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Advanced Minimal Access surgery
Wednesday, March 21, 2001, Chandigarh, India The Tribune

You have been doing laparoscopy and hysteroscopy since 1993. What exactly are these procedures?

Both of these are endoscopic procedures and in these we use a telescope to see inside the body and its organs. The laparoscope is introduced into the abdomen through a tiny puncture while the hysteroscope can be passed into the uterus through the cervix, or the mouth of the uterus for a clear and direct exploration of the mysteries inside.

When does a patient require hysteroscopy?

Hysteroscopy is a powerful tool for the diagnosis of a large variety of gyne problems ranging from abnormal uterine bleeding after a pregnancy or abortion, due to hormonal imbalance or because of fibroids, polyps or cancer of the uterus. All patients, who are not able to conceive, invariably require a hysteroscopic examination of the uterus.

Laparoscopy is being used to perform many operations. Does hysteroscopy also offer surgical treatment in addition to diagnosis?

Certainly. Many kinds of operations can be done inside the uterus with the help of hysteroscopy — like the removal of fibroids, polyps and foreign bodies.

If such advanced surgeries are done, why are laparoscopic and hysteroscopic surgeries called “minimally invasive”?

All surgeries outside and inside the uterus traditionally require a 10 cm-long abdominal incision. Laparoscopic surgery requires minute punctures on the abdomen and the beauty of hysteroscopic surgery is that it can be passed through the natural opening of the uterus below. There is minimum handling of tissues by hands, mops, swabs and instruments with the consequent decrease of post-operative problems.

Do these patients require post-operative hospital stay like other kinds of “open” abdominal surgery?

Since there are only minute or no punctures on the abdomen, patients are often discharged the same day or within 24 hours. In fact, we often do surgical procedures at the same sitting as a diagnostic hysteroscopy.

Can you tell us something about the complications of hysteroscopy?

No procedure in our profession can offer a 100% cure or a 0% complication rate. The more advanced the surgery, the higher are the chances of perforation. Infection, bleeding and fluid overload may occur following a major surgery, (rare after diagnostic procedures). Importantly, since a lot many hysteroscopic surgeries can be done under local or regional analgesia, the complications due to general anaesthesia are avoided.

What is the place of hysteroscopic surgery?

We are now moving beyond the uterus and using the hysteroscope to cannulate the tubes in cases of tubal obstruction causing infertility. There was a time, a few years ago, when we were recommending hysteroscopy instead of “blind” D & C. Today, hysteroscopic surgery has replaced a lot of our conventional gyne “open” surgeries for fibroids, polyps, adhesions, septa and infertility. Hysteroscopy has changed the way we approach any gyne patient today, and with newer advances now available, it is definitely a surgery of the future.

Further information with regard to the topics mentioned above can be obtained from Gyne Endoscopy Centre, 44 D, Chandigarh.

Uterine Balloon Therapy

Doctor, What exactly is Uterine Balloon Therapy?

Dr Nirja Chawla: Uterine Balloon Therapy Ablation  is  a  procedure  being  introduced  for  the  first  in  Chandigarh  but  very  popular  in  Mumbai  and  in  Western  countries .It  is  used  to  destroy  the  lining  of  the  uterus  to  stop  or  reduce  heavy  bleeding  in  patients  who  do  not  want  to  have  more  children .

When are periods termed heavy?

Dr Nirja Chawla: Heavy  periods  or  excessive  menstrual  bleeding  is  defined  as  blood  loss  of  more  than  80 ml ( 5 tablespoons  approximately )  during  one  menstrual  cycle.  This  translates  as  bleeding  for  than  7  days  or  presence  of  clots  or  using  more  than  10  pads  per  cycle  or  repeated  tendency  to  stain  clothes  or  bed sheets.  Since  more  than  2/3 rd  of  such  women  have  anaemia ,  they complain  of  weakness,  lethargy ,  fatigue , irritability ,  quick  to  catch  infections  and  overall  poor   health .

What are the causes of heavy periods?

