Abnormalities of menstruation can be distressing and affect a woman’s daily activities at work or at home. It is important to track your monthly cycle and note the frequency, the duration of menstruation, the quantity of bleeding and associated symptoms. Some women easily get through their monthly periods with few or no concerns. Their periods come like clockwork, starting and stopping at nearly the same time every month, causing little more than a minor inconvenience. However, other women experience a host of physical and /or emotional symptoms just before and during menstruation. From heavy bleeding and missed periods to unmanageable mood swings, these symptoms may disrupt a woman’s life in major ways. Most menstrual cycle problems have straightforward explanations, and a range of treatment options exist to relieve symptoms.

How the Menstrual Cycle Works

Your menstrual period is part of your menstrual cycle—a series of changes that occur to parts of your body on average, every 28 days. Some normal menstrual cycles are a bit longer, some are shorter. The first day of your menstrual period is day one of your menstrual cycle. The average menstrual period lasts about five to seven days. A “normal” menstrual period for you may be different from what’s “normal” for someone else.

Types of Menstrual Disorders

If one or more of the symptoms you experience before or during your period causes a problem, you may have a menstrual cycle “disorder.” These include:

• Abnormal Uterine Bleeding (AUB), which may include heavy menstrual bleeding, no menstrual bleeding (Amenorrhea) or bleeding between periods (irregular menstrual bleeding)
• Dysmenorrhea (painful menstrual periods)
• Premenstrual Syndrome (PMS)

A brief discussion of menstrual disorders follows below:

Heavy menstrual bleeding

Bleeding is considered heavy if it interferes with normal activities. Blood loss during a normal menstrual period is about 5 tablespoons, but if you have heavy menstrual bleeding, you may bleed as much as 10 to 25 times that amount each month. You may have to change a tampon or pad every hour, for example, instead of three or four times a day.

If you are past menopause and experience any vaginal bleeding, it is important to consult your doctor immediately.

Heavy menstrual bleeding can be caused by:

• Hormonal imbalances
• Structural abnormalities in the uterus, such as polyps or fibroids
• Medical conditions

Many women with heavy menstrual bleeding can blame their condition on hormones. Your body may produce too much or not enough oestrogen or progesterone necessary to keep your menstrual cycle regular.

Certain medical conditions can cause heavy menstrual bleeding. These include:

• Blood clotting disorders
• Thyroid problems
• Idiopathic thrombocytopenic purpura (itp), a bleeding disorder characterised by too few platelets in the blood
• Liver or kidney disease
• Leukaemia
• Medications: anticoagulant drugs such as heparin.

Other gynaecologic conditions that may be responsible for heavy bleeding include:

• Fibroids
• Miscarriages
• Ectopic Pregnancies

Amenorrhea

You may have experienced the opposite problem of heavy menstrual bleeding, which is no menstrual period at all. This condition is called amenorrhea, or the absence of menstruation. It is normal before puberty, after menopause and during pregnancy. If you don’t have a monthly period and don’t fit into one of these categories, then you need to consult a gynecologist.

There are two kinds of amenorrhea:

1. Primary
2. Secondary

• Primary amenorrhea is diagnosed when you reach the age of 16 and still haven’t menstruated. It’s usually caused by some problem in your endocrine system, which regulates your hormones. Sometimes this results from low body weight associated with eating disorders, excessive exercise, or medications. Several things can cause this medical condition, such as a problem with your ovaries or an area of your brain called the hypothalamus or genetic abnormalities. Delayed maturing of your pituatary gland is the most common reason, but you should be checked for any other possible reasons.




• Secondary amenorrhea is diagnosed if you had regular periods, which suddenly stopped for three months or longer. It can be caused by problems that affect oestrogen levels, including stress, weight loss, exercise, or illness.

Additionally, problems affecting the pituitary gland (such as elevated levels of the hormone, prolactin) or thyroid (including hyperthyroidism or hypothyroidism) may cause secondary amenorrhea. This condition can also occur if you’ve had your ovaries surgically removed.

Severe menstrual cramps (dysmenorrhea)

Most women have experienced menstrual cramps before or during their period at some point in their lives. For some, it’s part of their regular monthly routine. But if your cramps are especially painful and persistent, this is called dysmenorrhea, and you should consult a gynecologist. Pain from menstrual cramps is caused by uterine contractions, triggered by prostaglandins, hormone-like substances that are produced by the uterine lining cells which circulate in your bloodstream.

If you have severe menstrual pain, you might also find you have some diarrhoea or an occasional feeling of faintness where you suddenly become pale and sweaty. That’s because prostaglandins speed up contractions in your intestines, resulting in diarrhoea, and lower your blood pressure by relaxing blood vessels, which leads to lightheadedness.

