Narang Medical Center

Hello Friends,

I am Dr. Divya, I am a laparoscopic and infertility specialist. I am going to talk about abnormal uterine bleeding and the role of menstrual hygiene to prevent abnormal uterine bleeding as well. As we know, a menstrual cycle consists of 28 days plus-minus 7 days for a duration of 4-7 days, with a mean menstrual blood loss of 35ml. Whatever makes an abnormality in the flow, the duration or the frequency of the blood flow is known as abnormal uterine bleeding. And especially if you are clotting, in normal menstrual cycle bleeding does not clot, so if you are clotting that means its an abnormal uterine bleeding. There are various sub-heading to abnormal uterine bleeding, you could be bleeding heavily for more than seven days or more than 85ml, which is known as menorrhagia, you could be bleeding in between your cycle which is known as intermenstrual bleeding. You could be bleeding post-Quintus which could be dangerous, you must see your doctor concerning that. You could be bleeding infrequently in a duration of more than 35 days or you could be just spotting which is known as hyper menorrhagia, or you could be bleeding every 21 days which is known as polymenorrhea. All these causes, people come to us to OPD concerning these problems around 20-30% in reproductive age group between 18-35 to 40 or post-menopausal age group or perimenopausal. 70% patients come concerning with this problem. Pelvic inflammatory disease where there is lower abdominal pain, where there is discharge, you can have fever high grade, foul-smelling discharge is also a major cause of abnormal uterine bleeding. Other causes could be anything like polyp which is a outgrowth within the uterine cavity or could be a fibroid which is outgrowth or ingrowth of the endometrium or the myometrium or it could also be other causes you are born with or easy coagulability that means you are bleeding,

If you have a small scratch or nasal bleed which need medical attention and you are bleeding more than 10 minutes is known as coagulopathy, with you are born it could be function of the platelets or it could be dysfunction in the coagulation system or could be fibroid or could be because of endometrial cancer or it could be because of IUCD or it could be because of infection like we mentioned in the pelvic inflammatory disease. Or it could be because of hypothyroid and kidney and liver diseases. So if you have any of these menstrual abnormalities, you must see a doctor. Early consultation means earlier and easier management. It can be managed with minor drugs with less side effects. Only when you delay then you require either hormonal treatment or you require any surgical management. Otherwise only medical management with iron supplementations suffices for this. Other than abnormal uterine bleeding there could be other causes other than pathological causes, it could also be because of just hormonal imbalance which is known as DUP, so that usually occurs when you are starting your menses or when you are ending menses usually. But it can occur anytime in-between as well. So, along with abnormal uterine bleeding, it is known as dysfunctional uterine bleeding, it does not have a pathological cause, so these things do require medical attention.

Most important is postmenopausal bleeding, which means you have been bleeding after you have been having a normal cycle and you stop for an year and then you start bleeding or spotting is known as post-menopausal bleeding. Postmenopausal bleeding requires urgent attention, it’s 25% of that do have malignancies, there could be benign causes there could be senile vaginitis, which is tropic changes because of the sudden sensation of your hormones. But yes other than that postmenopausal bleeding does require attention. So what we talked about is that somebody basically in the history that when you can come to a doctor, when you have an abnormal uterine bleeding, if you have tuberculosis major cause, hyperthyroid is a major cause, liver and kidney diseases are major cause, if you have coagulopathy, is a cause, if you have an intrauterine device is a cause, other than any other structural abnormalities which are diagnosed and are ultrasound. Menstrual hygiene, menstrual hygiene also caters to a huge amount in the abnormal uterine bleeding.

