventually have a miscarriage (i.e. spontaneous pregnancy loss).

Subchorionic hemorrhage

• In this condition, blood collects between the gestational sac and the wall of the uterus.
• At times, the intrauterine clot can be seen on ultrasound examination.
• The body frequently reabsorbs these blood clots; however, occasionally there may be passage of old dark blood or even small clots from the vagina.

Dr. Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi, with over 14 years’ experience in handling all kinds of bleeding during pregnancy. She specializes in high risk pregnancy management and handling.

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

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

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

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

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

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

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

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

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

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

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

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

Diagnosis

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

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

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

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

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

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

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

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

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

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

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

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

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

Higher risk of severe disease, ICU admission

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

Higher risk of blood clots

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

Placenta damage and vertical transmission

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

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

Preterm birth

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

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

Do pregnant women face greater risk from COVID-19?

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

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

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

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

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

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

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

How are prenatal checkups changing?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

COVID-19 and Abortion

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

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

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

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

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

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

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

In addition, some specific reasons include:

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

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

Possible choices for such a woman include:

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

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

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

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

If you don’t have any known condition affecting your menstrual cycle, your period should start within 30 days of the start of your last period.

A period is officially considered late if it’s been more than 30 days since the start of your last period. After six weeks without bleeding, you can consider your late period a missed period.

Several things can delay your period, from basic lifestyle changes to chronic health conditions. Here’s a look at 10 potential culprits.

1. You’re stressed out

Your body’s stress response system is rooted in a part of your brain called the hypothalamus. While you may no longer be running from predators, your body is still hardwired to react as if you were.

When your stress level peaks, your brain tells your endocrine system to flood your body with hormones that switch on your fight-or-flight mode. These hormones suppress functions that aren’t essential to escaping an imminent threat, including those of your reproductive system.

If you’re under a lot of stress, your body can stay in fight-or-flight mode, which can make you temporarily stop ovulating. This lack of ovulation, in turn, can delay your period.

2. You’ve lost or gained weight

Severe changes in body weight can screw with your period’s timing. Extreme increases or decreases in body fat, for example, can lead to a hormonal imbalance that causes your period to come late or stop entirely.

In addition, severe calorie restriction affects the part of your brain that “talks” to your endocrine system, giving instructions for the production of reproductive hormones. When this communication channel is disrupted, hormones can get out of whack.

3. You’ve upped your workout intensity

A strenuous exercise regimen can also cause missed periods. This is most common in those who train for several hours a day. It happens because, whether intentionally or not, you’re burning way more calories than you’re taking in.

When you burn too many calories, your body doesn’t have enough energy to keep all its systems running. This can lead to a hormonal imbalance that throws off your menstrual cycle, leading to missed or late periods.

Periods typically go back to normal as soon as you lessen training intensity or increase your caloric intake.

4. You have PCOS

Polycystic ovary syndrome (PCOS) is a set of symptoms caused by an imbalance of reproductive hormones. People with PCOS don’t ovulate regularly. As a result, your periods may be lighter than normal, arrive at inconsistent times, or disappear altogether.

Other PCOS symptoms can include:

• excess or course facial and body hair
• acne on the face and body
• thinning hair
• weight gain or trouble losing weight
• dark patches of skin, often on the neck creases, groin, and underneath breasts
• skin tags in the armpits or neck
• Infertility

5. You’re using hormonal birth control

Many love the pill because it makes their periods so regular. But it can sometimes have the opposite effect, especially during the first few months of use.

Similarly, when you stop taking the pill, it can take a few months for your cycle to get back to normal. As your body returns to its baseline hormone levels, you may miss your period for a few months.

If you’re using another hormonal birth control method, including an IUD, implant, or shot, you might completely stop getting your period.

6. You’re in perimenopause

Perimenopause is the time leading up to your menopausal transition. It typically starts in your mid- to late 40s. Perimenopause lasts for several years before your period stops completely.

For many, missed periods are the first sign of perimenopause. You may skip a period one month and be back on track for the following three. Or, you may skip your period three months in a row and find that it arrives unexpectedly, often lighter or heavier than you’re used to.

7. You’re in early menopause

Early menopause, also known as premature ovarian failure, happens when your ovaries stop working before you turn 40.

When your ovaries aren’t working the way they should, they don’t produce enough estrogen. As estrogen levels drop to all-time lows, you will begin to experience the symptoms of menopause.

Late or missed periods may be an early sign. You may also experience hot flashes, night sweats, and trouble sleeping.

Other signs of premature ovarian failure include:

• vaginal dryness
• trouble getting pregnant
• decreased sexual desire
• trouble concentrating

8. You have a thyroid condition

Your thyroid is a butterfly-shaped gland in your neck that produces hormones that help regulate many activities in your body, including your menstrual cycle. There are several common thyroid conditions, including hypothyroidism and hyperthyroidism.

Both hypothyroidism and hyperthyroidism can affect your menstrual cycle, causing irregularity, but hyperthyroidism is more likely to cause late or missed periods. Sometimes, your period may disappear for several months.

Other symptoms of a thyroid issue include:

• heart palpitations
• appetite changes
• unexplained weight changes
• nervousness or anxiety
• slight hand tremors
• fatigue
• changes to your hair
• trouble sleeping

The bottom line

Your period is generally considered late once it’s been at least 30 days since the start of your last period.

Many things can cause this to happen, from routine lifestyle changes to underlying medical conditions. If your period is regularly late, make an appointment with your Gynecologist to determine the cause.

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