What is senile vaginitis?
Senile or atrophic vaginitis is an inflammation or irritation of the vagina caused by thinning and shrinking of the tissues of the vagina and decreased lubrication of the vaginal walls. This is due to a lack of oestrogen. This condition is common in post menopausal women.
What is the cause?
Senile vaginitis is typically caused by a decrease in oestrogen, as normally occurs after menopause. The disorder may occur in younger women who have had surgery to remove their ovaries. Some women experience it immediately after childbirth or while breastfeeding, since oestrogen levels are lower at these times.
The factors that increase the risk include:
Menopause
Decreased ovarian functioning
Radiation therapy
Chemotherapy
Immune disorder
Elevated prolactin level during lactation
Medications containing anti oestrogen properties
Natural oestrogen deficiency before menopause
Smoking
What are the symptoms?
Senile vaginitis is characterised by:
Vaginal soreness - an itching or burning sensation.
Slight vaginal discharge.
Burning on urination.
Light bleeding after intercourse.
Painful sexual intercourse
How is it diagnosed?
A pelvic examination reveals thin, pale vaginal walls. A wet preparation (microscopic evaluation of the vaginal discharge) may be done to rule out other causes of vaginitis. Hormonal studies may be done if the menopausal status is uncertain.
Laboratory tests include:
Wet preparation/cytological smear of cells from the vagina
Ultrasonography of the uterine lining
Serum hormone concentration
Vaginal pH
What is the treatment?
The lack of circulating, natural oestrogens being the primary cause of atrophic vaginitis, hormone replacement therapy is the most logical treatment and has proved to be effective. Topical oestrogen creams or tablets may be used in the vagina or oral oestrogen replacement therapy may be initiated. Usually this is effective in overcoming the problem. Painful sexual intercourse may be helped by using water-soluble vaginal lubricants. Relief is usually achieved by implementing one or more of the treatments outlined. It is necessary to get medical help in women who are experiencing vaginal soreness, burning, itching, or painful sexual intercourse even after using lubricants.
What is the prevention?
For post-menopausal women in particular, regular sexual activity, with or without a partner, is recommended. Sexual activity improves blood circulation in the vagina, which helps maintain the tissue.
Showing posts with label women's health. Show all posts
Showing posts with label women's health. Show all posts
Rubella (German Measles)
What are Torch infections?
TORCH is an acronym for a special group of infections. These may be acquired by a woman during pregnancy. "TORCH" stands for the following infections:
Toxoplasma infection, also called toxoplasmosis
Other infections, such as hepatitis B, syphilis, and herpes zoster, (the virus that causes chickenpox)
Rubella, the virus that causes German measles
Cytomegalovirus, or CMV
Herpes simplex virus, the cause of genital herpes
What is rubella?
Rubella and measles are contagious viral infections best known by the distinctive red rash that may appear on the skin of those who contract either of the illnesses. However, rubella isn't as infectious as measles and is usually not as severe, which is why it is also called the three-day measles. But if a pregnant woman contracts rubella, especially during her first trimester, the virus can cause miscarriage, stillbirth or serious birth defects in the developing fetus — a condition known as congenital rubella syndrome. These defects can include deafness, growth retardation and heart problems.
What are the causes?
Rubella is caused by a virus that passes from person to person hence spreading the disease. It can spread when an infected person coughs or sneezes, or by direct contact with an infected person's respiratory secretions, such as mucus. It can also be transmitted from a pregnant woman to her unborn child. A person with rubella is contagious from one week before the onset of the rash until about one to two weeks after the rash disappears.
What are the symptoms?
The signs and symptoms of rubella are so mild that they're hard to notice, especially in children. The signs and symptoms generally appear between two and three weeks after the exposure to the virus. They last for about two to three days and may include:
Mild fever
Headache
Stuffy or runny nose
Inflamed, red eyes
Enlarged, tender lymph nodes at the base of the skull, the back of the neck and behind the ears
Pink rash that begins on the face and quickly spreads to the trunk and then to the arms and legs, before disappearing in the same sequence
Aching joints, especially in young women
What is the diagnosis?
The rubella rash looks like many other viral rashes. Doctors usually confirm rubella with the help of laboratory tests.
If the doctor suspects that the patient has rubella, virus culture or a blood test can be done, which can detect the presence of different types of rubella antibodies in the blood. These antibodies indicate whether a person had a recent or past infection, or a rubella vaccine.
What is the treatment?
No treatment can shorten the course of rubella infection. Most of the time the symptoms are so mild that treatment usually isn't necessary. However, doctors often recommend isolation from others — especially pregnant women — during the infectious period.
If a woman contracts rubella while she is pregnant, she should discuss the risks to the baby with the doctor. If the woman wishes to continue her pregnancy, she may be given antibodies called hyperimmune globulin that can fight off the infection. This can reduce the symptoms but does not eliminate the possibility of the baby developing congenital rubella syndrome.
Treatment for congenital rubella syndrome varies depending on the extent of the infant's problems. Children with multiple complications may require early treatment from specialists.
How can care be taken at home?
In rare instances when a child or adult is infected with rubella, simple self-care measures are required:
Rest in bed as necessary
Take acetaminophen to relieve discomfort from fever and aches
Tell friends, family and co-workers — especially pregnant women — about the diagnosis if they may have been exposed to the disease
Don't give aspirin to children who have a viral illness. Aspirin in children has been associated with Reye's syndrome — a rare, but serious illness that can affect the blood, liver and brain of children and teenagers after a viral infection.
Can rubella be prevented?
The rubella vaccine is usually given as a combined measles-mumps-rubella (MMR) vaccine, which contains the safest and most effective form of each vaccine. Children should receive the MMR vaccine between 12 and 15 months of age, and again between 3 and 6 years of age — before entering school. It is particularly important that girls receive the vaccine to prevent rubella during future pregnancies.
Usually babies are protected from rubella for six to eight months after birth because of the immunity passed on from their mothers. But if a child requires protection from rubella before 12 months of age — for example, for certain foreign travel — the vaccine can be given as early as 6 months of age. But children who are vaccinated early still need to be vaccinated at the recommended ages later.
TORCH is an acronym for a special group of infections. These may be acquired by a woman during pregnancy. "TORCH" stands for the following infections:
Toxoplasma infection, also called toxoplasmosis
Other infections, such as hepatitis B, syphilis, and herpes zoster, (the virus that causes chickenpox)
Rubella, the virus that causes German measles
Cytomegalovirus, or CMV
Herpes simplex virus, the cause of genital herpes
What is rubella?
Rubella and measles are contagious viral infections best known by the distinctive red rash that may appear on the skin of those who contract either of the illnesses. However, rubella isn't as infectious as measles and is usually not as severe, which is why it is also called the three-day measles. But if a pregnant woman contracts rubella, especially during her first trimester, the virus can cause miscarriage, stillbirth or serious birth defects in the developing fetus — a condition known as congenital rubella syndrome. These defects can include deafness, growth retardation and heart problems.
What are the causes?
Rubella is caused by a virus that passes from person to person hence spreading the disease. It can spread when an infected person coughs or sneezes, or by direct contact with an infected person's respiratory secretions, such as mucus. It can also be transmitted from a pregnant woman to her unborn child. A person with rubella is contagious from one week before the onset of the rash until about one to two weeks after the rash disappears.
What are the symptoms?
The signs and symptoms of rubella are so mild that they're hard to notice, especially in children. The signs and symptoms generally appear between two and three weeks after the exposure to the virus. They last for about two to three days and may include:
Mild fever
Headache
Stuffy or runny nose
Inflamed, red eyes
Enlarged, tender lymph nodes at the base of the skull, the back of the neck and behind the ears
Pink rash that begins on the face and quickly spreads to the trunk and then to the arms and legs, before disappearing in the same sequence
Aching joints, especially in young women
What is the diagnosis?
The rubella rash looks like many other viral rashes. Doctors usually confirm rubella with the help of laboratory tests.
If the doctor suspects that the patient has rubella, virus culture or a blood test can be done, which can detect the presence of different types of rubella antibodies in the blood. These antibodies indicate whether a person had a recent or past infection, or a rubella vaccine.
What is the treatment?
No treatment can shorten the course of rubella infection. Most of the time the symptoms are so mild that treatment usually isn't necessary. However, doctors often recommend isolation from others — especially pregnant women — during the infectious period.
