Frequently Asked Questions

Polycystic ovary syndrome (PCOS) is a condition where the ovaries develop more follicles than normal every month, but unlike in a normal woman, these follicles do not release eggs. It is estimated that between 22% and 33% of women have polycystic ovaries. This is commonly associated with infertility. The treatment of this condition involves some lifestyle changes like weight control and exercise, and medication depending on the severity of your symptoms and also whether you want to have children or not. Metformin, as in your case, is sometimes used by specialists as a treatment for infertility in women with PCOS, although the evidence that it really works is contradictory and it has some unpleasant side-effects, such as nausea and vomiting. If you are overweight, it is very important to lose weight before trying fertility drugs. Even a modest weight loss can help your insulin levels get nearer to normal and get ovulation going again, if it has stopped. Surgery is also helpful in some women if they do not respond to fertility drugs. A technique called laparoscopic ovarian drilling (LOD) is used to destroy the tissue on the ovaries that is producing testosterone. The effects are often temporary, but LOD can improve the hormone imbalance and the ovulation cycle long enough for the woman to conceive. The advantage of this procedure is that it does not increase the risk of multiple pregnancy, unlike many other infertility treatments. Please approach an infertility expert for further treatment plans or any change in medication, since the best treatment approach can be taken only after a thorough clinical and laboratory examination of both you and your husband.

How is the discharge? Is it watery or like mucous? Does it have any bad smell? Is there any associated bleeding? It is normal to have some amount of discharge during the later weeks of pregnancy. The discharge could also be urine, due to the pressure of the enlarging uterus on the urinary bladder. This tends to happen in the later stages of pregnancy. It could be serious if it is amniotic fluid due to any rupture of the water bags. This normally happens as a gush of fluid, but nevertheless, it can initially start off as trickling of small quantities of fluids. This needs immediate medical attention. If the discharge has foul smell and you have any associated itching or burning sensation in the vaginal area, it might be due to a fungal infection. You might also need to get yourself checked for any urinary infection.

It is normal to have some amount of discharge during the later weeks of pregnancy. Do you have any associated itching or burning sensation in the vaginal area? There is a possibility that it might be due to a fungal infection. You might also need to get yourself checked for any urinary infection. How is the discharge? Is it watery or like mucous? Is there any bleeding from your vagina? You said that the discharge is associated with some smell? Is this a foul smell or does it smell like urine? The discharge could also be urine, due to the pressure of the enlarging uterus on the urinary bladder. This tends to happen in the later stages of pregnancy. I would suggest that you speak to your gynecologist and have her check you, as a clinical examination is essential before commenting on why you are having this problem.

Irregular menstruation can be due to several medical conditions like prolactinomas (tumor of the anterior pituitary gland), thyrotoxicosis, hormonal changes in perimenopause, and Graves’ disease. In women who involve in endurance exercises such as running or swimming, menstrual cycles can be infrequent. The degree of menstrual abnormality is directly proportional to the intensity of the exercise. Eating disorders like over-eating or under-eating can also result in oligomenorrhea. You have not mentioned your age. If you are in the menopausal age group that is above 45 years, this is a normal pattern, before your periods stop. But, if you are in the child-bearing age group, do have yourself checked by a gynecologist to rule out any other associated problems. If there are no problems, then you do not have to worry.

Pimples, just like those on the face, could appear anywhere else in the body including the vaginal region. These are pus filled, just look a pimple on the face. Pimples in the vaginal region could also be genital warts, due to sexually transmitted infections, like Human Papilloma Virus infection. These appear like small cauliflowers, which are dry, and do not contain any liquid in them. I suggest that you see a gynecologist to find out the exact cause and get treated appropriately.