Dr Nirja Chawla: 40%  of  heavy  periods  are  due  to  hormonal  imbalance  and  called  dysfunctional  uterine  bleeding ( DUB ) .  Other  causes  include  benign  conditions (fibroids ,  polyps) , precancer   and   cancer  of  the  uterus ,  infections ,  disorders  of  blood ,  liver ,  kidneys  or  the  use  of  certain  drugs  like  anticoagulants ,  steroids ,  chemotherapy .  UTERINE  BALLOON  THERAPY  is  indicated   in  patients  of  DUB  before  menopause  when  they  do  not  desire  any  more  children.

What are the other treatment options for DUB?

Dr Nirja Chawla: Drug  therapy  usually  prescribed  for  DUB  can  reduce  heavy  bleeding  in  25-80 %  of  the  cases  but  cannot  stop  them  altogether.  These  remedies  have  their  own  side- effects  and  contraindications .  They  have  to  be  given  for  long  periods  of  time  to  be  effective  and  symptoms  usually  return  once  medicines  are  stopped .

Dilatation  and  Curettage  (D&C)  works  only  as  a  temporary  measure  since  only  the  top  layer  of  the  lining  of  the  uterus  is  scraped  away .  It  should  be  limited  for  the  purpose  of  diagnosis  only,  for  which  too  Hysteroscopic  biopsy  is  better  since  it  is  done  under  direct  view  of  the  telescope  whereas  D&C  is  a  blind  procedure .

Other  surgical  options  include  hysterectomy   (removal  of  the  uterus )  and  two  forms  of  endometrial   ablation (destroying  the  lining  of  the  uterus) – one  uses  electrocautery  under  vision  (TCRE)  and  the  other  uses  simple  heat  energy (Uterine  Balloon  Therapy) .  Hysterectomy  is  a  major  surgery  with  high  risks  either  due  to  the  surgery  itself  or  due  to  the  anesthesia .  It  requires  several  days  of  hospitalization  and  4-6 weeks  for  complete  recovery.  TCRE ,  though  minimally  invasive  and  better  than  hysterectomy  has  a  mortality  rate  of  0.02%  and  serious  complications  in  up to  7%  patients .

How exactly does Uterine Balloon Therapy work?

Dr Nirja Chawla:  The  Thermachoice  Uterine  Balloon  Therapy  system  consists  of  a  4.5 mm  diameter  catheter  with  a  latex  balloon  at  one  end  which  houses  a  heating  element. The  control  unit  automatically  monitors , displays , and  controls  the  preset  pressure  and  temperature  inside  the  balloon  and  the  duration  of  treatment . For  safety,   the  device  automatically  deactivates  when  pressure  rises  or  falls  below  a  particular  set  limit . The  pressure  inside  the  balloon  is  maintained  at  160-180 mmHg  and  temperature  at  87 degrees C  for  8  minutes . This  effectively  destroys  the  lining  of  the  uterus  upto  3-7 mm  which  is  enough  to  decrease  heavy  bleeding  but  not  enough  to  harm  structures  outside  the  uterus . The lining then sloughs off as discharge over next 10 days.

What are the advantages of Uterine Balloon Therapy over other treatments for heavy periods ?

Dr Nirja Chawla: The  Thermachoice  Uterine  Balloon  Therapy  system  is  approved  by  FDA ( Food  and  Drugs  Administration )  for  the  treatment  of  heavy  periods.       It  is  highly  successful :  90%  respond  with  decreased  bleeding  and  in  20%  bleeding  stops  altogether. It  is  extremely  safe  :  minor  complications  like  pain , fever , infections  may  occur  in  less  than  3%  of  patients , which  respond  to  simple  measures. It  is  well   tolerated   under  local  anaesthesia  and  sedation  and  does  not  need  general  anaesthesia .Hospital  stay  is  for  4-6  hours  only  and  return  to  normal  activity  in  2  days .It  is  of  special  benefit  to  those  for  whom  other  therapies  are  ineffective , risky  or  contraindicated  for  various  reasons . One  out  of  three  women  have  had  hysterectomy  by  the  time  they  are  60  years Since20%  of  all  hysterectomies  are  for  DUB , minimally  invasive  procedures  like  Uterine  Balloon  Therapy   can  help  decrease  the  total  number  of  major  surgeries  with  great benefit  to  the  patients . In  fact , hysterectomy , which  involves  removal  of  an  organ , should  be  the  last  resort  in  patients  with  heavy  periods  due  to  dysfunctional  uterine  bleeding .