Premenstrual syndrome (PMS)

PMS is a term commonly used to describe a wide variety of physical and psychological symptoms associated with the menstrual cycle. About 30 to 40 percent of women experience symptoms severe enough to disrupt their lifestyles. PMS symptoms are more severe and disruptive than the typical mild premenstrual symptoms that as many as 75 percent of all women experience. There are more than 150 documented symptoms of PMS, the most common of which is depression. Symptoms typically develop about five to seven days before your period and disappear once your period begins or soon after.

Physical symptoms associated with PMS include:

• Bloating
• Swollen, painful breasts
• Fatigue
• Constipation
• Headaches

Emotional symptoms associated with PMS include:

• Anger
• Anxiety
• Confusion
• Mood swings and tension
• Crying and depression
• Inability to concentrate

A miscarriage is the loss of a pregnancy before 20 weeks of gestation. Any bleeding in pregnancy should be examined and assessed by a gynecologist, as this is often one of the first signs of a miscarriage. Another sign of miscarriage is abdominal pains which are usually accompanied by bleeding.

Patients who are at risk for miscarriages include:

• Patients who have had a previous miscarriage
• Age (Older women. Usually > 40years old)
• Chronic medical conditions
• Uterine or cervical problems
• History of birth defects or genetic problems
• Infections
• Smoking, drinking and illicit drug use
• Medications
• Environmental toxins
• Paternal factors
• Obesity

Once a miscarriage is diagnosed, you will need to be admitted to ensure that you are monitored and that your womb is cleaned to prevent complications such as infection and excessive bleeding. Counselling will also be offered to assist.

Sexually transmitted infections or STIs are infections that are passed from one person to another through sexual contact. The causes of STI’s are:

• Bacteria
• Parasites
• Yeast
• Viruses

There are more than 20 types of STIs including:

• Chlamydia
• Genital Herpes
• HIV /AIDS
• Human Pappiloma Virus (HPV)
• Syphillis
• Trichomoniasis

The correct use of condoms greatly reduces, but does completely eliminate the risk of catching or spreading STIs.

Fibroids are noncancerous masses of muscular tissue and collagen that can develop within the wall of the uterus. They are the most common benign tumor in premenopausal women. By the time women are 50 years old, 80 percent will have fibroids, but only 20 percent of women with fibroids will have any symptoms.

Fibroids are also known as uterine leiomyomas or myomas. While fibroids can cause a variety of symptoms, they may not cause any symptoms at all. Heavy bleeding is the most common symptom associated with fibroids and the one that usually prompts a woman to make an appointment with a gynecologist.

Fibroids may cause a range of other symptoms too, including pain, pressure in the pelvic region, abnormal bleeding, painful intercourse, urinary symptoms, or problems with fertility.

What actually causes fibroids to form isn’t clear, but genetics and hormones are thought to play a big role. Your body may be predisposed to developing fibroids. They seem to grow or shrink depending on oestrogen levels in your body.

Fibroids usually grow slowly during your reproductive years, but about 40 percent of fibroids increase in size with pregnancy. At menopause, fibroids shrink because oestrogen and progesterone levels decline. Using menopausal hormone therapy containing oestrogen after menopause usually does not cause fibroids to grow.

Growth of a fibroid after menopause is a reason to see a gynecologist to make sure nothing else is causing the growth. A variety of treatments exist to remove fibroids and relieve symptoms. If you learn you have fibroids but aren’t experiencing symptoms, you usually won’t need treatment.

Who is at Risk for Fibroids?

African-American women are more likely than Caucasian women to have them, and they are more likely to develop fibroids at a younger age. If women in your family have already been diagnosed with fibroids, you have an increased risk of developing them. You may also be at an increased risk if you are obese or have blood pressure problems.

Types of Fibroids:
Fibroids form in different parts of the uterus:

• Intramural fibroids are confined within the muscle wall of the uterus and are the most common fibroid type. They expand, which makes the uterus feel larger than normal. Symptoms of intramural fibroids may include heavy menstrual bleeding, pelvic pain, back pain, frequent urination, and pressure in the pelvic region.
• Submucosal fibroids grow from the uterine wall into the uterine cavity. They can cause heavy menstrual bleeding with associated bad menstrual cramps and infertility.
• Subserosal fibroids grow from the uterine wall to the outside of the uterus. They can push on the bladder or bowel causing bloating, abdominal pressure, cramping and pain.
• Pedunculated fibroids grow on stalks out from the uterus or into the uterine cavity, like mushrooms. If these stalks twist, they can cause pain, nausea or fever, or extremely rarely can become infected.

