III. REPRODUCTIVE HEALTH CONCERNS IN FEMALES

III. REPRODUCTIVE HEALTH CONCERNS IN FEMALES

A. MENSTRUAL PROBLEMS

What is a painful menstrual period?

Painful menstrual periods are marked by crampy lower abdominal pain. A woman may feel sharp pain that comes and goes, or have dull, aching pain. Painful menstrual periods may also cause back pain. The pain may begin several days before or just at the start of your period. It generally subsides as menstrual bleeding tapers off.

How can painful menstrual periods be managed at home?

The following steps may allow you to avoid prescription medications: (i) Apply a heating pad to your lower abdomen (below the umbilicus). Be careful NOT to fall asleep with it on. (ii) Take warm showers or baths. (iii) Drink warm beverages. (iv) Do light circular massage with your fingertips around your lower abdomen. (v) Walk or exercise regularly, including pelvic rocking exercises. (vi) Follow a diet rich in complex carbohydrates such as whole grains, fruits, and vegetables, but low in salt, sugar, alcohol, and caffeine. (vii) Eat light but frequent meals. (viii) Practice relaxation techniques like meditation or yoga. (ix) Keep your legs elevated while lying down. Or lie on your side with knees bent.

When should a doctor be consulted for painful menstrual periods?

A doctor may be consulted if self care measures have not relieved the pain for 3 consecutive months or if there is a history of passage of large blood clots. Also occurrence of pain more than 5 days prior to the period and continuation after the period gets over warrants a doctor’s consultation.

What is pre-menstrual syndrome?

Premenstrual syndrome (PMS) involves symptoms that occur in relation to the menstrual cycle. The symptoms usually begin 5 to 11 days before the start of menstruation. Symptoms usually stop when menstruation begins, or shortly thereafter. These symptoms may include headache, swelling of the feet, backache, abdominal cramps, breast tenderness, bloating sensation etc.

What are the causes of PMS?

An exact cause of PMS has not been identified. It occurs more often in women between their late 20s and early 40s, those with at least one child, those with a family history of depression, or women with a past medical history of depression after delivery of first child.

How can pre menstrual syndrome be managed at home?

Self-care methods for managing PMS include: (i) Regular Exercise – at least twenty minutes to half an hour everyday, which may include brisk walking or cycling.(ii) Dietary measures: Increased whole grains, vegetables, fruit, and decreased or no salt, sugar and coffee may prove beneficial. (iii) Maintain a daily diary or log to record the type, severity, and duration of symptoms. A "symptom diary" should be kept for a minimum of 3 months. The diary will greatly assist the doctor not only in the accurate diagnosis of PMS, but also with the proposed treatment methods. (iv) It is important to get adequate rest.

When is a heavy menstrual period said to be occurring?

If there is soakage through a sanitary pad every hour for 6 consecutive hours, this is considered a very heavy period.

What are the common causes of heavy menstrual periods?

The common causes of heavy menstrual periods include: (i)Growths on the uterine lining (ii) Unexplained- referred to as dysfunctional uterine bleeding (iii) Thyroid gland problems (iii) Blood clotting disorders. (iv)Intra uterine device. (v) Stress.

What is a prolonged menstrual period?

A prolonged period is one that lasts longer than 7 days.

What are the common causes of prolonged menstrual periods?

Prolonged menstrual periods may result from (i) Ovarian cysts (ii) Sometimes the cause may not be found-referred to as dysfunctional uterine bleeding. (iii)Bleeding disorders and intake of anti clotting medications. (iv) Stress

What is an irregular menstrual period?

An irregular menstrual period is one in which the duration can vary excessively from cycle to cycle, with the periods occurring too frequently or being separated by an unusually long duration.

Is it normal to have irregular periods during the first few teenage years?

Yes. At first, the menstrual periods typically are irregular. The girl may have 2 months between periods, or may have two periods in 1 month. Over time, they become more regular.

What are the causes of irregular menses?

Menstrual periods that are abnormally frequent can be caused by (i) Endometriosis is a condition of unknown cause that can lead to pelvic pain and frequent bleeding. (iii) Sometimes, the cause of unclear, in which case the woman is said to have dysfunctional uterine bleeding. (iii)Ovarian cysts (iv) Stress

Is there a cause for worry if bleeding during menses lasts for only 2-4 days instead of the usual 5 days?