What is the place of hysteroscopic surgery?

We are now moving beyond the uterus and using the hysteroscope to cannulate the tubes in cases of tubal obstruction causing infertility. There was a time, a few years ago, when we were recommending hysteroscopy instead of “blind” D & C. Today, hysteroscopic surgery has replaced a lot of our conventional gyne “open” surgeries for fibroids, polyps, adhesions, septa and infertility. Hysteroscopy has changed the way we approach any gyne patient today, and with newer advances now available, it is definitely a surgery of the future.

Further information with regard to the topics mentioned above can be obtained from Gyne Endoscopy Centre, 44 D, Chandigarh.

Institutional Delivery and AIDS, STDs

Could you please explain the seriousness of an infected pregnant woman? The threat to infant & her own life if she is callous or does not get proper treatment for AIDS/HIV.

79% of women with AIDS are in the 20 – 44 age groups, which is when they are likely to have children.

When infected women conceive, it is not really the increased complications of pregnancy like small weight or preterm babies which are so important because these complications are more due to the low socio-economic status of these women rather than AIDS per se.
Other issues are more important. The drugs required for their own treatment of AIDS can harm the baby, especially in the first 3 months of pregnancy. Knowing this, many women still desire to continue pregnancy for many reasons. In such cases, often all the drugs have to be stopped for these 3 months, but by doing this the mother is harmed as she may develop resistance to the treatment of AIDS. It is like choosing between the devil and the deep sea.
The most important issue in an infected pregnant woman is that if pregnancy is continued, the mother may transmit HIV infection to her baby. Nearly 5 million children have died so far worldwide and in our country, India, 75,000 infected babies are estimated to be born every year.
The crux of this issue is that women should protect themselves from AIDS and should avoid a pregnancy if they have HIV infection.

what exactly does institutional delivery mean?

Institutional delivery means delivering your baby in a hospital, where the doctors have expertise in managing and treating pregnant patients with AIDS. In fact it is not just delivery alone but the entire antenatal checkup during the pregnancy from the time it begins should be in such a hospital setting.
A study done in New York showed that women with AIDS survived longer when cared for in clinics which had high experience in dealing with such patients as compared to low-experience clinics.

Why should women opt for it & not midwifes’ as normally is the case in less privileged/lower strata women in our country?

Many pregnant women with AIDS are likely to belong to lower socio-economic groups. This is not to say higher strata women will not get infected if they to have high risk behaviour like multiple sexual partners.
But once any infected woman gets pregnant, poor or rich, she should have her check up and delivery only with doctors experienced in the management of AIDS because other than routine tests and check up during her pregnancy, she will need to be monitored to see whether her disease is worsening or not and to check for side-effects of treatment by various blood tests. She will also need to be screened for other sexually transmitted diseases like syphilis, gonorrhoea, hepatitis etc. and for cancer of the genital tract with Pap smear.
In some cases a Caesarean delivery may be required if the infection is too heavy. Even during a normal delivery, what we call Universal Precautions need to be taken to prevent infections from spreading to the medical and nursing staff and other patients from the infected blood of the AIDS patient.
All this knowledge and facility will not be available in usual delivery places and certainly not with dais and midwives.

In case an infected pregnant woman does decide to go in for an institutional delivery, will she deliver a more healthy & not infected infant ?

If the risk of transmission of HIV infection from an infected mother to her child is taken as 15-20%, this risk can be decreased to below 2% if the mother has her pregnancy supervised and delivered in an institution or hospital with experience in management of AIDS.
So an institutional delivery ensures not only better health and longer survival of the mother but also a lesser chance of the baby being infected.
But much will depend on whether the infected mother started treatment before she became pregnant or during early pregnancy or she delayed attending hospital and taking treatment till she went into labour. So don’t delay.