Treatment of Uterine Fibroids

Treatment of uterine fibroids is tailored around your symptoms. Options include conservative, medical, radiological, and surgical. The various options and modalities for treatment will be discussed with you and a treatment plan will be tailored to fit your particular needs and requirements.

There are many different kinds of ovarian cysts. The diagnosis of an ovarian cyst is made after performing an ultrasonographic examination of the female genital system, particularly the ovaries.

The common symptoms of an ovarian cyst include:

• Abdominal bloating and swelling
• Pelvic pain
• Painful intercourse
• Nausea and vomitting

Various treatment options are available and a gynecologist will discuss these with you.

This is a pregnancy which implants outside of the uterine cavity. More commonly in the fallopian tubes. It is important to consult a gynecologist as soon as you find out you are pregnant so as to confirm the location of the pregnancy. An ectopic pregnancy is a gynaecological emergency and you will need to be admitted for treatment. Treatment options are medical and surgical. The best option for you will be discussed with you by a gynecologist.

Symptoms of Chronic Pelvic Pain:

Women with CPP have one or more of the following symptoms:

• Constant or intermittent pelvic pain
• Lower backache for several days before menstrual period, subsiding once period starts
• Pain during intercourse (rarely, some vaginal bleeding after intercourse)
• Pain on urination and /or during bowel movements (rarely, blood in urine or stool)
• Painful menstrual periods (dysmenorrhea)
• Severe cramps or sharp pains

The course of CPP is unpredictable and different in every woman. Symptoms may stay constant, disappear without treatment or suddenly increase. They sometimes decrease during pregnancy and improve after menopause. The severity of pain is also unpredictable. It may range—even in the same woman—from mild and tolerable to so severe it interferes with your normal activities. Your physical or mental state can also cause the level of pain to fluctuate, so you may experience fatigue, stress and depression. Moderate to severe pain generally requires medical or surgical treatment, although such therapies are sometimes unsuccessful at entirely relieving pain.

Unrelieved, unrelenting pelvic pain may affect your sense of well-being, as well as your work, recreation, and personal relationships. You may begin to limit your physical activities and show signs of depression (including sleep problems, eating disorders and constipation), and your sex life and role in the family may change.

When pelvic pain leads to such emotional and behavioural changes, the International Pelvic Pain Society (IPPS) calls the condition “chronic pelvic pain syndrome” and says that the “pain itself has become the disease.” In other words, the pain is more of a problem than the original cause. In fact, a medical examination may find nothing physically wrong with the area that hurts. Nonetheless, the nerve signals in that area continue to fire off pain messages to the brain, and you continue to feel hurt.

Causes of Chronic Pelvic Pain

There are two kinds of pain. Acute pain typically occurs with an injury, illness or infection. A warning signal that something is wrong, it lasts only as long as it takes for the injured tissue to recover. In contrast, chronic pain lasts long after recovery from the initial injury or infection and is often associated with a chronic disorder or an underlying condition.

Endometrioses

Kindly refer to the section on Endometrioses.

Another common cause of CPP is pelvic inflammatory disease (PID). PID is one of the most common gynaecologic conditions, usually related to a sexually transmitted disease. However, many women recuperate fully from STD-related PID, and we don’t exactly know why PID sometimes leads to CPP.

One of the most common contributors to pelvic pain is dysfunction of the pelvic floor and hip muscles. This problem often accompanies pain originating from the reproductive organs, but can occur on its own or persist after other sources are successfully treated.

Other Causes of Chronic Pelvic Pain

Other causes of CPP are diagnosed more frequently by other kinds of clinical care specialists, such as urologists, gastroenterologists, neurologists, orthopedic surgeons, psychiatrists, and pain management physicians. They include diseases of the urinary tract or bowel as well as hernias, slipped discs, drug abuse, fibromyalgia and psychological problems.

Characteristics of Pelvic Pain Patients

Despite the number of possible causes, many women with chronic pelvic pain receive no diagnosis. These are often the women who make the rounds of various specialists seeking relief, only to be told the pain is “all in their heads.” They may also be subjected to multiple tests or even unnecessary surgery. These women may feel that the pain is somehow their fault, when in fact, the lack of a diagnosis represents the limitations of medical science.