No, there is no need to worry. Periods change over time and from cycle to cycle.

What needs to be done in case of Heavy, Prolonged or Irregular Menstrual Periods?

(i) Keep a record of your menstrual cycles, including when menstruation begins and ends, how much flow you have (count numbers of pads used, noting whether they are soaked), and any other symptoms you experience. (ii) Consult a doctor if the problem persists beyond 3 months.

What is absent menstruation?

Absent menstruation refers to appearance of no menstruation by age 16. The Causes may include: (i) Birth defects of the female reproductive system (ii) Lack of an opening in the membrane at the entrance of the vagina (hymen) (iii) Problem with glands in the brain

B. ABNORMAL VAGINAL DISCHARGE

What is vaginal discharge and when is it said to be abnormal?

Vaginal discharge is composed of mucous secretion produced by the cervix. Disease may be indicated if vaginal discharge is abnormal in color, odour, or consistency, or significantly increased in amount.

Which are the conditions that lead to an increase in the normal vaginal secretion?

The amount of normal vaginal discharge may be increased in conditions such as sexual excitement, emotional stress and ovulation (when you produce and release an egg from your ovary in the middle of your menstrual cycle)

What are the causes of abnormal vaginal discharge?

These conditions can lead to abnormal vaginal discharge: (i) Sexually transmitted infections. (ii) Fungal/yeast infection of the vagina common in diabetics and those with weak immune system.

How can abnormal vaginal discharge be prevented?

To help prevent vaginal discharge: (i) Genital area must be kept clean and dry. (ii) Douching (splashing water into the genital area) should be avoided. While many women feel cleaner if they douche after menstruation or intercourse, it may actually worsen vaginal discharge because it removes healthy bacteria lining the vagina that are there to protect you from infection. (iii) Stress should be avoided. (iv) Condoms must be used to avoid catching or spreading sexually transmitted diseases. (v) Blood sugars should be kept under good control in case there is presence of diabetes.

Should a doctor be consulted for an abnormal vaginal discharge?

Yes, a doctor should be consulted promptly. Your doctor will take a brief history about your symptoms, conduct a pelvic examination and prescribe a treatment accordingly.

C. OVARIAN CYSTS

What are ovarian cysts?

An ovarian cyst is a growth or swelling on, or inside, the ovary. It may be solid, or filled with fluid.

Are ovarian cysts cancerous?

The vast majority of ovarian growths are not cancerous.

What are the symptoms of ovarian cysts?

Ovarian cysts may produce the following symptoms: (i) Many women experience no symptoms when they have an ovarian cyst, particularly if it's small. (ii) Certain cysts grow large and may cause the abdomen to swell. (iii) Depending on where the cyst is and its size, it may put pressure on the bladder or bowels, making you need to go to the toilet more often. (iv) You may also notice abdominal discomfort and sex may be uncomfortable or painful. (v) Your periods may be affected; they may become irregular or the bleeding may be heavier or lighter than usual. (vi) Appearance of excess facial and body hair (vii) Deepening of voice.

What is the treatment for ovarian cysts?

While some cysts may disappear on their own, other cysts may need surgery. Your doctor will discuss with you the pros and cons of surgery.

What is Polycystic Ovary Syndrome (PCOS)?

Polycystic simply means 'many cysts' and describes the appearance of the ovary on ultrasound scan.

What are the symptoms of PCOS?

The symptoms of PCOS include: (i) Irregular or absent periods (ii) Infertility (iii) Unwanted body hair (iv) Acne (v) Weight gain (vi) Abdominal discomfort.

What is the treatment for PCOS?

PCOS can be treated by hormonal medicines or surgery. The discretion for treatment lies with the doctor.

D.PROLAPSE

What is prolapse?

Prolapse refers to descent of a pelvic organ like uterus, bladder, urethra or rectum into the vagina.

What are the causes of prolapse?

Prolapse occurs as a result of weakening of the pelvic muscles due to (i) repeated childbirth (ii) old age (iii) lumps in the uterus due to fibroid (iv) obesity (v) Spinal injuries.

What are the common symptoms of prolapse?