If a woman contracts rubella while she is pregnant, she should discuss the risks to the baby with the doctor. If the woman wishes to continue her pregnancy, she may be given antibodies called hyperimmune globulin that can fight off the infection. This can reduce the symptoms but does not eliminate the possibility of the baby developing congenital rubella syndrome.
Treatment for congenital rubella syndrome varies depending on the extent of the infant's problems. Children with multiple complications may require early treatment from specialists.
How can care be taken at home?
In rare instances when a child or adult is infected with rubella, simple self-care measures are required:
Rest in bed as necessary
Take acetaminophen to relieve discomfort from fever and aches
Tell friends, family and co-workers — especially pregnant women — about the diagnosis if they may have been exposed to the disease
Don't give aspirin to children who have a viral illness. Aspirin in children has been associated with Reye's syndrome — a rare, but serious illness that can affect the blood, liver and brain of children and teenagers after a viral infection.
Can rubella be prevented?
The rubella vaccine is usually given as a combined measles-mumps-rubella (MMR) vaccine, which contains the safest and most effective form of each vaccine. Children should receive the MMR vaccine between 12 and 15 months of age, and again between 3 and 6 years of age — before entering school. It is particularly important that girls receive the vaccine to prevent rubella during future pregnancies.
Usually babies are protected from rubella for six to eight months after birth because of the immunity passed on from their mothers. But if a child requires protection from rubella before 12 months of age — for example, for certain foreign travel — the vaccine can be given as early as 6 months of age. But children who are vaccinated early still need to be vaccinated at the recommended ages later.
Menstrual problems
Menstruation is a normal part of a woman’s reproductive cycle. The ovary periodically releases an egg. It also releases a hormone called oestrogen, which stimulates the lining of the uterus to grow and get prepared to receive the fertilized egg. If, however, the egg does not get fertilized, the uterus sheds its lining resulting in menstrual flow. This flow repeats itself in a cycle of approximately 28 days until a woman gets pregnant or has approached menopause.
A slight discomfort or pain associated with menstruation is quite normal but if it becomes severe, a doctor should be consulted for problems that may not be really visible. The three main problems associated with menstruation are:
Lack of periods- amenorrhoea
Painful periods- dysmenorrhoea
Heavy periods- menorrhagia
Premenstrual Syndrome (PMS or PMT)
Amenorrhoea
Amenorrhoea is the absence or abnormal stoppage of menstruation. It can be of a primary or secondary nature. It can be due to normal physiological reasons like pregnancy, breast feeding or menopause. Infact, the commonest cause of physiological amenorrhoea is pregnancy. The abnormal (pathological) causes are:
Girls who have attained the age of 16 years and still not started getting their periods are said to have primary amenorrhoea. Secondary amenorrhoea occurs when a woman who was having normal periods suddenly stops menstruating for more than 6 months.
It can be due to a hormonal imbalance or a developmental problem. Stress, severe dieting, increased levels of exercise or chronic illness could also add to the problem. Most often women do not give importance to this but it needs to be dealt with more cautiously as it may be a sign of an underlying problem- imbalance in the production of reproductive hormones or even uterine cancers.
Dysmenorrhoea
Dysmenorrhoea or pain during the periods may be quite normal in most of the cases. Primary dysmenorrhoea is more common in teens and is not caused by a disease. It is because of the production of a hormone called prostaglandins in large quantities leading to nausea, headaches, diarrhoea and severe cramps. These symptoms last only for a day or two.
Secondary dysmenorrhoea is pain caused by some physical condition like fibroids in the uterus, infections in the pelvic region or growth of tissues normally found only in the uterus outside the uterus-the ovaries, fallopian tubes or other parts of the pelvic cavity, a condition called endometriosis.
Menorrhagia
A heavy period is one that lasts longer than eight days, saturates napkins within an hour or includes large clots of blood in the menstrual flow. It is very common in adolescents because of slight hormonal imbalances at their age. An imbalance in the levels of oestrogen and progesterone hormones allows the uterine wall to keep building up resulting in bleeding that is very heavy. In some cases it can also be due to fibroids, vaginal infections or thyroid problems.
Premenstrual Syndrome
PMS refers to a combination of physical and emotional symptoms experienced by all women during the menstrual cycle, usually just before menstrual bleeding begins. The intensity and range of symptoms vary from person to person. These include:
Temporary weight gain, due to accumulation of water in the body.
Headaches and cramps.
Painful breasts.
Tension and depression, irritability and stress.
PMS is usually at its worst 7 days before the period starts and disappears before it begins. Diet that is low in sodium and salt, increased fluids, high fibre, high complex carbohydrates, low fat and low sugar may be taken. Exercise, massage, relaxation techniques may help in relieving the symptoms.
What to do if the problem is suspected?
A visit to the doctor becomes important
if a girl has not started her periods till the age of 16 or is having irregular periods. The most likely cause could be a hormonal imbalance. Unhealthy eating habits can also lead to the same.
if she stops getting her periods or it becomes irregular after being regular for 6 months or longer. Severe dieting can cause this problem.
if she has extremely heavy or long periods that are painful and associated with anaemia. This could be a sign of growth in the uterus, thyroid condition or some kind of infection.
How can a doctor help?
To diagnose the problem:
the doctor will do a thorough pelvic examination.
blood tests(to check hormone levels).
sometimes even urine and stool tests.
an ultrasound or CAT scan may be performed with the tests to arrive at a correct diagnosis.
If a fibroid or other such growths is identified medicines or surgery as suggested by the doctor would be required. Hormone therapy to rectify the imbalance in the production of hormones can also be suggested. Severe menstrual pain with no underlying medical cause can be treated by medicines like ibuprofen or acetaminophen.
Does self management work?
Several things that can be done on a self help basis to combat the problem. These include:
A balanced diet with lots of fresh fruits and vegetables.
Cutting down on salty processed foods to check water retention.
Reducing caffeine intake to maintain emotional calm.
According to a recent study, increasing the amount of calcium in the diet reduces the severity of PMS symptoms.
Above all a brisk walk that helps in the release of endorphins (chemicals in the body that make one feel good) or a warm bath are suggested to keep fresh and relieved.
A slight discomfort or pain associated with menstruation is quite normal but if it becomes severe, a doctor should be consulted for problems that may not be really visible. The three main problems associated with menstruation are:
Lack of periods- amenorrhoea
Painful periods- dysmenorrhoea
Heavy periods- menorrhagia
Premenstrual Syndrome (PMS or PMT)
Amenorrhoea
Amenorrhoea is the absence or abnormal stoppage of menstruation. It can be of a primary or secondary nature. It can be due to normal physiological reasons like pregnancy, breast feeding or menopause. Infact, the commonest cause of physiological amenorrhoea is pregnancy. The abnormal (pathological) causes are:
Girls who have attained the age of 16 years and still not started getting their periods are said to have primary amenorrhoea. Secondary amenorrhoea occurs when a woman who was having normal periods suddenly stops menstruating for more than 6 months.
It can be due to a hormonal imbalance or a developmental problem. Stress, severe dieting, increased levels of exercise or chronic illness could also add to the problem. Most often women do not give importance to this but it needs to be dealt with more cautiously as it may be a sign of an underlying problem- imbalance in the production of reproductive hormones or even uterine cancers.
Dysmenorrhoea
Dysmenorrhoea or pain during the periods may be quite normal in most of the cases. Primary dysmenorrhoea is more common in teens and is not caused by a disease. It is because of the production of a hormone called prostaglandins in large quantities leading to nausea, headaches, diarrhoea and severe cramps. These symptoms last only for a day or two.
Secondary dysmenorrhoea is pain caused by some physical condition like fibroids in the uterus, infections in the pelvic region or growth of tissues normally found only in the uterus outside the uterus-the ovaries, fallopian tubes or other parts of the pelvic cavity, a condition called endometriosis.
Menorrhagia
A heavy period is one that lasts longer than eight days, saturates napkins within an hour or includes large clots of blood in the menstrual flow. It is very common in adolescents because of slight hormonal imbalances at their age. An imbalance in the levels of oestrogen and progesterone hormones allows the uterine wall to keep building up resulting in bleeding that is very heavy. In some cases it can also be due to fibroids, vaginal infections or thyroid problems.
Premenstrual Syndrome
PMS refers to a combination of physical and emotional symptoms experienced by all women during the menstrual cycle, usually just before menstrual bleeding begins. The intensity and range of symptoms vary from person to person. These include:
Temporary weight gain, due to accumulation of water in the body.
