Contraception

For all women, young and old, family planning is very important. Having the ability to be able to plan when you want a pregnancy and when you don’t want it, is a basic right. In my opinion when women are truly independent and empowered in this aspect of their life we would have achieved true female liberation!

In the series of posts that will follow this one, I will try and explain the various options available for preventing a pregnancy, their advantages and disadvantages and a basic idea about how to use them.

The aim is to dispel some wrong notions and clarify certain controversial points.

First I begin by telling you about the full spectrum of choices available to couples**  to prevent unwanted pregnancies.

** i say couples because there are many methods which the male partner can use. As a couple you should be able to discuss these with him and many a times your partner may want to be the one to manage the contraception. So don’t be shy and talk about it!

So, what is contraception?

Contraception is any method that a couple uses to prevent an unwanted pregnancy. They can be natural, non hormonal or hormonal. We can also group them into male and female  contraception.

What are the various choices available to couples?

The following is a broad classification of contraceptive methods used all over the world:

Contraception

In the next few posts i will discuss each of these individually.

It would be interesting to get your queries, concerns and experiences so that I can address some of them in the next post.

Till then – be safe!

Polycystic Ovarian syndrome

Polycystic ovarian syndrome (PCOS)

 

Lately, the diagnosis of this condition especially among young women is becoming more common.I have a lot of women tell me that they have been told they have PCOS, I am not sure all of them actually do!

The American statistics show that 1 in 25 to 1 in 10 women may be having PCOS. But maybe many women are also being over diagnosed.

The data also shows that 1 in 5 women have ovaries with polycystic appearance. So what is the difference?

What is this condition? How can you suspect you have it?

What does it mean for your health? What are the long term implications for this? Can it be treated or controlled?

These are some of the many questions that may be going through your head if u have recently been told you have this condition. There are many myths associated with this condition and I will try and answer and resolve as many of them as I can.

What is PCOS?

PCOS stands for Polycystic ovarian syndrome. It is a condition of hormonal disturbance in females resulting in any or all of the following: irregular periods, weight gain, difficulty in conceiving, acne and some other long term complications.

Polycystic ovaries are a part of this syndrome. Ovaries with a large number of follicles, with a typical appearance on ultrasound are called polycystic ovaries. Not all women with polycystic ovaries have the syndrome.

What are the common symptoms?

The most common symptom of PCOS is irregular periods. The periods usually come at irregular and prolonged intervals, sometimes being absent for 2-3 months also. This may be associated with weight gain, increased facial hair, acne and difficulty in getting pregnant.

How can the diagnosis be confirmed?

The diagnosis is confirmed based on your symptoms, Ultrasound for your ovaries and some blood tests for hormones. It is best to have these tests and ultrasound done on the second or third day of your period.

According to the Rotterdam criteria for diagnosis of PCOS two out of the three criteria should be present.

These are :

  1. Irregular prolonged periods
  2. Signs of increased androgens (male hormones) like excessive hair/ acne OR blood reports suggestive of the same
  3. Ultrasound showing polycystic ovaries : Ovaries which are larger than normal ovaries and have more than double the number of eggs, as seen on ultrasound.

What causes PCOS?

The exact cause behind PCOS is not clearly defined. It is believed to be an imbalance between male and female hormones in the body leading to excessive male hormones which leads to the manifestations of PCOS. The excess of male hormones makes it difficult for the ovary to produce and release an egg every month, resulting in irregular periods and subsequently difficulty in conceiving.

The development of PCOS may also be liked to Insulin resistance and this may be the factor linking it to diabetes in the long run.

What does it mean once I have been diagnosed with PCOS?

PCOS is not a disease. It is a collection of symptoms. But it also has short and long term implications for your health if it is not corrected.

Short term Health concerns:

Weight gain and acne

Excessive hair on face and chest, also called hirsutism

Irregular periods which may be associated with heavy periods also

Inability or difficulty to conceive

Miscarriage in early pregnancy

Long term concerns:

Long standing PCOS, especially if periods remain irregular or less frequent than 3 times a year, can lead to Diabetes, high blood pressure, Obesity, cardiac problems, cancer of the womb, depression, snoring and daytime sleepiness.

What is the treatment for PCOS?

As PCOS is not a disease there is no definite treatment for it. However, there are some lifestyle changes and medications that can help reduce the chances of your having symptoms and any complications of PCOS.