What is the corelation between AIDS & STD’s?

STD’s, as the name suggests, is mainly transmitted to other human beings through sexual activity. AIDS is also a STD. 80% of AIDS are transmitted through intimate sexual contact. Therefore if a patient has one, he or she is more likely to get the other too.
Presence of STD, whether those with ulcers like Syphilis or Genital Herpes, or the non ulcerative STDs like gonorrhoea and vaginal discharges, increase the risk of, both, getting HIV infection as well as transferring it.
Many STDs do not have any symptoms and therefore remain undiagnosed. In these cases, many may be at increased risk of acquiring and transmitting HIV without knowing it.
Normally, the risk of transmission of HIV is higher from men to women, but if a STD is present in any partner, HIV infected women can transmit the disease to their male partner as much as man to woman.

What kind (s) of STD’s can an HIV infected person have and pass on to his spouse or anyone else?

Earlier only 5 diseases were called Venereal Diseases but currently more than 20 diseases are classified under the new name, STD – Sexually Transmitted Diseases, because their main mode of transmission to another human being is close, intimate sexual contact. These diseases include those caused by bacteria like Gonorrhoea, Syphilis; those caused by viruses like Herpes, Genital Warts, Hepatitis or HIV/AIDS; those caused by protozoa and fungus which cause vaginal infections and discharges and even scabies and pubic lice are included in this list.
An HIV infected person can have any of these sexually transmitted disease, except that they occur in a more severe and persistent form and are more difficult to treat. Even HPV related cancers of the lower part of the uterus are more common in HIV patients.

What is the best preventive measure(s) against STD’s?

The best prevention of STD is abstinence or no sexual activity at all.
If this is not possible, then correct and consistent use of condom, irrespective of whether you are using other family planning measures, whether you are pregnant or in menopause – whenever there is a sexual activity one should know how to use condoms correctly, without slippage, and to use them every time.
Have only one sexual partner of whom you are sure does not have any STD or what is called high risk behaviour like intravenous drug user. Ideal would be for both partners to undergo voluntary testing for HIV before start of a sexual relationship.
As far as possible, in the younger age group, as in adolescents before the age of 20 years, learn to say ‘No’ to sex. This SAY NO campaign in Zimbabwe has done wonders in changing to positive health behaviour.
And finally, if one gets infected with an STD, treat it early to reduce chances of acquiring AIDS.

Are STD’s life threatening if unattended (and for an AIDS infected person how can it aggravate the already grave situation)?

STDs can cause extreme physical ill health as well mental anguish if not treated. Syphilis can damage brain, heart and blood vessels. Gonorrhoea can cause sepsis, pneumonia. Hepatitis can cause liver damage leading to cancer, liver failure and death. In women STDs can also cause pelvic infections, chronic pain, infertility and tubal pregnancy and cancers. STDs and AIDS can be transmitted to the baby either during pregnancy itself or during labour or from breast feeds. The diseases can also cause congenital defects, blindness and mental retardation in the baby. The drugs used in their treatment can also harm the unborn baby.
Since AIDS damages the immune system of the body, all kinds of infections and cancers appear, which are much more severe and less responsive to treatment than usual. AIDS is a very serious disease, which if untreated will progress to a certain death within 20 months.


I’m Shalini, 32, from Jammu . My mother underwent menopause at 40. Should I be worried?

The chances of your having menopause earlier are higher but there is really no need to be ‘worried’, Shalini. Be alert to this possibility, however, and take remedial measures to decrease your chances of having problems if you were to follow your mother’s footsteps. Avoid getting overweight because women are more prone to the bad effects of obesity like abnormal lipids in the blood, high blood pressure, blocked arteries, heart attacks, and diabetes. Eat right – high fibre, low fat, low carbohydrates, seasonal bright coloured foods, 5-6 helpings of fresh fruits and vegetables, 1 glass of milk, some fish or dietary omega 3 fatty acids and a few nuts every day. Avoid junk food and colas. Exercise to keep your weight in check, to improve the performance of your heart and to deposit calcium in your bones. Share this information with your mother and see that she takes at least 1000mg of calcium and 200 iu of vitamin D supplement daily since she is already menopausal. Your mother must also have her annual check up done which includes blood tests, Pap Smear for cancer cervix screening, Bone Mineral Density test and a mammography. If your mother has any stress factors, help her solve them and identify some ways – gardening, music, reading or even cooking which could serve as stress busters for you.