Simply put, there is no simple answer to the question, “What causes chronic pelvic pain?” and no “typical patient.” Still, a woman with pelvic pain is more likely to:

• Have been sexually or physically abused
• Have a history of drug and alcohol abuse
• Have a history of sexual dysfunction
• Have a mother or sister with chronic pelvic pain
• Have history of pelvic inflammatory disease (pid)
• Have had abdominal or pelvic surgery or radiation
• Have previous or current diagnosis of depression
• Have a structural abnormality of the uterus, cervix or vagina
• Be of reproductive age, especially aged 26 to 30 years

Some of these, like family history, surgery and PID, are obvious risk factors; others (drug abuse, depression) may be risk factors or may result from having chronic pain.

A natural event that marks the end of fertility and childbearing years. Technically, menopause results when the ovaries no longer release eggs and decreases production of the sex hormones oestrogen progesterone and, to a lesser extent, androgen.

Menopause is said to have occurred when a woman has not had a period for 12 months.

Menopause & the Reproductive Cycle
Reproduction

During the reproductive years, a gland in the brain generates hormones that causes an egg from the ovaries to be released from its follicle each month. As the follicle develops, it produces the sex hormones oestrogen and after ovulation, progesterone, which results in a thickened uterine lining. This enriched lining is prepared to receive and nourish a fertilised egg, which could develop into a foetus. If fertilisation does not occur, oestrogen and progesterone levels drop, the lining of the uterus breaks down and menstruation occurs.

Perimenopause

For reasons unknown, your ovaries gradually begin to function less efficiently during your mid-to-late 30s. In your late 40s, the process accelerates along with greater hormone fluctuations. This affects ovulation and levels of the hormones oestrogen and progesterone.

During this transition period, called perimenopause, you may experience irregular menstrual cycles and unpredictable episodes of menstrual bleeding. By your early to mid-50s, your period will likely end.

Most women can tell if they are approaching menopause because their menstrual periods start changing. The “menopause transition” is a term used to describe this time, as is perimenopause.

Menopause

But menopause itself is a woman’s final menstrual period, which can be confirmed after she goes 12 consecutive months with no period, and no other biological or physiological cause can be identified. It also may occur when both ovaries are surgically removed or damaged. Until that time, a woman in her late 40s or 50s may still be able to get pregnant, despite irregular periods.

Medical Intervention

Although the majority of women experience “natural” or spontaneous menopause, some women may experience menopause due to a medical intervention. Surgically removing both ovaries, a procedure known as bilateral oophorectomy, triggers menopause at any age. Induced menopause can also occur if the ovaries are damaged by radiation, chemotherapy or certain drugs. Some medical conditions also may cause menopause to occur earlier.

Naturally Occurring

Just as every woman’s body is unique, each woman’s menopause experience will be highly personal. In fact, some women experience no physical symptoms at all, except the end of their menstrual periods.

Menopause can occur as early as your 30s and, rarely, as late as your 60s. However, there is no correlation between the time of a woman’s first period and her age at menopause. In addition, age at menopause is not influenced by race, height, the number of children a woman has had or whether she took oral contraceptives for birth control.

Early Menopause

Although the average age for menopause in the United States is 51, some women experience it later or earlier. Early menopause is defined as occurring at any age younger than age 45. Menopause that occurs in women younger than 40 is called premature menopause or premature ovarian failure and it can naturally occur. But symptoms of premature menopause, such as irregular periods, may signal an underlying condition, so it is important to discuss any symptoms with your health care professional.

What influences the time of menopause? Genetics are a key factor. The age at which your mother stopped her periods may be similar to when you stop your menstrual periods. And women who smoke cigarettes experience menopause two years earlier, on average, than non-smoking women.

Symptoms of Menopause

• Irregular Periods: About four to eight years prior to natural menopause, typically in a woman’s late 40s, menopause-related changes may begin. One of the most common and annoying symptoms you may notice during your 40s is that your periods become irregular. They may be heavy one month and very light the next. They may get shorter or last longer. You may even begin to skip your period every few months or lose track of when your periods should start and end. These symptoms are caused by irregular oestrogen and progesterone levels.
• Changes in Hormone Levels: Levels of hormones vary erratically and may be higher or lower than normal during any cycle. For example, if you don’t ovulate one month—which is common for women in their late 40s—progesterone isn’t produced to stimulate menstruation, and oestrogen levels continue to rise. This can cause spotting throughout your cycle or heavy bleeding when menstruation does start.
  One note of caution: although irregular menstrual periods are common as you get closer to menopause, they can also be a symptom of uterine abnormalities or uterine cancer. See your health care professional as soon as possible if your periods stop for several months and then start again with spotting or heavy bleeding. If you have irregular spotting, if you have bleeding after intercourse, or if you start bleeding after menopause. Be sure to mention any menstrual irregularities during regular checkups. Uterine biopsy and vaginal ultrasound are the only ways to evaluate these symptoms and determine whether they are caused by abnormalities in the uterus. Irregular spotting can also be a symptom of cervical cancer, which may be picked up by a Pap Smear test (see screening in Treatment section).