Headaches and cramps.
Painful breasts.
Tension and depression, irritability and stress.
PMS is usually at its worst 7 days before the period starts and disappears before it begins. Diet that is low in sodium and salt, increased fluids, high fibre, high complex carbohydrates, low fat and low sugar may be taken. Exercise, massage, relaxation techniques may help in relieving the symptoms.
What to do if the problem is suspected?
A visit to the doctor becomes important
if a girl has not started her periods till the age of 16 or is having irregular periods. The most likely cause could be a hormonal imbalance. Unhealthy eating habits can also lead to the same.
if she stops getting her periods or it becomes irregular after being regular for 6 months or longer. Severe dieting can cause this problem.
if she has extremely heavy or long periods that are painful and associated with anaemia. This could be a sign of growth in the uterus, thyroid condition or some kind of infection.
How can a doctor help?
To diagnose the problem:
the doctor will do a thorough pelvic examination.
blood tests(to check hormone levels).
sometimes even urine and stool tests.
an ultrasound or CAT scan may be performed with the tests to arrive at a correct diagnosis.
If a fibroid or other such growths is identified medicines or surgery as suggested by the doctor would be required. Hormone therapy to rectify the imbalance in the production of hormones can also be suggested. Severe menstrual pain with no underlying medical cause can be treated by medicines like ibuprofen or acetaminophen.
Does self management work?
Several things that can be done on a self help basis to combat the problem. These include:
A balanced diet with lots of fresh fruits and vegetables.
Cutting down on salty processed foods to check water retention.
Reducing caffeine intake to maintain emotional calm.
According to a recent study, increasing the amount of calcium in the diet reduces the severity of PMS symptoms.
Above all a brisk walk that helps in the release of endorphins (chemicals in the body that make one feel good) or a warm bath are suggested to keep fresh and relieved.
Menopause
What is menopause?
Menstruation is a process during which women normally shed the lining of the uterus at regular intervals under the influence of the female sex hormone, oestrogen. At about the age of 45 to 50 the ovaries stop making oestrogen and the withdrawal of the hormone results in stoppage of the monthly menstrual periods. This is called menopause and it happens naturally to all women sooner or later but may also be induced if the ovaries are removed or stop functioning for any other reason.
What does oestrogen do?
Oestrogen along with another female sex hormone, progesterone plays an important role in developing the female body and its functions, most notably pregnancy. Development of breasts, broadening of hips and functions of the vagina, uterus and other female organs depend on oestrogen. With progesterone, it maintains the cyclical periods and prepares the uterus for pregnancy.
Other beneficial effects include maintaining bone growth and protecting the heart by increasing the good cholesterol (HDL) and lowering the bad cholesterol (LDL). This is why women are less prone to heart attacks before menopause. This protective effect is lost after menopause.
What are the symptoms of menopause?
The majority of women will observe some symptoms during menopause, but the intensity of these varies in different women.
Irregular bleeding - Menstrual periods have three normal patterns of stopping: they may suddenly stop, they may come on time, but keep reducing in the quantity of flow till they finally stop or they may keep getting delayed till they finally stop. Heavy or frequent periods are NOT normal.
Hot flushes - This is the most prominent symptom. There is a sudden sensation of heat that spreads to various parts of the body, particularly the face. Flushing and sweating may occur. These flashes of warmth last a few seconds or minutes. These are more common in the first few years after menopause but may continue for many more years. If they occur very frequently, they can be the cause of social embarrassment. These flashes may be brought on in hot and humid weather, by drinking caffeine or alcohol or eating spicy foods.
Vaginal thinning and dryness - Due to oestrogen withdrawal, the vagina becomes thinner and dry. This makes sexual intercourse painful. There may be associated itching and irritation. Regular sexual intercourse may help keep the vagina moist and toned.
Mood changes - Women become irritable and anxious around menopause. There may be loss of memory and concentration and lack of energy. Depression may also be present. These symptoms may not be a direct effect of oestrogen withdrawal, but may be compounded by career pressures, sexual inadequacies and loss of fertility and body image.
Sexuality - Several factors adversely effect the libido or sex drive. Besides the mechanical factor of vaginal dryness that makes intercourse painful, mood fluctuations and lack of energy all contribute to a poor sex drive.
Osteoporosis - Bones become thin, weak and are more likely to break. This happens because the oestrogen that helps reduce bone absorption is no longer available. Osteoporosis is more likely in Asian women, and those that are slim built. Cigarette smoking increases the risk of developing osteoporosis.
Heart disease - Women lose the protective effect of oestrogen in preventing heart disease after menopause. They then become susceptible to heart attack as much as men. This risk is increased if the woman is obese, has high blood pressure or diabetes, smokes cigarettes and does not do any physical activity regularly.
What can be done?
Menopause happens to all women and cannot be prevented. The bad effects can be minimized by hormone replacement therapy (HRT). In this, oestrogen along with progesterone is given around the time of menopause. These reduce the symptoms of menopause, prevent bone loss and reduce the risk of heart attack. However, HRT is not without its risks, which may include cancer of the breast or the uterus. The risks and benefits of HRT must be fully discussed with the doctor before starting treatment.
Menstruation is a process during which women normally shed the lining of the uterus at regular intervals under the influence of the female sex hormone, oestrogen. At about the age of 45 to 50 the ovaries stop making oestrogen and the withdrawal of the hormone results in stoppage of the monthly menstrual periods. This is called menopause and it happens naturally to all women sooner or later but may also be induced if the ovaries are removed or stop functioning for any other reason.
What does oestrogen do?
Oestrogen along with another female sex hormone, progesterone plays an important role in developing the female body and its functions, most notably pregnancy. Development of breasts, broadening of hips and functions of the vagina, uterus and other female organs depend on oestrogen. With progesterone, it maintains the cyclical periods and prepares the uterus for pregnancy.
Other beneficial effects include maintaining bone growth and protecting the heart by increasing the good cholesterol (HDL) and lowering the bad cholesterol (LDL). This is why women are less prone to heart attacks before menopause. This protective effect is lost after menopause.
What are the symptoms of menopause?
The majority of women will observe some symptoms during menopause, but the intensity of these varies in different women.
Irregular bleeding - Menstrual periods have three normal patterns of stopping: they may suddenly stop, they may come on time, but keep reducing in the quantity of flow till they finally stop or they may keep getting delayed till they finally stop. Heavy or frequent periods are NOT normal.
Hot flushes - This is the most prominent symptom. There is a sudden sensation of heat that spreads to various parts of the body, particularly the face. Flushing and sweating may occur. These flashes of warmth last a few seconds or minutes. These are more common in the first few years after menopause but may continue for many more years. If they occur very frequently, they can be the cause of social embarrassment. These flashes may be brought on in hot and humid weather, by drinking caffeine or alcohol or eating spicy foods.
Vaginal thinning and dryness - Due to oestrogen withdrawal, the vagina becomes thinner and dry. This makes sexual intercourse painful. There may be associated itching and irritation. Regular sexual intercourse may help keep the vagina moist and toned.
Mood changes - Women become irritable and anxious around menopause. There may be loss of memory and concentration and lack of energy. Depression may also be present. These symptoms may not be a direct effect of oestrogen withdrawal, but may be compounded by career pressures, sexual inadequacies and loss of fertility and body image.
Sexuality - Several factors adversely effect the libido or sex drive. Besides the mechanical factor of vaginal dryness that makes intercourse painful, mood fluctuations and lack of energy all contribute to a poor sex drive.
Osteoporosis - Bones become thin, weak and are more likely to break. This happens because the oestrogen that helps reduce bone absorption is no longer available. Osteoporosis is more likely in Asian women, and those that are slim built. Cigarette smoking increases the risk of developing osteoporosis.
Heart disease - Women lose the protective effect of oestrogen in preventing heart disease after menopause. They then become susceptible to heart attack as much as men. This risk is increased if the woman is obese, has high blood pressure or diabetes, smokes cigarettes and does not do any physical activity regularly.
What can be done?
Menopause happens to all women and cannot be prevented. The bad effects can be minimized by hormone replacement therapy (HRT). In this, oestrogen along with progesterone is given around the time of menopause. These reduce the symptoms of menopause, prevent bone loss and reduce the risk of heart attack. However, HRT is not without its risks, which may include cancer of the breast or the uterus. The risks and benefits of HRT must be fully discussed with the doctor before starting treatment.