Lifestyle modifications

A healthy diet

Eating a balanced diet with plenty of fruits and vegetables has been associated with improvement in this condition.

Losing weight with diet and exercise also improves the hormonal imbalance. It has been shown that losing even 5 % of your weight might be enough to improve your symptoms. BMI or body mass index is a good way to monitor your health. The BMI depends on a person’s weight and height. It is best to maintain your BMI between 19 and 25.

Regular routine. Sleeping on time i.e. not very late and trying to get up early also helps improve PCOS.

Stress management. Techniques to reduce stress like meditation, music therapy, exercise etc also help reduce the severity of PCOS.

Medications:

Cyclical hormonal pills: Sometime you may be given hormonal pills like the contraceptive pills to regularize the period. These do not treat he condition but while you are taking the medicines your periods will come on time and the other symptoms like acne and hirsutism may also improve. However they are likely to come back once you stop the pills.

Metformin: Medications that reduce insulin resistance can help reduce the imbalance between male and female hormones and hence improve the symptoms.

But the most important and effective method of dealing with PCOS remains weight loss and lifestyle management.

The take home message is that PCOS is a very common condition among young women and although it may seem difficult in the beginning, can be kept under control with a disciplined lifestyle and a little help from medications.

 

 

 

 

 

 

 

Bleeding in early pregnancy!

One of the scariest thing in pregnancy is when you find yourself bleeding. Even a small red or brown coloured spot on your undergarments can really make you fear for your pregnancy. Although I agree that bleeding from the vagina in pregnancy is not a good sign but many a times the bleeding will not really turn out to be very significant. So here is a little information and guidance on vaginal bleeding in pregnancy.

Vaginal bleeding in early pregnancy

So one out of every four women can have bleeding in early pregnancy (first three months of pregnancy). However most of them will go on to have an otherwise normal pregnancy. The bleeding could be something not so serious or it could be a symptom of miscarriage or other complications like ectopic or molar pregnancy.

Possible causes

Implantation bleeding:  In very early pregnancy as the sac of the baby attaches to the lining of the womb there may be some areas where the sac is not completely attached. There can be slight bleeding from these areas as the baby burrows deep into the womb to get attached and start growing. This is normal and will not cause any risk to your pregnancy.

Possible miscarriage or risk of miscarriage: Whenever the fetus is not growing properly in the womb or has passed away very early there can be some bleeding. In early pregnancy one out of every 5 pregnancies can result in a miscarriage. This can be confirmed by a scan done by your doctor.

Ectopic pregnancy: When the fetus implants outside the lining of the womb it is called an ectopic pregnancy. The uterus being empty can result in slight spotting and the growing pregnancy outside the womb can cause bleeding inside your tummy to result in risk to you. This is a condition that must be diagnosed at the earliest with scan and hcg tests for earliest treatment and best outcome. An ectopic pregnancy cannot result in a healthy baby, it has to terminated.

Molar pregnancy: This is a condition where the pregnancy does not have a live fetus. Instead it is only abnormal placental tissue that grows and fills the womb. This is not very common and will require immediate treatment.

Bleeding from the cervix : sometimes a polyp or cervical lesion can bleed in pregnancy specially after intercourse.

Unexplained bleeding: sometimes no cause can be identified.

What you should do

Contact your obstetrician or GP at the earliest. If you are having heavy bleeding visit the closest early pregnancy assessment unit or accident and emergency. Also report to the emergency ASAP if you have associated fainting, dizziness or severe tummy pain. Meanwhile try and rest, avoid intercourse and stay calm.

What tests you may be offered

Your doctor will ask you a few questions about your pregnancy and the bleeding. He or she will then most likely offer a scan to check the pregnancy and some blood and /or urine tests. It is absolutely fine to do a trans vaginal (from down below) scan if the doctor feels it is needed. It will not increase the risk to you or the baby. In fact it will make the diagnosis more clear to your doctor. Sometimes your doctor may want to put in a small tube like instrument called a speculum in the passage down below to see if the bleeding is from the cervix. Again that is safe for you.

You may be asked to give a sample of your urine to rule out infection. Blood tests may be done to check the level of the pregnancy hormone (hcg) or your hemoglobin and blood group. Sometimes the doctor may do a swab from down below for chlamydia.

