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:
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.
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
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.
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!
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
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
I have realised over the last many years working as an Obstetrician and Gynecologist (OBGYN) that most women have many many questions about their health and may not have figured out the answers. It does not matter if you are a teenager or a mature lady there are some things that are just never clear.
This is a place where you can find answers to many of your questions related to your body – your periods, your hormones, your infections and your pregnancy!
Not knowing what’s happening inside of you can be disturbing and uncomfortable.
This is just my little effort to make you all feel better about yourselves and put your fears to rest
If you don’t find it on the posts yet, just send me a query and i will get back to you ASAP.