A health-y approach to adolescence

Adolescent:- Stanley Hall (“the Father of Adolescence”) described the period of adolescence as the period of ‘storm and stress’.

The Government of India in National Youth Policy defines adolescents as individuals between 13 to 19 yrs. of age. It is a transitional stage of physical, sexual and mental human development occurring between puberty and legal adulthood. It is imperative to have a thorough knowledge or awareness of the normal changes occurring in this age-group, and prevalence of specific gynecological problems in order to seek quality medical services.

Adolescence can be divided into three sub phases:
  1. Early adolescence (10-14 years): characterized by the onset of puberty and transition out of childhood.
  2. Middle adolescence (14-17 years): at this stage they may question and explore their sexual identity, which may be stressful without any support.
  3. Late adolescence (17-19 years): Transition into adult roles indicated by responsible and mature approach to one’s personal and intimate relationships
Gynecological problems of adolescents occupy a special space in the spectrum of gynecological disorders of all ages. Menstrual abnormalities are the most common problems of adolescent girls. Different gynecological problems in adolescent age group are:
  1. Menstrual Disorders
  2. Leucorrhoea
  3. Infections
  4. Ovarian Cyst
  5. Teenage Pregnancy
  6. Infertility
Majority of girls with menstrual disorders suffers from puberty menorrhagia and if not treated it may lead to anemia. Common infections which can trouble an adolescent girl are urinary infection, Pelvic Inflammatory Disease (exclusively seen among married adolescent girls). PCOD (polycystic ovarian disease) is the most common cause of secondary amenorrhoea among adolescents.
Problems, such as infection, discharge, menorrhagia, faced by the young adolescent girls usually remain untreated for long periods due to lack of awareness, and shyness in the females of this age group. However if these problems persist for long, they have dire consequences on the general health of the females, as well as complication related to pregnancy. It is important that all discomforts and symptom, are discussed with a gynecologist in details, with a lot of openness. Doctors are professional, and regardless of your age and problem, they are ready to help you for your condition. It is important to note that allopathy works on symptom based diagnosis. It is important that you share each and every details of your health, however minor the symptom is, you share it with your gynecologist. Importance of sharing every minor detail, can never be over-emphasized.

HOMEOPATHIC TREATMENT OF ENDOMETRIOSIS

WHAT IS ENDOMETRIOSIS?


The lining of the womb (uterus) is known as endometrium. Endometriosis is a condition in which the endometrium is present outside of the uterus as well. Usually the ectopic endometrium is seen in lower abdomen only (ovaries, Fallopian tubes, pelvis) but endometriosis may rarely spread to parts other than pelvis and can appear anywhere in body.

In endometriosis, the endometrium present at abnormal sites also respond to each menstrual cycle. So the endometrium outside the uterus also thickens, breaks and bleeds with each cycle of menses.

Since the abnormal sites of endometrium in endometriosis have no way of exit to discharge out the blood, cysts are formed entrapping the discharge. The surrounding tissues are also irritated causing adhesions and the organs stick to each other.

Sometimes there are no symptoms in mild endometriosis but mostly women suffer from severe pain during periods, during sexual intercourse and infertility can also occur.


RISK FACTORS:


  1. NULLIPAROUS: never giving birth can trigger endometriosis.

  2. EARLY MENARCHE: early onset of menses during puberty.

  3. LATE MENOPAUSE: having menses till old age can trigger endometriosis.

  4. OESTROGEN: high levels of oestrogen can also cause endometriosis.

  5. BEING THIN: being underweight can also cause endometriosis.

  6. SMOKING: can predispose to development of endometriosis.

  7. ALCOHOL: consumption in large amount on regular basis can also trigger endometriosis.

  8. FAMILY HISTORY: of endometriosis can also be a factor.

  9. UTERINE ABNORMALITIES: which don’t trap the menstrual flow can also cause endometriosis due to inflammation.

COMPLICATIONS:


  1. INFERTILITY: females with endometriosis have difficulty in conceiving. Endometriosis may obstruct the way of egg or sperm thus preventing fertilisation.

  2. OVARY CANCER: endometriosis may predispose to develop ovarian cancer at a higher rate than expectation.

SYMPTOMS & CAUSES


SYMPTOMS


  • PAINFUL PERIODS: mild cramping and pain is normal during periods but for a woman with endometriosis; pain is far worse and restrict her daily life works. The pain starts before the periods start and last for several days with pain in lower back.

  • PAINFUL SEXUAL INTERCOURSE: due to adhesions sexual intercourse is painful and pay may occur for quite some time after intercourse.