What treatments you might be offered

Depending on what the doctor feels is the cause of your bleeding you may be asked to come back in after 48 hours for a blood test (suspected ectopic pregnancy), advised rest and observation at home and review scan after 1-2 weeks, offered admission in case of heavy bleeding or medications to complete the miscarriage if the miscarriage is confirmed. Pregnancy supplements can continue. The role of progesterone medications that “support” the pregnancy is controversial. Research has not shown any clear benefit but you may choose to take them after discussing them with your doctor.

 What precautions you need to take

Well, in the early months the most common cause of miscarriage is abnormality in the baby itself. So, in a way nature miscarries the babies which are not healthy. So you can rest assured that the miscarriage or any adverse outcome is not related to your activity level, what you ate or did etc. However being more careful if you are having bleeding will not do any harm. So avoid travelling if not necessary, may avoid intercourse for a few days, try and avoid constipation and straining at stools and rest as much as you can.

 Good luck and hope you never have to go through a period of uncertainty where you fear for your pregnancy and unborn child, but in case you do keep the faith and feel free to write to me at drnehagami(at)gmail.com

Pink!

Pink! The colour of the month!

 

Breast Cancer Awareness Talk at GEMS world Academy Parents Association Meeting
Breast Cancer Awareness Talk at GEMS world Academy Parents Association Meeting

October is being celebrated as the breast cancer awareness month all over the world. It is the time of the year when doctors, nurses, dieticians and social workers join hands to strengthen the fight against this deadly cancer.

So why is this so important? Well to start with breast cancer is the second most common cancer affecting women. (the first being lung cancer) One out of every 8 women is expected to suffer from this disease once in her lifetime. Also it is a disease that affects the woman of the house but leaves a mark on the entire family. And most importantly there is enough evidence to show that both prevention and early detection can reduce the damage caused by this cancer.

Before we talk about prevention, we need to know what the risk factors for Breast cancer are. Most important is your age. This cancer is mostly seen in women over the age of 50, but can develop in younger women as well. But the risk increases as you grow older. Then comes family history and genetic factors. If you have had any female member in your immediate family (mother, sister, aunt, grandmother, daughter) with breast cancer, especially before the age of 40 then you are at a higher risk. Two or more relatives with breast cancer at any age is again a risk factor. Although male breast cancer is rare, if anyone in your family has had it, it is again a high risk factor. The point to remember is that if anyone in the family has had breast cancer, you must consult your doctor to discuss specific preventive strategy for you and your family. History of ovarian cancer in family members also increases your risk of both cancers.

Another set of risk factors is linked to your periods, pregnancies and breast feeding. So having periods from an early age, menopause at a late age, first baby at a more advanced age ( let’s say after 35) and not breast feeding, all increase your risk of Breast cancer. SO do think about these when you are planning your life, especially if you have any other risk factors.

Hormonal medications: Oral contraceptives have often been linked with breast cancer. However the evidence is not very strong. Oral contraceptive pills (those that contain both estrogen and progesterone) are known to increase the chance of other non cancer breast conditions. A recent guideline by the NHS (UK) reports a slight increase in breast cancer while you are on the pills. So speak to your gynecologist if you have any concerns. Certain types of hormone replacement therapy (HRT) medicines, used for menopause, do have an increased risk. Again, speak to your doctor if you have been advised to use HRT.

Another very important set of risk factors has to do with lifestyle.

Smoking and alcohol increase your risk of breast cancer. Avoid smoking and limit alcohol to maximum of two drinks per week. Obesity also increases the risk. Being physically active reduces the risk, try and walk for just 15-20 minutes per day and you would have done yourself a huge favour! two and a half hours of moderate activity per week can decrease your risk of having breast cancer by as much as 30 %!!

Sadly, despite the healthiest of lifestyles, many women still get breast cancer. This tells us that no one is really safe or protected from this condition. Here comes the role of early detection.

There are three main ways to achieve this.

Breast Self examination: This is the examination of the breasts by the woman herself, preferable every month after her periods. This was very popular in the 1970s but recently some studies has shown that it may not really increase early detection of cancer. Instead it was found to increase the anxiety in women due to benign lumps and a increased rate of unnecessary biopsies. However if you are motivated to do the Self Breast examination then you must learn the correct technique form your doctor.