Other Changes and Signs of Menopause Include:

• Hot flashes (sudden warm feeling, sometimes with blushing)
• Night sweats (hot flashes that occur at night, often disrupting sleep)
• Fatigue (probably from disrupted sleep patterns)
• Mood swings
• Vaginal dryness
• Fluctuations in sexual desire or response
• Difficulty sleeping

Menopause-Related Health Conditions

Although there is a wide range of possible menopause-related conditions, most women experiencing natural menopause only have mild disturbances during the perimenopausal years. However, you should be aware that there are at least two major health conditions that can develop in the post-menopausal years: coronary artery disease and osteoporosis.

• Coronary Artery Disease: Your body’s oestrogen helps protect against plaque buildup in your arteries. It does this by helping to raise HDL cholesterol (good cholesterol), which helps remove LDL cholesterol (the type that contributes to the accumulation of fat deposits called plaque along artery walls). As you age, your risk for developing coronary artery disease (CAD)—a condition in which the veins and arteries that take blood to the heart become narrowed or blocked by plaque—increases steadily. Heart attack and stroke are caused by atherosclerotic disease, in most cases.
• Osteoporosis: Your body’s own oestrogen helps prevent bone loss and works together with calcium and other hormones and minerals to build bones. Your body constantly builds and remodels bone through a process called resorption and deposition. Up until around age 30, the body makes more new bone than it breaks down. But once oestrogen levels start to decline, this process slows down.

By menopause, your body breaks down more bone than it rebuilds. In the years immediately after menopause, some women may lose as much as 20 percent of their bone mass in the first five to seven years following menopause. Although loss of bone density eventually levels out, in the years ahead, keeping bone structures strong and healthy to prevent osteoporosis becomes more of a challenge. Osteoporosis occurs when bones become too weak and brittle to support normal activities.

Preventing Menopause-Related Health Condition with Exercise

Not all women develop heart disease or osteoporosis. Many more things affect your heart and your bones than oestrogen alone. For example, exercise improves your cardiovascular system—your heart, lungs and blood vessels—at any age. It can help decrease high blood pressure, a concern for half of women over age 60, and can help maintain bone mass. It can also help reduce weight gain, a major risk factor for heart disease, diabetes and many other health conditions common to older women.

You are never too old to begin or continue exercising. A simple walking routine for 30 minutes, four to five days a week can provide health benefits. There are other exercise options. Talk to your health care professional about which one fit your lifestyle and medical needs.

If your bones are strong and healthy as you enter menopause, you’ll have better bone structure to sustain you as you age. Bone loss varies from woman to woman. You can improve bone strength as you age by exercising regularly and making sure you get enough calcium in your diet or from supplements. Exercise also helps improve balance, muscle tone and flexibility, which can diminish with aging. Weakness in these areas can lead to more frequent falls, broken bones and longer healing periods.

Women today can expect to live as much as one-third of their lives beyond menopause. The years following menopause can be healthy years, depending on how you take care of yourself

Polycystic Ovary Syndrome (PCOS) is the most common hormone abnormality of reproductive-age women, the most common cause of infertility in women and an important harbinger of metabolic disorders such as diabetes and heart disease. It affects an estimated 5 percent to 10 percent of females and is associated with an increased risk of diabetes and obesity, and possibly an increased risk of stroke and cardiovascular disease. The syndrome is generally characterised by the presence of polycystic ovaries, hyperandrogenism (the condition caused by excess male hormones or male-like traits), and irregular ovulation and menstruation. The symptoms of PCOS can vary.

The syndrome was previously called Stein-Leventhal Syndrome after the physicians who first characterised it in the 1930s. Although its cause remains unknown, it usually presents in young women or adolescents, and the main symptoms are irregular or absent periods and excess unwanted facial and /or body hair growth (hirsutism). As the term “polycystic ovary syndrome” suggests, the disorder is often accompanied by enlarged ovaries containing multiple small painless benign “cysts” or tiny follicles about 1/8 to 1/4 inch in diameter.

During a normal menstrual cycle in which a woman ovulates (called an ovulatory cycle), a small number of follicles begin to grow. One becomes the biggest, or dominant follicle. This dominant follicle then ruptures and releases the egg.

