Psychiatry

cyclic-antidepressants
Divalproex Or Valproic Acid
Divalproex and valproic acid are drugs, which in the body are changed into a chemical called valproate. Valproate is classified
heavy-and-irregular-menstruation-1
Heavy and irregular Menstruation
In the past, large family size, prolonged breastfeeding and reduced life expectancy limited the number of menstrual cycles experienced by
dysmenorrhea-1
Dysmenorrhea
Pain during menstruation is an almost universal experience among women and, when severe, it has a significant economic impact through
medical-terms-in-obg-1
Medical Terms in OBG
Medical terms in obstetrics and gynaecology abortion, amniocentesis, anaemia, anaesthesia, antenatal, bacteria organisms, bacterial vaginosis, bicornuate uterus (womb), biopsy.
did-you-know-1
Did you know?
You have two ovaries, one on each side of your uterus. Ovaries are the size and shape of almond and
infertility-1
Managing Infertility
A guide to managing infertility. The desire to have a child is natural, and most women plan on experiencing pregnancy
menopause-1
The Menopause
The Menopause is a time of change in your body, and often in your life too. You may find this
pi-disease-1
PI Disease
Pelvic inflammatory disease (PID) is caused by infections which enter the body through the cervix and work their way up
venlafaxine
Emergency Contraception
If you have had sex without using contraception, or if your contraception might have failed (unprotected sex), you can use
be-breast-aware
Be Breast Aware
Breast awareness is a part of general body awareness. It is a process of getting to know your own breasts
disulfiram
Disulfiram
Disulfiram inhibits the breakdown of alcohol in the body, resulting in a build-up of a chemical called acetaldehyde; this results
antisocial-personality-disorder
Carbamazepine
Carbamazepine is classified as a mood stabilizer and anticonvulsant agent. Carbamazepine is used primarily in the treatment of acute mania
cyclic-antidepressants
Lithium
Lithium is classified as a mood stabilizer. It is a simple element, found in nature in some mineral waters, and
medication
Cognition Enhancers
Cognition enhancers primarily used in the symptomatic treatment of mild to moderate Alzheimer, dementia…
medication
Psychostimulants
Psycho stimulants are primarily used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children…
manasvi_icon

No health without mental health!

Dr. Vijayakumar D.R MBBS, DPM, DNB (NIMHANS), CCST (UK)

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Divalproex Or Valproic Acid

Psychiatry

Divalproex Or Valproic Acid

PATIENT INFORMATION ON DIVALPROEX OR VALPROIC ACID

Divalproex and valproic acid are drugs, which in the body are changed into a chemical called valproate. Valproate is classified as a mood stabilizer and anticonvulsant agent.

Uses

Valproate is used primarily in the treatment of acute mania and in the long-term control or prophylaxis of Manic Depressive Illness (Bipolar Disorder). It is also used in the treatment of seizure disorders as well as migraine headaches.

Though not approved for these indications, Valproate has also been found to be useful in the augmentation of antidepressants in the treatment of depression, augmentation of narcoleptics in the treatment of schizophrenia, and in behavior disturbances, such as chronic aggression or impulsivity.

How does the doctor decide what dose (how many milligrams) to prescribe?

The dose of evaporate is different for every patient and is based on how much valproate is in blood, as well as the response to treatment. The doctor will measure the drug level in the blood during the first few months. The valproate level that is usually found to be effective for most patients is between 350 and 700 mol/L (50-100 uGu/ml).

You may initially take your medication several times a day (2 or 3); after several weeks, the doctor may decide to prescribe the drug once daily.

On the morning of your blood test, take the morning dose of valproate after the test to avoid inaccurate results.

How quickly will the drug start working?

Control of manic symptoms may require up to 14 days of treatment. Because valproate takes time to work, do not decrease or increase the dose or stop the medication without discussing this with your doctor. Improvement in seizures as well as aggression/impulsivity also occur gradually.

How long should you take this medication?

Following the first episode of mania it is recommended that valproate be continued for a minimum of one year; this decreases the chance of being ill again. The doctor may then decrease the drug slowly and monitor for any symptoms; if none occur, the drug can gradually be stopped. For individuals who have had several episodes of mania or depression, valproate should be continued indefinitely. Long-term treatment is generally recommended for recurring depression, seizure disorder and aggression/ impulsivity.

Side effects

Side effects occur, to some degree, with all medication. They are usually not serious and do not occur in all individuals. They may sometimes occur before beneficial effects of the medication are noticed. If a side effect continues, speak to your doctor about appropriate treatment.

Common side effects that should be reported to your doctor at the next appointment include:

  • Drowsiness and lethargy, difficulty concentrating-This problem goes away with time. Use of other drugs that make you drowsy will worsen the problem. Avoid driving a car or operating machinery if drowsiness persists.
  • Ataxia or unsteadiness, in coordination-Discuss this with your doctor as this may require an adjustment in your dosage.
  • Blurred vision-This usually occurs at the start of treatment and tends to be temporary. Reading under a bright light or at a distance may help; a magnifying glass can be of temporary use. If the problem continues, advise your doctor.
  • Nausea or heartburn, vomiting, mild cramps-If this happens, take the medication with food.
  • Muscle tremor, shaking of the hands or arms-Speak to your doctor as this may require an adjustment in your dosage.
  • Changes in hair texture, hair loss.
  • Weight changes-Monitor your food intake; avoid foods with high fat content (e. g., cakes and pastry).
  • Changes in the menstrual cycle.

Rare side effects you should report to your doctor IMMEDIATELY include:

  • Soreness of the mouth , gums , or throat, mouth lesions
  • Skin rash or itching, swelling of the face
  • Nausea, vomiting, abdominal pain
  • Lethargy, weakness, fever, or flu-like symptom
  • Easy bruising, bleeding (e. g., frequent nose bleeds, bleeding from the gums), appearance of splotchy purplish darkening of the skin
  • Yellowing of the skin or eyes, darkening of urine
  • Unusual eye movements
  • Severe dizziness

Let your doctor know as soon as possible if you miss your period or suspect you may be pregnant.

What should you do if you forget to take a dose of your medication?

If you take your total dose of evaporate in the morning and you forget to take it for more than 6 hours, skip the missed dose and continue with your schedule the next day. DO NOT DOUBLE THE DOSE. If you take the drug several times a day, take the missed dose when you remember, then continue with your regular schedule.

Interactions with other medication

Because valproate can change the effect of other medication, or may be affected by other medication, always check with your doctor or pharmacist before taking other drugs, including over-counter medication such as cold remedies. Always inform any doctor or dentist that you are taking this drug.

Precautions

  1. Do not increase or decrease your dose without consulting your doctor.
  2. This drug may impair the mental and physical abilities and reaction time required for driving a car or operating other machinery. Avoid these activities if you feel drowsy or slowed down.
  3. If your are taking the capsule form of divalproex, swallow it whole; chewing the capsule may irritate your mouth.
  4. The liquid form of valproic acid should not be mixed with carbonated beverages, such as soda pop. This may cause an unpleasant taste or mouth irritation.
  5. To treat occasional pain, avoid the use of aspirin and related products , as it can affect the blood level of valproate; acetaminophen , or ibuprofen are safer alternatives.
  6. Report any changes in mood or behavior to your physician.
  7. Store your medication in a clean, dry area at room temperature. Keep all medication out of the reach of children.

If you have any questions regarding this medication, do not hesitate to contact your doctor, pharmacist, or nurse

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Heavy and irregular Menstruation

OBG

Heavy and irregular Menstruation

INTRODUCTION

In the past, large family size, prolonged breastfeeding and reduced life expectancy limited the number of menstrual cycles experienced by women. Currently, women may experience more than 400 menstrual periods during reproductive life, and problems related to menstruation are a common cause of consultation to gynecologists. Abnormal bleeding can be a consequence of pelvic pathology, including malignant disease, but the majority of women who present with bleeding problems have no underlying abnormality. Indeed, a significant proportion of women who complain of heavy bleeding are found to have normal menstrual loss if this is measured objectively. Concerns about the widespread use of hysterectomy in this situation have led to a well-developed evidence base for medical management. This , together with less invasive surgical methods, has increased the range of options available for the relief of menstrual bleeding problems. 

DEFINITIONS

Menorrhagia is heavy, regular blood loss occurring over several consecutive cycles. The accepted definition of heavy blood loss based on objective measurement is more than 80 ml per period, although a loss of 60 ml or more is associated with the development of anaemia. The term menorrhagia excludes inter menstrual or postcoital bleeding and should be distinguished from irregular bleeding or sudden changes in bold loss, all of which may be associated with underlying pathology . Regular heavy bleeding without an identified local cause is also known as dysfunctional uterine bleeding (DUB). It is useful to distinguish between ovulatory dysfunctional bleeding (regular cyclist) and anovulatory dysfunctional bleeding. The latter usually occurs at the extremes of reproductive life and results in prolonged, irregular, sometimes heavy bleeding for which different management strategies are appropriate.

INCIDENCE

It has been estimated that 5 per cent of women aged between 30 and 49 report with excessive menstrual bleeding in a year. Excessive menstrual bleeding accounts for 12 per cent of gynecology referrals . 

AETIOLOGY

The aetiology depends on the pattern of abnormal bleeding and is also influenced by the age of the patient and other factors. 

Menorrhagia

Fibroids are the commonest structural cause of menorrhagia . Heavy bleeding associated with fibroids is often painless; painful heavy periods may be secondary to adenomyosis . Coagulation disorders are a rare cause of menorrhagia and usually present in young women in whom there is likely to be a history of other bleeding problems.

In cases of objectively confirmed menorrhagia (> 60mL blood loss per period), abnormalities in the local control of menstruation have been described. These include abnormal levels of the vasoconstrictors. Abnormalities of the local coagulation mechanisms have also been described. 

Heavy irregular bleeding

Anovulatory menstrual cycles are common following the menarche and in the lead up to the menopause, and abnormal bleeding is a consequence of prolonged stimulation of the endometrium by oestrogen, unopposed by progesterone. Bleeding is painless and in teenagers is usually limited to a few cycles. In the peri menopause, various histological abnormalities may occur, ranging from simple hyperplasia that is reversible by progestogen to severe atypical and malignancy. Anovulatory dysfunctional bleeding is also a well-recognized consequence of polycystic ovary syndrome. Irregular bleeding may be associated with other endocrine disorders, particularly thyroid disease, although the underlying mechanism is unclear. 

Intermenstrual and postcoital bleeding

These two frequently co-exist and may have a common etiology. While serious pathology, in particular cervical carcinoma, may be present, most cases are due to benign cause and often no cause can be found. Bleeding at mid-cycle is secondary to the mid-cycle oestradiol surge and is regarded as physiological. In young women, Chlamydia infection may present with Intermenstrual or postcoital bleeding. On visualization of the cervix, benign cervical conditions such as polyps may be present. 

MANAGEMENT

Decisions regarding both investigation and treatment are influenced by a number of factors, which include the age and reproductive status of the individual women, the pattern and severity of her symptoms and the degree of disruption that she experiences. Many women may simply seek reassurance. A detailed and accurate history is assessing in eliciting any relevant medical problems and in assessing the impact of the problem for each individual woman. 

Investigations

Menorrhagia

Abdominal and bimanual pelvic examinations should be performed, together with a cervical smear if due and a full blood count. If examination is normal , no additional investigations are required prior to the initiation of therapy . If the uterus is felt to be enlarged (>10-12 week size), an ultrasound scan will be helpful in delineating fibroids or excluding other causes of a pelvic mass. If coagulation disorders are suspected, particularly in young women, a clotting screen should be carried out . Where medical treatment has failed , or where there are specific risk factors for endometrial cancer (obesity, tamoxifen therapy, polycystic ovary syndrome), more detailed evaluation of the endometrial cavity should be carried out.

Prolonged or irregular bleeding

Most cases will be associated with the peri menopause. Endocrine investigation is unnecessary unless there is clinical suspicion of thyroid disease or premature ovarian failure . 

Endometrial assessment should be clinic based and includes endometrial sampling in combination with either transvaginal ultrasound (TVS) or outpatient hysteroscopy . Hysteroscopy is regarded as a gold standard for endometrial evaluation when used in combination with biopsy. 

Intermenstrual and postcoital bleeding

Careful examination of the cervix is essential, and any suspicious findings are an indication for colposcopy. In young women, Chlamydia infection should be excluded Where the bleeding is confined to mid-cycle, further investigation is not required. TVS is a simpler and less invasive primary investigation in the detection of endometrial polyps or submusosal fibroids . Although the incidence of polyps and endometrial abnormalities rises with increasing age, sub mucosal fibroids are more common in younger women.

MEDICAL MANAGEMENT

Non-hormonal therapy

For women menorrhagia requiring non-hormonal treatment, antifibrinolytics (e.g. Tranexamic acid) or non steroidal anti – inflammatory drugs (NSAIDs; e. g. mefenamic acid) are first-line drugs . Both are used only during menstruation and are generally well tolerated. As antifibrinolytics and NSAIDs have different mechanisms of action in menorrhagia, they may be effective when used in combination .  

Combined oral contraceptive pill

For women requiring contraception or for whom hormonal agents are acceptable, combined oral contraceptive pill (COCP) preparations are effective in reducing menstrual bleeding, controlling cycle irregularities and relieving menstrual pain.

Progestogen

Cyclical progestogen are traditionally the drug of first choice for the control of anovulatory dysfunctional bleeding. 

Progestogen-releasing intrauterine system

The levonorgestrel – releasing intrauterine system (LNG-IUS) is licensed in many countries for the relief of menorrhagia. The continuous exposure of the endometrial to progestogen induces progressive atrophy, with reduction of menstrual bleeding by more than 80 per cent after 3-6 months and more than 90 per cent at 12 months .

