• Rukmani Birla Hospital,Gopalpura Bypass Road, Near Triveni Bridge,Gopalpura,Jaipur – 302018.

Category Archives: Obstetrics and Gynaecology

PREGNANCY AFTER WEIGHT LOSS SURGERY – BENEFITS AND RISKS

Obesity is not only an undesirable condition but also a very unhealthy state, which if not managed, can cause a lot of health problems. Obesity is considered a disease of excess body fat, where the BMI of a person is more than 30. Obesity also has three levels:

  • Level 1: BMI level up to 35
  • Level 2: BMI level up to 40
  • Level 3: BMI level of 40 and above

While diet, exercise, lifestyle changes, and several other non-invasive methods including mediations fail to reduce the weight and the related health problems – the only resolution remains is that of a weight-loss surgery or medically known as bariatric surgery. Bariatric Surgery aims to reduce body fat by making changes in the digestive system of the body. In bariatric surgery, the doctor will modify the digestive system to limit the intake of food by making the stomach smaller; thus making one feel fuller even after a small meal. It may also involve making changes in the small intestines to limit the absorption of nutrients and calories from food.

Bariatric Surgery is the most sought after method in cases where diet and exercises have failed to produce results and obesity has been causing severe health complications such as:

  • High blood pressure
  • Heart problems
  • Chronic digestive disorders including GERD
  • Type 2 Diabetes
  • Stroke

Hence, weight loss surgeries have become a very sought-after medical procedure, especially for women; and most women who undergo bariatric surgery are in their reproductive ages. Hence, it becomes very critical to evaluate the effect of weight loss surgery on pregnancy. In general, weight-loss surgery aims to resolve the problem of obesity – which is one of the major causes of infertility in women. Therefore, in a consensus, a pregnancy after weight-loss surgery is healthy and safe, provided it managed well. It is fit for both the baby and the mother as compared to pregnancy in obese woman. That said, some of the significant benefits and risks involved should be known so that women can make an informed choice.

Benefits of pregnancy after a weight-loss surgery

  • Prevents women from gestational diabetes
  • Minimizes risk of preeclampsia – a condition that raises the blood pressure and causes damage to organs post 20 weeks of pregnancy
  • Enhances fertility – improves polycystic ovary syndrome, anovulation, irregular menses, etc.
  • Resolves hormonal imbalances
  • Improved neonatal outcomes
  • Normal breastfeeding
  • Improves hypertension

Risks of pregnancy after a weight-loss surgery

While the dangers of a pregnancy post a bariatric surgery vary from case-to-case; yet some general hazards that have been observed in women include:

  • Risk of the baby being deprived of essential nutrients such as protein, iron, folate, calcium, Vitamin B12 and D
  • Low birth weight
  • Acute gastrointestinal problems during pregnancy, such as nausea, vomiting, abdominal pain, bleeding, etc.
  • Abdominal cramping and bloating
  • Risk of Hyperinsulinemia and hypo-glycemia leading to tachycardia, palpitations, anxiety, etc.
  • Risk of malabsorption
  • Increased chances of a caesarean delivery
  • Anaemia
  • Preeclampsia
  • Chances of stillbirth
  • Fetal neural tube defects
  • Intestinal obstruction/hernia
  • Gastric ulcers
  • Band/staple line complications
  • Higher chances of premature birth
  • Higher chances of congenital anomalies
  • Miscarriage (rare cases)
  • Impair foetal development
  • Foetal and neonatal complications

That said, weight loss surgery post-pregnancy is a highly risky pregnancy with many potential complications that may arise during pregnancy. Hence, detailed considerations must be taken into account and also all conditions should be thoroughly discussed with the doctor, before going ahead with the pregnancy.

However, women who conceive post a weight loss surgery can mostly manage with pre-emptive attention, care and regular guidance. Some of the necessary steps that must be undertaken to ensure a healthy pregnancy for both the mother and child – post a weight loss surgery are:

  • Pregnancy should only be considered if the weight stabilizes post a weight loss surgery. Typically weight supports in approximately 12 to 24 months after surgery. This prevents the foetus from being adversely affected by dramatic weight loss
  • Regular monitoring of the baby’s growth and health should be undertaken. Foetal ultrasound during the third trimester is advised to assess growth.
  • Closer surveillance of the maternal weight and nutritional status of the pregnant woman should be undertaken.
  • During the lactation period, regular assessments every three months, are recommended in women after bariatric surgery
  • Nutritional supplements – such as folic acid, vitamin B-12, vitamin D, iron and calcium – as advised by the doctor based on the type of weight-loss surgery and specific nutritional needs, should not be missed.
  • In case no deficiencies are noted, a full blood count along with measurement of iron, ferritin, calcium, and vitamin D levels should be conducted every trimester of the pregnancy.
  • Glucose level of the mother should be consistently monitored, especially for women who have undergone restrictive/malabsorptive surgery.
  • Oral drug administration must be cautiously watched in women who have undergone a gastric bypass surgery
  • Extreme caution must be taken while consuming non-steroidal anti-inflammatory drugs during postpartum to avoid gastric ulceration.

