Category: Woman Health

WHAT IS PAP TEST?

The Pap test (Papanicolaou test), is also called the Pap smear or smear test. It is a simple test that scrapes cells off the surface of your cervix for examination in a laboratory.

WHY HAVE IT?

It can detect early warning signs of cancer of the cervix (cancer of the neck of the uterus). This is one of the most curable forms of cancer if detected early; hardly any women would die from it if all had regular Pap tests as recommended by the medical profession. Cervical cancer is related to exposure to the human papillomavirus (HPV or wart virus).

The early changes in the cells cause no symptoms, and the women in the early stages of cervical cancer feel quite healthy.

WHO SHOULD HAVE IT?

Any woman from 18 years of age who has had sex, including gay sex, should have a Pap test.

It should be performed after every 2 years AND up to the age of 69.

Even women who have stopped having periods or stopped having sex or have had the HPV vaccine should have regular Pap tests.

WHAT IS THE IDEAL TIME TO HAVE PAP TEST?

The best time to have a Pap test is any time after your period has finished. It should not be done if you have been douching or using vaginal tablets in the previous 48 hours.

You should wait for 34 hours after intercourse.

HOW IS THE PAP TEST DONE?

It is part of a normal pelvic or vaginal examination.

1. You lie on your back or your side on the couch.
2. An instrument called a speculum is slid gently into your vagina and then opened so that the doctor can see the cervix clearly, with the help of a light.
3. The smear is then taken with a thin spatula and a soft brush.

It is really a very thin amount of mucus with cells
that sit on the surface and the small opening of the cervix.

The smear is then placed on a glass slide, which is sent away to be tested.

Does the Pap test hurt or take long?

It is a simple test that does not take long (only about 2 to 3 minutes) and is uncomfortable, especially if you are tense, but should not cause any pain. The more relaxed you are the better. Deep breathing will help you relax.

WILL I FELL EMRASSED?

It is quite normal to feel a little embarrassed.

Doctors, of course, are used to doing these tests and perform many each day, so they understand.

Nobody has ever died of embarrassment, but many have died of cancer of the cervix by not having a Pap test.

WHAT ABOUT THE RESULT?

The results take about 1 to 2 weeks.

Ask your doctor when you should ring for the results. The results are almost always normal.

Abnormal cells are seen in only about 3 in 1000 tests and do not always mean cancer.

The microscopic findings are not infallible, unfortunately, but are improving all the time and are almost 100% accurate.

If there is any doubt, you will be recalled for a repeat test. For most women who have abnormal cells, the treatment is simple and effective.

WHAT ARE THE NEWER LABORATORY METHODS?

These are the Thin Prep and Papnet methods of studying the cells from the Pap test which is done in the usual way.

They appear to be better at picking up abnormal cells in doubtful cases but cost more.

However, the standard smear remains highly effective for screening

NOTE:

• A Pap test is simple, quick, and painless.
• It should be done every 2 years.
• It should be done throughout life from the start of sexual activity for up to 69 years.
• The test enables early detection of cell changes that could lead to cancer of the cervix.
• Cancer of the cervix is curable if detected early.
• The test is your safeguard

PAINFUL PERIODS ( DYSMENORRHOEA)

WHAT IS DYSMENORRHOEA?

It is the medical term for painful periods. These can occur as part of an otherwise normal menstruation cycle—this is known as primary dysmenorrhoea.

On the other hand, painful periods can be caused by a problem that has developed in the uterus (womb),

Such as fibroid tumors or infection and this is called secondary dysmenorrhoea.

WHAT ARE CAUSES OF PRIMARY DYSMENORRHOEA?

It is caused by high levels of prostaglandins, which are natural substances produced by the lining of the uterus.

One of the actions of prostaglandins is to cause the muscles of the uterus to contract tightly, thus producing cramping sensations.

The problem is associated with the onset of ovulation, which is when the ovary starts releasing eggs.

WHAT ARE SYMPTOMS?

Period pains vary a lot in strength and position. Some women have a dull, dragging pain in the abdomen or lower back, or in both areas; others have more severe cramping abdominal pain.