Mastectomy
What is mastectomy?
Mastectomy is the surgical removal of the breast, usually to remove a malignant tumour. It is also done in other conditions like cystic breast disease or in case a lump is too big to be removed by lumpectomy. Mastectomy involves removal of the whole breast (simple mastectomy) or a part of it depending on the extent of infection (segmental mastectomy). More often, in cases of cancer, the whole breast along with adjacent muscles is removed (radical mastectomy). It is best performed when the cancer is in its earliest stages.
When is it done?
The procedure is usually done to remove cancerous growths in the breasts. Women, and in some cases men, may require mastectomy.
What happens during the procedure?
The operation is performed under general anaesthesia. The skin around the breast is cleansed with an antiseptic to prevent any infection. A cut is made in the breast around the nipple and the areola to expose the underlying tissues. The entire breast tissue along with the tumour is nobilised. The chest muscles are removed along with the breast in most cases of cancer. After the tumour is removed, the incision is sutured. Antibiotics may be prescribed to avoid post operative infection.
What happens after the procedure?
After the operation, the patient usually has an intravenous tube and an oxygen tube attached to her. Anaesthesia may result in a slightly sore throat when the patient awakens. The doctor may ask the patient to cough out vigorously and breathe deeply so as to clear the lungs.
The patient may receive antibiotics to prevent infection. The patient may be discharged as soon as she feels strong enough which is usually in a week's time. Many women may feel depressed after a mastectomy due to concerns about their looks and sexuality. Mastectomy leaves the woman's chest flat which may cause cosmetic concerns.
However, there are many ways in which the deformity may be disguised, e.g., by wearing padded brassiers or with silicone breast implants. These procedures are being widely used throughout the world.
What can be the post-operative complications?
There may be fluid infection under the skin due to faulty drainage. This may lead to the destruction of cells.
Some women may experience pain in the chest region. This is called post-mastectomy pain syndrome.
Infection in the lymph nodes may cause swelling on the operated side of the arm, called lymphoedema.
Mastectomy is the surgical removal of the breast, usually to remove a malignant tumour. It is also done in other conditions like cystic breast disease or in case a lump is too big to be removed by lumpectomy. Mastectomy involves removal of the whole breast (simple mastectomy) or a part of it depending on the extent of infection (segmental mastectomy). More often, in cases of cancer, the whole breast along with adjacent muscles is removed (radical mastectomy). It is best performed when the cancer is in its earliest stages.
When is it done?
The procedure is usually done to remove cancerous growths in the breasts. Women, and in some cases men, may require mastectomy.
What happens during the procedure?
The operation is performed under general anaesthesia. The skin around the breast is cleansed with an antiseptic to prevent any infection. A cut is made in the breast around the nipple and the areola to expose the underlying tissues. The entire breast tissue along with the tumour is nobilised. The chest muscles are removed along with the breast in most cases of cancer. After the tumour is removed, the incision is sutured. Antibiotics may be prescribed to avoid post operative infection.
What happens after the procedure?
After the operation, the patient usually has an intravenous tube and an oxygen tube attached to her. Anaesthesia may result in a slightly sore throat when the patient awakens. The doctor may ask the patient to cough out vigorously and breathe deeply so as to clear the lungs.
The patient may receive antibiotics to prevent infection. The patient may be discharged as soon as she feels strong enough which is usually in a week's time. Many women may feel depressed after a mastectomy due to concerns about their looks and sexuality. Mastectomy leaves the woman's chest flat which may cause cosmetic concerns.
However, there are many ways in which the deformity may be disguised, e.g., by wearing padded brassiers or with silicone breast implants. These procedures are being widely used throughout the world.
What can be the post-operative complications?
There may be fluid infection under the skin due to faulty drainage. This may lead to the destruction of cells.
Some women may experience pain in the chest region. This is called post-mastectomy pain syndrome.
Infection in the lymph nodes may cause swelling on the operated side of the arm, called lymphoedema.
Fibroadenoma (Breast lump)
What is fibroadenoma?
Fibroadenomas are benign breast tumours commonly found in young women. Fibroadenoma means a tumour composed of glandular (related to gland) and fibrous (containing fibres) tissues. Breast fibroadenomas, abnormal growths of glandular and fibrous tissues, are most common between the ages of 15 and 30. They are found rarely in postmenopausal women. Described as feeling like marbles, these firm, round, movable, and rubbery lumps range from 1 cm-5 cm in size. Giant fibroadenomas are larger, lemon-sized lumps. Usually single, nearly 10-15% of women have more than one. While some types of breast lumps come and go during the menstrual cycle, fibroadenomas typically do not disappear after a woman's period, and should be checked by a doctor.
What are the causes?
The cause of breast fibroadenomas is unknown. They may be dependent upon oestrogen, because they are common in premenopausal women, can be found in postmenopausal women taking oestrogen, and because they grow larger in pregnant women.
What are the symptoms?
Fibroadenomas usually cause no symptoms and may be discovered during breast self-examination, or during a routine check-up.
How is the diagnosis made?
When the doctor takes a complete medical history, they will ask when the lump was first noticed, if there were any symptoms or changes in lump size, and if there is any personal or family history of breast disease. The doctor thoroughly feels the breasts. Tests are done, usually including mammography or ultrasound scans, or surgical removal of cells or tissue for examination under the microscope (biopsy).
Diagnostic tests include:
Mammogram - an x-ray examination of the breast
Ultrasound scan - a technique that uses sound waves to display a two-dimensional image of the breast, showing whether a lump is solid or fluid-filled (cystic)
Fine-needle aspiration biopsy - a minor procedure wherein fluid or cells are drawn out of the lump through a small needle
Core biopsy - a procedure wherein a larger piece of tissue is withdrawn from the lump through a larger needle
Incisional biopsy - a surgical procedure wherein a piece of the lump is removed through an cut or incision
Excisional biopsy - a surgical procedure wherein the entire lump is removed through an cut or incision
What is the treatment?
Breast fibroadenomas are removed by lumpectomy, or surgical excision under local or general anaesthesia. Sometimes lumps in younger women are not removed but are monitored by self-examination, yearly doctor check-ups, and mammograms. Surgery is generally recommended for women over 30, and for lumps that are painful or enlarging.
It is recommended to include a low-fat, high-fibre, vegetarian-type diet, a reduction in caffeine intake, supplementation with fish oil and vitamins E and C and the application of hot compresses to the breast.
What is the prognosis?
Breast fibroadenomas are not cancerous. The lumps recur in up to 20% of women.
What is the prevention?
Breast fibroadenomas cannot be prevented. They can be discovered early by regular breast self-examination
Fibroadenomas are benign breast tumours commonly found in young women. Fibroadenoma means a tumour composed of glandular (related to gland) and fibrous (containing fibres) tissues. Breast fibroadenomas, abnormal growths of glandular and fibrous tissues, are most common between the ages of 15 and 30. They are found rarely in postmenopausal women. Described as feeling like marbles, these firm, round, movable, and rubbery lumps range from 1 cm-5 cm in size. Giant fibroadenomas are larger, lemon-sized lumps. Usually single, nearly 10-15% of women have more than one. While some types of breast lumps come and go during the menstrual cycle, fibroadenomas typically do not disappear after a woman's period, and should be checked by a doctor.
What are the causes?
The cause of breast fibroadenomas is unknown. They may be dependent upon oestrogen, because they are common in premenopausal women, can be found in postmenopausal women taking oestrogen, and because they grow larger in pregnant women.
What are the symptoms?
Fibroadenomas usually cause no symptoms and may be discovered during breast self-examination, or during a routine check-up.
How is the diagnosis made?
When the doctor takes a complete medical history, they will ask when the lump was first noticed, if there were any symptoms or changes in lump size, and if there is any personal or family history of breast disease. The doctor thoroughly feels the breasts. Tests are done, usually including mammography or ultrasound scans, or surgical removal of cells or tissue for examination under the microscope (biopsy).
Diagnostic tests include:
Mammogram - an x-ray examination of the breast
Ultrasound scan - a technique that uses sound waves to display a two-dimensional image of the breast, showing whether a lump is solid or fluid-filled (cystic)
Fine-needle aspiration biopsy - a minor procedure wherein fluid or cells are drawn out of the lump through a small needle
Core biopsy - a procedure wherein a larger piece of tissue is withdrawn from the lump through a larger needle
Incisional biopsy - a surgical procedure wherein a piece of the lump is removed through an cut or incision
Excisional biopsy - a surgical procedure wherein the entire lump is removed through an cut or incision
What is the treatment?