Spontaneous expulsion occurs in 3-6 per cent of women and there is an initial incidence of breakthrough bleeding as high as 25-55 per cent in the early months. Progestogen side effects of bloating , breast tenderness, mood swings and acne may occur, and careful counseling is essential prior to insertion .

Other medical therapies 

Second-line drugs are available for the control of severe bleeding when simpler measures have failed and, as they reliably induce amenorrhea, are useful in the management of severe anemia or in the presence of medical disorders when surgery may be contraindicated. Gonadotropins releasing hormone (Gnrh) agonists induce a hypogonadal state via their central action. While effective, these approaches are usually limited to short-term use because of their side effects . 

SURGICAL MANAGEMENT

While medical treatment should always be used as first-line therapy for menorrhagia , limitations in efficacy and side effects will result in many women seeking a surgical solution for their problem. Traditionally, hysterectomy has been the principal surgical management for menstrual disorders. Hysteroscopy methods of endometrial ablation are now well established as day case or outpatient procedures, and recent developments include ‘second-generation’ techniques that are simpler and safer than conventional methods. In common with all surgical procedures, adequate information and counseling are essential in the decision-making process 

Endometrial ablation

The object of endometrial is the complete destruction of the endometrial down to the basal layer, resulting in fibrosis of the uterine cavity and amenorrhea . In practice it is very difficult to achieve complete destruction, and rates of amenorrhea are rarely in excess of 20-30 per cent. However, patient satisfaction rates are over 70 per cent in the short term . 

Established techniques carried out under direct hysteroscopy vision involve the use of fluid for distension and irrigation . These comprise:

  • Laser ablation,
  • Endometrial loop resection using electro diathermy,
  • Roller ball electro diathermy ablation.

Of these, laser ablation is limited by its costs to a very few centres. All three are operator dependent, time consuming and carry risks of systemic fluid absorption, haemorrhage and uterine perforation with heat damage to adjacent structures. 

Newer techniques have been developed with the object of reducing operator dependency and minimizing risk. Of these, the best evaluated to date are microwave and thermal balloon ablation. Endometrial ablation should be offered as a treatment option to women with a history of failed medical treatment for menorrhagia .

KEY POINTS

  • Clinical presentation with heavy menstrual bleeding may be influenced by the presence of other menstrual complaints .
  • Young women presenting with Intermenstrual or postcoital bleeding should be tested for Chlamydia .
  • Primary investigation of abnormal bleeding should be by TVS and endometrial biopsy followed by hysteroscopy if findings are abnormal or equivocal .
  • NSAIDs and antifibrinolytics are effective in the management of menorrhagia .
  • The COCP is effective for menorrhagia provided there are no contraindications 
  • Cyclical progestogen are effective for menorrhagia when given for 21 days out of 28 and for control of anovulatory dysfunctional bleeding .
  • Continuous high-dose progestogen (e. g. depot preparations ) may be useful if they induce amenorrhea .
  • The LNG-IUS device is highly effective in relieving menorrhagia, but adequate counseling is needed prior to insertion .
  • Drugs that induce amenorrhea are useful for the short-term management of severe menorrhagia or for endometrial thinning prior to endometrial ablation .
  • Endometrial polyps and small sub mucous fibroids should be removed by hysteroscopy surgery.
  • Endometrial ablation is cheap, safe and effective for the relief of menorrhagia in the short term and outcome is best if it is carried out in women over the age of 45 .
  • Newer techniques of ablation are as effective as older techniques and are simpler to perform [I].
  • Long-term satisfaction is high with hysterectomy but it is associated with significant morbidity and mortality and should be offered only if simpler alternatives have failed 
  • Vaginal hysterectomy may be more cost effective than the abdominal route but outcome is more dependent on the skill of the operator.
  • The route selected for hysterectomy should be determined by the skill and experience of the individual surgeon.

SOURCE: RCOG

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Dysmenorrhea

OBG

Dysmenorrhea

INTRODUCTION

Pain during menstruation is an almost universal experience among women and, when severe, it has a significant economic impact through loss of time from work or education. Pain related to or exacerbated during menstruation or sexual intercourse may be a consequence of underlying pelvic pathology, although not all women with pelvic pain have a gynecological causes of cyclical pelvic pain but some reference is made to the multifactorial nature of the problem.

DEFINITIONS

Dysmenorrhea is pain that occurs during menstruation. Primary dysmenorrhea is also known as primary spasmodic dysmenorrhea. This is a useful descriptive term for a condition of cramping lower pain that may radiate to the lower back and thighs, often associated with gastrointestinal and neurological symptoms. It typically lasts for between 8 and 72 hours, although young women almost universally experience milder symptoms.

Secondary dysmenorrhea is menstrual related pain, which is secondary to identifiable pelvic pathology. It is characteristically associated with deep painful intercourse and the pain may precede the onset of menstrual bleeding. It is regarded as distinct from the condition of chronic pelvic pain in which pain of at least 6 months’ duration is present continuously or intermittently, not associated exclusively with menstruation or sexual intercourse. However, there is considerable overlap between the two conditions. 

PREVALENCE

The prevalence of chronic pelvic pain among women aged 18-50 years is around 15 per cent.

CAUSES

Uterine hyperactivity has been demonstrated in women with primary dysmenorrhea. The response represents the extremes of the normal physiological response of the uterus to progesterone withdrawal, as primary dysmenorrhea is not regarded as pathological condition.

Severe dysmenorrhea in young women is rarely due to any underlying abnormality. One exception is pain secondary to congenital abnormalities that are associated with obstruction to menstrual flow, for example cryptomenorrhoea in an accessory uterine horn. 

Many of the conditions that cause secondary dysmenorrhea may also present with chronic pelvic pain, in particular endometriosis, which occurs in around one-third of laparoscopies carried out for pelvic pain . Adenomyosis is a cause of secondary dysmenorrhea in older multiparous women. Uterine fibroids do not characteristically cause pain unless there is an acute complication such as torsion or expulsion. 

Around one-third of laparoscopies carried out for the investigation of pelvic pain or secondary dysmenorrhea are negative . This must not be interpreted as implying that the pain is psychogenic. Non-gynecological conditions can be exacerbated or enhanced during menstruation. In particular, irritable bowel syndrome is commonly diagnosed following negative investigations for pelvic pain. Pelvic pain may be musculoskeletal or nerve-related. Psychosocial factors are also important. Factors such as personality traits, coping strategies, health beliefs and influences of family members may predispose an individual to the development of chronic pain. There is also a high prevalence in women with a history of physical or sexual abuse.

Pelvic venous congestion is a condition described in multiparous women of reproductive age. Chronic dull, aching pain is characteristically exacerbated perimenstrually, by activity and by sexual intercourse, and relieved by lying down. It is attributed to the presence of dilated veins in the broad ligament and ovarian plexus. 

MANAGEMENT

Investigation

Primary dysmenorrhea does not require investigation . If symptoms are atypical, giving rise to a suspicion of endometriosis or other pathology pelvic ultrasound is indicated. Although a simple pelvic examination can provide reassurance, this is not indicated in a teenager who is not sexually active . A transabdominal ultrasound scan will exclude uterine abnormalities or significant ovarian pathology and should provide reassurance if negative. 

Abdominal and pelvic examination may be helpful in identifying tenderness and the presence of any masses. As endometriosis can only be diagnosed with certainty by laparoscopy , the nature and risks of the procedure require adequate discussion. 

Management of primary dysmenorrhea

Non -steroidal anti- inflammatory drugs

These drugs inhibition of the enzyme cyclo-oxygenase. Ibuprofen, mefenamic acid and aspirin are all effective in primary dysmenorrhea. The overall incidence of side effects is low and generally related to the gastrointestinal tract

Combined oral contraceptive pill

These preparations have been widely used for many years for the relief of primary dysmenorrhea. The theoretical basis for their action is via inhibition of ovulation. 

Alternative therapies

These are popular with the public and are widely used. These comprised vitamin B1 , vitamin B6 , vitamin E ( in combination with ibuprofen), magnesium , omega -3 fatty acids, and Japanese herbal combination. 

New therapeutic approaches in primary dysmenorrhea

Non-steroidal anti-inflammatory drugs (NSAIDs) in current use inhibit two different is forms of the enzyme cyclooxygenase, known as COX- 1 and COX-2 . Selective inhibitors of the enzyme COX-2 may have similar analgesic efficacy but fewer of the side effects of the drugs in current use. 

Secondary dysmenorrhea and chronic pelvic pain

Management of secondary dysmenorrhea will depend on its underlying cause. In cases of chronic pelvic pain where a diagnosis of endometriosis is suspected, laparoscopic confirmation of the diagnosis is unnecessary and a trial of medical therapy is justified provided that there are no other indications for surgery such as the presence of a suspicious adnexal mass . 

Antidepressants

In the absence of pelvic pathology, there is a tendency for chronic pain to be attributed to depression. Although symptoms of depression and sleep disturbances may be more prevalent among women with chronic pain, the interaction is likely to be complex and not necessarily causative.

Progestogen for pain secondary to pelvic venous congestion

Although there is some dispute about the existence of the condition, treatment with continuous medroxyprogesterone acetate (MPA) has been advocated for women with chronic pelvic pain and dyspareunia attributed to the presence of pelvic varicosities. 

KEY POINTS

  • Primary dysmenorrhea is experienced by more than two-thirds of women and a minority are severely incapacitated.
  • Investigation is unnecessary unless there are atypical symptoms or abnormal findings on pelvic examination .
  • Ultrasound is a useful non-invasive method for the detection of pelvic abnormalities.
  • NSAIDs are effective for the first-line management of primary dysmenorrhea.
  • COCPS are effective in primary dysmenorrhea .
  • Dietary supplements (magnesium, vitamin B1) may have a role in the management of dysmenorrhea. 
  • Pain attributed to pelvic venous congestion is relieved by continuous high-dose MPA 
  • Antidepressants are not effective in the management of chronic pelvic pain 
  • Where possible, chronic pelvic pain should be managed in a multidisciplinary clinic.
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Medical Terms in OBG

OBG

Medical Terms in OBG

MEDICAL TERMS IN OBSTETRICS AND GYNAECOLOGY

AbortionA way of ending a pregnancy using either medicines (medical abortion) or a surgical operation (surgical abortion).
AmniocentesisA procedure to take a sample of the fluid surrounding a baby in the womb. It can be carried out after the 15th week of pregnancy, by inserting a needle through the abdomen into the womb. It can be used to detect the presence of conditions such as Down syndrome.
Amniotic fluidThe watery liquid surrounding and protecting the growing fetus in the uterus.
AnaemiaAnaemia is when the level of haemoglobin in your blood is lower than normal; it can be mild or severe. Anaemia can cause tiredness, breathlessness, fainting, headaches and your heart to beat faster.
AnaesthesiaA form of pain relief.
AntenatalBefore birth.

 

BacteriaOrganisms (so small that they are can only be seen through a microscope) that may cause certain kinds of infection.
Bacterial vaginosis (BV)A very common vaginal infection which is caused by an imbalance in the types of bacteria in the vagina. It causes discharge and soreness. BV is not sexually transmitted. It does not affect men.
Bicornuate uterus (womb)A uterus resembling a heart-shape (rather than the usual pear-shape).
BiopsyA procedure to take a small sample of tissue from some part of the body for examination.
BladderThe organ in the pelvis which expands to store urine and contracts to pass it out through the urethra.
Blood groupYour blood group is determined by the presence of chemical markers (known as antigens or proteins), on the surface of your red blood cells. Group A blood has A antigens, Group B blood has B antigens, Group AB blood has both A and B antigens and Group O blood has no antigens on the red blood cells.
Breech positionWhen the baby is lying bottom first in the womb.
Caesarean deliveryAn operation to deliver the baby by cutting through the wall of the abdomen and the uterus. It may be done as a planned (elective) or an emergency procedure.

 

CancerThe organs and tissues of the body are made up of tiny building blocks called cells. Cancer is a disease of these cells.
Cardiotocography (CTG)A machine which traces the baby’s heart rate and the woman’s contractions before and during birth to assess the baby’s wellbeing.
CatheterA small tube that can be passed through a part of the body; for example, through the urethra (to empty the bladder).
CervixThe entrance or neck of the womb, at the top of the vagina.
Chocolate cystsCysts which form on the ovaries in some women who have endometriosis.
ChromosomesThe genetic structures within cells which contain our DNA (the material that carries genetic information). A normal cell contains 46 chromosomes.
ChronicSomething that persists or continues for at least six months.
Complete miscarriageWhen all the pregnancy tissue has been passed and the uterus is empty.
ConceptionA process which begins with fertilisation of an egg by sperm and ends with successful implantation of the embryo.
ContraceptionPrevention of pregnancy.

 

Dilatation and curettage (D&C)A small operation which opens the entrance of the womb (the cervix) in order to remove tissue from the lining of the womb (the endometrium).
DeliveryBirth of a baby and its afterbirth. A baby may be delivered through the vagina or by Caesarean section.
DopplerA method for measuring the flow of blood; for example, through the umbilical cord during pregnancy.
DysmenorrhoeaPainful periods.
DyspareuniaPain during or after sexual intercourse.

 

Ectopic pregnancyA pregnancy where a fertilised egg (embryo) implants outside the womb (usually in one of the fallopian tubes).
Early miscarriageWhen a woman loses her pregnancy in the first three months.
EclampsiaA serious and life-threatening complication of pre-eclampsia. The main problem associated with eclampsia is fits (seizures/convulsions).
EndometriumThe lining of the womb (uterus).
EpisiotomyA cut made through the vaginal wall and perineum to make more space to deliver the baby.
Estrogen (previously oestrogen)A female sex hormone produced by the ovaries as part of the menstrual cycle. It encourages an egg to mature and stimulates thickening of the lining of the womb in preparation for pregnancy. Levels vary during the menstrual cycle.