Hi, I am Manish, my mother who is 52 is undergoing menopause. She has been behaving in an irritating manner for quite some time and she is moody and temperamental whenever we try to talk to her. Please tell us how can we help her cope with the stress of menopause?

Manish, how sweet of you, as a son, to be concerned about your mother. Do you know, however, that menopause per se is not stressful. Women do not go ‘mad’ at menopause. It can be a gentle transition from reproductive phase to a period free phase. Mood changes, irritability and depression are common in these years, more often due to social causes like death or illness in family, retirement blues, financial insecurity, need to take care of old parents and children going away from home –the ‘Empty Nest Syndrome’ coupled with the thoughts that you are needed no more. Help and support her in whatever way you can. Understand her fears and tensions but I would discourage you to ‘cookie-poochie’ her in an excessive way because she should not get emotionally dependent on anyone. Show that you love her even when she is older, greyer and you don’t need her help to ‘go to school’ as it was. Encourage her to go back to the joys of days when she did not have responsibility of rearing a family like painting, singing or anything creative. Don’t force her in religious pursuits like temple going or mantra chanting, as some youngsters are wont to say, unless she desires.
Menopause does, however, cause sleep disturbances and night hot flashes/sweats which impair good sleep. This would manifest as irritability during the day. If troublesome, hot flushes can be managed by simple measures: decrease the room temperature without increasing covers, avoid food, alcohol, and stimulants like caffeine, exercise at least 3 hours before bedtime. Avoid spicy and non-vegetarian food, decrease fat and sugar intake. Counseling helps as well as exercise especially aerobics, but only during the day. The hours before bedtime should be spent in quietitude and meditation. Increase intake of dietary phytoestrogens like soy, Bengal gram, lentils, pulses and if further help is required, hormones or other medicines can be prescribed by the doctor.

I am a 23 year old from Ludhiana . I read somewhere that menopause causes a lot of bleeding. Do I have to go through the pain? Are there any medicines available to lessen the pain?

Menopause does not cause heavy bleeding. Any such bleeding is abnormal and needs immediate attention by doctor. A ‘normal’ menopause should have periods which become lesser in flow and/or the gap between periods increases. Any change from the above two criteria – either heavy bleeding or bleeding occurring more frequently than usual is not normal. Further, any bleeding occurring 1 year after the last period is termed as ‘postmenopausal bleeding’. All these abnormal bleeding patterns need thorough investigation.Menopause is not a pain. It is a natural life event, not a disease. Just as growing from a schoolgirl to a young adult is not painful, neither is menopause. If you can learn how to live totally, each moment lived to its fullest dimension, then one neither regrets the moment passed nor fears the moment yet to come. Your fear of menopause could be an underlying fear of ageing. All fears, even a fear of lizards, say, are a fear of dying. You are young. Why not find that which is deathless within you. Then no old age, menopause, wrinkles, some degree of inevitable bodily illness will terrify you.
While you ponder over this, may I suggest that you don’t miss your daily glass of milk and your calcium supplements. All girls should follow this advice up to the age of 25 years, during their pregnancy and when breast feeding their babies. One glass of milk and moderate exercise will help to build up your bone bank. By the time you reach menopause, your bone bank balance will be sufficient to overcome the excessive loss of bone that begins soon after menopause. By the time a woman is 20 years past her menopause she has already lost almost 50% of her bone mass. 50% of the patients with hip fracture die and the rest are almost bedridden. The longevity of life is important, no doubt, but the quality of life is far more important. And the time to ensure menopausal years free from fracture risk begins as soon as the girl child is born, by ensuring an adequate calcium intake.