In some, the pain may be felt in front of the thighs.

The pain is worse at the beginning of the period and may even commence up to 12 hours before the menses appear. It usually lasts for 24 hours but may persist for 2 or 3 days. Some women may get nausea and vomiting, and in severe cases, fainting may occur.

WHAT ARE RISKS?

Dysmenorrhoea is very common, but most cases are mild and do not require medical attention. There is no risk at all unless it is a symptom of an underlying problem such as pelvic infection.

WHAT IS THE TREATMENT?

Studies indicate that taking 100 mg of vitamin B1 (thiamine) daily is worth trying. For most women painkillers such as paracetamol relieve the pain.

For the simple ineffective analgesics:

It is recommended to take an anti-inflammatory agent (such as naproxen or ibuprofen)

If the pain is severe, your doctor may prescribe a stronger analgesic that neutralizes the effect of prostaglandins. Taking the contraceptive pill usually stops dysmenorrhoea. It often disappears after you have a baby or as you get older

Keeping fit by leading a healthy lifestyle (including avoiding smoking and excessive alcohol and undertaking regular exercise) seems to help, as does practicing relaxation techniques such as yoga.

If you get severe pain, rest in bed. Simple measures such as placing a hot-water bottle over the painful area and curling your knees up to your chest as you lie on your side may provide relief

WHEN YOU SHOULD CONSULT YOUR DOCTOR?

Consult your general practitioner if the pain worsens or if you develop period pain following 3 or 4 years of relatively pain-free periods.

WHAT CAUSES BREAST PAIN?

Breast pain/painful breast (known as mastalgia) has several possible causes. General breast discomfort is common in the second half of a woman’s menstrual cycle and is called cyclical mastalgia.

The pain or discomfort is often related to the menstrual cycle, and may come on about the time ovulation takes place and be greatest just before a period.

It is caused by normal hormonal changes and is not harmful.

OTHER CAUSES ARE:

• pregnancy (breast tenderness tends to be more common during the first trimester)
• after childbirth (breasts may become swollen with milk and painful, and breastfeeding itself may cause breast pain)
• infection (e.g., inflammation of the breast, known as mastitis, or an abscess, both of which may occur after childbirth)
• breast lumps (e.g., in fibrocystic disease; these tend to be more tender just before a menstrual period)
• certain drugs
• weight gain
• poorly fitting bras.

NOTE:

Early breast cancer is usually painless, but all lumps need careful investigation.

IS IT COMMON?

It is a very common problem, with about 2 out of 3 women complaining of breast pain at some stage of their lives. It is most common in the thirties and early forties.

WHAT ARE THE SYMPTOMS?

The pain can vary from very mild to severe. It is usually a heaviness or discomfort in the breasts, while some women experience a prickling or stabbing sensation. The breasts may feel lumpy or quite normal to touch. The breasts may be so tender that hugging and fondling cause distress.

WHAT IS THE TREATMENT?

The first thing to keep in mind is that breast pain is common, and in only 1 case in 200 will cancer be the cause. No treatment may be needed in mild cases and the problem may settle in 3–6 months.

SELF-HELP

• Reduce weight if you are overweight: aim to keep at an ideal weight.
• Reduce or cut out caffeine.
• Follow a nutritious, low-fat diet high in complex carbohydrates.
• Wear good-quality comfortable bras.
• Take a mild analgesic for pain, such as paracetamol or ibuprofen, either by mouth or topical (rubbed onto the breast).

NATURAL MEDICATION

Vitamins may help (although studies have not shown any proven benefit):

• vitamin B1 (thiamine): 100 mg per day
• vitamin B6 (pyridoxine): 100 mg per day
• evening primrose oil capsules: 4 g per day. Use one or a combination of these agents.

DRUG TREATMENT

Your doctor may change your oral contraception or hormone replacement therapy (if you are taking it) or prescribe other hormonal drugs. Be sure to talk with your doctor before taking any medication or supplement.