  • HEAVY PERIODS: heavy flow is seen during menses.

  • SPOTTING BETWEEN MENSES: may also be seen in some cases.

  • INFERTILITY: due to obstruction caused by endometriosis adhesions the egg and sperm fail to meet causing infertility.

  • REGULAR MENSTRUAL SYMPTOMS: nausea, vomiting, weakness, fatigue and bloating is also seen during menses.

CAUSES


  • BACK FLOW OF MENSTRUAL BLOOD: would cause sticking of endometrial cells to stick to the ovaries, Fallopian tubes or in pelvic cavity and they would grow there and bleed there.

  • TRANSFORMATION OF PERITONEAL TISSUES:  to endometrial tissues would cause endometriosis.

  • OESTROGEN: can trigger transformation of tissues in the foetus to endometrial tissues at abnormal places. Prolonged administration of oestrogen in adult life can also trigger the transformation.

  • SURGICAL SCAR: of hysterectomy or cesarean section may cause sticking of endometrial tissues to the scar causing endometriosis.

DIAGNOSIS & TREATMENT


DIAGNOSIS


  • PELVIS EXAMINATION: uterus and surrounding structures are movable as the uterus hangs freely with support of ligaments but adhesions caused by endometriosis can cause restriction of mobility.

  • TRANSVAGINAL ULTRASONOGRAPHY: would reveal adhesions and endometriomas (trapped secretions in a cyst).

  • MRI: would give more detailed information.

  • LAPAROSCOPY: is surgical procedure that allows visualisation of the abdomen thus would reveal the condition.

TREATMENT:


  • PAIN MANAGEMENT: is first line of treatment which is given by administering NSAIDS, painkillers etc.

  • HORMONE THERAPY: oral contraceptive pills would help in relieving pain but it would not treat the condition completely.

  • SURGERY: is done to remove tissues of endometriosis at abnormal sites.

  • HYSTERECTOMY: along with ovaries is done in rare cases.

  • HOMEOPATHY: is an alternative system of medicine which can help in permanent treatment of endometriosis very well.

MANAGEMENT


  • HOT FOMENTATION: hot baths, hot water bag can help in relieving pain along with cramping.

  • REGULAR EXERCISE: can help in improving the symptoms over time.

  • HEALTHY DIET: would help in feeling healthy.

  • HOMEOPATHY: homeopathic medicines would help in permanent treatment of endometriosis.

HOMEOPATHIC MANAGEMENT


There are several homeopathic medicines available which can treat the conditions permanently. Medicines like pulsatilla, natrum mur, sulphur, calcarea carb, tuberculinum, causticum etc act very well in managing the cases of endometriosis. But the medicines should be given only after the symptom study and constitutional study.


DO’S & DON’TS


DO’S


  • Do regular physical exercise.
  • Use hot water bag for pain.
  • Hot baths would also help in those days to feel better.
  • Take healthy diet

DON’TS

  • Don’t smoke.
  • Don’t take much alcohol.
  • Don’t stress out.

 

Why dysmenorrhea needs medical attention?

DYSMENORRHEA (painful periods/ menstrual cramps) one of the most common gynaecological SYMPTOM that affect the quality of life of women. the term dysmenorrhea is derived from greek words dys – painful/ abnormal; meno – month and rrhea – to flow.

PRIMARY DYSMENORRHEA

Dysmenorrhea is primary when it occurs in the absence of co-existent pelvic pathology. It is due to excessive levels of prostaglandins (hormone ) which stimulates uterine contractions and vasoconstriction (the constriction/narrowing of the blood vessels) which potentiate myometrial (the middle layer of the uterus) ischemia (inadequate blood supply) causing pain.

Age at onset : 16–25 yrs

Onset of pain (spasmodic) is just prior to menstruation.

usually self-limited.

SECONDARY DYSMENORRHEA

Dysmenorrhea is secondary when there is an identifiable anatomic or macroscopic pelvic pathological condition. There may be associated vaginal discharge, dysperiunia (painful sexual intercourse), menorrhagia (heavy bleeding at menstruation).

Age at onset : 30- 45 yrs

Onset of pain : Pain (congestive) increases through the luteal phase (before period starts) peaking at onset of menstruation.

Secondary dysmenorrhea may arise from a number of underlying pathological conditions.