 

Fallopian tubesThe pair of hollow tubular organs that extend from the womb and end in fimbriae near the ovaries. Each month one ovary releases an egg which moves down the fallopian tube into the womb. The fallopian tube is where the egg is fertilised by sperm in the natural conception process.
FertilisationWhen a sperm penetrates an egg and forms an embryo. Natural fertilisation takes place in a woman’s fallopian tubes , but can be achieved outside the body by assisted conception techniques such as IVF.
FertilityThe ability to conceive a baby and, for a woman, to become pregnant.
Fertility problemWhen you have not been able to conceive a baby. Fertility problems can affect men and women.
FetusAn unborn baby.
Folic acidA B vitamin necessary to reduce the risk of a baby being born with a neural tube defect (spina bifida). A woman should take folic acid (400 micrograms) 3 months before she conceives and for 12 weeks after she becomes pregnant.
FollicleA small sac in the ovary, in which the egg develops.
Follicle stimulating hormone (FSH)A gonadotrophin hormone produced by the pituitary gland. It stimulates the development of follicles in a woman’s menstrual cycle and regulates sperm and hormone function in men.
Forceps deliverySmooth metal instruments that look like large spoons or tongs to help deliver the baby.

 

Haemorrhage

Bleed very heavily. 
A haemorrhage can happen:
after 24 weeks of pregnancy (antepartum haemorrhage).
during birth (intrapartum haemorrhage).
immediately after birth (postpartum haemorrhage).

HeparinA type of anti-coagulant medication that is given by injection.
HerpesA family of viruses which cause a range of infections including chickenpox (Herpes zoster, or varicella), cold sores and genital herpes (Herpes simplex).
Hormone treatmentHormones are produced naturally in the body. They control the activity of normal cells. Hormones can be given as treatment for disease or to replace hormones no longer produced by the body.
HormonesNaturally occurring substances, made by specialised cells in the body, which affect the metabolism and other body functions. They can also be used as drug treatment. Naturally occurring hormones include: follicle stimulating hormone, gonadotrophins, human chorionic gonadotrophin, luteinising hormone, oestrogen, progesterone, prostaglandin. Synthetic hormones include some corticosteroids, progestogen.
Human immunodeficiency virus (HIV)HIV is short for human immunodeficiency virus. It is a viral infection which attacks the body’s immune system, making it hard to fight off other infections. HIV is passed through contact with body fluids (blood, semen, breast milk).
HypertensionRaised blood pressure.
HypotensionLow blood pressure.
HysterectomyAn operation to remove the cervix and womb, carried out through a cut on the abdomen (abdominal hysterectomy) or the vagina (vaginal hysterectomy) . The ovaries can be removed at the same time, if necessary.
Hysterosalpingo-contrast-sonographyAn ultrasound test of the fallopian tubes or the womb, using fluid injected through the cervix (the entrance of the womb).
Hysterosalpin-gogram (HSG)An x-ray of the fallopian tubes or the womb, using fluid injected through the cervix (the entrance of the womb).
HysteroscopyA procedure to examine the womb through a small telescopic microscope (called a hysteroscope) which is passed through the vagina and cervix.
  
  
ImplantationThe process through which an embryo attaches to the lining of the womb.
In vitro fertilisation (IVF)A technique by which eggs are collected from a woman and fertilised with a man’s sperm outside the body. Usually one or two resulting embryos are then transferred to the womb. If one or more of them implants successfully in the womb it results in a pregnancy.
Incomplete miscarriageA miscarriage has started, but there is still some pregnancy tissue left inside the uterus.
IncontinenceWhen an individual does not have full control over the bladder and/or bowel. Problems with incontinence can range from slight to severe.
Induction of labourWhen labour is started artificially.
InfertilityWhen a couple fail to conceive after having regular (defined as two to three times a week) sexual intercourse for more than a year.
Intensive Care UnitA specialist unit within a hospital that provides intensive care medicine.
Intracytoplasmic sperm injection (ICSI)A form of assisted conception in which a single sperm is injected into an egg.
IntrapartumDuring birth.
Intrauterine contraceptive device (IUCD)A small contraceptive device that is fitted into the womb. Made of plastic and copper, it has one or two soft threads at the end which hang through the cervix into the top of the vagina.
Intrauterine insemination (IUI)A form of assisted conception which places sperm into a woman’s womb through the cervix.
Intrauterine system (IUS)A small T-shaped contraceptive device that is fitted into the womb. Made of plastic, it slowly releases the hormone progestogen.
  
  
KaryotypeA record of the complete set of your chromosomes.
KaryotypingA procedure to produce a karyotype using a blood or tissue sample. It is used to check for abnormalities in the number, form or structure of the chromosomes. These abnormalities may cause disease or dysfunction.
  
  
LabourThe stages of childbirth. Labour is divided into three stages; first, second and third.
LaparoscopyA procedure in which a surgeon uses a small telescopic microscope (called a laparoscope) to look at or operate on part of the abdomen or pelvis.
LaparotomyA surgical procedure through an opening (which is larger than that used for laparoscopy) into the abdomen.
  
  
Medical abortion A way of ending a pregnancy by using medicines. 
MenopauseThe time when a woman’s periods cease, usually around 50 years of age. 
Menstrual cycleThe process by which an egg develops each month and the lining of the womb is prepared for possible pregnancy. If the egg is not fertilised, it is reabsorbed back into the body and the lining of the womb (the endometrium) is shed (this is what is known as a period or menstruation) and the cycle begins again. The cycle is controlled by hormones. On average a cycle lasts 28 days. Some women have shorter cycles, some have longer ones.
  
  
NeonatalologistA doctor who specialises in caring for newborn babies.
  
  
ObstetricianA doctor who specialises in the care of pregnant women.
OedemaSwelling in any part of the body predominantly due to ‘leaked’ fluids.
OestrogenA female sex hormone produced by the ovaries as part of the menstrual cycle. It encourages an egg to mature and stimulates thickening of the lining of the womb in preparation for pregnancy. Levels vary during the menstrual cycle.
OligohydramniosToo little fluid (amniotic fluid) surrounding the baby in the uterus.
OvariesA pair of organs (each about the size of an almond) in a woman’s pelvis. They produce follicles from which eggs develop.
OvulationThe process by which the ovaries produce and release an egg each month. Ovulation usually takes place around 10-16 days before a period.
  
  
Pelvic inflammatory disease (PID)An infection in the womb, fallopian tubes and/or pelvis caused by infections such as chlamydia and gonorrhoea . It can cause scarring or blockage of the fallopian tubes and fertility problems.
Pelvic painPain in the lower abdomen or pelvis.
PeriodA bleed from the vagina between every 3 to 5 weeks which forms part of the menstrual cycle.
PessariesA medication or device which is placed in the vagina.
PlacentaAn organ which develops from the embryo in the womb during pregnancy. It links the baby with the mother’s system and provides it with nourishment. It is delivered after the baby, when it is also known as the afterbirth.
Placenta praeviaThe placenta is too low in the womb and covers all or part of the entrance (the cervix). In most women, the placenta usually moves out of the way, as the womb stretches around the growing baby, and does not cause a problem.
Polycystic ovariesOvaries which have at least twice as many developing follicles as normal ovaries in the early part of the menstrual cycle.
Polycystic ovary syndrome (PCOS)Polycystic ovary syndrome (PCOS) is a condition which can affect a woman’s menstrual cycle, fertility, hormones and aspects of her appearance. It can also affect long-term health. A diagnosis is usually made when a woman has any two of the following:

irregular periods,more hair than is usual for you and/or blood tests which show higher testosterone levels than normal,an ultrasound scan which shows polycystic ovaries.

PolyhydramniosToo much fluid (amniotic fluid) surrounding the baby in the uterus.
PostnatalAfter birth.
Pre-eclampsiaA condition that occurs in pregnancy, usually associated with high blood pressure and protein in the urine.
Pregnancy testA test on a sample of urine or blood to confirm whether a woman is pregnant. 
ProgesteroneA hormone produced as a result of ovulation. It prepares the lining of the womb to enable a fertilised egg to implant there.
ProlapseA hernia where the bladder, womb or bowel pushes through the wall of the vagina.
  
  
Recurrent miscarriage  When a woman loses three or more pregnancies.
Reproductive organsOrgans in the male and female body designed to help reproduction.
Reproductive yearsThe time from the onset of menstrual periods (menarche) in women to the menopause, when periods stop.
Rupture of membranesThe medical term for the breaking of waters in pregnancy.
  
  
SemenThe fluid that contains sperm.
Sexually transmitted infection (STI) An infection that is passed on through the close physical contact during sex. With some STIs you have no symptoms, so it is important to be tested if you think you have been at risk. See also chlamydia, genital herpes and HIV. 
Spina bifida A condition which affects the unborn baby in the early stages of pregnancy. Spina bifida causes damage to the spinal cord and nerves. 
Spontaneous vaginal birthThe birth of a baby through the vaginal canal without assistance. 
Sterilisation A term for methods of permanent contraception for women ( tubal occlusion) and men ( vasectomy). 
Stress incontinence A condition which means you leak urine during normal everyday activities (for instance if you cough, sneeze, laugh, exercise or change position). Usually happens because the muscles that support the bladder are too weak. 
Sutures Stitches. 
  
  
TamponA tube of absorbent material, such as cotton, that fits into the vagina to absorb the menstrual blood.
TemperatureThe degree of hotness or coldness of a body or an environment.
TermBetween 37 and 42 weeks of pregnancy.
Threatened miscarriageBleeding or cramping in a continuing pregnancy.
Transabdominal scanA scan. The scan probe is moved across the abdomen.
Transvaginal scanAn ultrasound scan where the probe is placed inside the vagina.
Transverse positionWhen the baby is lying across the womb.
TrimesterA three-month period of time. Pregnancy is divided into three trimesters: First trimester – up to around 13 weeks Second trimester – to around 13 to 26 weeks Third trimester – around 27 to 40 weeks.
Tubal occlusionA permanent method of contraception for women through an operation which blocks, seals or cuts the fallopian tubes. Also known as sterilisation.
  
  
UltrasoundHigh frequency sound waves used to provide images of the body, tissues and internal organs.
Umbilical cord (umbilicus)The cord that connects a mother’s blood system with a baby’s (through its navel) and is cut after the birth.
UrethraThe tube through which urine empties out of the bladder.
Uterus (also known as womb)The organ where a baby develops during pregnancy. Made of muscle, it is hollow, stretchy and about the size and shape of an upside-down pear.
  
  
VaginaThe canal leading from the vulva to the cervix.
Vaginal bleeding during pregnancyVaginal bleeding in pregnancy is bleeding coming through the vagina during pregnancy, for any reason.
Vaginal dischargeAny vaginal secretion apart from menstrual bleeding.
Normal vaginal dischargeA clear or whitish fluid that comes from the vagina or cervix.
Abnormal vaginal dischargeAbnormal smelling, yellow or green discharge. This should be assessed by a doctor.
Vaginal examination – InternalA check to feel the size, position of the vagina and cervix to exclude any abnormality or problem. This may be carried out by use a speculum.
Vaginal swabA vaginal swab looks like a cotton bud, but it is smaller and rounder. Some have a small plastic loop at the end instead of a cotton tip. It is wiped over the vagina to pick of samples of fluid to check for infection.
VasectomyA permanent method of contraception for men. It blocks, seals or cuts the tube (the vas deferens) which carries sperm from the testicles to the penis. Also known as sterilisation.
Ventouse deliveryAn instrument (ventouse) that uses suction to attach a soft or hard plastic or metal cup on the baby’s head to help deliver the baby.
  
  
Weak CervixWhen the cervix (the neck of the womb) opens too early in pregnancy, in the second trimester, and without contractions. Used to be known as ‘incompetent cervix’.
WombUterus.
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Did you know?

OBG

Did you know?

Did you know?

You have two ovaries, one on each side of your uterus. Ovaries are the size  and shape of almond and contain your ova or eggs.

The fallopian tubes are near the ovaries. These are thin , about 10cm long and they carry egg from ovary to womb(uterus).

The uterus is pear shaped hollow structure .It can stretch to hold a baby and shrink back after delivery.

Cervix is the lower part of uterus which connects to vagina. when a woman is pregnant ,the cervix is plugged with mucus to protect the developing baby from infection.

Your vagina is about 8-10 cm long which leads your cervix to the entrance(vulva).

The menstrual cycle

The menstrual cycle is the process in which an egg develops, released when signals are given by the gland, if conception does not happen prepares the uterus to bleed, but if conception happens prepares the lining of uterus for a possible pregnancy. These events are caused by chemical messengers or hormones.

Ovulation is when egg is released from ovary. Once released ,it travels down the fallopian tube to uterus..After ovulation the mucus in the cervix becomes thick and sticky. If the egg is not fertilized it will be reabsorbed naturally , hormone levels falls and menstrual cycle ends. The cycle begins with shedding of womb lining as periods.

Conception

It is a process that begins with fertilization. For fertilization   to take place an egg needs to meet a sperm following intercourse. It takes about 3 hours for the sperm to fully enter the egg. . The fertilised egg moves down the fallopian tube to the prepared womb for implantation . conception is now complete and pregnancy begins. 

An average pregnancy lasts 280 days

Very rarely a pregnancy develops outside the womb, usually in the fallopian tube , this is called ectopic/ tubal pregnancy.