Hi I’m a 30 year old working woman, I have heard that menopause is a very tough phase. Since I’m a working professional, can you suggest some ways to make menopause easy for me, can we prepare our mind & body for it?

All working people retire some day. Suddenly you will not be as important as you are now and someone younger will be better than you at your best. Even though working women never retire from household work, have you discovered the joys of doing nothing? You are running in two directions at the same time, continuously multi-tasking. Take time out to the watch the bees in your garden as they merrily chase each other, flavour the fragrances in the air, feel the raindrops as they tingle your skin, taste each morsel of food slowly, with joy. Try and catch what the wind is whispering to the trees. In silence. Once you go back to heightened awareness of your senses, both your mind and body will disappear. Then, any effects, as your body and mind age, will not touch you.
Most important, for working women, however, is to see how they create guilt for themselves in all situations as they juggle career and family together. If nothing else, it is this guilt and regret which will destroy you in your ‘mature’ years. The solution: live every moment totally absorbed in what you are doing at that time.
Care for your family, certainly, but spare some time for caring for your body too. It has to last you a long time. Eat only so much and what the body needs. Avoid putting on weight. Exercise – walking, aerobics, weights as well as some yog stretches and asanas 3-5 times each spread over a week. Do something totally different from your work as a hobby. Don’t do meditation. Be meditative. Enjoy being alive. Then there is no need to prepare in any other special way for the natural events of life.

Premenstrual syndrome (PMS)

what exactly is PMS and how can you handle it?

Premenstrual Syndrome or PMS, as it is commonly known, is a disorder in which certain symptoms occur in the days just before a period. These symptoms may be physical, like backache, headache, pain or swelling of the breasts, a sensation of bloating or weight gain before the menstrual period. The patients may have emotional symptoms, like anxiety, irritability, exhaustion, lethargy, mood swings, depressions, loss of appetite or craving for certain foods, or else the patient may have changes in behaviour e.g. violence, clumsiness or loss of concentration.
One of the best ways to manage PMS is by what is called the ‘Self-Help Therapy’. As the first line of management, it is excellent and relieves the symptoms in about 50-75% cases. There are three parts to this very important treatment. The first is to alter your diet. The rationale behind this is self-explanatory e.g. reducing salt intake decreases retention of fluid, bloatedness and weight gain; decreasing alcohol intake decreases depressive pre-menstrual symptoms, frequent meals keeps sugar levels normal, and weight reduction in obese women helps to decrease PMS. One should also avoid ‘junk’ foods, limit caffeine intake and intake of animal fats. The second important part is to modify your lifestyle. Aerobic physical exercise like brisk walking for 30 – 40 minutes in the second half of the menstrual cycle helps by a ‘mood elevating effect’ and by taking the woman away from the often-stressful home environment. Many patients relish this form of ‘self help’. Other stress busters and relaxation techniques like yoga, hypnosis, music, poetry, meditation and acupuncture work very well for some women. The third part of the Self-Help Therapy is the addition of certain vitamins like vitamin E and B6, which help, in low doses.

what should one do if Self-Help does not help?

The next step is, of course, to visit your gynecologist who will first confirm the diagnosis and rule out any psychiatric or medical problem. Very often, the supportive attitude and reassurance by the doctor is known to bring relief in the symptoms. The treatment is individualized according to the patient and the most prominent symptom is treated first. Medicines are available which help in reducing the premenstrual weight gain; painful breasts, emotional symptoms, headache and backache, but their side effects prevent their use for long durations of time. Each new treatment should be given at least 3 months before trying another.

Is it women with a certain temperament are more prone to it. By this we mean that are women who are more sensitive or please explain…

There is a relationship between stress and personality disorders and PMS. Life itself is full of stresses and the ability to cope varies with different people. Those who cannot cope, and are so-called, sensitive, do have more of PMS and many other medical problems.

One very important finding in daily practice is that mothers of women with PMS have suffered from PMS themselves. They, in fact, transfer their agonies and stresses to their daughters. This becomes like hypnosis of sorts. If women view some discomfort during periods as a very natural event, their own daughters are less likely to suffer.