COMMON CAUSES

  1. Endometriosis
  2. Pelvic Inflammatory Disease ( Infections)
  3. Adenomyosis
  4. Intrauterine polyps
  5. Submucosal fibroids
  6. IUCDs

LESS COMMON

– Congenital uterine abnormalities

– Cervical stenosis

– Asherman syndrom

– Chronic ectopic pregnancy

– Pelvic congestion syndrome

– Ovarian cysts or neoplasms

RISK FACTORS FOR DYSMENORRHEA

Young age, early menarche, heavy menstrual flow, nulliparity (state in which a woman has never carried a pregnancy), smoking, depression, anxiety, stress.

MANAGEMENT

Treatment of dysmenorrhea is aimed at providing symptomatic relief as well as inhibiting the underlying processes that causes symptoms.

Primary dysmenorrhea respond to

  1. NSAIDs (nonsteroidal anti-inflammatory drugs, blocking production of prostaglandins) that provide analgesic (pain-killing) and anti-inflammatory effects eg: aspirin, ibuprofen and naproxen. Should be offered as first line treatment for pain relief.
  2. COCs (combined oral contraceptives) are commonly used as a second line therapy when NSAIDs are ineffective, poorly tolerated or contraindicated. COCs inhibit ovulation and endometrial tissue growth, thereby decreasing prostaglandin release. Contraception is the additional benefit of COCs.

Treatment of Secondary dysmenorrhea must address the underlying disease ( cyst removal/ removal of submucosal fibroids/polyps etc ). Secondary dysmenorrhea may be resistant to NSAIDs and COCs.

5 common gynecological conditions in which yoga can be helpful!

The science of yoga works at much subtler and deeper levels than just the physical. Yoga treats body, mind and soul as one single entity. A regular yoga practice offers an increased flexibility, muscle tone, mental clarity, enhanced circulation and boosts immunity. Make yoga a part of your daily routine because regular yoga is very important for it to be effective. Doing a little yoga each day makes a big difference

The 5 common gynecological conditions in which yoga can be helpful are:

  1. PCOS – Yoga reduces the levels of stress hormones like cortisol which are responsible for increasing the levels of androgens in PCOS. Increased levels of testosterone are responsible for weight gain in patients. Holding weight bearing poses helps to build up muscles, increased muscle mass which helps to combat insulin resistance. Yoga works on adreno-pituitary axis and provides hormonal balance. Stretching effect on abdomen and helps to stimulate ovarian function. Yoga benefits for women in proper metabolism functioning thus helps in maintaining healthy body weight and controlling hunger.

Asanas for PCOS : Prasarita paddotasana, Ardhachakrasana, Uttanapadasana, Pawanmuktasana, Bhujangasana, Dhanurasana, Baddhakonasana, Bhunamanasana, Ustrasana, Ardhamatsyendrasana, Padmasana, Nadishuddhi pranayama, Bhramari pranayama

  1. Menstruation – Yoga helps you navigate the most unpleasant feelings of your cycle and ease contractions of the uterus that cause cramps. PMS (premenstrual syndrome) is the most common problem women experience before their menstrual period. PMS causes insomnia, irritability, discomfort, depression, headaches, etc. All these conditions can be alleviated by regular yoga practice. Yoga also helps with irregular mense like oligomenorrhea, metrorrhagia.

 Asanas for Irregular periods :  Adhomukho svanasana,  Ustrasana,  Bhujangasana, Dhanurasana, malasana, matsyasana, halasana, baddha konasana

  1. Fertility – regular yoga practice increases ovulation and hormonal balance, reduces stress and increases blood circulation to the reproductive organs thus improves their function.

Asanas for Infertility :  paschimottanasana, Hastapadasana, janu shirshasana, baddha konasana, Viparita karani, balasana, Kapalbhati parnayama, Bhramari pranayama,  Setu bandhasana, Bhujangasana, Shavasana

  1. Menopause – During menopause, yoga can help you deal with the changes your body is going through. It helps with side effects experienced during this hormonal shift including insomnia, anxiety, depression and mood swings.

Asanas for Infertility :  Kapalbhati, Tada-asana, Hast-padasana, Trikonasana, Badhakonasana, Shavasana, Bhujangasana, Natrajasana, Pawanmuktasana, supta matsyendrasana, virabhadrasana

  1. Pregnancy –  Yoga helps women get through their pregnancy with less discomfort. Helps with back pain as it is more common in pregnant women. Also it helps with the birth and postpartum stages. Yoga can be beneficial after pregnancy, postnatal yoga strengthens pelvic floor muscles as well as abdominal muscles.