Clinical Breast Examination: This refers to Examination by your GP or gynecologist to try and detect any lumps. However this is no more recommended for early detection of breast cancer as studies have not shown much advantage.

Mammogram/ Ultrasound:

The American cancer society recommends that screening mammograms should be offered from the age of 40 with annual mammograms till 54 and then be done every 2 years. The NHS (UK) recommends 2 yearly mammograms between the ages of 50-70 years. They are thinking of increasing the age range from 47-73 years now. More frequent screening will be suggested to you by your doctor if you have a strong family history or any other risk factors.

A mammogram is an X ray of the breasts taken while compressing the breast between two plates. It can be slightly uncomfortable but has no long term harmful effects on you. If there is anything suspicious on the mammogram you may be called back in for further tests like ultrasound, needle aspiration or biopsy. 4 out of every ten women who undergo mammograms are called back in but only one out of them may actually have something serious.

So put on your walking shoes, Get active and do go for your screenings. It might help you to live a healthier and happier life!

Breast Cancer Awareness Talk at GEMS World Academy Parents Association meeting
Breast Cancer Awareness Talk at GEMS World Academy Parents Association meeting

 

PCM in Pregnancy! yes or no?

There has been a recent study which has reported that taking paracetamol (PCM) in pregnancy can possibly increase the risk of your baby having asthma. This was a large study conducted in Norway and published in 2016 (1).
The study showed that paracetamol intake by the mother during pregnancy, increases the risk of the baby going on to develop childhood asthma by 13 %. Also, giving a baby paracetamol in the first 6 months of life increases the risk of asthma by 29 %, as per this study.
However we need to understand that the study does not tell us at what dose this effect is seen. Also, Paracetamol remains the only safe medication to manage fever in pregnancy. And we do know that fever if left untreated can be more harmful for the fetus.
But, the lesson to be learnt from this study is that paracetamol (for that matter any drug) should be consumed in pregnancy only when needed, at the lowest dose possible and for the least amount of time.
So take your PCM with caution and ofcourse after discussing with your doctor!

Reference

1.  Magnus M.C et al. Prenatal and infant paracetamol exposure and development of asthma: the Norwegian Mother and Child Cohort Study Int J Epidemiology first published online February 9, 2016 doi:10.1093/ije/dyv366

 

Pregnant!!! What to eat?

If you are pregnant, especially if this is your first pregnancy, I am sure you have a million questions. Your main concern is that you want to give your baby the healthiest start possible. a very important aspect of that is what you eat!!

Well, worry not! Diet in pregnancy is no rocket science. If you are lucky ( even though you may not agree at the time ) you have mothers, mothers in law, sisters, aunts etc to guide you. But if not, don’t panic. Overall you should be able to continue to eat what you have been eating. You might crave for things you have never liked before or develop an aversion to certain food items you liked earlier. But that is normal. It is best to listen to your body and eat what you FEEL like eating.

How much to eat?

These days, it is not recommended to increase the total calories in your diet in the first 6 months of your pregnancy( NICE, UK). From the seventh month onwards you should be eating a bit more i.e. about 200 kcal more per day. So, even if you are carrying twins or triplets you do not need to “eat for two”. In fact the normal weight gain is only 11-16 kgs in pregnancy.

What to eat?

In the initial months you may lose your appetite, however that will usually improve by the end of your third month. Try and ensure the following:

a. Eat three proper meals and three snacks in between. It is best to divide the portions of your lunch and dinner into two and eat them a couple of hours apart. This allows better digestion and higher energy levels for longer. Try and eat something every 1 and a 1/2 to 2 hours even if it is just a fruit or biscuit.

b. Keep one third of your meal carbohydrate based. This includes brown bread, brown rice, whole grain or multi grain breads and pasta, potatoes etc.

c. Eat lots and lots of fruits and vegetables. Unless you have a problem in your blood sugars, there should be no restriction on the fruits you eat. They will provide you with the necessary vitamins and minerals and also fibre.This additional fibre will also help reduce constipation which is very common in pregnancy.

d. Foods rich in iron: include a portion of foods like pulses, red meat, green vegetables like spinach, jaggery, dry fruits like raisins and apricots.

e. Foods rich in calcium : Try and consume more of dairy products – low fat yoghurt, milk and cheese. Other foods rich in calcium are Spinach, kale, soybean, tofu, fortified cereals like cornflakes etc.