Breast fibroadenomas are removed by lumpectomy, or surgical excision under local or general anaesthesia. Sometimes lumps in younger women are not removed but are monitored by self-examination, yearly doctor check-ups, and mammograms. Surgery is generally recommended for women over 30, and for lumps that are painful or enlarging.
It is recommended to include a low-fat, high-fibre, vegetarian-type diet, a reduction in caffeine intake, supplementation with fish oil and vitamins E and C and the application of hot compresses to the breast.
What is the prognosis?
Breast fibroadenomas are not cancerous. The lumps recur in up to 20% of women.
What is the prevention?
Breast fibroadenomas cannot be prevented. They can be discovered early by regular breast self-examination
Birth control pills (Oral Contraceptives)
What are birth control pills?
Birth control pills (oral contraceptives) are a method of birth control that uses hormones to prevent pregnancy. The man-made female hormones in the pills change a woman's natural hormone levels and prevent her ovaries from releasing an egg each month. If a woman does not ovulate she cannot get pregnant because there is no egg to be fertilized. The cervix also produces less and thicker mucous so that sperm cannot easily enter the uterus. In addition, the lining of the uterus becomes thinner, so it would be more difficult for a fertilized egg to stay in the uterus.
What are the types?
The most commonly used pills are "combined" pills. They contain man-made forms of 2 hormones: oestrogen and progesterone. There is also a progesterone-only pill (the mini-pill), but it is not as effective and causes a lot of blood spotting between menstrual periods.
How are the pills used?
The combined pills usually come in a package of 28 pills. They are also available in 21-pill packs. The doctor decides which type of package is best suited for a person. She will probably advise one to start taking the pills on the Sunday after the period has started or on the first day of the next period, depending on one’s preference.
If one is using the 21-pill pack, it is necessary to take 1 pill every day for 3 weeks. One should stop taking the pills for 7 days and then start a new pack.
If one is using the 28-day package, it is necessary to take 1 pill every day for 4 weeks and then start a new package the next day. The last 7 pills contain no medication for birth control; they just keep one in the habit of taking a pill every day. It is important to try to take the pills at approximately the same time every day. The period will usually occur soon after the last hormone-containing pill is taken.
Some antibiotics can affect the way birth control pills work in one’s body. If one is taking antibiotics, it is necessary to tell the doctor. One may need to use an additional form of birth control while one is taking antibiotics.
What if one forgets to take a pill?
If one forgets to take some of the pills, one will have menstrual bleeding at unpredictable times and one may get pregnant.
If one forgets to take a pill, it is necessary to take it as soon as one remembers and take the next pill at the usual time. If one misses 2 consecutive pills, one should take 2 pills each day for 2 days and then go back to the regular schedule.
If one misses 3 or more pills, stop taking the pills and use a different birth control method until the next menstrual cycle starts. If the menstrual cycle does not start on schedule, it is necessary to get in touch with a doctor.
If one has forgotten to take 2 or more pills and have missed a period, one might be pregnant. One should stop taking the pills and use other forms of birth control until pregnancy is ruled out. One should not stop taking the pills if one has taken them correctly.
When to start taking the pills after having a baby?
If one is breast feeding the baby, one should not take oral contraceptives until one has a good milk supply. This will take about 4 to 6 weeks after the birth. Then, a low-dose pill or progesterone-only pill may possibly be used. It is necessary to talk to the doctor about when one can start the pills again. Also, one should remember that breast feeding is not a sure protection against pregnancy, so one should use another form of birth control before one starts taking birth control pills again.
If one is not breast feeding the baby, one may be able to start taking birth control pills 1 to 2 weeks after the birth or when one begin menstruating again. It is necessary to check with a doctor before one starts taking birth control pills again.
What are the benefits?
The main benefit of birth control pills is that they are effective in preventing pregnancy but do not interrupt sexual intercourse. The pills also may decrease the risk of uterine and ovarian cancer, ovarian cysts, rheumatoid arthritis, and ectopic (tubal) pregnancy. Also, when one uses birth control pills, the periods become regular, lighter, and less painful. There is also a lower incidence of pelvic inflammatory disease (PID), fibrocystic changes in the breasts, and fibroadenoma (benign tumours) of the breast.
Generally, women who have no gynaecologic problems before they start taking oral contraceptives have no trouble becoming pregnant after they stop taking birth control pills, regardless of how long they have been taking them. There is no advantage to "taking a break" from birth control pills unless one has problems specifically related to the pills. When one wishes to get pregnant, it is recommended that one waits until one has had at least 2 normal menstrual periods after stopping the pills.
What are the disadvantages?
One disadvantage of birth control pills is that one must remember to take a pill every day.
Problems one may have while taking birth control pills include:
irregular bleeding for the first few months
nausea and vomiting
weight gain
breast swelling and tenderness
increased appetite
depression
headaches
scant or missed periods
high blood pressure
dizziness
Women who take birth control pills and smoke, especially those over 35 years old, have an increased risk of severe problems such as heart disease and blood clots. The heart disease could cause a heart attack. The blood clots may cause leg pain or swelling, chest pain, stroke, or death.
It is necessary to monitor one’s blood pressure after one has taken the pills for 3 months. Birth control pills do not protect one from sexually transmitted diseases such as AIDS. Latex condoms are the only safe way to protect against AIDS.
It is necessary to consult a doctor if one experiences:
leg pain or swelling
loss of vision or double vision
bleeding irregularities
more headaches than usual
numbness of arms, legs, or any other part of your body
Birth control pills (oral contraceptives) are a method of birth control that uses hormones to prevent pregnancy. The man-made female hormones in the pills change a woman's natural hormone levels and prevent her ovaries from releasing an egg each month. If a woman does not ovulate she cannot get pregnant because there is no egg to be fertilized. The cervix also produces less and thicker mucous so that sperm cannot easily enter the uterus. In addition, the lining of the uterus becomes thinner, so it would be more difficult for a fertilized egg to stay in the uterus.
What are the types?
The most commonly used pills are "combined" pills. They contain man-made forms of 2 hormones: oestrogen and progesterone. There is also a progesterone-only pill (the mini-pill), but it is not as effective and causes a lot of blood spotting between menstrual periods.
How are the pills used?
The combined pills usually come in a package of 28 pills. They are also available in 21-pill packs. The doctor decides which type of package is best suited for a person. She will probably advise one to start taking the pills on the Sunday after the period has started or on the first day of the next period, depending on one’s preference.
If one is using the 21-pill pack, it is necessary to take 1 pill every day for 3 weeks. One should stop taking the pills for 7 days and then start a new pack.
If one is using the 28-day package, it is necessary to take 1 pill every day for 4 weeks and then start a new package the next day. The last 7 pills contain no medication for birth control; they just keep one in the habit of taking a pill every day. It is important to try to take the pills at approximately the same time every day. The period will usually occur soon after the last hormone-containing pill is taken.
Some antibiotics can affect the way birth control pills work in one’s body. If one is taking antibiotics, it is necessary to tell the doctor. One may need to use an additional form of birth control while one is taking antibiotics.
What if one forgets to take a pill?
If one forgets to take some of the pills, one will have menstrual bleeding at unpredictable times and one may get pregnant.
If one forgets to take a pill, it is necessary to take it as soon as one remembers and take the next pill at the usual time. If one misses 2 consecutive pills, one should take 2 pills each day for 2 days and then go back to the regular schedule.
If one misses 3 or more pills, stop taking the pills and use a different birth control method until the next menstrual cycle starts. If the menstrual cycle does not start on schedule, it is necessary to get in touch with a doctor.
If one has forgotten to take 2 or more pills and have missed a period, one might be pregnant. One should stop taking the pills and use other forms of birth control until pregnancy is ruled out. One should not stop taking the pills if one has taken them correctly.
When to start taking the pills after having a baby?
If one is breast feeding the baby, one should not take oral contraceptives until one has a good milk supply. This will take about 4 to 6 weeks after the birth. Then, a low-dose pill or progesterone-only pill may possibly be used. It is necessary to talk to the doctor about when one can start the pills again. Also, one should remember that breast feeding is not a sure protection against pregnancy, so one should use another form of birth control before one starts taking birth control pills again.