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Managing Infertility

OBG

Managing Infertility

A guide to managing infertility.

  The desire to have a child is natural, and most women plan on experiencing pregnancy and childbirth at a certain point in their adult lives. Although conceiving a child may seem like the easiest thing in the world, it is actually not the case for many couples.

This explores the implications of infertility and treatment options- the effects it can have on you, your emotions, your sexuality and your relationships. It also outlines a number of ways in which you and your partner can cope with the problem of infertility. 

Background on infertility.

 Infertility is generally defined as the inability to conceive after one year of trying to become pregnant. Most couples assume that they are fertile and expect to conceive soon after they stop using birth control. However, 10% of all women of childbearing age are infertile, and about one quarter will experience at least one period of infertility sometime during their lives.

Causes of infertility.

 Most couples that have difficulties achieving pregnancy are not sterile, but are usually infertile or subfertile (having a reduced chance of conceiving spontaneously in the normal way).

The most common known causes of infertility are spermatozoal defects, ovulatory disorders and tubal disease. But the biggest group is due to “unexplained infertility”. This is when a couple fails to conceive after 18 months of regular intercourse, and no cause is found.

Among couples who seek medical help, infertility is exclusively a problem in the female in about 40% of cases, and exclusively in the male in about 30% of cases. In the balance of cases, infertility results from problems in either partners or the cause of the infertility cannot be explained.

• The World Health Organisation believes that between 60 to 80 million couples in the world are infertile.

• Between 2 – 10% of couples are unable to conceive a child by natural means, and a further 10 – 25% are unable to have a second or subsequent child.

• It is estimated that about 1 in 6 couples seek help in trying to achieve a pregnancy. This help can range from basis advice from their doctor, to undergoing in vitro fertilization (IVF) therapy.

Treatments offers hope.

 A diagnosis of infertility does not have to mean childlessness. It can often just mean that becoming pregnant is a challenge- one that can be aided significantly by medical treatment. Today’s treatments offer a good rate of success, and approximately three out of four women will get pregnant as a result of treatment.

Experiencing infertility.

  To have your family is a universal dream, and the thought of not being able to can make you and your partner feel that something is wrong with you.

 Learning that you have an infertility problem can lead to painful and difficult emotions. It involves rethinking many things you may have taken for granted: children and family life, genetic continuity, the experience of conception, pregnancy and birth, the meaning of your life plan and marriage, and your sexuality.

 The following are examples of common feelings experienced by many couples dealing with infertility.

Confusion.

“I simply assumed I was fertile. I took birth control for years to avoid pregnancy, and it seems very ironic that I can’t conceive now. I don’t know why I can’t. I feel very confused about the whole situation, and it’s hard to make sense of it all.”

Frustration.

 “I learned about my infertility only after trying to become pregnant for some time. Now my life seems on hold, and a lot of my time spent on medical appointments, tests, and treatments. Sometimes I feel frustrated and powerless.”

Fear.

 “For me, going through infertility brought up a lot of fears and questions. How long would it last? What if I never became a pregnant? Why didn’t my body do the things I wanted it to do? I was afraid of my feelings, afraid of my body and afraid of the future.”

Isolation.

 “I feel like I was the only woman I knew who was going through it. I stayed away from my friends because seeing their own children hurt me terribly. I felt very alone, like no one understood me.”

Guilt and shame.

 “I couldn’t accept that it was a medical problem. I began to blame myself, and wondered why I was being punished. I couldn’t figure out what I’d done to deserve infertility. My self- esteem was at the rock bottom and I felt like a failure. I began to worry about what my family would think, and if my husband would stay with me if we couldn’t get pregnant.”

Anger.

 “Everything makes me angry these days. My body, my partner, my family and friends. I get very upset when I hear about child neglect or abuse, because why should those people have children if they aren’t capable of loving them? I also get angry when I have to listen to well- intentioned advice. Hearing comments like ‘you’re not trying hard enough’ or ‘you should consider adoption’ just send me into a rage.”

Sadness and hopelessness.

“I feel like my future is hanging in the balance, and that I can’t hope for anything. I’m sad about the strain that infertility puts on my marriage and career. I’m very sad that I’ve had to put my life on hold while I try to get pregnant. I hate not having any definite answers or guarantees.”

Dealing with infertility as a couple.

Infertility can bring many changes to your relationship as a couple. It may bond your closer together, as mutual support and understanding leads to greater sharing and intimacy. But it can also bring forth feelings of guilt and resentment, particularly if no resolution is in sight. As a couple, you may have a lot of feelings in common when dealing with infertility, such as feeling out of control of your lives and your emotions.

Loss of control.

 You and your partner have probably planned your lives to begin a family at the most favorable time. You may have practiced birth control for years and waited until your careers were established before trying to conceive.  A diagnosis of infertility can remove the feelings of control over your life together.

Expressing feelings- the differences.

 You and your partner are also affected by infertility in different ways, related to how men and women have been socialized to think, feel and act.

  As a woman, you may feel responsible for much of the burden of infertility in a way that your husband may not. As a result, you can experience negative feelings, such as pain, anger, and fear, which can lead to anxiety and depression. These feelings are very common, and often the resulting friction can cause problems in your relationship.

 As a man, you may often feel more threatened expressing yourself since you’ve often been taught to repress your emotions. You are trained to take charge, to make decisions, and to think without being emotional. You tend to focus your energy on your work, a place where you feel you can have more control. You may also feel overwhelmed by the intensity of your partner’s emotions, which makes it hard for you to offer support.

You may both feel that no one else understands what you are going through, and may isolate yourselves from potential sources of support such as friends and other family members.

A stronger relationship.

 Infertility can test your relationship in a variety of ways, but providing mutual emotional support and working together can reduce some of the stress and help to avoid creating distance. It may even strengthen your relationship, as you both learn to give reassurance and encouragement, and realize that you can really depend on each other.

Sexuality.

 Failure to conceive affects both self- esteem and self- worth. This negative is sometimes reflected in a couple’s sexuality, which can be compounded by it being seen as the “source” of the infertility problem. After all, most people see fertility as a logical consequence of a couple’s sexuality.

 As time passes, you may find that sex loses its pleasurable aspects and feels like something of a chore. You and your partner may become aware of a loss of spontaneity, as medical procedure, temperature charts, and sex on a schedule can combine to take the joy out of your sex life. You may lose sight of each other and what brought you together as a couple.

 These important feelings can effect your sex life, but it is important to remember that you can help each other through the difficult times. Share your feelings with each other. Remember that your life together as a couple is rich and varied, and is not defined solely by your ability to conceive.

Infertility and your relationship.

 Infertility can have a significant impact on your relationship. It affects both partners physically, psychologically, socially and economically. Couples often report a wide range of emotions, including:

• Anger at infertility for taking over their lives.

• Anger at the inequity of infertility treatments. In most cases, women carry more of the burden than men do.

• Frustration over treatments that don’t guarantee a baby, after spending a great deal of time and emotional energy.

• Financial worries.

• A heightened sense of sensitivity and vulnerability.

• Frustration at the inability to make short- and long- term plans.

• Self- punishment – “perhaps I don’t deserve to have a child”

• Blame- “if only we’d done this or that, then we’d have a baby”.

• Desire to fight back and gain control of the process.

How your partner can help.

 Your partner cares about you and how infertility is affecting your relationship. Your partner wants to help you in any way possible, and this section is intended to help both of you.

What you as a partner can do:

 Infertility is a couple’s problem and is best approached as a team, through the commitment of both partners. Here are some ways in which you can support your partner during this difficult time.

Be a listener.

Ask them if they need to talk. Let them know that you are available for them. While listening, try to maintain an open mind and be supportive. Remind them that you love them no matter what. If they need additional support such as counseling, accompany them to appointments and attend counseling yourself if need be.

Be sensitive.

Don’t try to pretend that everything will be ok. Don’t trivialize their feelings, or give them empty reassurance.

Remember that working through infertility is a process that takes time. There are no guarantees, no package deals, no one right answer, and no quick choices. Your partner also needs patience as their feelings change. Don’t minimize or evaluate their feelings. Just allow these and give them time.

Stay informed.

This will help you maintain perspective about the array of choices you must make as a couple. The more information you have, the more knowledgeable decisions you can both make about your options.

Do things as a couple.

 Enjoyable experiences such as a lunch date, a shopping trip or a visit to a museum, help you both feel there is a outside of infertility.

Remember that your willingness to listen and support can go a long way towards helping you both handle the stress you are experiencing. Infertility is probably one of the most difficult situations you will ever have to deal with.

Managing infertility:

 What you need to know about infertility treatment.

Starting out.

 If you suspect your problem with your infertility, the best thing you can do is to take immediate actions. The earlier a problem is identified, the sooner your physician can recommend the treatment program that is right for you. Responding to early concerns about infertility can increase your chances for a successful outcome.

When should I seek treatment for infertility?

Infertility starts as soon as you seek professional help. Many infertile couples undergo a long process to attempt to conceive with no guarantees of success. On the other hand, there are couples who become pregnant soon after their first appointment with the fertility specialist, without any treatment at all.

Should my partner accompany me to the specialist?

 It takes two people to make a baby. Since both you and your partner are involved in the process, it is only fair that you both are part of it. The infertility specialist will be able to discuss with both of you and to also outline the chances of success and the possibility of failure.

What is the success rate of infertile couples getting pregnant with treatment?

Over half of the couples with more than two years of infertility eventually become successful in achieving pregnancy. With advances in infertility research and wider availability of newer techniques, the success rate of infertility treatment is increasing all the time.

Infertility treatments and procedures.

 Over the past decade or so, improvements in techniques and procedures in reproductive medicine have increased the variety and availability of procedure to assist couples in achieving pregnancy. The treatment recommended for you will depend on your particular diagnosis and your decision on which direction your treatment will take.

Treatment may include timing of intercourse, hormone therapy, intrauterine insemination (IUI) to bypass problems with sperm/cervical mucous interactions, in vitro fertilization (IVF) with embryo transfer, gamete intra fallopian transfer (GIFT), or intracytoplasmic sperm injections (ICSI).

During the course of your evaluation, various testing procedures to determine male partner status, uterine/ovarian status, and tubal status will provide your doctor with information to recommend treatment options for you. Often your doctor will decide on a less invasive treatment plan at the first, such as timed intercourse or IUI. However, if the treatment does not result in pregnancy after several cycles, your doctor will likely recommend another treatment, such as IVF or ICSI.

Whatever the treatment plan, the ultimate decision remains with you, your partner and your doctor. Read on for more information about treatments and procedures to begin your education process.  

Timed intercourse.

This is the most basic treatment for infertility. If testing determines that your tubes are clear, follicular development, endometrial development and semen analysis are normal, you can attempt pregnancy through timed intercourse. This procedure may include using a urine surge test kit to determine the time of ovulation upon which you and your partner will have intercourse at a given time. This is done to ensure that the sperm is in the fallopian tube at the time the egg is released and begins to travel down the tube.

A more advanced form of this treatment may include a monitoring ultrasound to determine follicular development and the development of the uterine lining. An injection of Human Chorionic Ganadotropin (HCG) can be given to induce ovulation and set up the timing for intercourse. 

IntraUterine insemination (IUI).

This procedure also known as “artificial insemination”, involves placing washed sperm into the uterus with a small catheter through the cervix. Sperm can be form the partner or form frozen donor sperm, depending upon your needs. IUI is often performed if you have had failed attempts at timed intercourse or if there is a determination of abnormal cervical mucous/sperm interaction, poor mucous, or hostile mucous which renders the sperm unviable. In the latter case, sperm are injected past the cervical barrier to enable them to move into the fallopian tube and reach the egg.

Variations in the procedure include taking medications to produce multiple follicles and the release of more than one egg in order to achieve fertilization.

Advantages of IUI.

• Minimally invasive.

• Less emotional commitment.

• Less time- consuming.

Disadvantages of IUI.

• Fertilization cannot be confirmed.

• Risk of multiple pregnancies.

• Tubes must be unobstructed.

In vitro fertilization- embryo transfer (IVF).

 IVF is probably the most common used of the Assisted Reproductive Technologies (ART). It is often known as the “test tube baby” procedure and has helped infertile couples conceive and bear children for well over two decades.

In order for a pregnancy to occur, an egg must be released from the ovary and unite with a sperm. This union, called fertilization, normally occurs within the fallopian tube. During the process of IVF, however, this union takes place in a laboratory after both eggs and sperm have been collected. The fertilised eggs are then transferred to the uterus to continue growth.

Down- regulation.

 Medication is given which temporarily switches off the messages going from the brain to the ovaries telling them to produce an egg on a monthly basis. In additional, down regulations prevents premature release of the egg. Thus, down regulation primarily serves to ensure correct timing of ovulation prior to egg collection.

 To ensure that the medication has worked, a blood sample is taken to check the level of oestradiol (one of the oestrogen hormones) and sometimes by performing an ultrasound scan of the ovaries and the womb (uterus). 

Ovarian stimulation and follicular monitoring.

Gonadotropins (e.g. HMG – human menopausal Ganadotropin) are given to stimulate the ovaries into producing the follicles, which contain the eggs. HMG contains equal parts of FSH (follicle stimulating hormones) and LH (luteinizing hormone). Both hormones are natural parts of the follicle stimulating process. Treatment with HMG lasts 1 to 2 weeks and involves a once- daily subcutaneous injection.

Your doctor or nurse will teach you have to give the injections yourself. The length of treatment will depend on how your ovaries respond; ovary response will be monitored with the use of ultrasound and a blood test that measures your oestrogen levels. Once ultrasound shows that the lead follicle has matured in size, HCG will be injected to trigger the release of the egg.