There are many myths associated with what to eat and what not to eat.

Ill be writing about some common myths – fact or fiction soon.

One last tip that worked for me and for many of my patients : eat something sweet, just chew it slowly, just after waking up and even before getting out of bed. Trust me, it will reduce your morning sickness!

If you have any specific queries please do write to me at drnehagami(at)gmail.com

 

 

Menstrual Hygiene

Unlike what we have been made to believe, periods are not dirty. However we do need extra hygiene measures during the days of menstruation to stay healthy and feel good.

There are many ways to absorb the blood during your period days.

Sanitary Towels/pads : These  are pads made of absorbent material which are placed in the underwear to soak the blood. It is best to change them regularly and avoid using the same pad for more than 3-4 hours.

Tampons : This is a small mass of absorbent material which can be inserted into the vagina to absorb the menstrual flow. You can use tampons at any age after you have started your period. They can be inserted with an applicator or your fingers. THey are most useful if you want to go swimming while you are on your period. They come in many sizes and u can choose depending on your flow. But remember to change them frequently ( every 4-6 hours) and do not use a larger size on less flow days as it can lead to a serious condition called Toxic shock syndrome. Also The FDA advises not to use the tampons overnight.

You may even use tampons on the heavy flow days or for swimming and pads on other days.

Another  alternative  is a menstrual cup. This is a  device made from soft silicone. It is about 2 inches long and reusable. You can place it in the vagina during your periods to collect the menstrual blood. You can then remove and wash it every 6-8 hours and reinsert it.

Whatever method of sanitation you use, it is important to change it regularly. Having daily baths and using special washes to wash the vagina even during your period will help keep you feeling fresh.

It is absolutely fine to have sex during your periods. The only thing to remember is that although chances of an unwanted pregnancy are minimal, you are still at risk of sexually transmitted infections ( maybe even at a higher risk) during your period, so try and use protection.

Do read up the post about abnormal periods and if you have any other queries, send them to drnehagami(at)gmail.com

 

How to take care of yourself

It’s quite a basic thing, however not something we are taught at school. And that is personal and menstrual hygiene. Some of us  go through most part of their lives doing what they have seen mothers and aunts and cousins do but are really in a  fix when their little sister or daughter asks to questions things.

Well, I thought it best to put together some tips to ensure you feel good about yourself whether you are on your period or not!

Routine care of your vulva and vagina :

The vagina is the tube leading from the outside to your cervix and Uterus and the vulva is the area down below which is the entrance to the vagina.

Both of these need special care to keep them clean and healthy. If not given proper attention it can lead to repeated episodes of itching, bad smell and even long term skin problems.

Some tips:

What to wear?

  • Try and avoid synthetic and tight underwear as it causes you to sweat more and locks the moisture in. Loose cotton panties are best for allowing air to reach your private parts. white coloured underwear is least irritant to the vulval skin. If u want to use dark coloured underwear wash it a few times before you start using it.
  • Avoid very tight clothing for very long periods of time, unless necessary.
  • If you do have to wear a tight dress or uniform at work try and spend the time at home without any underwear or loose cotton stuff.
  • It is best to sleep without your underwear unless you are on your period.
  • Change your underwear daily and its a good idea to buy new stuff every 6 months.
  • Avoid panty liners on a regular basis.

How to wash?

The vulva is covered with skin so it needs routine hygiene measures. The vagina on the other hand has plenty of normal helpful bacteria. So its a good idea to not wash it very vigorously with jet of water or soap as that may cause the good bacteria also to be washed away.

  • The vulva needs to be washed once a day. At the maximum you should wash the vulva and vagina twice a day but not more.
  • There is no need to scrub very hard. It is best to avoid soap. Instead you can use a lactic acid based wash.
  • Showering is better than soaking for long in a bath.
  • After the bath or washing the vagina, let the vulva dry completely or dab it gently with a soft towel. A hair dryer on a cool setting can also be used to dry the vulva.
  • Shampoos can irritate the vulval region. so be careful when you wash you hair and make sure the shampoo is completely washed off with water.
  • It is best to avoid fabric softeners and Biological washing powders while washing your underwear.