If one is not breast feeding the baby, one may be able to start taking birth control pills 1 to 2 weeks after the birth or when one begin menstruating again. It is necessary to check with a doctor before one starts taking birth control pills again.
What are the benefits?
The main benefit of birth control pills is that they are effective in preventing pregnancy but do not interrupt sexual intercourse. The pills also may decrease the risk of uterine and ovarian cancer, ovarian cysts, rheumatoid arthritis, and ectopic (tubal) pregnancy. Also, when one uses birth control pills, the periods become regular, lighter, and less painful. There is also a lower incidence of pelvic inflammatory disease (PID), fibrocystic changes in the breasts, and fibroadenoma (benign tumours) of the breast.
Generally, women who have no gynaecologic problems before they start taking oral contraceptives have no trouble becoming pregnant after they stop taking birth control pills, regardless of how long they have been taking them. There is no advantage to "taking a break" from birth control pills unless one has problems specifically related to the pills. When one wishes to get pregnant, it is recommended that one waits until one has had at least 2 normal menstrual periods after stopping the pills.
What are the disadvantages?
One disadvantage of birth control pills is that one must remember to take a pill every day.
Problems one may have while taking birth control pills include:
irregular bleeding for the first few months
nausea and vomiting
weight gain
breast swelling and tenderness
increased appetite
depression
headaches
scant or missed periods
high blood pressure
dizziness
Women who take birth control pills and smoke, especially those over 35 years old, have an increased risk of severe problems such as heart disease and blood clots. The heart disease could cause a heart attack. The blood clots may cause leg pain or swelling, chest pain, stroke, or death.
It is necessary to monitor one’s blood pressure after one has taken the pills for 3 months. Birth control pills do not protect one from sexually transmitted diseases such as AIDS. Latex condoms are the only safe way to protect against AIDS.
It is necessary to consult a doctor if one experiences:
leg pain or swelling
loss of vision or double vision
bleeding irregularities
more headaches than usual
numbness of arms, legs, or any other part of your body
Agoraphobia
What is agoraphobia?
Agoraphobia is an anxiety disorder. The people with agoraphobia avoid being in certain places or situations. They are afraid about having no way to escape or be overwhelmed with panic and having no help. An intense fear of driving, flying, crossing bridges, or being in shops are examples. The patients may become afraid of their reactions to these situations and this fear in itself can be disabling. In extreme cases, the agoraphobic person may never leave home.
Agoraphobia is often the end stage of panic disorder. Panic disorder is characterized by severe frequent panic attacks marked by a sense of impending doom. A person may be called agoraphobic when he/she tries to avoid situations, which he/she feels might trigger a panic attack.
How does it occur?
The exact cause is unknown. As with other types of mental illness, both genetic and environmental factors play a role.
What are the symptoms?
Agoraphobia may be the cause if a person often avoids going to places or doing things because of the fear of having no way to escape. Typical symptoms of panic attack may be:
Palpitations or suddenly fast heartbeat
Sweating even when it is not hot
Trembling or shaking
Shortness of breath, feeling of not getting enough air
Feeling of choking or chest pain
Nausea
Dizziness
Fear of going crazy, losing control of body functions or of dying
Numbness or detachment
Chills or hot flashes.
Panic attacks may occur several times a day, or the attacks may be scattered, occurring only occasionally. Even occasional attacks can lead to fear of returning to a place or doing something associated with a past attack. A panic attack may last 10-15 minutes, or longer, after which the person may be exhausted.
Women Women have agoraphobia two to four times more often than men. The condition tends to run in families. Agoraphobia may cause a person to avoid going places or doing things because of the fear of having a panic attack, of having no way to escape.
How is it diagnosed?
The doctor will enquire about the symptoms. Other common causes of the symptoms, such as a medical illness or a drug or alcohol problem should be ruled out. This requires a medical examination and tests.
What is the treatment?
The treatment depends on how the disorder interferes with the routine life. Agoraphobia can be treated by various therapies. These include behaviour therapy, relaxation therapy, cognitive therapy, visual imagery techniques and medications (antidepressants and anti-anxiety drugs) to prevent panic attacks. The most effective treatments usually require that the person be exposed to the feared situation repeatedly, perhaps accompanied by a trusted companion, until they learn that the experience (such as crossing a bridge or riding in an elevator) is not dangerous.
How long does agoraphobia last?
Without treatment agoraphobia can last for many years, even for a lifetime.
What can be done to help?
Discuss the issue with a doctor who is knowledgeable about the condition. Realise that the anxiety problem can be overcome. Do not use alcohol or other drugs to overcome anxiety. Learn as much as possible about agoraphobia, anxiety, and panic. Join a support group of others with similar problems, and share experiences and solutions.
Agoraphobia is an anxiety disorder. The people with agoraphobia avoid being in certain places or situations. They are afraid about having no way to escape or be overwhelmed with panic and having no help. An intense fear of driving, flying, crossing bridges, or being in shops are examples. The patients may become afraid of their reactions to these situations and this fear in itself can be disabling. In extreme cases, the agoraphobic person may never leave home.
Agoraphobia is often the end stage of panic disorder. Panic disorder is characterized by severe frequent panic attacks marked by a sense of impending doom. A person may be called agoraphobic when he/she tries to avoid situations, which he/she feels might trigger a panic attack.
How does it occur?
The exact cause is unknown. As with other types of mental illness, both genetic and environmental factors play a role.
What are the symptoms?
Agoraphobia may be the cause if a person often avoids going to places or doing things because of the fear of having no way to escape. Typical symptoms of panic attack may be:
Palpitations or suddenly fast heartbeat
Sweating even when it is not hot
Trembling or shaking
Shortness of breath, feeling of not getting enough air
Feeling of choking or chest pain
Nausea
Dizziness
Fear of going crazy, losing control of body functions or of dying
Numbness or detachment
Chills or hot flashes.
Panic attacks may occur several times a day, or the attacks may be scattered, occurring only occasionally. Even occasional attacks can lead to fear of returning to a place or doing something associated with a past attack. A panic attack may last 10-15 minutes, or longer, after which the person may be exhausted.
Women Women have agoraphobia two to four times more often than men. The condition tends to run in families. Agoraphobia may cause a person to avoid going places or doing things because of the fear of having a panic attack, of having no way to escape.
How is it diagnosed?
The doctor will enquire about the symptoms. Other common causes of the symptoms, such as a medical illness or a drug or alcohol problem should be ruled out. This requires a medical examination and tests.
What is the treatment?
The treatment depends on how the disorder interferes with the routine life. Agoraphobia can be treated by various therapies. These include behaviour therapy, relaxation therapy, cognitive therapy, visual imagery techniques and medications (antidepressants and anti-anxiety drugs) to prevent panic attacks. The most effective treatments usually require that the person be exposed to the feared situation repeatedly, perhaps accompanied by a trusted companion, until they learn that the experience (such as crossing a bridge or riding in an elevator) is not dangerous.
How long does agoraphobia last?
Without treatment agoraphobia can last for many years, even for a lifetime.
What can be done to help?
Discuss the issue with a doctor who is knowledgeable about the condition. Realise that the anxiety problem can be overcome. Do not use alcohol or other drugs to overcome anxiety. Learn as much as possible about agoraphobia, anxiety, and panic. Join a support group of others with similar problems, and share experiences and solutions.
Abortion
What is abortion?
Abortion is the termination of pregnancy by any method (spontaneous or induced) before the fetus is viable (less than 20 weeks of pregnancy) to survive independently.
Induced abortion:
Out of almost 35 million abortions, which take place annually in the world, more than half of them are illegal and performed by untrained, unskilled personnel under highly unhygienic conditions.
1. Abortion in the first three months of pregnancy
By Cervical dilatation followed by evacuation of uterus or
Menstrual aspiration (MR)
Surgical methods in the first three months
Medical methods
The main drugs used today are a group of drugs known as prostaglandin, which can be used orally or through injection intramuscularly / intravenously, or vaginally. These drugs are used by themselves or in combination with other drugs.
The methotrexate – misoprostol method: A woman receives an injection of methotrexate. Between five to seven days later she returns and inserts suppositories of misoprostol into her vagina.
The mifepristone – misoprostol method: Mifepristone also known, as RU-486 is an antiprogesterone. A woman swallows a dose of mifepristone. She returns in five to seven days and inserts suppositories of misoprostol into her vagina.
Risks:
Mifepristone, Methotrexate and misoprostol cause nausea and diarrhoea.