Nowadays they have come up with various things which are environment-friendly, budget-friendly, easy to use namely the organic pads. The organic pads are a huge hit, especially in the teenagers. It's somebody who has vaginal irritation, it maintains the normal ph of the vagina. So it’s just made up of outlining of either bamboo, cotton or jute and it has inner cellulose. It's very absorbent, it can absorb around 180ml but as a synthetic pad, cotton usually absorbs faster, but it can not retain that much, so synthetic clothes or organic pads need to be changed more frequently. But, yeah they are definitely environment-friendly, they required less water to be catered for, to be produced and to be. Other than that they are useful for maintaining ph balance they are useful to people who are allergic to synthetic pads. Every pad needs to be changed in 3-4 hours whether they are soaked or unsoaked, to maintain your menstrual hygiene. Other than that, menstrual cups, menstrual cups are made up of silicon rubber, they are easy to insert, budget-friendly, environment friendly, can take about an ounce of the blood, needs to be changed only in 12 hours, they can used when you are using intra-contraceptive devices, or you are having sexual intercourse, or you do exactly everything from swimming, yoga, mountaineering everything. So, menstrual cups are a big yes, it's easy to insert, but yes you need to know what size comes according to your vaginal wall capacity or length of the cervix, if you are bed children or not, so initially you need to be educated on that. After you know what has been done, it is very easy to insert or remove. Other than that are tampons, tampons are there for years, there are two types, there are cotton and rayon, of course cotton are much more environment friendly as well as it is safer. Tampons are easy to insert, but yes, of course, you need to know about tampons, how to insert and how to remove, and tampons only need to be on only for 6 hours, if it's for more than six hours it can lead to great diseases like toxic shock syndromes, so that comes with high-grade fever, if you have left it overnight then it’s a big big problem, it can lead to toxic shock syndrome, so you should be careful. If anybody with menstrual abnormality needs good menstrual hygiene as well as because PID (pelvic inflammatory disease) is also a major cause of abnormal uterine bleeding.

Thank You!

Hello,

I am Dr. Divya Wadhawan, Gynaecologist. Today I will talk about infertility and its remedies. How would studies were done on 19000 women where they say the reduction is required only in animal fat and the carbs improve your fertility rate by increasing your ovulation. So, what can you do in your diet is to increase a lot of fruits and vegetables. Especially watermelon. This increases the glutathione in your diet. Anything from vegetable juices is very healthy. They are a rich source of phytochemicals. What about fats. Plant-based fat is a big yes but animal base fat a big No. Anything from plant-like nuts, olive oil, grape seed oil decrease the inflammation in the body. Whatever is processed fat, like in pre-cooked food, french fries are a big no.

Complex carbs are a big yes But processed carbs like cake, cookies, white bread, what they do is they increase the glucose in the diet. It also increases the insulin which causes a decrease in ovulation. It also causes hormonal imbalance. So, processed carbs always do the opposite of complex carbs. You have to decrease your white rice content and also your pasta. Include a lot of bajra, jawar and millet in your diet. Again a big yes to plant protein. It can be lentils, beans, tofu, paneer. Infertility is being detected by animal protein. A big No to red meat. A fish you can have. They also improve sperm quality. A less and the non-low fat diet is a big no. The one with the full fat has a better result for your fertility. Processed sugar affect both. Insulin metabolism and hormonal imbalances.

So, a big no to the sugars. You can include honey and maple in your diet. Less than 200mg caffeine is allowed. It has 2 negative effects. It affects the musculature for the fallopian tubes. It has also a negative effect on cervical fluid because it causes dehydration. Soya protein is a good source only if it is taken into the natural form. But if it is taken in the processed form, it affects the estrogen. And hence converts the estrogen in testosterone. Seafood is a very good source of zinc, vitamin B12, Oyster, Brazillian nuts, sunflower seeds keeping up the testosterone level. But a high intake of dairy products affects the estrogen. Other then diet, sleep is also very important. 8 hours of sleep is important Vitamin D3 helps in estrogen and progesterone levels to be at a high.

Exercise has a huge role. 5% reduction in the weight loss keeps the estrogen levels at the normal level. Especially PCOS patients must be advised for exercises. They should be advised to eat a gluten-free diet because that also affects the inflammatory process by increasing the CRPs. Intercourse 2-3 times a week keeps the good sperm motility. You should avoid the intake of alcohol, tea, coffee, and smoke. No to painkillers because they affect the hormones because, in turn, they affect the ovulation. No to laptop especially to men. It is also seen that cold water bath improves the sperm motility and drink a lot of water. Keep the smile on. 15-20% of patients improve by just a lifestyle modification. If you have any query, you can consult me through Lybrate.

Thank You.