Asanas for Pregnany :

FIRST TRIMESTER :-Shvanasana, Yoga nidra, Viparita Karani, Badhakonasana, Supta UdarakarshanAsan, Trikonasana, Marjariasana ,Tadasan, Utthanasan, virabhadrasana, Bhramari Pranayama, Nadi Shodhan Pranayama 

SECOND TRIMESTER :-  Matsya Kridasan, Vajrasan,Marjariasana, Hasta Utthanasan, Tadasan, Utthanasan,  Meru Akarshanasan, Shvanasana, Yoga nidra, Viparita Karani,Bhramari Pranayama, Nadi Shodhan Pranayama

THIRD TRIMESTER :- Badhakonasana, Supta UdarakarshanAsan, Shoulder Rotation, Shvanasana, Yoga nidra, Viparita Karani, Bhramari Pranayama, Nadi Shodhan Pranayama 

 

To view yoga positions visit – http://www.yogicwayoflife.com/asana-the-yoga-postures/

 

 

Menstrual disorders in adolescent girls!

Phase of transition from childhood to adulthood

Constitute about one fifth of India’s population

Adolescents constitute a diversified group- School vs college going, married vs unmarried, educated vs uneducated, rural vs urban, different cast/ religion/ localities.

Broadly important problems of adolescents are :

  1. Body image issues – Rapid change in the bodies frequently make them compare with one another and may result in some psychological problems.
  2. Nutrition – due to gender discrimination girls are affected more by malnutrition and anemia which later have adverse affects on pregnancy and to newborn.
  3. Menstrual disorders :-
  • AUB (Abnormal uterine bleeding)- refers to bleeding that is excessive or occurs outside the normal cyclic pattern. The most common cause of AUB in the first 19 months after menarche is anovulatory cycles due to immaturity of the hypothalamic- pituitary- ovarian axis. Some other common causes may be related to stress, eating disorders, bleeding disorders & endocrine disorders like hypothyroidisms/ PCOS.

 DEFINITION :- Any change in the :

        Frequency of menstruation (24 – 35)

         Duration of flow (4 – 7 days) or

        Amount of blood loss (5- 80 ml)

 

 Traditional terms describing abnormalities of menstrual bleeding:-

           Amenorrhea – absent menses

           Oligomenorrhea – infrequent menses, occurring at intervals > 35 days

           Polymenorrhea – frequent menses, occurring at intervals < 24 days

           Metrorrhagia – menses occurring at irregular intervals

Menorrhagia or hypermenorrhea – abnormally long or heavy menses, lasting  > 7 days       or involving blood loss > 80 ml

 

Causes :- ovulatory dysfunction ( hypothalamic- pituitary- ovarian axis )

             – pregnancy related complications

             – bleeding diathesis ( thrombocytopenia, von Willebrand disease or leukemia )

             – infections

             – stress (psychogenic, exercise induced )

Management : oral hematinics to correct anemia, hemostatics (tranexamic acid), weight reduction if obese, hormones 9 cyclic progestrones, OCPs), treating underlying cause

  • Amenorrhoea
  • Primary amenorrhoea – the absence of menstruation by age 16 yrs in the presence of secondary sexual characterstics or by age of 14 yrs  in the absence of secondary sexual characterstics. Causes : congenital abnormalties in the development of ovaries/ genital tract or external genitalia….. Disturbance of the normal endocrinological events of puberty (40%).
  • Secondary amenorrhoea- the absence of 3 or more subsequent menstrual periods with formerly regular cycles. Cause : pituitary gland tumor,, an overactive thyroid gland, PCOS, obesity, stress, heavy exercise, low body fat.
  • Management – treatment of underlying cause
  • DYSMENORRHEA (painful periods/ menstrual cramps) one of the most common gynaecological SYMPTOM that affect the quality of life of women. the term dysmenorrhea is derived from greek words dys – painful/ abnormal; meno – month and rrhea – to flow.

PRIMARY DYSMENORRHEA

Dysmenorrhea is primary when it occurs in the absence of co-existent pelvic pathology. It is due to excessive levels of prostaglandins (hormone ) which stimulates uterine contractions and vasoconstriction (the constriction/narrowing of the blood vessels) which potentiate myometrial (the middle layer of the uterus) ischemia (inadequate blood supply) causing pain.

Age at onset : 16–25 yrs

Onset of pain (spasmodic) is just prior to menstruation.

usually self-limited.

SECONDARY DYSMENORRHEA

Dysmenorrhea is secondary when there is an identifiable anatomic or macroscopic pelvic pathological condition. There may be associated vaginal discharge, dysperiunia (painful sexual intercourse), menorrhagia (heavy bleeding at menstruation).