Symptoms that may be occur with all types of prolapse: (i) Feeling a lump or heavy sensation in the vagina (ii) Lower back pain that eases when you lie down (iii) lower abdominal pain or pressure (iv) Pain or lack of sensation during sex (v) inability to control urination and leaking urine.

What treatment options are available for prolapse?

Mild degrees of prolapse can be treated by (i) Pelvic exercises (ii) Inserting vaginal pessary to hold the prolapsed organ in place. Severe degrees of prolapse need to be corrected by different kinds of surgery.

E. VULVAL PAIN AND DISCOMFORT

What can cause vulval pain and itching?

Pain, itching, burning and irritation of the vulval area can be the result of a vaginal infection , or the result of a non-infectious skin problem such as dermatitis, eczema.

What are the causes of non infectious skin diseases which can cause vulval pain and discomfort?

A woman's vulva can also be affected by skin problems that are not infectious and cannot be passed on to sexual partners. Soap, disinfectants and detergents used for washing underwear can easily irritate vulval skin.

How can vulva skin problems be treated?

Treatment often includes using a steroid cream and emollients which are bland creams and ointments free of skin irritants. They can be used to soothe and hydrate sore and cracked skin and as a soap substitute to clean the vulva. They are available as creams and lotions and are available from chemists without a prescription.

How can a woman care for her vulval skin?

If you have, or are prone to, vulval problems, avoid wearing tights or tight fitting trousers. Avoid synthetic underwear and try cotton underwears that are not too tight. Use mild soap for washing the vulval skin.

What is the commonest cause of swelling in the vulva?

The commonest cause for swelling in the vulva is known as “Bartholin’s cysts”. Bartholins glands are two tiny glands present on both sides of the vaginal opening. There are tiny ducts in the gland and if those get 'clogged' up by skin cells or secretions, it can form a cyst - (a fluid filled sac). The cyst can grow from the size of a pea to larger than a golf ball.

How is Bartholin’s cyst treated?

The treatment really depends on several things; the size of the cyst, how painful it is, if it is infected and how your gynecologist chooses to treat them. Some cysts are just treated with oral antibiotics. Sometimes your gynecologist might decide to put a 'drain' into the cyst, The drain (like a thick string) stays in place for about 2 to 4 weeks. This allows the fluid to drain and causes a small opening to form inside the lip of your vagina. The drain is removed after that 2 - 4 week period.

F. OBSTETRIC FISTULA

What is an obstetric fistula?

A fistula is a hole between a woman's birth passage and one or more of her internal organs. This hole develops over many days of obstructed labor, when the pressure of the baby's head against the mother's pelvis cuts off blood supply to delicate tissues in the region. The dead tissue falls away and the woman is left with a hole between her vagina and her bladder and sometimes between her vagina and rectum. This hole results in permanent leaking of urine and/or feces.

What are the causes of obstetric fistula?

A fistula results from an obstructed labor that is left unrelieved and untreated. There are three delays that contribute to the development of a fistula: delay in seeking medical attention during labour; delay in reaching a medical facility; and delay in receiving medical care once arriving at a health care facility.

Can a fistula be cured?

Yes. An obstetric fistula can be closed with intravaginal surgery. If her surgery is performed by a skilled surgeon, a fistula patient has a good chance of returning to a normal life with full control of her bodily functions. The operation has a 93% success/cure rate.

G. ECTOPIC PREGNANCY

What is ectopic pregnancy?

Ectopic pregnancy is one in which the fertilized ovum (egg) is implanted and develops outside the uterus. The most common site is tube. Normally fertilization occurs in the tube and the fertilized ovum moves into the uterus. But in tubal pregnancy the ovum remains in the tube.

What are the main symptoms of an ectopic pregnancy?

The four important symptoms are-

Ammenorrhoea (no periods) of short duration.

Severe abdominal pain.

Vaginal bleeding.

Nausea, vomiting and fainting attacks.

What is to be done on suspicion of an ectopic pregnancy?

A. The women should be urgently rushed to a hospital. The principle in the management of acute ectopic is resuscitation and surgery done at the same time. Blood transfusion is done if required. A quick surgery stops the bleeding and improves the patients condition.

I. CANCERS OF THE REPRODUCTIVE TRACT

What is cancer?

Cancer affects body's basic unit, the cell. Cancer occurs when cells become abnormal and divide without control. This mass of extra tissue, called a growth or tumor, can be benign or malignant.