Egg retrieval and embryo observation.

 Thirty- six hours after the injection, retrieval of the eggs is undertaken. The procedure itself is formed at the hospital/ clinic most often by a transvaginal route. A needle, guided by ultrasound imaging, is inserted through the vaginal wall into the ovaries, where the follicles containing the eggs are punctured and the eggs withdrawn. The released eggs are transferred to the lab where their development stage is assessed. This procedure is usually done under a mild sedative or general anaesthetic. The procedure takes about 10-15 minutes, and you can return home a few hours after it. A sperm specimen is then washed and prepared for insemination. Each dish is placed in an incubator. The embryos are then observed for a few days for normal fertilization under a microscope.

Embryo transfer.

 If fertilization is successful, the embryo can then be transferred to the uterus. The transfer techniques is accomplished by placing a maximum of 3 embryos inside a narrow plastic tube (transfer catheter) which is then inserted into the uterus through the cervix. The process lasts only a few minutes. You may then rest for a couple of hours, and return home where you often are advised to take it easy for 1 or 2 days.

Luteal phase support. 

In some cases, supplemental Progestogen is occasionally used to improve the secretion of progesterone and estrogen during the luteal phase. It is administered in different to improve chances of implantation.

Pregnancy test and ultrasound.

A blood or urine pregnancy test will be taken. If the test is positive, an ultrasound examination will be arranged within the next two to four weeks. Once ultrasound confirms the presence of a healthy pregnancy, your doctor will discuss plans for pregnancy care with you.

Cases in which IVF may be recommended.

• Tubal disease.

• Endometriosis

• Cervical problems

• “Unexplained” infertility.

• Failure of IUI.

 Advantages of IVF.

• Fertilization is confirmed.

Disadvantages of IVF.

• Technical demanding.

• Risk of multiple pregnancies.

• Price/costs.

The IVF- process at a glance.

There are several major steps to the in vitro fertilization (IVF) process.

All of these are done on an outpatient basis:

• Down regulation of the pituitary, depending on which IVF protocol is used.

• Stimulation and monitoring of the follicles.

• Collection of the eggs.

• Collection and preparation of the sperm sample.

• Incubation of the eggs and sperm together in the laboratory, to allow for fertilization and early embryo development.

• Transfer of the embryos into the uterus.

• A two- week wait for a pregnancy test.

Intracytoplasmic sperm injection (ICSI).

ICSI is a type of assisted microsurgical fertilization that involves the injection of a single sperm directly into an egg. Over the last few years, various methods of assisted microsurgical fertilization (micromanipulation procedures) have been developed for use when the male partner exhibits poor sperm motility and/or low sperm count. ICSI allows a much higher fertilization rate for these patients with “normal” fertilization in over 50% of eggs. Eggs for ICSI are obtained in exactly the same way as those for IVF.

Following egg retrieval, the cells surrounding each egg are carefully removed. The eggs are then examined under a microscope and only those that are judged as mature are suitable for injection. Typically, 70% of the eggs that are obtained are suitable for ICSI. The sperm are washed and prepared. The egg and the sperm are then placed on a special microscope that has micromanipulator holds the egg in place, while the other is used to inject the sperm into the egg. The remainder of the procedure is similar to standard IVF with regard to incubation of the eggs and transfer of the resulting embryos.

Cases in which ICSI may be recommended.

• Very low number of motile sperm with normal appearance.

• Problems with sperm binding to and penetrating the egg.

• Antisperm antibodies (immune or destroy sperm) of sufficient quantity to prevent fertilization.

• Prior fertilization failure with standard IVF culture and fertilization methods.

• Absence of sperm in the seminal fluid.

Advantages of ICSI.

• Most effective procedure for male infertility.

• Overcomes some sperm quality problems.

Disadvantages of ICSI.

• Possibility of transmitting infertility to offspring.

• Technically demanding.

• Price/costs.

Awaiting the outcome.

Fertility treatment can bring with it a certain degree of emotional strain. The process is emotionally and physically demanding, often seems outside your control, and has no guarantee of a successful outcome- all of which can increase your stress levels. While most couples cope well with the stresses of IVF procedure, all couples will feel the pressures to some extent.

Taking control.

There is no escaping the stress of infertility treatment, but there are ways in which you can manage or reduce the stress and regain a sense of control over your life. Try these strategies to help you cope with the demands of fertility treatment:

•  Approach the infertility problem together with your partner as you would with any project. Your doctor can help both of you map out a strategy and a timetable.

• Collect information on the internet. There are many useful websites dealing with the subject of infertility.

• Try to keep the lines of communication open with your partner. This may not always be easy, but you need to support each other and communication is vital.

• Don’t be afraid to talk to others who have undergone fertility treatment. Their experiences will help you know you are not alone. Keep in mind, however, that everyone is unique and your situation is not exactly like anyone else’s.

• Don’t dwell on the short- term ups and downs of treatment. It is perfectly normal to feel frustrated and angry when things aren’t going you planned.

• Allow yourself to feel down when you have reached your limit. Remember that you are okay although you’re having trouble conceiving a baby.

• Consider taking time off from treatment if it becomes overwhelming.

• Make a date to have sex for fun during the “nonfertile” times of cycle. Try to bring back your original closeness.

• Try to redirect your focus toward something positive, such as a favourite hobby or new activity.

• Seek emotional support from a councilor or support group.

The result- before and after.

In particular, you can expect you and your partner’s stress levels to rise during the periods of waiting, for confirmation that fertilization has occurred and for a positive pregnancy test:

“You are sort of on a knife edge. You go into hospital and have the eggs taken out and then the sperm’s mixed and you feel you have to wait forever. You are so nervous and just hope for the best.”

“The hardest part of all has been the ups and downs. You go from the very heights to the bottom with just one phone call.” 

For many couples, a negative result can mean intense disappointment: “When I had a negative test no one could have prepared me for how devastated I was going to feel. I just screamed and cried and was desperately upset, and I wasn’t prepared that I was going to be that upset.”

“It was worse with IVF, knowing that you’d had 3 embryos put back. It doesn’t hit you straight away. No one who hasn’t been through this can understand what if feels like. We’ve both lost people close to us, but this is a different type of grieving, you’ve got nothing to remember what you are grieving for and it’s devastating.

These experiences are in stark contrast to the elation felt by women who achieve pregnancy:

“I don’t think that until a few months ago it dawned on me that I’d actually got the healthy children that I wanted.”

“I can’t believe it still- after this length of time. I can’t believe that I’ve got a baby, and neither my husband.”

Stay positive.

Although going through treatment can be very hard on you, it is important to remember that there is always hope, and success may be achieved after considerable effort. Even in normal fertile couples, there is no guarantee of conceiving right away, it may take time and repeated efforts. Remember that a successful resolution may be just around the corner for you, too. This can make it all worthwhile. 

Finding ways to cope.

 Infertility is an experience that continually fluctuates in intensity, so that at different times you may have different needs and experience different emotions. You must find your own ways of coping with the situation, and the following section provides a range of ideas on how you can take care of yourself and your partner during this difficult time.

Realize that infertility is a life crisis.

Infertility may be one of the hardest situations you’ll ever face. It can call into question the most fundamental expectations you have for yourself, your body, and your relationship. It’s normal to feel a sense of loss, to feel stressed, depressed, or overwhelmed.

Educate yourself.

Read as much as you can and don’t be afraid to ask questions. This is particularly important when dealing with infertility because the technology is complex and changes so quickly. Talking with your doctor and understanding your options enables you to make informed choices.

Don’t blame yourself.

Negative thoughts only make things seem worse. When you start feeling like you “should have” or “could have,” try to remind yourself that infertility is not your fault. Concentrate on the present and the future, and how you and your partner are going to manage the current situation.

Maintain your emotional partnership.

Couples often feel like adversaries during this time. Do your best not to place blame, and instead try to help each other. This doesn’t mean you need to feel exactly the same way at the same time (most experts say couples are often out of sync), but it does mean sympathizing with your partner’s situation. If you’re taking care of each other emotionally, you can unite to fight the problem.

Decline invitations to baby- focused activities.

If certain gatherings or celebrations (such as christenings) are too painful, give yourself permission to avoid them. Your friends and family will understand.

Get support.

 Society often fails to recognize the grief caused by infertility, which leads those struggling with infertility to hide their feelings. This only increases feelings of shame and isolation. Finding others who are going through the same thing can help you see that you are not alone and that your feelings are reasonable. Openly discussing your emotions can relieve tension, and can sometimes contribute to a higher pregnancy rate.

Consider counseling.

If you and your partner feel strained and isolated from one another, you may want to consider counseling. This has proven a very successful resource for many couples, and you may find it helps you share a new level of mutual respect and understanding. The ability to get through this together can open new doors to the future and deepen your relationship in a variety of ways.

Keep your perspective.

When it comes to fertility treatment, there are no guarantees. Trying to stay realistic can help you make smarter choices as you work your way through the emotional minefield of fertility treatment.

Pursue other interests.

Although you may feel like being treated for infertility ia a full- time job, it’s important to participate in some of the activities or hobbies that bring you pleasure. If you find that your old activities are painful- may be all your friends are parents now- look for a new diversion.

Setting limits, taking breaks.

Only you and your partner can decide your limits. Here are some questions you might want to ask yourself if you feel that treatment is too stressful, or if you may need to take a break from treatment:

• Do you feel that you are just going through the motions of treatment?

• Do you feel that you would have no regrets if you stopped treatment today?

• Have you and your partner drifted apart because of the infertility problem?

• Have you lost touch with yourself and your goals?

• Are you comfortable with other options available to you?

Often, taking a pause from fertility treatment can provide a release of tension and some needed perspective. Some couples even find that they achieve pregnancy at this point. Discuss it with your doctor, and consider whether taking a break is right is right for you.

Easing stress.

Here are some coping strategies that can help through this trying time.

• Read and learn as much as you can about infertility.

• Communicate fears and emotions to your partner on a regular basis.

• Support one another, but understand that at times it will be difficult to do this.

• Acknowledge the fact that periods of depression and anxiety may happen.

• Try to eliminate stressful activities.

• Allow yourself private time.

• Share your problems with supportive friends or other family members.

• Go to doctor appointments together so you both understand the tests and procedures.

• Write all of your questions down prior to your appointments so you don’t forget to ask your doctor to address each of your concerns.

• Take care of yourself by pursuing other interests.

• Discuss limits with your partner.

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The Menopause

OBG

The Menopause

menopause-1

INTRODUCTION

‘What is Menopause?’

The Menopause is a time of change in your body, and often in your life too.

 You may find this time to enjoy and take control of your life, when you have more time and energy for yourself.  

 Or you may find that the changes taking place in your life make you feel anxious or low. 

When will it happen to me?

 It usually happens between the ages of 45 and 52, although it can happen earlier or later.

What causes it?

    The monthly cycle is controlled by two natural chemicals called hormones, oestrogen and progesterone. These prepare the body for pregnancy each month. When pregnancy doesn’t occur, you have a period.

  As you grow older, your ovaries are less able to produce eggs each month and the level of oestrogen falls. Your periods will probably become irregular and unpredictable, until they finally stop altogether.

What are the symptoms?

Hot flushes, night sweats and felling emotional are all common symptoms of the menopause. They are caused by hormonal changes and vary from women to women. They may start before your periods stop, or develop several years later. They may be mild or they may be unpleasant and distressing. Irregular periods are another common sign that the menopause is approaching.

Irregular periods.

Your periods may become erratic and unpredictable some months or years before they actually stop. The flow might start to vary, from heavy one month to light the next. If your periods are very irregular or very heavy, see your doctor.

Hot flushes and night sweats.

      These can occur any time before or during the menopause. They can be uncomfortable, but they are not harmful. Some women have none at all.

Hot flushes and sweats usually happen in the week of your period in the lead up to the menopause. After your periods have stopped, they may happen more frequently.

      Hot flushes can happen on and off throughout the day, and may affect your sleep at night. They are probably caused by hormonal changes, but the exact cause is not known. You feel a wave of heat passing over your body, sometimes accompanied by redness, sweating or tingling. This can last for a number of seconds or up to several minutes. You may also feel a little faint and dizzy, and you may fell your heart beating faster.

     Sweats can happen with or without a flush, usually at night. After sweating, you can feel very cold. Night sweats can make it very hard to get a good night’s rest.

Dryness in the vagina.

    Your vagina may become drier, which can make sex painful or uncomfortable and increases the risk of vaginal inflection. There may also be an increased risk of cystitis (bladder infection). If you notice any unusual discharge from your vagina, this may be sign of infection ,see your doctor.

Feeling emotional.

       At this stage in their lives, many women experience symptoms such as headaches, forgetfulness, irritability and feeling low. For some, it is the worst aspect of menopause. As well as struggling with your own feelings, you may also worry about the effect of your mood swings on the people around you.

     The changes in your body may certainly be responsible for some of these feelings. Mood changes may become worse around the time of your periods, for example due to increased premenstrual tension. But there may be other reasons for feeling emotional or down, particularly due to the changes and stresses in your life.

      If you do not feel depressed, find someone sympathetic to talk to. This could help you understand why you are feeling the way you are. You could try talking to friends or relations who have gone through menopause and  your doctor. 

When can I stop using contraception?

     It’s best to discuss this with your doctor . Generally, women under 50 are advised to wait until they have had no periods for two years before stopping their method of contraception. Women over 50 should wait one year.

      Remember the ‘natural’ methods of birth control such as safe times or temperature monitoring is not reliable once your periods become irregular. Also, some forms of the pill might not be advisable around the time of the menopause, especially if you smoke. Again, discuss appropriate methods with your  doctor.