Age at onset : 30- 45 yrs

Onset of pain : Pain (congestive) increases through the luteal phase (before period starts) peaking at onset of menstruation.

Secondary dysmenorrhea may arise from a number of underlying pathological conditions.

COMMON CAUSES

  1. Endometriosis
  2. Pelvic Inflammatory Disease ( Infections)
  3. Adenomyosis
  4. Intrauterine polyps
  5. Submucosal fibroids
  6. IUCDs

LESS COMMON

– Congenital uterine abnormalities

– Cervical stenosis

– Asherman syndrom

– Chronic ectopic pregnancy

– Pelvic congestion syndrome

– Ovarian cysts or neoplasms

RISK FACTORS FOR DYSMENORRHEA

Young age, early menarche, heavy menstrual flow, nulliparity (state in which a woman has never carried a pregnancy), smoking, depression, anxiety, stress.

MANAGEMENT

Treatment of dysmenorrhea is aimed at providing symptomatic relief as well as inhibiting the underlying processes that causes symptoms.

Primary dysmenorrhea respond to

  1. NSAIDs (nonsteroidal anti-inflammatory drugs, blocking production of prostaglandins) that provide analgesic (pain-killing) and anti-inflammatory effects eg: aspirin, ibuprofen and naproxen. Should be offered as first line treatment for pain relief.
  2. COCs (combined oral contraceptives) are commonly used as a second line therapy when NSAIDs are ineffective, poorly tolerated or contraindicated. COCs inhibit ovulation and endometrial tissue growth, thereby decreasing prostaglandin release. Contraception is the additional benefit of COCs.

Treatment of Secondary dysmenorrhea must address the underlying disease ( cyst removal/ removal of submucosal fibroids/polyps etc ). Secondary dysmenorrhea may be resistant to NSAIDs and COCs.

 

PCOS is the most common endocrine (hormones) syndrome affecting women of reproductive age. It is more prevalent in obese women (28%) than those who are lean.

The effects of PCOS manifest via deranged hormonal profiles, excess of circulating androgen (free testosterone) , increase LH, decrease FSH, Insulin resistance, decrease SHBG (sex hormone binding globulin is a glycoprotien that binds to the two sex hormones:androgen and estrogen).Obesity induced insulin resistance causes an exacerbation of all the symptoms of PCOS.

Lifestyle modification, including a minimum of 30 min of moderately intense exercise at least 3 days per week and dietary interventions is the first line treatment. A weight loss of 5–10% has been shown to decrease testosterone concentrations, increase SHBG, normalize menses and improve fertility in women with PCOS. Prevention of excess weight gain should be emphasized in all women with PCOS with both normal & increased body weight.

  • Endometriosis : endometriosis defined as presence of estrogen dependent endometrial like tissue found outside uterus resulting in sustained inflammatory reaction. Adolescent girls suffering from chronic pelvic pain 70-80% are reported to have endometriosis. The diagnosis is often delayed in the adolescent girls for a period of more than 6-8 yrs if high index of suspicion is not there. To be suspected in adolescents when they have severe dysmenorrhea interfering with daily activities not responding to NSAIDs and OCPs.

               Management – continous use of OCPs, progestin, GnRH agonists are used only for girls  beyond 16 yrs, LNG- IUS  can be used in sexually active adolescents.

  • PREMENSTRUAL SYNDROME – A condition which manifests with distressing physical, behavioral and psychological symptoms in the absence of organic or underlying psychiatric disease, which recurs regularly during the luteal phase of each menstrual cycle and disappears or significantly regresses by the end of each menstruation.

          PMDD – Premenstrual dysphoric disorder, a severe subtype of PMS.

            Symptoms of PMS and PMDD :

 

Symptoms associated with PMS and PMDD
Physical Psychological and behavioral
Abdominal bloating, weight gain Anger, irritability
Breast tenderness or fullness anxiety
Cramps, abdominal pain (overeating/ food craving) Changes in appetite
fatigue Decrease in concentration
headache Depressed mood, mood swings
nausea Changes in libido
Swelling of extremities Increased or decreased sleep

 

Grading of severity

  • Mild – symptoms do not interfere with personal/ social and professional life.
  • Moderate – symptoms interfere with personal/ social and professional life, however the individual is still able to function and interact.
  • Severe – individual is unable to interact personally/ socially/ professionally – withdraws from social and professional activities

Management – dietary calcium and vitamin supplements, antidepressants, oral contraceptives, GnRH.