What is a benign tumour?

Benign tumors are not cancerous. They can usually be removed and, in most cases, they do not come back. The most important thing is that cells from benign tumors do not spread to other parts of the body.

What is a malignant tumour?

Malignant tumors are cancer. Cancer cells can invade and damage tissues and organs near the tumor. Cancer cells also can break away from a malignant tumor and enter the bloodstream and spread throughout the body.

I 1 CERVICAL CANCER

Who are the women who are at risk of getting cervical cancer?

Women who are at risk of getting cervical cancer are those who (i) have Multiple sexual partners (ii) started sexual intercourse early in life –during teens or early twenties (iii) women with history of genital warts or chronic sexually transmitted infections.

What are symptoms of cervical cancer?

In the initial stages, cervical cancer does not produce symptoms, Symptoms are produced when the cancer cells start invading nearby tissues. The most common symptom is abnormal bleeding. Bleeding may start and stop between regular menstrual periods, or it may occur after sexual intercourse. Menstrual bleeding may last longer and be heavier than usual. Increased vaginal discharge is another symptom of cervical cancer. These symptoms may be caused by cancer or by other health problems. Only a doctor can tell for sure. It is important for a woman to see her doctor if she is having any of these symptoms.

Can cervical cancer be prevented?

Yes, cervical cancer can be prevented by early detection of changes in the cervix by means of getting a regular cervical smear or Pap smear test done.

What is a Cervical smear or Pap smear test?

A smear test is a simple examination to check the health of a woman’s cervix. It is called a smear test (or Pap smear) because the doctor or nurse takes a small sample of cervical cells and smears them onto a glass slide to be analysed under a microscope.

Who should have a smear test?

All sexually active women should get a cervical smear test done every 3 to 5 years.

Is there any need for a non sexually active woman to get her smear test done?

Cervical cancer is extremely rare in women who have never been sexually active, therefore most recommendations suggest women don’t need to have smears until they’ve had sex.

How is a Pap smear done?

A warmed speculum is passed into the vagina to separate the walls so the doctor can see your cervix. A wooden spatula (thinner than a tongue depressor) is wiped across the cervix, and the smear is transferred to a glass slide.

When is the best time to get a smear done?

The best time to get a smear done is between the middle of your menstrual cycle – about half way between one period and the next. It’s easiest to get a good cell sample from your cervix at this time.

Is any vaccine available for protection against cervical cancer?

Yes, a vaccine (HPV Vaccine) is now available which protects against a virus known as Human Papilloma virus which is responsible for causing 70 % of cervical cancers

Who should receive the HPV vaccine?

The vaccine is for girls and women ages 9 to 26. It works when given before one has any contact with virus.

How is HPV Vaccine administered?

The vaccine is administered as 3 injections given over a span of 3 months.

What are its side effects?

It can cause pain, swelling, itching, and redness at the injection site, fever, nausea, and dizziness.

Does the vaccine protect everyone who is vaccinated against cervical cancer?

The vaccine may not fully protect everyone and does not prevent all types of cervical cancer, so it is important to continue regular cervical cancer screenings.

I 2 OVARIAN CANCER

Who are the women who are at risk of getting ovarian cancer?

The exact causes of ovarian cancer are not known. However, studies show that the following factors may increase the chance of developing this disease : (i) Family history. First-degree relatives (mother, daughter, sister) of a woman who has had ovarian cancer are at increased risk of developing this type of cancer themselves (ii) Age. The likelihood of developing ovarian cancer increases as a woman gets older. Most ovarian cancers occur in women over the age of 50, with the highest risk in women over 60. (iii) Women who have never had children are more likely to develop ovarian cancer

What are the symptoms of ovarian cancer?

The symptoms of ovarian cancer are almost similar to those of benign ovarian conditions such as menstrual disturbances, abdominal discomfort. At times, the symptoms may be vague such as loose motions, weight loss etc. Thus, you should see your doctor promptly

What are the treatment options for ovarian cancer?

Treatment options and outcomes for patients who have ovarian cancer depend on the exact classification of the cancer and how far it has spread before it is diagnosed

Is there any screening test for preventing ovarian cancer?

No screening test has yet been developed for early diagnosis of ovarian cancer.