In women with PCOS, the hypothalamic-pituitary (in the brain) functions abnormally, and high levels of hormones called androgens (commonly known as “male hormones”) disturb the ovulatory process, halting the normal development of the sacs, called follicles, that contain each individual egg (or ova). These halted or arrested follicles––whose appearance (via an ultrasound) is sometimes likened to a “string of pearls” on the outside border of the ovary––form the “cysts” observed in PCOS. These cysts are not tumors and do not require removal.

Treatment of PCOS, instead, is through the use of lifestyle modifications and medication to treat symptoms.

Many, but not all, women with PCOS will have the polycystic-looking ovaries (which are often two to five times larger than normal ovaries) for which the syndrome is named, but it is possible to be diagnosed with the syndrome without having this sign. And not all women with polycystic-appearing ovaries will have PCOS.

Many women with PCOS experience excess insulin production from the pancreas, which can result from insulin resistance, meaning that their cells don’t respond well to insulin, so the insulin has difficulty working in their bodies. Hence, higher levels of insulin are needed to maintain normal glucose and lipid levels. Insulin, a hormone produced by the pancreas, regulates a range of functions, including controlling blood sugar (glucose) and fats (lipids).

Insulin resistance can lead to hyperinsulinism or hyperinsulinemia. It is also a precursor to type 2 diabetes. Furthermore, the high levels of insulin help stimulate the ovaries to overproduce androgens, which may be the cause of PCOS in some women.

In addition to stimulating the ovaries to overproduce androgens, high levels of insulin can cause darkening of the skin around the neck and other crease areas, a condition called acanthosis nigricans, often accompanied by skin tags in these areas.

If the pancreas can’t produce enough insulin to compensate for the insulin resistance, glucose builds up in the blood, eventually leading to type 2 diabetes.

Up to 75 percent of women with PCOS have insulin resistance and about 10 percent develop type 2 diabetes by age 40. Insulin resistance and an increased risk of diabetes are major problems for obese women with PCOS, but they also cause problems for normal weight women with PCOS. For obese women with PCOS, treatment plans should incorporate diet and exercise.

Obesity in women with PCOS tends to be centered on the abdomen, a fat distribution pattern linked to increased risk of diabetes, heart disease and high blood pressure.

Up to 50 percent of women with PCOS also have sleep apnea, a condition that causes brief spells where breathing stops during sleep. Sleep apnea can worsen the degree of insulin resistance.

The most visible symptoms of PCOS stem from excessive levels of androgens, such as testosterone, produced by the ovaries and the adrenal glands. Androgens are often called “male hormones,” even though they are found in both men and women. They are usually present at higher concentrations in men and are an important factor in determining male traits and reproductive activity. Androgens, or androgen precursors, include testosterone, dihydrotestosterone (DHT), androstenedione, dehydroepiandrosterone (DHEA) or DHEA sulfate (DHEA-S).

Excessive levels of these hormones, a condition called hyperandrogenemia, or their exaggerated action, called hyperandrogenism can lead to some of the most common symptoms of PCOS in women, including:

• Excess body or facial hair (hirsutism)
• Oily skin and acne
• Oligo-ovulation (irregular ovulation and menstruation)
• Scalp hair loss and balding (male pattern balding and androgenic alopecia)

But such symptoms alone are not enough to support a diagnosis of PCOS. They may only indicate the presence of hyperandrogenism, which can result from several conditions.

Women with PCOS ovulate irregularly and /or infrequently and often have irregular menstrual periods. Inducing a period is important because the hormone progesterone promotes the normal shedding of the uterine lining (i.e., menstruation), preventing the buildup of the uterine lining, and reducing the risk of endometrial (uterine) cancer. However, progesterone is secreted by the ovaries only after ovulation occurs, so progesterone may need to be administrated to women with PCOS either alone regularly or as part of a combination hormonal contraceptive.

PCOS often is a cause of infertility due to a failure to ovulate.

Women with PCOS are more likely to be overweight or obese, although the exact relationship of PCOS and body weight is unknown. Excess weight worsens PCOS, but researchers do not yet know whether or not having PCOS makes patients more prone to obesity.

It is not surprising that women with PCOS often suffer from poor self image and may experience depression or anxiety. While the biochemical imbalances that cause symptoms are becoming better understood, the trigger or triggers for PCOS remain unknown. Most believe PCOS results from genetic defects, often in combination with environmental factors. Genetic defects may result in abnormal function of the hormones from the pituitary that regulate ovulation (LH and FSH), in abnormal development of the follicle, in increased production of male hormones (androgens), and in insulin resistance and excessive production of insulin. All these prevent the ovaries from functioning normally.