Report persistent pain or any persistent lumps to your doctor. See your doctor if you have a bloody or clear discharge from your nipple, if your breasts are swollen or hard, or if there are signs of breast infection such as redness in the breast or pus, or if you have a fever

NIPPLE PROBLEMS WHILE BREASTFEEDING

SORE NIPPLES

Sore nipples are a common problem and are considered to be caused mainly by the baby not taking the nipple into its mouth properly, often because of breast engorgement. The key point is to establish correct attachment. Any pain when the baby latches on indicates incorrect attachment. The problem is preventable with careful attention to the position of the baby at the breast and the baby’s sucking technique.

Other causes include a tongue tie in the baby, Candida infection, and spasms of the nipple.

HOW ARE SORE NIPPLES MANAGED?

• It is important to be as relaxed and comfortable as possible (with your back well supported) and for your baby to suck gently, so:
• Try to use the feeding position ‘chest to chest, chin on breast’.
• Vary the feeding positions. (Make sure each position is correct.)
• Start feeding on the less painful side first if one nipple is very sore.
• Express some milk first to soften and lubricate the nipple.

Avoid drying agents (such as methylated spirits, soap, and tincture of benzoin) and moisturizing creams and ointments, which may contain unwanted chemicals and germs

• If pain occurs during attachment, break the suction immediately with a finger, and try re-attaching.
• Gently break the suction with your finger before removing the baby from the breast. (Never pull the baby off the nipple.)
• Apply covered ice to the nipple to relieve pain.
• Keep the nipples dry by exposing the breasts to the air and/or using a hairdryer on a low setting.
• If you are wearing a bra, try a pliable nipple shield such as a Cannon shield inside the bra. Do not wear a bra at night

CRACKED NIPPLES

Cracked nipples are usually caused by the baby clamping on the end of the nipple rather than applying the jaw behind the whole nipple. Not drying the nipples thoroughly after each feed and wearing soggy breast pads are other contributing factors. Untreated sore nipples may progress to painful cracks.

WHAT ARE SYMPTOMS?

At first, the crack may be so small that you cannot see it. The crack is either on the skin of the nipple or where it joins the flat, dark part of the nipple (the areola). Sharp pain in your nipple with sucking probably means a crack has developed. Feeding is usually very painful, and bleeding can occur

HOW ARE CRACKED NIPPLES MANAGED?

Cracked nipples nearly always heal when you get the baby to latch onto the breast fully and properly. It usually takes only 1 to 2 days to heal.

• Follow the same rules as for sore nipples.
• Do not feed from the affected breast—rest the nipple for 1 to 2 feeds.
• Express milk from that breast by hand.
• Feed that expressed milk to the baby.
• Start feeding gradually with short feeds.
• A sympathetic expert such as an experienced nursing mother, midwife, or lactation consultant will be a great help if you are having trouble coping. They can observe and teach the correct technique.
• A pliable nipple shield may be used for a short period.
• Contact your doctor if the problem is not resolving.
• Take paracetamol or ibuprofen just before nursing to relieve pain.

INVERTED NIPPLES

WHAT are INVERTED NIPPLES?

It is a nipple that inverts or moves into the breast instead of pointing outwards when a baby tries to suck from it. When the areola is squeezed, the nipple retracts inwards.

WHAT IS THE TREATMENT?

During pregnancy, rolling and stretching the nipple by hand can be helpful. Your partner can assist with gentle oral and manual stimulation of your breasts and nipples. A simple treatment, which should start at the beginning of the seventh month of pregnancy, is the Hoffman technique:

1. Draw an imaginary cross on the breast with the vertical and horizontal lines crossing at the nipple.

2. Place the thumbs or the forefingers opposite each other at the edge of the areola on the imaginary horizontal line. Press in firmly and then pull the thumbs (or fingers) back and forth to stretch the areola.

3. In the vertical position, pull the thumbs or fingers upwards and downwards.

• Repeat this procedure about 5 times each morning.
• The nipple will become erect and is then easier to grasp so that it can be slowly and gently drawn out. After the baby is born, try to breastfeed early while the sucking reflex is strong and your breasts are soft.
• Before breastfeeding, draw the nipple out by hand or with a breast pump.
• Check that your baby is correctly positioned on the breast. Usually, with time, inverted nipples will be corrected by the baby’s sucking

After a miscarriage, you will undoubtedly be confused and wondering why this sad event happened to you. The main thing is to remember that it was nothing that you did wrong, and so you should not feel any sense of blame or guilt.