Incomplete abortion may require surgical evacuation.
Heavy bleeding may continue up to 7 days.
2. Abortion in the second three months of pregnancy:
Methods of second trimester abortion (13 – 20 week)
What are Medical methods?
Ethacridine lactate.
Prostaglandin
What are the Surgical methods?
Aspirotomy
Hysterotomy
Hysterectomy
Medical methods:
Ethacradine lactate:
This drug is introduced through a sterile catheter through the vagina into the uterine cavity and placed behind the pregnancy sac. This procedure is not painful. A maximum of 150 ml is installed. It takes between 48 to 72 hours to abort. The procedure is safe, cheap and easily available. To hasten the abortion, ethacridine can be used along with prostaglandin or oxytocin (a naturally available drug to increase uterine contractions).
Prostaglandin:
PG-E2: A gel of prostaglandin is inserted into the cervix at the clinic and the patient is asked to lie down for about half an hour and then allowed to go home. Early the following morning in the hospital a drip of oxytocin is started intravenously. Abortion is usually achieved in less than 24 hours and the abortion is complete
Misoprostol: It is available in tablet form and given orally or can be inserted vaginally. Two tablets of Mifepristone are given 24 hours later by an oral or vaginal dose of misoprostol. The uterus contracts causing cramping followed by the expulsion of the fetus. The cramps and the bleeding stops after the products have been expelled
Others: Drugs like urea, hypertonic saline, glucose, which are introduced into the pregnant sac have all been done away with in favour of the above mentioned methods.
Risks:
One needs to be at a hospital up to 3 days
Infection
Increased bleeding
Retained products, which may need surgical evacuation.
Surgical methods:
Anaesthesia:
General anaesthesia can be given depending on the pain threshold/apprehension of the patient.
Procedure:
Aspirotomy.
Hysterotomy.
Hysterectomy.
Aspirotomy:
Aspirotomy is a procedure similar to what is done in the first trimester. This method can be employed between 13-20 weeks of pregnancy. Prostaglandins might be used to help in dilatation of the cervix.
Hysterotomy:
Hysterotomy is a major operating procedure where the abdomen is opened. In hysterotomy, the uterus is opened and the contents of the uterus are removed directly under vision. This is like a caesarean.
Hysterectomy:
In hysterectomy, the uterus along with the pregnancy is removed in toto. At times hysterotomy or hysterectomy may be necessary because of a failure of a medical induction during the second trimester.
In the second trimester of pregnancy, medical methods are followed rather than surgical methods. This is because the risks and the convenience of the medical methods are far less than surgical termination.
An early diagnosis of pregnancy with early termination is safer in the second trimester.
What is the Indian MTP Act?
To avoid the misuse of induced abortions, laws have been enacted all over the world so that only qualified gynaecologists can perform MTP for definite indications at clinics or hospitals that are approved. The Medical Termination of Pregnancy Act was enacted in 1971 and was again revised in 1975.
It lays down the conditions under which a pregnancy can be terminated and the people and places authorised to do so.
Indications for an MTP, under the act, are:
When pregnant woman has a serious disease and continuation of pregnancy could endanger her life:
Heart disease
Severe hypertension
Uncontrolled vomiting during pregnancy
cancer of the cervix or breast
Diabetes mellitus with eye complication (retinopathy)
Epilepsy
Psychiatric disorder
Where the continuation of pregnancy could lead to substantial risk to the newborn causing serious physical or mental handicap:
Chromosomal abnormalities.
Rubella (German measles) infection in the mother during first three months
Congenital abnormalities in earlier births
Rh iso-immunisation
Exposure of the foetus to irradiation.
Pregnancy resulting from rape.
Conditions where the socio-economic status of the mother (family) hampers the progress of a healthy pregnancy and the birth of a healthy child.
Failure of a contraception, irrespective of the method used (natural or barrier or hormonal)
Consent:
Married: her own written consent; husband’s consent not necessary
Unmarried and over 18 years: her own written consent
Below 18 years or mentally unstable: written consent of guardian
Consent signifies and assures the clinician performing the procedure that the woman:
has chosen abortion of her own free will
has been informed about all her options
has been counseled regarding the procedure (risks involved and care to be taken following it)
Who are the person(s) qualified to do MTP?
Any qualified registered medical practitioner who has assisted in 25 MTPs
A house surgeon who has done six months posting in Obstetrics and Gynaecology
A person who has a diploma/degree in Obstetrics and Gynaecology
Three years of practice in Obstetrics and Gynaecology for those doctors registered before the 1971 MTP Act was passed.
One year of practice in Obstetrics and Gynaecology for those doctors registered on or after the date of commencement of the Act.
Whenever the pregnancy exceeds 12 weeks but is less than 20 weeks, opinion of two registered medical practitioners is mandatory
What are the approved places where MTP can be performed?
Any institution licensed by the Government to perform MTP. The certificate issued by the Government has to be prominently displayed at a site readily visible to persons visiting the place.
Why is counselling done?
Counselling is normally done by the attending doctor with the aim of helping her come to a decision as to the need of continuation or termination of the pregnancy and to resolve it in the direction that she chooses.
The purpose of counselling is to:
Relieve the anxiety of the patient who intends to undergo abortion.
Provide information about the methods, safety and risks.
Screen for guilt, or any psychiatric ailment.
Help the patient understand and cope with her feelings.
Help her to prevent future unplanned pregnancy.
Serious complications arising from abortions before 13 weeks are quite unusual. About 89% of the women who obtain abortions are less than 13 weeks pregnant. Of these women, 97% report no complications; 2.5% have minor complications that can be handled in the OPD or abortion facility; and less than 0.5% require some additional surgical procedure and/or hospitalisation. Complication rates are higher for abortions performed between 13 and 24 weeks. General anaesthesia, which is sometimes used in abortion, carries its own risks.
In addition to the duration of the pregnancy, significant factors that affect the possibility of complications include:
Technical expertise of the provider;
Anaesthetic risk;
General health of the woman
Method employed
What are the complications from legal abortion?
Possible complications from a surgical abortion procedure include:
Blood clots accumulating in the uterus, requiring another suctioning procedure, which occurs in less than 1% of cases;
Infections, most of which are easily identified and treated if the woman carefully observes instructions, which occur in less than 3% of cases;
Tear in the cervix, which may be repaired with stitches, which occurs in less than 1% of cases;
Perforation in of the wall of the uterus and/or other organs, which might heal on its own or require surgical repair or, rarely, hysterectomy, which occurs in less than 1/2 of 1% of cases;
Missed abortion, which does not end the pregnancy and requires the abortion to be repeated, which occurs less than 1/2 of 1% of cases;
Incomplete abortion, in which the tissue from the pregnancy remains in the uterus, and requires the abortion to be repeated, which occurs in less than 1% of cases;
Excessive bleeding caused by failure of the uterus to contract, which might require blood transfusion that occurs in less than 1% of cases.
What are the signs of a Post - Abortion Complication?
If a woman has any of the following symptoms after an abortion, she should contact the facility that provided the abortion immediately:
Severe pain;
Chills or fever with a temperature of 100.4 0F or more;
Bleeding that is heavier than the heaviest day of her normal menstrual period or that soaks through more than one sanitary pad in an hour;
Foul-smelling discharge from her vagina
Continuing symptoms of pregnancy.
How to prevent complications?
Women can certain things to lower their risks of complications. The most important thing is not to delay the abortion procedure. After six weeks from LMP, the earlier the abortion, the safer it is.
It's important to ask. Just as with any medical procedure, the more relaxed a person is and the more she understands what to expect, the better and safer her experience will be.
In addition, any woman choosing abortion should:
Find a good clinic or a qualified, licensed practitioner
Inform the practitioner of any health problems, current medications or; allergies to medications or anaesthetics;
Follow post-operative instructions;
Return for a follow-up examination.
Abortion is the termination of pregnancy by any method (spontaneous or induced) before the fetus is viable (less than 20 weeks of pregnancy) to survive independently.
Induced abortion:
Out of almost 35 million abortions, which take place annually in the world, more than half of them are illegal and performed by untrained, unskilled personnel under highly unhygienic conditions.
1. Abortion in the first three months of pregnancy
By Cervical dilatation followed by evacuation of uterus or
Menstrual aspiration (MR)
Surgical methods in the first three months
Medical methods
The main drugs used today are a group of drugs known as prostaglandin, which can be used orally or through injection intramuscularly / intravenously, or vaginally. These drugs are used by themselves or in combination with other drugs.