Because PCOS is mostly a genetic disorder, the risk of PCOS in family members is high. For example, an estimated 30 percent of mothers, and 50 percent of sisters and daughters of people with PCOS can be affected.

To date there is no cure for PCOS. Health care professionals can usually address the most bothersome symptoms. Because of the complexity of the hormonal interactions, you may need to see an endocrinologist. You may also need to visit a reproductive endocrinologist, especially if you are infertile and trying to conceive. Not all physicians have experience treating PCOS, so check with the doctor’s office to see if that doctor cares for many people with PCOS.

Endometriosis is a non-cancerous condition in which tissue similar to the endometrium (uterine lining) grows outside your uterus and adheres to other structures, most commonly in the pelvis, such as on the ovaries, bowel fallopian tubes or bladder. Rarely, does it implant in other places, such as the liver, lungs, diaphragm and surgical sites.

It is a common cause of pelvic pain and infertility. It affects about 5 million women in the United States. Historically thought of as a disease that affects adult women, endometriosis is increasingly being diagnosed in adolescents, as well. The most common symptoms are painful menstrual periods and /or chronic pelvic pain.

Others include:

• Diarrhoea and painful bowel movements, especially during menstruation
• Intestinal pain
• Painful intercourse
• Abdominal tenderness
• Backache
• Severe menstrual cramps
• Excessive menstrual bleeding
• Painful urination
• Pain in the pelvic region with exercise
• Painful pelvic examinations
• Infertility

It is important to understand that other conditions aside from endometriosis can cause any or all of these symptoms and other causes may need to be ruled out. These include, but are not limited to, interstitial cystitis, irritable bowel syndrome, inflammatory bowel disease, pelvic adhesions (scar tissue), ovarian masses, uterine abnormalities, malabsorption syndromes and, very rarely, malignancies.

When endometriosis tissue grows outside of the uterus, it continues to respond to hormonal signals—specifically estrogen—from the ovaries telling it to grow. Oestrogen is the hormone that causes your uterine lining to thicken each month. When oestrogen levels drop, the lining is expelled from the uterus, resulting in menstrual flow (you get your period). But unlike the tissue lining the uterus, which leaves your body during menstruation, endometriosis tissue is essentially trapped.

With no place to go, the tissue bleeds internally. Your body reacts to the internal bleeding with inflammation, a process that can lead to the formation of scar tissue, also called adhesions. This inflammation and the resulting scar tissue may cause pain and other symptoms.

Recent research also finds that this misplaced endometrial tissue may develop its own blood supply to help it proliferate and nerve supply to communicate with the brain, one reason for the condition’s severe pain and the other chronic pain conditions so many women with endometriosis suffer from.

The type and intensity of symptoms range from completely disabling to mild. Sometimes, there aren’t any symptoms at all, particularly in women with so-called “unexplained infertility.”

If your endometriosis results in scarring of the reproductive organs, it may affect your ability to get pregnant. In fact, 30 to 40 percent of women with endometriosis are infertile. Even mild endometriosis can result in infertility.

Researchers don’t know what causes endometriosis, but many theories exist. One suggests that retrograde menstruation—or “reverse menstruation”—may be the main cause. In this condition, menstrual blood doesn’t flow out of the cervix (the opening of the uterus to the vagina), but, instead, is pushed backward out of the uterus through the fallopian tubes into the pelvic cavity.

But because most women experience some amount of retrograde menstruation without developing endometriosis, researchers believe something else may contribute to its development. For example, endometriosis could be an immune system problem or local hormonal imbalance that enables the endometrial tissue to take root and grow after it is pushed out of the uterus.

Other researchers believe that in some women, certain abdominal cells mistakenly turn into endometrial cells. These same cells are the ones responsible for the growth of a woman’s reproductive organs in the embryonic stage. It’s believed that something in the woman’s genetic makeup or something she’s exposed to in the environment in later life changes those cells so they turn into endometrial tissue outside the uterus. There’s also the belief that damage to cells that line the pelvis from a previous infection can lead to endometriosis.

Some studies show that environmental factors may play a role in the development of endometriosis. Toxins in the environment such as dioxin seem to affect reproductive hormones and immune system responses, but this theory has not been proven and is controversial in the medical community.

Other researchers believe the endometrium itself is abnormal, which allows the tissue to break away and attach elsewhere in the body.

Endometriosis may have a genetic link, with studies finding an increase in risk if your mother or sister had the disorder. No specific genetic mutation has been clearly linked with the disease.

After counselling, a gynecologist will, at the request of the patient, perform termination of pregnancy for pregnancies up to 12 weeks of gestation (3-months).