Adenomeiosis is a condition where the tissue that normally lines the uterus (endometrium) grows within the muscular walls of the uterus. This usually happens late in the childbearing years. Why adenomeiosis occurs remains unknown, but it typically disappears after menopause. In some women, adenomeiosis causes no signs or symptoms or can cause only mild discomfort. But in others, it may cause symptoms like heavy or prolonged menstrual bleeding, severe cramping or sharp pelvic pain during menstruation (dysmenorrhea), menstrual cramps throughout the period, which worsens as one gets older, painful intercourse, intermenstrual bleeding and passage of clots during periods. There may be an increase in the uterus size to 2–3 times its normal size. For women who experience severe discomfort from adenomeiosis, treatment can help reduce the symptoms, but hysterectomy is the only cure. Since this condition resolves after menopause, treatment depends on your age. The various treatment options are:  Anti-inflammatory drugs  Hormone therapy  Hysterectomy

There are several medications for relieving symptoms of premenstrual syndrome. The success of these medications varies from woman to woman. Some of the commonly prescribed medications:  Exercise and limit salt intake: These help to reduce the weight gain, swelling and bloating associated with PMS.  Nonsteroidal anti-inflammatory drugs (NSAIDs): Some drugs can reduce cramps and breast discomfort, and are taken before or at the onset of your period.  Diuretics: When exercise and limiting salt do not help, taking diuretics, or water pills, can help your body shed excess water through your kidneys.  Antidepressants: These drugs help to reduce symptoms such as fatigue, food cravings and sleep problems and are the first-line agents for treatment of severe PMS. In women with PMS, antidepressants are given for 2 weeks before menstruation begins.  Oral contraceptives: These medications stop ovulation and stabilize hormonal swings, and thus offer relief from PMS symptoms.  Medroxyprogesterone acetate: In severe PMS, this injection can be used to temporarily stop ovulation. However, it may cause an increase in some signs and symptoms of PMS, like increased appetite, weight gain, headache and depressed mood.

Oligomenorrhea or infrequent periods usually occurs in women with polycystic ovary syndrome (PCOS). PCOS is a condition in which the ovaries become filled with small cysts. Women with PCOS have slightly higher levels of male hormones, called androgens. Oligomenorrhea can also be caused by emotional and physical stress, chronic illnesses, tumors that secrete estrogen, poor nutrition, thyroid problems and eating disorders such as anorexia nervosa. Female athletes develop oligomenorrhea many a time because of their strict diets and intense physical activity. Oligomenorrhea can be caused by a hormonal imbalance. I would suggest that you see a gynaecologist, who would do a complete examination and also get some lab tests done if required to find out the cause for your infrequent periods. Based on the findings, she or he would be able to suggest the correct treatment modality to you.

Your cycles are normal as long as your periods are regular and you do not have either scanty/excess bleeding, you should not worry. Breast tenderness and engorgement can occur during menstruation. Many women suffer from this problem. This typically starts a few days before your menstrual cycles and goes away within the first couple of days of period. You could try the following for symptomatic relief: • Wear support bras. • Reduce intake of caffeine. • Try over-the-counter pain relievers. • Some women benefit from supplements such as vitamin E, primrose oil, or flaxseed oil. If the pain is very severe and you are not able to tolerate it, then you could seek the advice of a gynecologist.

Vaginal discharge that is excessive, or of abnormal color or with odor, is an indication of underlying abnormality. Small amounts of vaginal discharge are normal and do not affect your daily routine. Discharge that stains your underwear so that you have to change it frequently, foul-smelling discharge, or discharge that is associated with itching are all indications of an underlying problem. These can include infection with candida and/or a few microorganisms, which may also include those that cause sexually transmitted infections. If the color of the discharge is grayish, yellowish, greenish, or brownish, you will need to consult with your gynecologist to have it evaluated and will most probably need to go on antibiotics. Fungal infections need treatment with both oral and locally applied antifungal agents. Effects depend on the cause, but if the problem is caused due to an infection, treatment is essential to prevent chronic problems such as infertility. You can avoid infecting your partner by asking him to use a condom or using a female condom yourself. Take care to avoid any chemical substances in the vagina to avoid aggravating the problem.

It appears that the vaginal discharge you have is abnormal. This is because you have noted irritation in the form of itching in the vagina. Small amounts of vaginal discharge are normal and do not affect your daily routine. Discharge that stains your underwear so that you have to change it frequently, foul-smelling discharge, or discharge that is associated with itching are all indications of an underlying problem. These can include infection with candida and/or a few microorganisms, which may also include those that cause sexually transmitted infections. If the color of the discharge is grayish, yellowish, greenish, or brownish, you will need to consult with your gynecologist to have it evaluated and will most probably need to go on antibiotics.