The methotrexate – misoprostol method: A woman receives an injection of methotrexate. Between five to seven days later she returns and inserts suppositories of misoprostol into her vagina.
The mifepristone – misoprostol method: Mifepristone also known, as RU-486 is an antiprogesterone. A woman swallows a dose of mifepristone. She returns in five to seven days and inserts suppositories of misoprostol into her vagina.
Risks:
Mifepristone, Methotrexate and misoprostol cause nausea and diarrhoea.
Incomplete abortion may require surgical evacuation.
Heavy bleeding may continue up to 7 days.
2. Abortion in the second three months of pregnancy:
Methods of second trimester abortion (13 – 20 week)
What are Medical methods?
Ethacridine lactate.
Prostaglandin
What are the Surgical methods?
Aspirotomy
Hysterotomy
Hysterectomy
Medical methods:
Ethacradine lactate:
This drug is introduced through a sterile catheter through the vagina into the uterine cavity and placed behind the pregnancy sac. This procedure is not painful. A maximum of 150 ml is installed. It takes between 48 to 72 hours to abort. The procedure is safe, cheap and easily available. To hasten the abortion, ethacridine can be used along with prostaglandin or oxytocin (a naturally available drug to increase uterine contractions).
Prostaglandin:
PG-E2: A gel of prostaglandin is inserted into the cervix at the clinic and the patient is asked to lie down for about half an hour and then allowed to go home. Early the following morning in the hospital a drip of oxytocin is started intravenously. Abortion is usually achieved in less than 24 hours and the abortion is complete
Misoprostol: It is available in tablet form and given orally or can be inserted vaginally. Two tablets of Mifepristone are given 24 hours later by an oral or vaginal dose of misoprostol. The uterus contracts causing cramping followed by the expulsion of the fetus. The cramps and the bleeding stops after the products have been expelled
Others: Drugs like urea, hypertonic saline, glucose, which are introduced into the pregnant sac have all been done away with in favour of the above mentioned methods.
Risks:
One needs to be at a hospital up to 3 days
Infection
Increased bleeding
Retained products, which may need surgical evacuation.
Surgical methods:
Anaesthesia:
General anaesthesia can be given depending on the pain threshold/apprehension of the patient.
Procedure:
Aspirotomy.
Hysterotomy.
Hysterectomy.
Aspirotomy:
Aspirotomy is a procedure similar to what is done in the first trimester. This method can be employed between 13-20 weeks of pregnancy. Prostaglandins might be used to help in dilatation of the cervix.
Hysterotomy:
Hysterotomy is a major operating procedure where the abdomen is opened. In hysterotomy, the uterus is opened and the contents of the uterus are removed directly under vision. This is like a caesarean.
Hysterectomy:
In hysterectomy, the uterus along with the pregnancy is removed in toto. At times hysterotomy or hysterectomy may be necessary because of a failure of a medical induction during the second trimester.
In the second trimester of pregnancy, medical methods are followed rather than surgical methods. This is because the risks and the convenience of the medical methods are far less than surgical termination.
An early diagnosis of pregnancy with early termination is safer in the second trimester.
What is the Indian MTP Act?
To avoid the misuse of induced abortions, laws have been enacted all over the world so that only qualified gynaecologists can perform MTP for definite indications at clinics or hospitals that are approved. The Medical Termination of Pregnancy Act was enacted in 1971 and was again revised in 1975.
It lays down the conditions under which a pregnancy can be terminated and the people and places authorised to do so.
Indications for an MTP, under the act, are:
When pregnant woman has a serious disease and continuation of pregnancy could endanger her life:
Heart disease
Severe hypertension
Uncontrolled vomiting during pregnancy
cancer of the cervix or breast
Diabetes mellitus with eye complication (retinopathy)
Epilepsy
Psychiatric disorder
Where the continuation of pregnancy could lead to substantial risk to the newborn causing serious physical or mental handicap:
Chromosomal abnormalities.
Rubella (German measles) infection in the mother during first three months
Congenital abnormalities in earlier births
Rh iso-immunisation
Exposure of the foetus to irradiation.
Pregnancy resulting from rape.
Conditions where the socio-economic status of the mother (family) hampers the progress of a healthy pregnancy and the birth of a healthy child.
Failure of a contraception, irrespective of the method used (natural or barrier or hormonal)
Consent:
Married: her own written consent; husband’s consent not necessary
Unmarried and over 18 years: her own written consent
Below 18 years or mentally unstable: written consent of guardian
Consent signifies and assures the clinician performing the procedure that the woman:
has chosen abortion of her own free will
has been informed about all her options
has been counseled regarding the procedure (risks involved and care to be taken following it)
Who are the person(s) qualified to do MTP?
Any qualified registered medical practitioner who has assisted in 25 MTPs
A house surgeon who has done six months posting in Obstetrics and Gynaecology
A person who has a diploma/degree in Obstetrics and Gynaecology
Three years of practice in Obstetrics and Gynaecology for those doctors registered before the 1971 MTP Act was passed.
One year of practice in Obstetrics and Gynaecology for those doctors registered on or after the date of commencement of the Act.
Whenever the pregnancy exceeds 12 weeks but is less than 20 weeks, opinion of two registered medical practitioners is mandatory
What are the approved places where MTP can be performed?
Any institution licensed by the Government to perform MTP. The certificate issued by the Government has to be prominently displayed at a site readily visible to persons visiting the place.
Why is counselling done?
Counselling is normally done by the attending doctor with the aim of helping her come to a decision as to the need of continuation or termination of the pregnancy and to resolve it in the direction that she chooses.
The purpose of counselling is to:
Relieve the anxiety of the patient who intends to undergo abortion.
Provide information about the methods, safety and risks.
Screen for guilt, or any psychiatric ailment.
Help the patient understand and cope with her feelings.
Help her to prevent future unplanned pregnancy.
Serious complications arising from abortions before 13 weeks are quite unusual. About 89% of the women who obtain abortions are less than 13 weeks pregnant. Of these women, 97% report no complications; 2.5% have minor complications that can be handled in the OPD or abortion facility; and less than 0.5% require some additional surgical procedure and/or hospitalisation. Complication rates are higher for abortions performed between 13 and 24 weeks. General anaesthesia, which is sometimes used in abortion, carries its own risks.
In addition to the duration of the pregnancy, significant factors that affect the possibility of complications include:
Technical expertise of the provider;
Anaesthetic risk;
General health of the woman
Method employed
What are the complications from legal abortion?
Possible complications from a surgical abortion procedure include:
Blood clots accumulating in the uterus, requiring another suctioning procedure, which occurs in less than 1% of cases;
Infections, most of which are easily identified and treated if the woman carefully observes instructions, which occur in less than 3% of cases;
Tear in the cervix, which may be repaired with stitches, which occurs in less than 1% of cases;
Perforation in of the wall of the uterus and/or other organs, which might heal on its own or require surgical repair or, rarely, hysterectomy, which occurs in less than 1/2 of 1% of cases;
Missed abortion, which does not end the pregnancy and requires the abortion to be repeated, which occurs less than 1/2 of 1% of cases;
Incomplete abortion, in which the tissue from the pregnancy remains in the uterus, and requires the abortion to be repeated, which occurs in less than 1% of cases;
Excessive bleeding caused by failure of the uterus to contract, which might require blood transfusion that occurs in less than 1% of cases.
What are the signs of a Post - Abortion Complication?
If a woman has any of the following symptoms after an abortion, she should contact the facility that provided the abortion immediately:
Severe pain;
Chills or fever with a temperature of 100.4 0F or more;
Bleeding that is heavier than the heaviest day of her normal menstrual period or that soaks through more than one sanitary pad in an hour;
Foul-smelling discharge from her vagina
Continuing symptoms of pregnancy.
How to prevent complications?
Women can certain things to lower their risks of complications. The most important thing is not to delay the abortion procedure. After six weeks from LMP, the earlier the abortion, the safer it is.
It's important to ask. Just as with any medical procedure, the more relaxed a person is and the more she understands what to expect, the better and safer her experience will be.
In addition, any woman choosing abortion should:
Find a good clinic or a qualified, licensed practitioner
Inform the practitioner of any health problems, current medications or; allergies to medications or anaesthetics;
Follow post-operative instructions;
Return for a follow-up examination.
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