Best Gynaecologist in Panchkula - Paras Bliss

1. Gynecological issues in women Menstrual problems Dr Harpreet Kour Isher Consultant Obstetrics & Gyanecology Paras Bliss, Panchkula

2. Onset of first periodswhat is normal ? • First menstrual periods called menarche. • Average age of menarche is 12 years • Usually occur within 2-3 years of breast budding which is the first sign of puberty • Cycles may be irregular in the first two years ranging from every 21 days to 45 days. • By the third year 60-80% of girls have a 21-34 day cycles as in adults.

3. What is abnormal ? • When menstrual periods have not begun within 3 years of breast development • When the period between periods exceeds 3 months • When periods have not begun by 15 years • When periods begin before 8 years • When periods have not begun by 14 years and there are signs excessive coarse hair growth or an eating disorder

4. When periods last for more than 7 days • Require frequent pad change i.e. every 1-2 hours • Associated with heavy bleeding and a family history of bleeding disorder or easy bruising or excessive bleeding.

5. Menstrual problems in reproductive age What is normal ? • Cycle length of 21-35 days • Period not more than 7 days • Less than one pad soaked in two hours; usually not more than 6 pads or tampons in a day • Pain in tummy , thighs and lower back usually on first two days and few hours before onset of periods

6. What is abnormal ? • Bleeding more than 7 days or heavy bleeding e.g. changing a pad very 2 hours frequently. • Bleeding at less than 21-22 days interval. • Bleeding at more than 34-35 days interval. • Recurrent post coital bleeding( after sexual intercourse ) • Intermenstrual bleeding( in between cycles )

8. Source of bleeding • Bleeding may be from the uterus , cervix , vagina ,vulva ; bowels ; urinary tract • Uterine bleeding may be heavy , moderate or mild • Bleeding from other parts of the lower reproductive system is usually not heavy unless a cancer of cervix or a vaginal tear. • Have to rule out bleeding from the urinary tract and the gastrointestinal tract.

9. Reasons-Heavy or prolonged bleeding • Lesions within the cavity or wall of the womb (uterus ) • Thickened lining of the cavity of the uterus • Hormonal imbalance and anovulation • Cancers

10. Other causes of abnormal bleeding • Undiagnosed pregnancy • Pelvic infections • Endometriosis • Functional ovarian cysts • Birth control pills and injections • Intra uterine device like copper T • Familial bleeding disorders • Endocrine disordres esp. thyroid and polycystic ovarian syndrome • Liver or renal diseases

11. Tests…… • Clinical examination including an internal examination • Pap smear • Pregnancy test • Ultrasound • Hormonal profile • Clotting tests • Endometrial biopsy • Diagnostic Hysteroscopy

12. Around menopause… • Irregular cycles • Bleeding may be less frequent • Bleeding may be more frequent • Bleeding may decrease in amount • Bleeding may increase in amount Important to consult if bleeding heavy and /or frequent ;and if periods continue till 52 years of age

13. After menopause • Menopause : No periods for at least one year continuously • Any bleeding after menopause, always consult a gynecologist. • Bleeding after menopause always abnormal

14. Tests • Trans vaginal ultrasound • Diagnostic Hysteroscopy • Endometrial biopsy

15. With the doc…. Will assess you on the whole and consider • Risk factors as obesity , polycystic ovaries , infertility or never had pregnancies, hypertension , diabetes. • Contraceptive history and irregularities • Stress levels • Eating disorders

16. So, please do… • Maintain a menstrual diary…don’t be ignorant about your dates. • Know what is abnormal and meet your doc. • If in the reproductive age group , make contraception a healthy habit.

17. THANK YOU ……..