What can I do to help myself?

       Some women have little or no trouble with the menopause. Don’t assume it’s going to be awful- every woman has a different experience. Even if you do have problems, there’s a lot you can do to help yourself.

• Be prepared. If you experience sweating at night, try lying on a large towel and use cotton night clothes and sheets. Keep a fan and bottle of cold water by your bed. If you get hot flushes throughout the day, wear layers of clothing that you can take off. Deep breathing can help to ‘cool down’ hot flushes.

• Eat a healthy, balanced diet. Eating sensibly and well is important for good health and for the prevention of osteoporosis.  

• Avoid smoking. If you smoke, try to quit. Smoking may make menopause start about one year earlier. It also increases the risk of osteoporosis and heart diseases.

• Stay active. Regular physical activity can also help you feel better. Try to treat this as a time to relax and reduce stress in your life.

• Use a vaginal lubricant. If dryness in your vagina makes sex painful or difficult, try using a lubricant such as KY jelly, available from any chemist.

• Consider Hormone Replacement Therapy. It can bring significant relief to menopause symptoms, including hot flushes, night sweats .

Should I talk to my family about what’s happening to me?

     Talking things through with your family, friends and colleagues can be very positive. Partners and families may be worried about the effect the menopause will have.

    If you are in a relationship, it’s important to help your partner understand what is happening and how you feel. If your symptoms seem to be causing difficulties, discuss how you can improve things.

   Since men don’t have a physical menopause themselves it’s hard for them to understand what a woman goes through at this time. Men often have emotional problems of their own in middle age, feeling nervous, irritable, tired or experiencing loss of confidence. It’s importance to keep communicating and supporting each through what can be a time of change for both of you.

Osteoporosis.

Osteoporosis, or thinning of the bones, affects both men and women. But it can be a problem for women because of the hormonal changes that occur at the menopause.

When bones become weaker and less dense, wrists, spines and hips are more likely to break. The spine starts to curve and there might be discomfort and pain.

    Thinning of the bones is natural, but there is a lot you can do to avoid osteoporosis by staying healthy and strengthening your bones. Even if you do develop it, treatment can prevent further thinning of the bones.

What are the symptoms?

    Osteoporosis develops gradually over many years, usually without any symptoms at all. Someone affected will probably not notice any problems until they are in 70’s. The first sign of it may be when the spine starts to curve, or when a slight fall or awkward movement causes a painful fracture.

Who gets it?

Osteoporosis can occur in both men and women at any time, but is more common from about 40 onwards. In women, thinning of the bones is more rapid around the time of- and just after- the menopause. This is because some women lose calcium more quickly as the level of oestrogen in their body drops.

  You are more likely to develop osteoporosis if you:

• Have had an early menopause.

• Have been treated with long- term corticosteroids.

• Have a history of missed periods.

• Have already broken a bone after a minor bump or fall.

• Have a family history of osteoporosis.

• Have a history of heavy smoking or drinking, low calcium intake or immobility.

Can it be treated?

Hormone Replacement Therapy (HRT) can halt and prevent further bones loss.

How can I help myself?

Since osteoporosis actually starts long before you notice any symptoms, it makes sense to take action now to prevent or reduce the effects.

• Eat a healthy, balanced diet. Eating a varied and well- balanced diet is important for good health. This can be done by choosing a variety of foods from each of the five food groups: milk and dairy foods; meat, fish and alternatives; bread, other cereals and potatoes; fruit and vegetables; foods containing fat, foods containing sugar. For healthy bones, make sure your diet includes calcium- rich foods such as milk and dairy foods (cheese, yoghurt and so on), nuts, canned fish, and dark, leafy vegetables. Fat- reduced varieties are healthier.

• Make sure you get enough vitamin D. This is particularly important in winter. Vitamin D helps to activate the production of calcium and is found in fortified margarines, oily fish, eggs and milk. It is also made by your skin when you go out into sunlight.

• Stay physically active. This is extremely important in maintaining bone density, muscle strength and balance throughout life. It reduces the risk of fracture and osteoporosis in later life. Try walking, dancing, cycling, tennis, swimming or something similar that you enjoy.

• Avoid smoking and heavy drinking. They can make the condition worse.

   Hormone replacement therapy (HRT).

   Hormone replacement therapy (HRT) can help ease or prevent some of the uncomfortable symptoms of the menopause. It can also protect against osteoporosis and heart disease. Some women believe HRT has completely changed their lives for the better. Others feel that they do not need it, or that it’s ‘unnatural’.

         You need accurate information about the nature of the treatment and its benefits and its drawbacks in order to decide if HRT is right for you.

What is hormone replacement therapy?

      Before, during and after the menopause, your body produces less and less of the hormone oestrogen. HRT is designed to ‘top up’ the body’s natural supply of oestrogen. Progestogen is usually added to protect the lining of the womb.

     Oestrogen is usually taken by mouth in tablet form, as a skin patch or skin gel, as a vaginal cream or ring to ease vaginal discomfort. Your doctor would be able to explain the different options.

What are the benefits?

HRT is prescribed to ease or prevent many of the uncomfortable symptoms associated with the menopause.

It can:

• Stop hot flushes and sweats.

• Restore the vagina’s elasticity and natural lubricant.

• Help you feel better in yourself. 

    HRT also protects against osteoporosis. It helps to prevent thinning of the bones in women after the menopause, especially when it is taken within a few years of the menopause when bone loss is most rapid. 

    HRT is particularly valuable for women who have had their ovaries removed before the menopause, as they are at an even higher risk of osteoporosis.

How long would I have to take it?

     A course of treatment can last from around six months to two years, sometimes a little longer under supervision. Symptoms such as hot flushes and vaginal dryness should not return after the treatment stops.

What are the risks?

    There may be a slightly risk of breast cancer when HRT is taken for 5-10 years or more. 

Are there any side effects?

     There might be some side effects, including the return of periods (withdrawal bleeds). If you are taking HRT and notice side effects, don’t stop taking the treatment- tell your doctor. There a many different doses and types of treatment, and if one kind of treatment does not work well for you, there should be other options.  

Possible side effects include:

Oestrogen 

• Breast tenderness and enlargement.

• Leg cramps.

• Bloating.

• Nausea.

• Headaches.

Progestogen

• Pain in the lower abdomen.

• Fluid retention, back pain.

• Depressed mood.

How do I know if HRT is right for me?

    This is something you should consider carefully and discuss with your doctor. Find out all the information you can about HRT. You will need to weigh the benefits to yourself against the possible risks. Much will depend on your medical history, symptoms and state of health.

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PI Disease

OBG

Pelvic inflammatory disease (PID)

pi-disease-1

INTRODUCTION

Pelvic inflammatory disease (PID) is caused by infections which enter the body through the cervix and work their way up into the pelvic cavity. It can range from a mild infection to a serious disorder. The bacteria which cause the sexually transmitted infections, Chlamydia and gonorrhea, are thought to be chiefly responsible for PID, although other bacteria may play a part.

Signs and symptoms.

 The symptoms of PID can vary in different women and this makes it difficult for doctors to diagnose it. It can be an acute (sudden and severe) or a chronic (long- term) infection.

The most common symptoms of acute PID is:

• Severe abdominal pain.

Other symptoms may include:

• A high temperature.

• Nausea.

• Vaginal discharge.

• Fast pulse.

• Pain or discomfort during sex.

The most common symptoms of chronic PID are:

• Constant abdominal pain or discomfort.

• Weakness and tiredness.

• Very heavy, painful periods.

• Pain or discomfort during the sex.

• Intermenstrual bleeding.

Sometimes PID can be almost or entirely symptomless.

How PID develops.

The infections which cause PID may get into the pelvic cavity when:

• An infection is not treated or is not treated promptly.

• The cervix is dilated (opened) during childbirth, miscarriage or an abortion.

• An intrauterine contraceptive device (IUD) is inserted.

If PID is not identified and treated it may scar the fallopian tubes- the tubes along which an egg passes to get to the womb. This can cause infertility. It will also increase the risk of an ectopic pregnancy (when the fertilised egg begins to grow in the fallopian tube or outside it, rather than in the womb). Once the tubes are scarred, reinfection will cause more damage, even after the original infection has been treated.

Diagnosis.

• The doctor can sometimes identify PID by examining your pelvic area for swollen or painful areas.

• If the doctor suspects that the infection has developed into an abscess you may be given an ultrasound scan.

• Sometimes  gynecologist may need to carry out a laparoscopy. This is a minor operation, using local or general anaethethic. A small cut is made (usually just below the naval) to allow a gynecologist to see your pelvic organs through a small telescopic camera.

Treatment.

PID is treatment with antibiotics, bed rest and pain killers. For most women a course of tablets taken for at least 2 weeks is sufficient. In severe cases a stay in hospital may be necessary so that antibodies can give intravenously.

If you are allergic to any antibiotics, or if there is any possibility that you may be pregnant, it is important that you tell your doctor.

It is important that you finish any course of treatment. If treatment is interrupted, it may be necessary to start again from the beginning.

Follow- up.

You will be advised to avoid vigorous activities, including sex, until any inflammation has gone.

It is important that your partner has a check- up at a  clinic before you start having sex again.

Remember, after treatment, using condoms during sex can reduce your risk of getting or passing on sexually transmitted infections.

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Emergency Contraception

OBG

Emergency Contraception

venlafaxine

INTRODUCTION

   If you have had sex without using contraception, or if your contraception might have failed (unprotected sex), you can use emergency contraception, there are two methods of emergency contraception- pills and an IUD. The IUD is the most effective.

  If you act quickly, emergency contraception will usually prevent pregnancy.

“All the advice and treatment you receive is confidential- wherever your receive it”.

Method 1:

Progestogen- only emergency pills.

Emergency contraceptive pills contain a Progestogen hormone which is similar to the natural progesterone women produce in their ovaries. They should be taken within three days (72 hours) of having unprotected sex. They are more effective the sooner they are taken. However they are more effective the sooner they are taken. However they are not as effective as using other methods of contraception such as the pill or condoms regularly and do not protect you against sexually transmitted infections.

Q. How do I take them?

 A. Emergency pills come in packet of two. The two pills should be taken together, at the same time, and as soon as possible after unprotected sex.

Q. How do emergency pills work?

A. The pill may:

• Stop an egg being released (ovulation).

• Delay ovulation.

• Stop a fertilized egg setting in your womb (implanting).

Q. How effective are emergency pills?

A. Emergency contraceptive pills are very effective. They are more effective the sooner they are taken after sex.

• If taken within 24 hours of unprotected sexual intercourse, they will prevent more than 9 out of 10 (95%) pregnancies expected to occur if no emergency contraception had been used.

• If taken 72 hours after unprotected sex they will prevent more than 5 out of 10 (58%) pregnancies expected to occur if no emergency contraception has been used.

Q. Will emergency pills protect me from pregnancy until my next period?

A. No. Emergency pills will not protect you from pregnancy if you have further unprotected sex. 

Q. Can anyone use emergency pills?

A. Almost every woman can use emergency pills. However, if you are taking certain prescribed or complementary medicines, or suffer from particular illness you may need special advice. Tell your doctor about any medicines you are taking or any illness you may have.

Q. What are the disadvantages?

A. There are no serious short or long term effects from using emergency pills. Some women will feel sick and have headaches, dizziness, tiredness, breast tenderness and abdominal pain. A very small number of women will vomit.

Q. How will emergency pills affect my period?

A. Your period may come earlier than expected or it may be up to a week late. Mostly, it comes within a few days of when you would expect it. You may experience some irregular bleeding between taking the emergency pills and getting your next period. This can range from spotting to being quite heavy.

Q. Do I need to see a doctor  after I’ve taken the pills?

A. Not usually, but go and see a doctor  if:                      

• Your next period is more than seven days late.Your period is shorter or lighter than your usual period.

• You have any sudden or unusual pain in your lower abdomen.

These could be signs of an ectopic pregnancy (a pregnancy that develops outside the womb, usually in a fallopian tube). Although this is not common, it is serious

• You think you may be pregnant.

• You want to talk about using regular contraception.

• You are worried that you might have caught a sexually transmitted infection.

Q. Can the emergency pills fail?

A. Emergency pills are very effective and should be taken as soon as possible after unprotected sex. They are most effective if taken within 24 hours. They are most likely to fail if you:

• Take the pills more than 72 hours after unprotected sex.

• Vomit within two hours after taking the pills.

• Don’t take the pills as instructed.

• Have had unprotected sex at another time, either since your last period or since taking the pills.

Q. What if vomit within two hours of taking either pill?

A. Speak to your doctor. They may give you extra pills, a medicine to stop you vomiting again or suggest having a copper IUD fitted (method 2).

Q. How will I know if the emergency pills have worked?

A. If you have taken the pills correctly and your next period seems normal, it is unlikely that you will be pregnant. If you are worried, seek advice.

Q. Are there any risks if the emergency pills fail?

A. Emergency pills have not been shown to affect a pregnancy or harm a developing baby. As with any pregnancy there is a small chance that an ectopic pregnancy may occur.

Q. Can I use emergency pills regularly?

A. Emergency pills are not as effective as other contraceptive methods regularly. If you do not want to become pregnant you should always use contraception. You can take emergency pills more than once- this is not dangerous, but may disrupt your periods. If you want advice on any method of contraception ask your doctor.

Q. Can I get emergency pills in advance?

A. Yes, if you are worried about your contraceptive method failing or cannot get emergency contraception easily. Ask your doctor .

Q  If I’m using regular contraceptive pills, can I continue to take them after I’ve used the emergency pills?