WHAT IS MISCARRIAGE?

A miscarriage, which is called a spontaneous abortion in medical terms, is the spontaneous ending of pregnancy before the baby (fetus) can survive outside the womb. This is usually considered to be up to the 20th week. A loss after this time is called a stillbirth. Sometimes it is complete (when both fetus and afterbirth are expelled); sometimes it is incomplete (when only part of the pregnancy is expelled).

WHAT ARE THE SURPRISING FACTS?

• About 1 in 4 pregnancies are ‘lost’ (i.e. miscarried).
• Many are lost soon after conception; in such a case the woman may not be aware of anything except a small alteration in her period.
• In most cases, the fetus is lost in the first 12 weeks and is obvious to the mother.

WHAT ARE SYMPTOMS?

The first symptom is the loss of blood from the vagina, which can vary from slight to heavy flow. At this stage, it is called a threatened miscarriage. When the solid products are passed, you feel pain due to cramping of the uterus. It is usual for only some parts to be passed to the outside, while others (e.g. the afterbirth) stay behind. This is referred to as an incomplete miscarriage or abortion. However, if the miscarriage is later in the pregnancy (such as at 20 weeks), it is more usual to have a complete abortion.

WHAT IS THE CAUSE OF MISCARRIAGE?

Most miscarriages occur without an obvious cause. However, in many, there is something wrong with the developing fetus, and a miscarriage is nature’s way of handling the problem.

This abnormality may be caused by a genetic disorder, or by a viral infection that has affected the fetus in the first 12 weeks. Often the mother is unaware that she has picked up a serious infection (such as rubella, influenza, or cytomegalovirus), but it is harmful to the delicate growing tissues of the fetus.

In other cases, abnormalities of the uterus may not allow the fertilized egg to attach to its lining, or it may reject the developing fetus later on. The mother may also have a clotting disorder of the blood

BLIGHTED OVUM

This occurs when a pregnancy sac is formed in the uterus but there is no developing baby and the sac is expelled. It is a common cause of miscarriage.

WHAT ARE RISKS?

There is usually no risk to the mother’s health. However, if the miscarriage is incomplete and not treated, infection or anemia from blood loss could occur. If you get a fever, heavy bleeding, severe pain, or an offensive discharge, contact your doctor. After a miscarriage, you may feel emotionally upset or depressed, with feelings of loss and grief. If so, you will require help.

WILL IT HAPPEN AGAIN?

Having a miscarriage doesn’t make it any more likely you will have another miscarriage. The odds favor your next pregnancy being successful. There is no special treatment to prevent any further miscarriages, and it is best left to nature to take its course. However, it is advisable to keep healthy and not indulge in alcohol, smoking, or the use of other drugs.

WHAT IS THE TREATMENT?

It is usual to have a surgical ‘cleaning’ of your uterus, especially if the miscarriage was early in the pregnancy and bleeding continues. This is called a dilation and curettage (D&C). However, many women, in consultation with their doctor, choose to ‘let nature take its course’ and let it resolve by itself. The bleeding may then stop in a few days. If it persists, a D&C is then an option.

Other aspects of treatment include:

• basic pain medication such as paracetamol
• blood tests and possible ultrasound examination
• checking for Rhesus blood grouping (a Rhesus-negative person may be given immunoglobulin)
• reduced activity and rest for at least 48 hours.

Pay attention to any adverse emotional reactions—make sure you talk about any unusual feelings. Talk over your feelings with your partner and family. You will need at least a week off work

HOW SOON WILL WAIT BEFORE TRYING AGAIN?

You can safely start trying to get pregnant again very soon. It is best to wait until you have had at least one normal period. Your next period may be heavy and abnormal. Use sanitary towels and not tampons for the next 4 weeks.

Make sure that your body is ready before having sex again. It usually takes a while to become interested in sex again, and therefore partners have to be very patient and understanding.

WHAT IS THE MENOPAUSE?