The final message for mothers of girls who suffer from PMS is to teach their daughters to flow with all changes in life in a relaxed way and for those who suffer from PMS is ‘ Don’t give up hope ‘.

When women get married…what kind of safety measures should women take.. if they are not planning to have a family immediately…

One of the best ways to plan what contraception should be used is to discuss this issue with your prospective husband BEFORE you are married. You must visit your doctor together to learn about the advantages and disadvantages of different contraceptive methods available. If you are too shy about this very important issue, then visit alone or with another sensible adult. The reason for taking this decision about 1-2 months before you are married is that you get adequate time to start oral contraceptives and get used to taking them. Contraceptive pills are an excellent way to postpone your pregnancy till you desire. They have minimal side effects and give very good protection. Their failure rate is just 0.2 – 2%. Another way is for the husband to use condoms. Their failure rate is high, about 20-25%, mainly because condom use is directly related to the sex act. Sometimes, it may become irritating to interrupt the sex act to wear the condom. Other than that, its use is dependant on the wishes and will of the husband who may not care to use it even though the wife may not desire a pregnancy at that time.

And is it fair to say that women share an equal and important part in deciding as to when they want a family

Women have a large role to lay in this decision now but it is important to note that they have their husband’s permission for this. The credit of this goes to the man, not to the so-called independence of the modern Indian woman. Meaning thereby, that it is still the man who decides whether his wife has a vote in this decision or not. If the husband decides that contraception should be used, so will it be. If he decides that it enhances his image and ego, he allows his wife a vote on this decision. There are men who will refuse to use condoms despite his wife having had several abortions. It is very rare to find that a woman has taken a decision on whether or not to start a family and contraceptive use against the wishes of her husband. It will still take a long time for Indian women to realize that they have an equal, if not more, and INDEPENDENT role in this decision.

Give us 10 important points essential for women during her pregnancy.

All women should keep some important points in mind during their pregnancy:

  1. Diet should be balanced to contain adequate proteins, vitamins and minerals. It should be light, nutritious and easily digestible.
  2. Dietary supplements of Folic Acid, Iron and Calcium are still required in all pregnancies to allow the baby its full growth.
  3. Rest and Sleep – Even though you can continue your routine activities, strenuous exercise should be avoided in the first 3 months and last 3 months. You should sleep, if possible, for 2 hours in the afternoon and 8 hours at night. In the last few weeks, sleep by turning to the left side which improves oxygen supply to the baby.
  4. There is a tendency to constipation during pregnancy, which can be avoided by increasing fibre in the diet as in vegetables, by drinking plenty of water and by having Isabgol husk, if required.
  5. Personal hygiene and daily bath is important but take care not to slip in the bathroom.
  6. Wear loose and comfortable clothes and avoid high heels. Walk alertly especially on uneven floors.
  7. Check to see that the nipples are not turned inwards. If so, massage in last few weeks of pregnancy can help to get them ready to feed the baby.
  8. Avoid intercourse in first and last 3 months, but if this is difficult, ask your husband to use a condom and to be gentle.
  9. Travel in jerky vehicles should be avoided. Air travel in pressurized aircraft is safe. Rail travel is preferable to road travel. Avoid long journeys.
  10. Visit the doctor regularly and don’t forget your Tetanus injections.

And along with this give us 10 points which the woman should keep in mind during her first year of motherhood.

The first pregnancy and baby are always very special to a woman. But she has to be more alert in this important event of her life so that her ignorance does not cause her any mishap or misery.