If you have not had your periods at all in the past 4 months, you will need to take pregnancy test to rule out pregnancy. If your periods have become irregular, but you still have them, you will need to have your thyroid hormone levels tested. This is because the menstrual cycle is regulated by several hormones and some aspect of this mechanism is regulated by thyroid hormones. A decrease in the level of circulating thyroid hormones will result in changes such as weight gain, cold intolerance, hoarseness of voice, swelling in feet, inability to feel emotions fully, menstrual irregularity, etc. In women, hypothyroidism is more common due to increased stress and due to other physiological functions that also take a toll. If diagnosed with hypothyroidism, you will be treated with tablets that are supplements of the hormone. In the meantime, it would be ideal if you could focus on improving your diet with essential micronutrients and proteins while developing a physical fitness routine for yourself.

You will need to have yourself evaluated by a gynecologist thoroughly. The first step to increasing your chances for conception is regularizing your monthly cycle. This can be done by medical therapy that will regularize the hormone secretion and action in your body. Once this has been done, your doctor can put you on medicines that will enhance your chances of ovulation, and therefore, conception. You will then need to have intercourse in the fertile period of your cycle so that the released egg is fertilized. For guidance on what medications may be best for you, you will first need to tell us what medications you are on currently. Ensure that you keep your diet balanced and start yourself on supplements that contain the requisite daily allowance for calcium, iron and folic acid, if these micronutrients are not a constant part of your diet.

Menopause is a time in a woman’s life when her periods stop permanently. It marks the end of her reproductive period. Menopause happens when ovaries stop producing the hormones—estrogen and progesterone which regulates menstruation. Menopause usually occurs most often after age 45. But, some women can experience menopause early, either as a result of a surgical intervention, such as hysterectomy, or damage to the ovaries, such as from chemotherapy. Some of the symptoms associated with menopause are: • Irregular or skipped periods • Hot flashes and/or night sweats • Insomnia • Depression and mood swings • Vaginal dryness • Headaches • Changes in libido (sex drive) Menopause is not a disorder. Most women do not need treatment for it. However, if symptoms are severe, medicines may help. After menopause, women are more vulnerable to osteoporosis (brittle bone) and heart disease. Exercise and eating the right diet can help keep women healthy as they age.

As you might have seen, there is a subsection “Reproductive health”, which has many articles that discuss in details various aspects regarding female reproductive health and gynecological problems. You can access the information in this link: http://indianwomenshealth.com/Your-Reproductive-Health-61.aspx We are positive that the website will give you abundant information about gynecological issues and address your need. However, do keep us posted on any further doubts you have in this regard or you have any specific query to be answered. You could also get in touch with the Chairperson of the Expert Panel behind the site, Dr. Kamini Rao at the following address: Bangalore Assisted Conception Centre No: 6/7, Kumarakrupa Road, High Grounds, Bangalore - 560 001, India.

Brown discharge immediately following menstruation, for a day or two, can be considered normal. However, discharge continuing beyond 1 or 2 days needs to be evaluated by a specialist doctor. You will also need to specify the onset of any other symptoms such as cramps or passing of clots to further evaluate the condition. Your gynecologist will ask you to undergo an ultrasound scan which will give a good idea about the state of the uterus and surrounding structures. Further treatment or investigations will then be determined based on these findings. In the meantime, ensure that you consume a balanced diet and plenty of fluids. Also incorporate a regular exercise routine in your lifestyle.

Polycystic ovarian disease is associated with a series of symptoms and related illnesses. This disease usually presents with abdominal pain, weight gain, irregular periods, etc. The presence of PCOD is also an indicator for developing impaired glucose metabolism and this can cause a diabetic state. Bigomet is metformin, which is not a hormone, but is a medicine used in the treatment of diabetes. It is used in women with PCOD as it has been shown to enhance ovulation and can thus increase fertility. In addition, it also causes some amount of weight loss. Homeopathy is based on the principle of imitating a disease's symptoms through medicines and is relatively safe as it uses highly diluted medicines. However, you may want to consider consulting a gynecologist for further guidance and treament with other fertility-enhancing medicines as required.