A. Yes if you needed emergency contraception because you forgot some of your regular pills, you should take a contraceptive pill again within 12 hours of taking the emergency pills. You will need to use an additional contraceptive method, such as condoms, until your contraceptive pill is effective again. This will vary depending on which type of pill you take. 

Method 2:

The copper IUD.

Q. What’s involved?

A. A doctor  fits a copper intrauterine device (IUD) in your womb up to five days after you had unprotected sex, or up to five days after the earliest time you could have released an egg (ovulation). If you need to come back to have the IUD fitted, you may be advised to take emergency pills in the meantime.

Q. How does the IUD work?

A. It may stop an egg being fertilized or implanting in your womb.

Q. How effective is a copper IUD?

A. The IUD is most effective method of emergency contraception. It will prevent more than 9 out of 10 (98%) pregnancies expected to occur if no emergency contraception had been used. It can also provide ongoing contraception if you want to use this method.

Q. Can anyone use an IUD?

A. Most women can use an IUD for emergency contraception. An IUD may be suitable if you:

• Want to use the most effective method of emergency contraception.

• Are too late to take emergency pills (over 72 hours after unprotected sex).

• Do not want to, or cannot, take Progestogen.

• Want to use the IUD as an ongoing method of contraception.

Q. What are the disadvantages of using an IUD for emergency contraception?

A. When an IUD is fitted there is a small chance of you getting infection in your womb within 21 days after it is put in. If you have been at risk of getting a sexually transmitted infection you may have screening tests done at the time the IUD is fitted and you may also be given some antibiotics. This will help to reduce the chance of pelvic infection occurring.  Very rarely perforation of womb could occur.    

Q. Do I need to see a doctor  after the IUD is fitted?

A. It is important to see a doctor  three to four weeks after the IUD is fitted, whether or not you have had a period. This is to check you are not pregnant, that the IUD is still in the correct place and to discuss any problems.

Q. When can I have IUD removed?

A. If you do not want to keep the IUD as your regular contraceptive method, it can be removed as soon as you are sure you are not pregnant (usually during your next period).If you have not started to use a hormonal method of contraception (such as the contraceptive pill) you will need to use an extra contraceptive method such as condoms, for seven days before the IUD is taken out. This is because sperm can live inside your body for up to seven days and could fertilise an egg once the IUD is 

More questions about emergency contraception.

Q. Does emergency contraception cause an abortion?

A. No, emergency contraception may stop ovulation or fertilization of an egg, or stop a fertilised egg from implanting in the womb. Medical research and legal judgment are quite clear that emergency contraception (pills or an IUD) prevents pregnancy and is not abortion. Abortion can only take place after a fertilised egg has implanted in the womb. People who believe life begins when the egg is fertilised may not wish to use the emergency contraception methods .

Q. What should I do if I think there’s a problem?

A. If you are worried about anything to do with your emergency contraception see your doctor as soon as you can. See your doctor  straight away if you think you are pregnant or have any of the following:

• A sudden or unusual pain in your lower abdomen.

• A shorter, lighter or delayed period.

• A smelly discharge from the vagina.

• A high temperature.

These could be signs of an ectopic pregnancy or an infection, which can be serious.

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Be Breast Aware

OBG

Be Breast Aware

be-breast-aware

What is breast awareness?

Breast awareness is a part of general body awareness. It is a process of getting to know your own breasts and becoming familiar with their appearance. Learning how your breasts feel at different times will help you to know what is normal for you.

You can become familiar with your own breast tissue by looking and feeling- in any way that is best for you (e.g. in the bath, shower, when dressing).

Being breast aware and knowing what is normal for you will help you to be aware of any changes from normal, should these happen.

The normal breast.

Before the menopause normal breasts feel different at different times of the month. The milk- producing tissue in the breast becomes active in the days before a period starts. In some women, the breast at this time feels tender and lumpy, especially near the armpits.

After a hysterectomy the breasts usually show the same monthly differences until the time when your periods would have stopped.

After the menopause activity in the milk- producing tissue stops. Normal breasts feel soft, less firm and not lumpy.

Changes to look out for.

Appearance. Any change in the outline or shape of the breast, especially those caused by arm movements, or by lifting the breasts. Any puckering or dimpling of the skin.

Feelings.  Discomfort or pain in one breast that is different from normal, particularly if new and persistent.

Lumps.  Any lumps, thickening or bumpy areas in one breast or armpit which seem to be different from the same part of the other breast and armpit. This is very important if new.

Nipple change. Nipple discharge, new for you and not milky. Bleeding or moist reddish areas which don’t heal easily. Any change in nipple position- pulled in or pointing differently. A nipple rash on or around the nipple.

What to do if you find a change.

There can be many reasons for changes in the breast. Most of them are harmless but all of them need to be checked as there is a small change they could be the first sign of cancer.

If you see any change in your breast from what is normal for you, tell your doctor without delay. Remember, you are not wasting anyone’s time. If there is a cancer present, the sooner it is reported, the more simple treatment is likely to be. This offers greater prospects of benefit in terms of quality of life.

Breast cancer is very rare in women under the age of 40. The likelihood of developing breast cancer increases with age.

Breast screening.

If you are aged 50 and over it is strongly recommended three- yearly mammography, this is an X- ray procedure which can detect breast changes at a very early stage. 

Routine X- ray breast screening is not available for women under 50 as it has not been shown to be of benefit. If you have any cause for concern about your breasts tell your doctor.

Breast awareness five- point code.

  1. Know what is normal for you.
  2. Look and feel.
  3. Know what changes to look for.
  4. Report any changes without delay.
  5. Attend for breast screening if aged 50 or over.
[INSERT_ELEMENTOR id="9731"]
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Disulfiram

Psychiatry

Disulfiram

PATIENT INFORMATION ON DISULFIRAM

Use

Disulfiram is primarily used as a deterrent to alcohol use/abuse.

How quickly will the drug start working?

Disulfiram inhibits the breakdown of alcohol in the body, resulting in a build-up of a chemical called acetaldehyde; this results in an unpleasant reaction when alcohol is consumed. This reaction can occur 10-20 minutes after drinking alcohol and may last up to 2 hours.

The reaction consists of: flushing, choking, nausea, vomiting, increased heart rate and decreased blood pressure (dizziness). At times the reaction could be fatal.

How long should you take this medication?

Disulfiram is usually prescribed for a set period of time to help the individual stop the use of alcohol. Do not decrease or increase the dose without discussing this with the doctor.

Side effects

Side effects occur, to some degree, with all medication. They are usually not serious and do not occur in all individuals. They may sometimes occur before beneficial effects of the medication are noticed . If a side effect continues, speak to your doctor about appropriate treatment.

Common side effects that should be reported to your doctor at the next appointment include:

  • Drowsiness, lethargy, depression-This problem goes away with time. Use of other drugs that make you drowsy will worsen the problem. Avoid driving a car or operating machinery if drowsiness persists.
  • Energizing/ agitated feeling-Some individuals may feel nervous or have difficulty sleeping for a few days after starting this medication.
  • Headache-Temporary use of analgesics (e.g., acetaminophen, ASA).
  • Skin rash- Contact your doctor.
  • Garlic-like taste

Rare side effects you should report to your doctor IMMEDIATELY include:

  • Yellow tinge in the eyes or to the skin; dark-colored urine
  • Soreness of the mouth, gums, or throat
  • Skin rash or itching, swelling of the face
  • Nausea, vomiting, loss of appetite, lethargy, weakness, fever, or flu- like symptoms

What should you do if you forget to take a dose of your medication?

If you take your total dose of the drug in the morning and you forget to take it for more than 6 hours, skip the missed dose and continue with your schedule the next day. DO NOT DOUBLE THE DOSE.

Interactions with other medication

Because disulfiram can change the effect of other medication, or may be affected by other medication, always check with your doctor or pharmacist before taking other drugs, including over-the-counter medication such as cold remedies. Always inform any doctor or dentist that you see that you are taking this medication.

Precautions

  1. Do not increase or decrease your without consulting your do
  2. Report to your doctor any changes in sleeping or eating habits or changes in mood or behavior.
  3. Avoid all products (food and drugs) containing alcohol, including tonics, cough syrups, mouth washes and alcohol-based sauces. A delay in the reaction may be as long as 24 hours.
  4. Exposure to alcohol-containing rubs or solvents (e.g., after-shave) may trigger a reaction.
  5. Carry an identification card stating the name of the drug you are taking.
  6. Store your medication in a clean, dry area at room temperature. Keep all medication out of the reach of children.

If you have any questions regarding this medication, do not hesitate to contact your doctor, pharmacist, or nurse

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Carbamazepine

Psychiatry

Carbamazepine

PATIENT INFORMATION ON CARBAMAZEPINE

Carbamazepine is classified as a mood stabilizer and anticonvulsant agent.

Uses

Carbamazepine is used primarily in the treatment of acute mania and in the long-term control prophylaxis of Manic Depressive Illness (Bipolar Disorder). 

It is also used in the treatment of seizure disorders as well as certain pain syndromes ( e. g., trigeminal neuralgia).

Though not approved for these indications, carbamazepine has also been found to be useful in the treatment of withdrawal reactions from alcohol or sedative/hypnotics, and in behavior disturbances, such as chronic aggression or impulsivity.

How does the doctor decide what dose (how many milligrams) to prescribe?

The dose of carbamazepine is different for every patient and is based on how much carbamazepine is in the blood, as well as the response to treatment. The doctor will measure the drug level in the blood on a regular basis during the first few months. The carbamazepine level that is usually found to be effective for most patients is between 17 and 50 micro mol/L (4-12 microgm/ml).

You may initially take your medication several times a day (2 or 3); after several weeks, the doctor may decide to prescribe the drug once daily.

On the morning of your blood test, take the morning dose of carbamazepine after the test to avoid inaccurate results.

How quickly will the drug start working?

Control of manic symptoms may require up to 14 days of treatment. Because carbamazepine takes time to work , do not decrease or increase the dose or stop the medication without discussing this with your doctor. Improvement in seizures, pain symptoms, as well as aggression/impulsivity also occur gradually.

How long should you take this medication?

Following the first episode of mania it is recommended that carbamazepine be continued for a minimum of one year; this decreases the chance of being ill again. The doctor may then decrease the drug slowly and monitor for any symptoms; if none occur, the drug can gradually be stopped. For individuals who have had several episodes of mania or depression, carbamazepine should be continued indefinitely. Long-term treatment is generally recommended for recurring depression , seizure disorder and aggression/impulsivity.

Side effects

Side effects occur, to some degree, with all medication. They are usually not serious and do not occur in all individuals. They may sometimes occur before beneficial effects of the medications are noticed. If a side effect continues, speak to your doctor about appropriate treatment. 

Common side effects that should be reported to your doctor at the next appointment include:

  • Drowsiness and lethargy, difficulty concentrating-This problem goes away with time. Use of other drugs that make you drowsy will worsen the problem. Avoid driving a car or operating machinery if drowsiness persists.
  • Dizziness-Get up from a lying or sitting position slowly; dangle your legs over the edge of the bed for a few minutes before getting up. Sit or lie down if dizziness persists or if you feel faint-then call the doctor.
  • Ataxia or unsteadiness-Discuss this with your doctor as this may require an adjustment in your dosage.
  • Blurred vision-This usually occurs at the start of treatment and tends to be temporary. Reading under a bright light or at a distance may help; a magnifying glass can be of temporary use. If the problem continues, advise your doctor.
  • Dry mouth-Sour candy and sugarless gum help increase saliva in your mouth; try to avoid sweet, calorie-laden beverages. Drink water and brush your teeth regularly.
  • Nausea or heartburn-If this happens , take the medication with food . If vomiting or diarrhea occur and persist for more than 24 hours, call your doctor.
  • Muscle tremor-Speak to your doctor as this may require an adjustment in your dosage.
  • Changes in sex drive or sexual performance-Discuss this with your doctor.
  • Weight changes-Monitor your food intake; avoid foods with high fat content (e. g., cakes and pastry).

Rare side effects you should report to your doctor IMMEDIATELY include:

  • Soreness of the mouth, gums, or throat, mouth lesions
  • Skin rash or itching, swelling of the face
  • Nausea, vomiting, loss of appetite, lethargy, weakness, fever, or flu-like symptom
  • Easy bruising, bleeding, appearance of splotchy purplish darkening of the skin
  • Confusion or disorientation

Let your doctor know as soon as possible if you miss your period or suspect you may bepregnant.

What should you do if you forget to take a dose of your medication?

If you take your total dose of carbamazepine in the morning and you forget to take it for more than 6 hours, skip the missed dose and continue with your schedule the next day. DO NOT DOUBLE THE DOSE. If you take the drug several times a day take the missed dose when you remember, then continue with your regular schedule.

Interactions with other medication

Because carbamazepine can change the effect of other medication, or may be affected by other medication, always check with your doctor or pharmacist before taking other drugs, including over-the-counter medication such as cold remedies. Always inform any doctor or dentist that you see that you are taking this drug.

Precautions

  1. Do not increase or decrease your without consulting your doctor.
  2. Avoid drinking grapefruit juice while on carbamazepine as it can affect the level of carbamazepine in your body.
  3. If your are on liquid carbamazepine, do not mix it with any other liquid medication.
  4. This drug may impair the mental and physical abilities and reaction time required for driving a car or operating other machinery. Avoid these activities if you feel drowsy or slowed down.
  5. Do not stop your drug suddenly as this may result in withdrawal symptoms such as anxiety, irritability and emotional liability.
  6. Report any changes in mood or behavior to your physician.
  7. Tablets or capsules of carbamazepine should be swallowed whole; do not crush them.
  8. Store your medication in a clean, dry area at room temperature. Keep all medication out of the reach of children.