Menopause is the end of menstruation, which in most women occurs between the ages of 45 and 55, with an average age of 51 years. It comes from the Greek word men (month) and pauses (halt).

However, the term is used in a broader sense to describe the months or years before and after the last period, during which the periods become irregular and the body adjusts to reduced levels of female hormones.

This may last 2 to 5 years or sometimes longer.

WHAT CAUSES THE MENOPAUSE?

The female hormones, estrogen, and progestogen are no longer produced by the ovary

because of a decline and finally a complete absence of mature eggs (ova).

WHAT ARE SYMPTOMS?

In some women symptoms (other than the cessation of periods) may be mild or absent. Common symptoms include the following.

PERIODS CHANGE

Periods may stop abruptly or after a prolonged irregular pattern such as lighter periods occurring further apart or heavier frequent periods.

Fertility is greatly reduced, far more unpredictable, and finally absent.

HOT FLUSHES

These symptoms are a sensation of heat, usually in the face and neck, but can be experienced from head to toe and last from seconds to minutes.

They may be accompanied by sweating, palpitations, headache, faintness, and disturbed sleep, and can be aggravated by alcohol, hot foods and drinks, and stress.

In themselves they are harmless, but they can cause embarrassment, sleep disruption, tiredness, and anxiety. They may continue from a few months to many years after the periods cease.

VAGINAL AND BLADDER SYMPTOMS

The normally moist tissue of the vagina and base of the bladder can become dry and inelastic. This can result in uncomfortable intercourse and an increased chance of infection of the bladder or vagina.

EMOTIONAL PROBLEMS

A woman may experience fluctuating levels of energy and concentration with tiredness, irritability, lack of confidence, and loss of interest in sexual activity.

Occasionally anxiety and depression can be a problem

IS OSTEOPOROSIS (thinning of bone)A PROBLEM

It has been shown that reduced levels of estrogen cause increased loss of calcium from bone tissue, which causes osteoporosis of varying degrees.

Certain drugs and medical conditions and smoking can aggravate it.

If you are slightly built or have a family history of osteoporosis, speak to your doctor about this potential problem.

WHAT SHOULD BE DONE?

While it is important to accept that menopause is a natural fact of life and nothing to be embarrassed or worried about, you should discuss any unpleasant problems with an understanding friend or your doctor.

It is important to lead a healthy life:

follow a correct diet, avoid obesity, get adequate relaxation and exercise, and reduce the use of cigarettes, caffeine, and alcohol.

It is normal and healthy to continue sexual relations, but a vaginal lubricant such as K-Y gel may be necessary if your vagina is too dry.

Contraception is advisable for 12 months after the last period.

WHAT ABOUT HORMONE REPLACEMENT THERAPY (HRT)?

If you have troublesome symptoms, hormones (both estrogen and progestogen) can be given. Usually, special skin patches or tablets are prescribed. A vaginal cream or tablet containing estrogen is available for a dry vagina.
However, there are concerns about the long-term use of HRT, especially in women with previous breast cancer and those with a strong family history of it.

HRT can still be used to relieve the unpleasant symptoms of hot flushes but in the short term for 1 to 2 years.

It should be reviewed with a view to continuing HRT safely for up to 5 years in total.

ARE THERE ALTERNATIVE TO HRT?

There are natural preparations, that have shown benefits for some women, such as those containing black cohosh extract (especially) and chaste tree extract (vitex agnus castus)

But be cautious of over-the-counter remedies as many are ineffective. Ask your doctor about alternatives

NOTE:

• Menopause is a normal change representing the end of reproductive life.
• Report to your doctor if you have a return of unusual bleeding.
• Continuing medical checks for breast examination, Pap tests, and general health assessment are important

MASTITIS WITH BREASTFEEDING

WHAT IS MASTITIS?

Mastitis is an area of inflammation of breast tissue, in particular, the milk ducts and glands of the nursing mother. It is caused by a cracked nipple or blockage of the ducts due to a problem with the drainage of the milk. Germs from the outside get into and grow in the stagnant milk.

WHAT ARE THE SYMPTOMS?