  1. My first advice would be to read up and have a broad idea about pregnancy, labour and child rearing BEFORE you conceive. Listen to your elders politely but follow the advice of your doctor only and don’t get alarmed by horror tales told by other women.
  2. Along with your husband, make one visit to the doctor before conceiving so that she can check, as far as possible, that all is well. If necessary, take Rubella vaccination and wait 3 months before you plan pregnancy.
  3. It may be wiser to reduce your weight to normal range and to start Folic Acid tablets before you conceive.
  4. It is certainly not essential to eat for two during pregnancy, as old women say, but it should be balanced. Never force yourself to eat because your mother-in-law loves you so much. Watch out for excessive weight gain.
  5. Look out for warning signs during pregnancy – persistent headache, blurring of vision, excessive vomiting, decreased urine output, bleeding, leaking of watery fluid and painful contractions of the uterus. Seek medical help immediately.
  6. You can start breastfeeding the baby soon after birth. For the first 3 days, the grayish, watery discharge from the breast MUST be fed to baby. Even though it appears that baby is not satisfied, it is not always so.
  7. Avoid cleaning the breast vigorously after each feed because this removes all the natural oil around the nipple, which prevents friction while breastfeeding.
  8. Give the whole black area around the nipple, called the areola, to the baby and not nipple alone otherwise the nipples get cracked.
  9. Feed the baby on demand but for not more than 30 minutes at each time. Never feed the baby just before his bath time and don’t forget to burp the baby after the feed.
  10. Energy spent in caring for your baby yourself, including bathing and nappy changing, helps in getting you back in shape quickly. But before you resume your sexual activity, adopt a good contraceptive method.

Generally women get sloppy and casual about their appearance after completing their family. Tips to take care of health and appearance. Message.

One thing is very clear that there is no need to be paranoid about looking beautiful and young even when you are old enough to have completed your family. To adorn yourself in glitter and fancy clothes is important to catch your mate. Not after that. But some women go to the other extreme by being very uncaring of their health needs, which is bad. As far as appearance is concerned, to be neat, clean, unsmelly, reasonably presentable is enough. After completing your family, keep a watch on the health of your loved ones as well as yourself. Eat sensibly but don’t eat for the taste of your tongue alone but for health benefits. Keep your tummy just short of being full. Exercise is very important. The easiest is brisk walking for 45 minutes a day, 5 days in a week. Invest in a good pair of walking shoes. As a woman, take in  adequate of dairy products and after the age of forty, do add Calcium to your diet. Use music, meditation and yoga to keep yourself sane in the mad rush of bringing up your family.

For my message to you all, I would like to quote from Gautam Buddha’s Dhammapada. Please do meditate on it. “You too shall pass away. Knowing this, how can you quarrel?

Health Tips

Health Tips

  • A normal menstrual period comes after 21-35 days, lasts 2- 6 days with an average flow of 20 – 60 ml (1-4 tbsps). Anything other than this is abnormal.
  • If a girl has normal development of breasts but does not start her periods by the age of 16 years, she needs to visit her gynecologist.
  • All sexually active girls should have an annual cancer screening, the Pap Smear, every year, starting from 21 years.
  • Vaginal discharge is abnormal only if it is yellow in colour, curdy white, smelly or itchy.
  • The nature of cysts in the ovaries can be made out well on ultrasound. Not all cysts require surgery. Most disappear if repeat ultrasound is done after 6-8 weeks.
  • Fibroids are benign, not cancerous, tumours of the uterus. Not all fibroids require removal of uterus.
  • Menopause is the permanent stopping of periods around average age of 48-49 years. Any bleeding after menopause should not be ignored and should be investigated with ultrasound and hysteroscopy.
  • Hysteroscopy is Endoscopy of the uterus using a thin telescope from the natural passage below. It is the “Gold Standard” method of investigating all problems inside the uterus. All D&C procedures are obsolete.
  • Fat on the stomach area – the ‘pear shaped woman’, is worse than being overall fat because it is associated with high blood pressure, high blood sugars and abnormal lipids.
  • If a patient has heavy periods due to hormonal problems and does not want another pregnancy, she can now be treated by a simple Balloon Therapy instead of removing her uterus.
  • An unplanned pregnancy can be prevented by taking the emergency contraceptive pill easily available over the counter.
  • Emergency contraception should be used only for emergencies and should not replace routine contraception.
  • Condoms are a must to prevent sexually transmitted diseases and AIDS but additional contraception – pills or Copper-T, should be used to prevent pregnancy.
  • All girl children should be given calcium supplements till they are 25, during pregnancy and breast feeding, to build up their ‘bone bank’ before they reach menopause.