If you have any questions regarding this medication, do not hesitate to contact your doctor, pharmacist, or nurse

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Lithium

Psychiatry

Lithium

PATIENT INFORMATION ON LITHIUM

Lithium is classified as a mood stabilizer. It is a simple element, found in nature in some mineral waters, and is also present in small amounts in the human body.

Uses

Lithium is used primarily in the treatment of acute mania and in the long-term control or prophylaxis of Manic Depressive Illness (Bipolar Disorder).

Though not approved for these indications, lithium has also been found to augment the effects of antidepressants in depression and obsessive compulsive disorder, and is useful in the treatment of cluster headaches, as well as chronic aggression or impulsivity. 

How does the doctor decide what dose (how many milligrams) to prescribe?

The dose of lithium is different for every patient and is based on how much lithium is in the blood, as well as the response to treatment. The doctor will measure the lithium level in the blood on a regular basis during the first few months. The lithium level that is usually found to be effective for most patients is between 0.6 and 1.2 mmol/L (mEq/L).

You may initially take your medication several times a day (2 or3); after several weeks, the doctor may decide to prescribe the drug once daily. It is important to drink 8-12 cups of fluid daily when on lithium (e. g., water, juice, milk, broth, etc.)

On the morning of your lithium blood test, take the morning dose of lithium after the test to avoid inaccurate results.

How quickly will the drug start working?

Control of manic symptoms may require up to 14 days of treatment. Because lithium takes time to work, do not decrease or increase the dose or stop the medication without discussing this with your doctor.

Improvement in symptoms of depression, obsessive compulsive disorder, cluster headaches, as well as aggression/ impulsivity also occur gradually.

How long should you take this medication?

Following the first episode of mania it is recommended that lithium be continued for a minimum of one year ; this decreases the chance of being ill again. The doctor may then decrease the drug slowly and monitor for any symptoms; if none occur, the drug can gradually be stopped.

For individuals who have had several episodes of mania or depression, lithium should be continued indefinitely.

Long-term treatment is generally recommended for recurring depression, obsessive-compulsive disorder, cluster headaches or aggression/impulsivity.

Side effects 

Side effects occur, to some degree, with all medication. They are usually not serious and do not occur in all individuals. They may sometimes occur before beneficial effects of the medication are noticed. If a side effect continues, speak to your doctor about appropriate treatment.

Common side effects that should be reported to your doctor at the next appointment include:

  • Lethargy, difficulty concentrating-This problem usually goes away with time. Use of other drugs that make you drowsy will worsen the problem. Avoid driving a car or operating machinery if drowsiness persists.
  • Nausea or heartburn-If this happens, take the medications with food. If vomiting or diarrhea occur and persist for more than 24 hours, call your doctor.
  • Muscle tremor, weakness, shakiness, stiffness-Speak to your doctor as this may require an adjustment in your dosage.
  • Changes in sex drive or sexual performance-Discuss this with your doctor.
  • Weight changes-Monitor your food intake; avoid foods with high fat content (e. g., cakes and pastry).
  • Increased thirst and increase in frequency of urination-Discuss this with your doctor.
  • Skin changes, e.g., dry skin, acne, rashes.

Side effects you should report IMMEDIATELY, as they may indicate the amount of lithium in the body is higher than it should be, include:

  • Loss of balance
  • Slurred speech
  • Visual disturbances (e. f., double-vision)
  • Nausea, vomiting, stomach ache
  • Watery stools, diarrhea (more than twice a day)
  • Abnormal general weakness or drowsiness
  • Marked trembling (e. g., shaking that interferes with holding a cup), muscle twitches, jaw shaking

IF THESE OCCUR CALL YOUR DOCTOR RIGHT AWAY. If you cannot reach your doctor, stop taking the lithium until you get in touch with him. Drink plenty of fluids and snack on salty foods (e. g., chips, crackers). If symptoms continue to get worse, or if they do not clear within 12 hours , go to the Emergency Department of the nearest hospital. A clinical check-up and a blood test will show the cause of the problem.

Rare side effects you should report to your doctor IMMEDIATELY include:

  • Soreness of the mouth, gums or throat
  • Skin rash or itching, swelling of the face
  • Nausea, vomiting, loss of appetite, lethargy, weakness, fever, or flu-like symptoms
  • Swelling of the neck (goiter)
  • Abnormally frequent urination and increased thirst (e. g., having to get up in the night several times to pass urine)

Let your doctor know as soon as possible if you miss your period or suspect you may be pregnant.

What should you do if you forget to take a dose of your medication?

If you take your total dose of lithium in the morning and you forget to take it for more than 6 hours, skip the missed dose and continue with your schedule the next day. DO NOT DOUBLE THE DOSE. If you take the drug several times a day, take the missed dose when you remember, then continue with your regular schedule.

Interactions with other medication

Because lithium can change the effect of other medication, or may be affected by other medication, always check with your doctor or pharmacist before taking other drugs, including over-the-counter medication such as cold remedies. Always inform any doctor any doctor or dentist that you see that you are taking lithium.

Precautions

  1. Do not increase or decrease your dose without consulting your doctor.
  2. This drug may impair the mental and physical abilities and reaction time required for driving a car or operating other machinery. Avoid activities if you feel drowsy or slowed down.
  3. Do not stop your drug suddenly as this may result in withdrawal symptoms such as anxiety, irritability and emotional liability.
  4. Report any changes in mood or behavior to your physician.
  5. It is important to drink 8-12 cups of fluids daily ( e. g., water , juice, milk, broth, etc.)
  6. Do not change your salt intake during your treatment, without first speaking to your doctor ( e. g., avoid no-salt or low-salt diets).
  7. If you have the flu, especially if vomiting or diarrhea occur, check with your doctor regarding your lithium dose.
  8. Use extra care in hot weather and during activities that cause you to sweat heavily (e. g., hot baths, saunas, exercising). The loss of too much water and salt from your body may lead to changes in the level of lithium in your body.
  9. Tablets or capsules of lithium should be swallowed whole; do not crush them.
  10. Store your medication in a clean, dry area at room temperature. Keep all medication out of the reach of children. 

If you have any questions regarding this medication, do not hesitate to contact your doctor, pharmacist, or nurse

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Medical Specialists

Cognition Enhancers

Psychiatry

Cognition Enhancers

PATIENT INFORMATION ON COGNITION ENHANCERS

The name of your medication is- Donepezil hydrochloride

Use

Cognition enhancers primarily used in the symptomatic treatment of mild to moderate Alzheimer’s disease, dementia. 

How quickly will the drug start working?

Improvement in concentration and attention is noted is noted over a period of several weeks. Because these drugs take time to work do not decrease or increase the dose without discussing this with the doctor.

How does the doctor decide on the dosage?

The drug is started at a low dose to minimize the chance of side effects. The dose can be increased after several weeks if minimal improvement is seen. The dose of the drug tacarine is determined by the results of tests of liver function, which the physician performs on a regular basis.

How long should you take this medication?

Cognition enhancers are usually prescribed for a period several years.

Side effects

Side effects occur, to some degree, with all medication. They are usually not serious and do not occur in all individuals. They may sometimes occur before beneficial effects of the medication are noticed. If a side effect continues, speak to your doctor about appropriate treatment. 

Common side effects that should be reported to your at the next appointment include:

 

  • Energizing/ agitated feeling, excitability-Some individuals may feel nervous or have difficulty sleeping for a few days after starting this medication. If you are taking the medication in the evening, the physician may decided to prescribe it earlier in the day.
  • Headache-This tends to be temporary and can be managed by taking analgesics (aspirin, acetaminophen, paracetamol ) when required.
  • Nausea, vomiting, heartburn-If this happens, take the medication with food or milk.
  • Diarrhea or constipation, flatulence.
  • Loss of appetite, weight loss- Taking the medication after meals, eating smaller meals more frequently or drinking high calorie drinks may help.
  • Muscle aches or cramps-Can be managed by taking analgesics when required.
  • Nasal congestion.
  • Hot flushes.

Rare side effects you should report to your doctor IMMEDIATELY include:

  • Yellow tinge in the eyes or to the skin; dark-colored urine
  • Soreness of the mouth, gums, or throat
  • Skin rash or itching, swelling of the face
  • Nausea, vomiting, loss of appetite, lethargy, weakness, fever, or flu-like symptoms
  • Severe agitation or restless

What should you do if you forget to take a dose of your medication?

If you take your total dose of the drug in the morning and you forget to take it for more than 6 hours, skip the missed dose and continue with your schedule the next day. DO NOT DOUBLE THE DOSE. If you take the drug several times a day, take the missed dose when you remember, then continue with your regular schedule.

Interactions with other medication

Because these drugs can change the effect of other medication, or may be affected by other medication, always check with your doctor or pharmacist before taking other drugs, including over-the-counter medication such as cold remedies. Always inform any doctor or dentist that you see that you are taking a cognition enhancer.

Precautions

  1. Do not increase or decrease your dose without consulting your doctor
  2. Report to your doctor any changes in sleeping or eating habits or changes in mood or behavior.
  3. Do not stop your drug suddenly as this may result in changes in behavior and/or concentration.
  4. This drug may interact with medication prescribed by your dentist, so let him/her know the name of the drug you are taking.
  5. Store your medication in a clean, dry area at room temperature. Keep all medication out of the reach of children.

If you have any questions regarding this medication, do not hesitate to contact your doctor, pharmacist, or nurse

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Psychostimulants

Psychiatry

Psychostimulants

PATIENT INFORMATION ON PSYCHOSTIMULANTS

The name of your medication is methylphenidate

Use

Psycho stimulants are primarily used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children and adults. These drugs are also approved for use in Parkinson’s Disease and Narcolepsy (a sleeping disorder). Though they are currently not approved for this indication, psycho stimulants have been found useful in the treatment of refractory depression.

How quickly will the drug start working?

Some response to psycho stimulants is usually noted within the first week of treatment of ADHD and tends to increase over the next 3 weeks.

How does the doctor decide on the dosage?

Psycho stimulants come in various preparations including short-acting and slow release forms. The dose is based on the body weight and is usually given several times a day. Take the drug exactly as prescribed; do not increase or decrease the dose without speaking to your doctor.

How long should you take this medication?

Psycho stimulants are usually prescribed for a period of several years. Some clinicians may decide to prescribe “ drug holidays” to individuals on this medication, I. e., the drug is not taken at certain times (e. g., week-ends, vacations, etc.).

Side effects

Side effects occur, to some degree, with all medication. They are usually not serious and do not occur in all individuals. They may sometimes occur before beneficial effects of the medication are noticed. If a side effect continues, speak to your doctor about appropriate treatment.

Common side effects that should be reported to your doctor at the next appointment include:

  • Energizing/agitated feeling , excitability-Some individuals may feel nervous or have difficulty sleeping for a few days after starting this medication. If you are taking the medication in the evening, the physician may decided to prescribe it earlier in the day.
  • Increased heart rate and blood pressure-Speak to your doctor.
  • Headache-This tends to be temporary and can be managed by taking analgesics (aspirin, acetaminophen) when required. Blood pressure should be checked.
  • Nausea or heartburn- If this happens, take medication with food or milk.
  • Dry mouth-Sour candy and sugarless gum help increase saliva in your mouth; try to avoid sweet, calorie-laden beverages. Drink water and brush your teeth regularly.
  • Loss of appetite, weight loss-Taking the medication after meals, eating smaller meals more frequently or drinking high calorie drinks may help.
  • Blurred vision-This usually occurs at the start of treatment and may last 1-2 weeks. Reading under a bright light or at a distance may help; a magnifying glass can be of temporary use. If the problem continues, advise your doctor.
  • Mild hair loss-Inform your doctor.

Rare side effects you should report to your doctor IMMEDIATELY include:

  • Muscle twitches, tics or movement problems
  • Fast or irregular heart beat
  • Persistent throbbing headache
  • Soreness of the mouth, gums, or throat
  • Skin rash or itching, swelling of the face
  • Any unusual bruising or bleeding, appearance of splotchy purplish darkening of the skin
  • Nausea, vomiting, loss of appetite, lethargy, weakness, fever, or flu-like symptoms
  • Yellow tinge in the eyes or to the skin; dark-colored urine
  • Severe agitation or restlessness
  • A switch in mood to an unusual state of happiness or irritability; fluctuations in mood

Let your doctor know as soon possible if you miss your period or suspect you may be pregnant.

What should you do if you forget to take a dose of your medication?

If you take the psycho stimulant 2-3 times a day forget to take a dose by more than 4 hours, skip the missed dose and continue with your regular schedule. DO NOT DOUBLE THE DOSE.

Interactions with other medication

Because psycho stimulants can change the effect of other medication, or may be affected by other medication, always check with your doctor or pharmacist before taking other drugs, including over-the-counter medication such as cold remedies. Always inform any doctor or dentist that you see that you are taking a psycho stimulant drug. 

Precautions

  1. Do not increase or decrease your dose without consulting your doctor.
  2. Do not chew or crush the tablets or capsules.
  3. Use caution while driving or performing tasks requiring alertness as these drugs can mask symptoms of fatigue and impair concentration.
  4. Report to your doctor any changes in sleeping or eating habits or changes in mood or behavior.
  5. Do not stop your drug suddenly as this may result in withdrawal symptoms such as insomnia and changes in mood and behavior.
  6. This drug may interact with medication prescribed by your dentist, so let him/her know the name of the drug you are taking.
  7. Store your medication in a clean, dry area at room temperature. Keep all medication out of the reach of children.

If you have any questions regarding this medication, do not hesitate to contact your doctor, pharmacist, or nurse

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