And some more advice – 

  • Sometimes creams, even herbal ones can have something that may irritate your vulval skin. Try and avoid using them on the vulva or in the bath.
  • There are emollients available that can be used on the vulva. They also act as a moisturizer. You can check with your doctor or pharmacy for one.
  • If your partner uses condoms and you are regularly have itching after intercourse you may have allergy to the spermicide or lubricant being used.
  • Avoid shaving pubic hair.Use a hair clipper instead.

Having lots of water everyday and including probiotics in your diet( yoghurt etc) also helps to keep you feeling better – overall and down below also!

Hope all this helps you in feeling good about yourself – Inside out !

Planning a pregnancy?? :-)

Ok so you and your partner have decided that you are ready for a baby!!

It may have been one of you pushing the other, one may be more ready than the other, but a healthy pregnancy results when you, the mom to be are sure you want to go ahead!

It will not be easy. The changes that come with pregnancy are a piece of cake compared to taking care of a baby! BUT… If you are ready and happy to welcome the little one, it will all be worth it!!

So let’s talk about what all do you need to know, plan and do before you get that lil bump!

  • Fertile period – This is the time during the month you are most likely to conceive. If you have regular 28-30 day cycles, then your ovulation most likely occurs on the 14-16th day. So if you count the first day of your bleeding as day 1 you are most likely to conceive if you have intercourse with your partner between day 10- day 20. A good idea is to do that every other day as that ensures a better sperm count and hence higher chances of conceiving. In case you have irregular periods you should speak to your gynecologist to help you determine your fertile period.
  • Pre-pregnancy checks – If you are planning a pregnancy it would be a good idea to see your gynecologist and get a few tests done. This is to ensure that you are at the peak of your health and if any supplements or vaccinations are required, then there is time to plan those before you become pregnant. If u have a specific medical condition then its best to see your doctor at least 3 months before planning the pregnancy. This will help to optimise your health and change the medications to those that are safe to take in pregnancy. You could email me at drnehagami(at)gmail.com.
  • One of the tests that should be done are to check for Immunity to rubella. In case you have never been vaccinated or exposed to rubella then you would be found to be non immune on the test. In this case you could choose to take the vaccine and postpone the pregnancy for at least one month. Other tests may be directed to screen for thyroid problems or diabetes or infections like HIV or hepatitis B/C. This is done so as to plan treatment and ensure that there is least effect of these conditions on the baby and you.
  • Diet and lifestyle – food, exercise, alcohol, smoking

Increasing your fresh fruits and vegetable portions helps to ensure a healthier pregnancy. A low pre-pregnancy intake has been linked to low weight of the baby. Continue a regular exercise routine. you can continue to exercise throughout pregnancy. Of course, once you are pregnant, you may need to discuss this with your trainer.

  • Alcohol, when consumed in large amounts during pregnancy, has been shown to affect the baby in many ways. It can cause the baby to be small and have low intelligence and behavioural problems. There can even be formation defects. So it’s a good idea to stop drinking if you’re planning a pregnancy or at least restrict it to 14 units of alcohol per week. And avoid binge drinking i.e. spread this maximum limit over at least three days. A half  pint of beer, or two thirds of a small glass of wine, or one small measure of spirits is considered one unit of alcohol.
  • Smoking- I would strongly advice you to stop smoking if you are pregnant or planning pregnancy. In fact it is advised that neither you nor the father to be should be smoking during the pregnancy. This is because smoking can affect the baby and your pregnancy. It can cause miscarriage, formation defects in the baby, small baby, delivery before time, bleeding in late pregnancy and even death of the baby inside your womb.
  • Pre-existing medical problems may cause some concern to you during your pregnancy. But most conditions can be managed easily with just some extra caution and vigilance. So talk to your doctor or send me a mail and ill try and guide you.
  • Pregnancy problems in the past can have a bearing on the next pregnancy. Collect all your old records and try and remember if you were given any special instructions last time. It’s always a good idea to inform your current team as soon as possible about whatever you remember from the last time, however insignificant it may seem to you. A good doctor will pick up the clues!
  • Cesarean delivery in the past usually does not affect your pregnancy but may increase the chances of your having a repeat cesarean delivery. Again, your obstetrician should be able to guide you to the best mode of delivery for you, after looking at all your individual factors!

So good luck! Hope you have fun planning and going through your pregnancy!!