You will need to be admitted to successfully complete the termination and also to ensure that no complications arise.

In addition to the conventional pregnancy test that you would have purchased and performed at home, a gynecologist will, upon consultation, run specific blood tests to confirm your pregnancy, if indicated. Then he will perform an ultrasound examination to further confirm your pregnancy and to ensure that it is located in the correct place.

Pregnancies that are not located within the uterus (ectopic pregnancies) can pose serious health consequences and will be treated as an emergency.

GYNAE WORX offers a wide range of contraceptive options to his patients including the following below.

Further details and information regarding each of the options will be presented and fully explained to you at consultation, so as to enable you to make an informed decision as to which choice will best suit your needs:

• Contraceptive counselling and advice
• Emergency contraception and counselling
• Barrier methods: Condoms, diaphragms, cervical caps
• Injectable contraception: Depo provera and Nur Isterate
• Implants: Implanon inserted in the inner aspect of upper arm
• Combined oral contraceptive pill
• Intra uterine contraceptive device (commonly known as the loop)
• Mirena intrauterine contraceptive device
• Transdermal skin patch
• Nuva vaginal ring
• Bilateral tubal ligation

This is a screening test done to detect abnormal cells which lead to cancer of the cervix (mouth of the womb).

This ultrasound investigation is performed to assist in the diagnosis of various gynaecological conditions.

In this test, a sample of the inner lining of the uterus, known as the endometrium, is taken and sent for testing to obtain a diagnosis in women who present with abnormalities of the womb including abnormal uterine bleeding.

A hysterectomy is surgical removal of the uterus. Several medical conditions can be treated or cured with a hysterectomy. Hysterectomies can be performed to stop abnormal uterine bleeding. Other reasons to have a hysterectomy include:

• Endometrial hyperplasia with atypia, an overgrowth of the uterine lining in which uterine cells contain precancerous changes
• Cancer of the uterus, ovaries, fallopian tubes or cervix
• Pelvic prolapse, in which the ligaments that support pelvic structures like the uterus weaken and the organs drop
• Uterine fibroids, when other, less invasive treatments have not provided relief (myomectomy, removal of just the fibroids, is a less invasive surgical option for fibroid removal)
• Uncontrollable bleeding after childbirth

For some women, a hysterectomy is the answer to years of suffering from uterine problems. For others, a hysterectomy is a last resort to treat cancer or another life-threatening condition.

Unless you have a severe pelvic infection, cancer or uncontrollable bleeding, there is usually no reason to rush into the decision. Most hysterectomies are elective procedures (as opposed to emergencies), there is usually plenty of time to explore all options.

A polyp is an abnormal growth of tissue arising form a mucous membrane.

Polyps of gynecological origin which are symptomatic in nature (most commonly irregular menstrual bleeding) will need to be examined and biopsied by your gynecologist. This is done to confirm the nature thereof, before instituting the appropriate treatment.

Polyps may be benign or malignant in nature.

A polyp of gynecological origin can be arise from the cervix, uterus or even the endometrium.

This is performed to make a diagnosis of any cervical (mouth of the womb) mass or lesion so as to use the appropriate treatment.

This is an alternative to open surgery which makes use of small camera incisions to perform an operation.

This has the following benefits:

• Shorter hospital stay
• Quicker recovery.
• Minimal scar formation
• Less complications of wound healing.

Procedures which can be conducted laparoscopically include:

• Removal of ectopic pregnancy
• Sterilisation
• Removal of ovarian cysts
• Diagnosis of cause of pelvic pain (Diagnostic Laparoscopy)
• Surgery for endometrioses

Hysteroscopy is a procedure in which the inner cavity of the uterus is examined using a camera. It can help in finding the cause for a number of conditions such as abnormal uterine bleeding and infertility. It can also be used as a treatment method for most of these conditions as well.

The inability to concive can be a very distressing and emotionally draining situation for any couple. It is important to consult as soon as you or your partner suspect that

there may be a problem concieving.

At Gynae Worx, we offer comprehensive counselling for couples faced with infertily as well as a complete workup to ascertain the cause of the infertility.

Once this has been established, we will offer various treatment options for your particular diagnosis.

Furthermore, we at Gynae Worx will be able to refer you to highly experieced infertility specialists, should your particular situation require such.

At Gynae Worx, we offer various screening tests for a variety of gynaecological cancer. Referral to highly experienced oncological units for further management and treatment is provided for where required.

Various Urogynecological conditions can be worked up and diagnosed. Where required, a referral to highly experienced Urogynecological units for further management will be provided for.