You may feel a lump and then a sore breast at first. Then follows a red, swollen, tender area (see diagram) with fever, tiredness, weakness, and muscle aches and pains (like having influenza).

WHAT ARE THE RISK?

If treated early and properly, mastitis starts to improve within 48 hours. Doctors regard it as a serious and rather urgent problem because a breast abscess can quickly develop without treatment and the abscess may require surgical drainage, usually by needle aspiration. Apart from the bacterial infection, infection with Candida (thrush) may occur, especially after the use of antibiotics. Candida infection usually causes severe breast pain—a feeling like a hot knife or hot shooting pains, especially during and after feeding. A breast abscess is diagnosed by ultrasound examination.

WHAT IS THE TREATMENT?

• Antibiotics: your doctor will prescribe a course of antibiotics, usually for 10 days. If you are allergic to
• penicillin, tell your doctor.
• Painkillers: take aspirin or paracetamol when necessary for pain and fever.
• Keep the affected breast well-drained.
• Keep breastfeeding: do this frequently and start with the sore side. It is safe to do so.
• Make sure the baby is latched on properly and change feeding positions to drain the milk.
• Heat the sore area of the breast before feeding: have a warm shower or use a warm face washer or a warm hot-water bottle.
• Cool the breast after feeding: use a cold face washer from the freezer.
• Apply cool, washed cabbage leaves over the affected side between feeds (optional).
• Massage any breast lump gently towards the nipple while feeding.
• Empty the breast well: hand expresses if necessary.
• Get sufficient rest: rest when you feel the need to do so and get help in the home.
• Keep to a nutritious diet and drink plenty of fluids.

HOW IT CAN BE PREVENTED?

Breast engorgement and cracked nipples must be attended to. It is important to make sure your milk drains well.

Faulty drainage can be caused by the following reasons:

an oversupply of milk, missed feeds, the breast not being fully emptied (e.g., from rushed feeding, poor attachment or wrong feeding positions), exhaustion, poor nutrition, and too much pressure on the breast (e.g. bra too tight and sleeping face-downwards).
Keep the breasts draining by expressing or by waking the baby for a feed if he or she sleeps for long periods. For an oversupply, try feeding on one breast only at each feed.

Avoiding caffeine and smoking may also help. Golden rule: ‘Heat and drain the breasts.’

NOTE: It is quite safe to continue breastfeeding with the affected breast unless your doctor advises otherwise

WHAT IS HIRSUTISM?

Hirsutism is the presence of the excessive body or facial hair. For women, the areas most affected are the ‘beard’ area (upper lip, chin, front of the ears), the chest, the abdomen, and the front of the thighs.

The condition varies from being mild and hardly noticeable to being obvious.

WHAT IS NORMAL?

Many women feel they are very ‘hairy’, but if this occurs in the normal female hair-growth areas (such as the armpits, forearms, pubic area, and around the nipples) there is no cause for concern.

A tendency to be ‘hairy’ may run in families or be prevalent in some races, such as those from the Mediterranean region.

Even if the hair growth seems to be in a male pattern,

there is usually no serious underlying cause and the problem can be treated. 

WHAT CAUSES HIRSUTISM?

It is due to excessive hair growth caused by overactive male sex hormones (present in all women) at the hair root.

The reason for this is unclear. Often hairiness runs in families or is more common in certain races.

It is rare in Asians. Certain medications, such as anti-epilepsy drugs and some oral contraceptive pills, can cause it.

It is usually associated with polycystic ovarian syndrome and uncommonly

it can be caused by cysts or tumors of the ovaries or adrenal glands.

WHAT CAN BE DONE?

Your doctor will need to take a full medical history and examine you to assess your hair growth. A blood test may be necessary.

WHAT IS THE TREATMENT?

• Your doctor may be able to reassure you that your hair growth is normal, and therefore no therapy is needed.
• Cosmetic measures (such as bleaching, waxing, or shaving) or treatment with depilatory creams or electrolysis can help. Bleaching is a simple and good option. Your doctor will advise what will suit you. There is no evidence that shaving increases the rate of hair growth, but plucking the hair does stimulate growth. Do not pluck hairs around the lips and chin.
• Laser epilation may also help but seems to be most suited for dark hair on light skin and lasts about 6 months.
• Medical treatment with drugs such as spironolactone can be used if your hair growth is excessive and causes you understandable social embarrassment.
• It will probably take at least 3 months for you to notice any difference in your hairiness, and for most women, the hair grows back once they stop taking the medications.
• Eflornithine (Vaniqa) used to slow the regrowth of unwanted facial hair following laser treatment.

WHAT IS MENORRHAGIA?

Menorrhagia means unusually heavy periods or bleeding between periods, Women with menorrhagia may experience ‘flooding’, may pass large clots with the menses, And it may have periods that are prolonged (lasting more than 7 days).

• Normal period blood loss is between 20 to 60 mL (4 to 12 teaspoonfuls).
• The average blood loss in a menstrual cycle is 30 to 40 mL.
• A heavy period of blood loss is more than 80 mL (half a teacup).

It is a common complaint affecting 5 to 10% of women.

WHAT ARE THE SYMPTOMS?

Apart from heavy blood loss during the period and bleeding or spotting between periods.

There may be cramping pains in the lower abdomen. Heavy bleeding may be described as ‘saturated pads’, ‘frequent changing’, ‘accidents’, and ‘clots’.

There may be prolonged bleeding.

Since there is a risk of iron deficiency, symptoms of anemia such as fatigue and weakness may occur.

WHAT ARE CAUSES?

In most cases the exact cause is unknown and the uterus (womb) and ovaries appear normal—this is called ‘dysfunctional uterine bleeding’. It is most common at the extremes of reproductive age—menarche and menopause.

We do know that a chemical called prostaglandin is a factor since its level in the lining of the uterus (the endometrium) is high in women with heavy periods and tends to stop the clotting of blood.

KNOWN CAUSES INCLUDE:

• fibroids, which are non-cancerous growths in the muscle of the uterus
• hormone contraceptives including Depo Provera
• endometriosis of the uterus
• the intrauterine device (IUD)—a contraceptive device placed in the uterus
• bleeding disorders and warfarin used to reduce blood clotting
• miscarriage and ectopic pregnancy
• infection, including sexually transmitted infection
• endometrial cancer in the lining of the uterus.

HOW MENORRHAGIA IS DIAGNOSED?

Apart from a thorough clinical examination by your doctor including a pelvic examination and Pap test, some of the following tests may be ordered:

• blood tests to check for anemia
• abdominal and vaginal ultrasound
• endometrial biopsy
• D & C (dilatation and curettage)
• Hysteroscopy, where a ‘telescope’ is placed inside the uterus for inspection

WHAT IS THE TREATMENT?

SURGICAL TREATMENT

• D & C to gently scrape away the endometrium
• Total removal of the endometrium
• Surgery to remove tumors such as fibroids and polyps
• Hysterectomy (removal of the uterus), which is the last resort if all other options including more limited surgery
• have not worked

TREATMENT OF DYSFUNCTIONAL BLEEDING

In this category, there is no clear-cut cause so the aim of treatment is to reduce the amount of blood loss.

This is done by giving hormone treatment (progesterone) or anti-prostaglandin medication such as non-steroidal anti-inflammatory drugs (NSAIDs), or by helping blood clotting and reducing bleeding (tranexamic acid).

If the doctor and the patient agree that the heavy periods do not interfere too much with life.

A decision can be made to live with the problem but monitor it,

including checking for anemia.

EXAMPLES OF TREATMENT ARE:

• The oral contraceptive pill. This is an important treatment as it reduces bleeding by one-third.
• Progesterone tablets. These are excellent, especially for acute heavy bleeding.
• Progesterone-releasing IUD. This device (Mirena) releases hormone gradually and makes the lining of the uterus very thin. It also acts as a contraceptive.
• Tranexamic acid (Cyklokapron). This is the most effective therapy, reducing bleeding by almost half. The tablets should be taken four times a day for 4 days.

NOTE:

• Keep a menstrual diary.
• Rest as much as possible.
• Take iron supplements (best to have blood tests first).
• Eat a well-balanced diet.
• Avoid aspirin (may increase bleeding).