In all, the risks outweigh the benefits of a pregnancy post a weight loss surgery. However, there have been many successful cases with no complications. Also, as per research and evidence, pregnancy post a weight-loss surgery is healthier for the baby and mother, as compared to a pregnancy complicated by obesity. Yet, all cases must be individually evaluated and discussed with the specialized medical practitioner before making a final decision.

AMENORRHEA TYPES, CAUSES, AND TREATMENT

Amenorrhea is a condition in women that implies the absence of menstrual periods during the reproductive age – after puberty and before menopause. Amenorrhea is a not a disease though it is a health disorder that might have serious complications and must be treated with care. That said, it does not necessarily indicate infertility in women. Generally, women menstruate once a month beginning from the age of 13-14 years and continuing until 50 years of age – when women experience menopause. Also, during conditions such as pregnancy and breastfeeding, menstruation stops temporarily. Still, in other cases, when women do not get their periods for a specific time – the condition is referred to as Amenorrhea.

Types of Amenorrhea

There are two basic types of amenorrhea, namely:

Primary Amenorrhea: This condition occurs when a woman does not start having periods during puberty, i.e., if the periods do not begin by the age of 16 years, medical help should be taken. 

Secondary Amenorrhea: This condition occurs when a woman has periods, but then they cease to occur. However, the condition is normal during pregnancy and breastfeeding, but when it occurs irrespective of these two factors, it is referred to as secondary amenorrhea. A woman who has secondary amenorrhea, used to have regular periods but then does not have any period for 3 months or in other cases, used to have irregular periods but then does not have any for 6 months or more. 

Symptoms of Amenorrhea

The main symptom of amenorrhea is the absence of menstrual periods; however, other symptoms apart from this are:

  • Milky discharge from nipples
  • Headache
  • Excessive hair on the face
  • Pelvic pain
  • Acne
  • Changes in breast size
  • Weight Gain

In the case of primary amenorrhea, the woman can also experience lack of breast development.

Causes of Amenorrhea

Some of the underlying causes of amenorrhea are:

Natural Amenorrhea: Conditions such as pregnancy, breastfeeding and menopause cause natural amenorrhea.

Contraceptives: Women who take contraceptives may suffer from amenorrhea, even afterdiscontinuing of the birth control pills, it may some time for regular ovulation and menstruation to return.

Medications: Certain medicines, including antipsychotics, cancer chemotherapy, anti-depressants, blood pressure drugs, etc. – can cause periods to stop.

Lifestyle Factors: Lifestyle factors such asbelow hamper the regular periods:

  • Low body weight: Extremely low body weight disrupts hormonal functioning and problems in ovulation, leading to amenorrhea.
  • Excessive exercise: Low body fat, stress and high usage of energy by athletes and sportswoman make them more prone to amenorrhea. More so, rigorous training activities such as ballet also can cause amenorrhea.
  • Stress: Stress can alter the normal menstrual cycle by disturbing the hormones in the brain that regulate the menstrual cycle.
  • Depression: Depression can alter hormonal functioning, causing amenorrhea.
  • Poor Nutrition: Lack of adequate nutrition in the body can cause severe deficiencies resulting in menstrual problems.
  • Place and Weather change may also cause Amenorrhea.

Hormonal and Medical Problems: Some hormonal disturbances and medical issues can also cause amenorrhea, such as:

  • Polycystic ovary syndrome (PCOS): This problem causes high and sustained levels of hormones as compared to fluctuating hormonal level that is needed for regular periods.
  • Thyroid malfunction: An overactive and underactive thyroid gland causes menstrual irregularities.
  • Pituitary tumour: A benign tumour in the pituitary gland can cause hormonal imbalances leading to irregular menstrual cycles.
  • Premature menopause: Some women experience menopause before the age of 50 due to the diminishing ovarian supply of eggs.
  • High Prolactin hormone level also can cause amenorrhea.

Structural Problems

Some issues with sexual organs can also lead to amenorrhea, such as:

  • Uterine scarring: Scarring on the line of the uterus due to factors such as caesarean delivery, D&C and treatment of uterine fibroids, etc.prevents regular build-up and flaking of the uterine lining.
  • Absence of reproductive organs: Absence or improper development of reproductive organs since birth can cause menstrual problems.
  • Vaginal structural abnormality: Structural abnormality such as a membrane wall that blocks the outflow of blood, can lead to menstrual issues.

Risk Factors of Amenorrhea

Certain factors may increase the risk of amenorrhea in some women, such as:

  • Family history
  • Eating disorders
  • Rigorous and consistent physical exertion/training

Complications of Amenorrhea

Some problems that may arise because of amenorrhea include:

  • Infertility: Absence of menstrual cycles implies no pregnancy
  • Osteoporosis: Absence of menstrual cycles can lead to the weakening of bones, called osteoporosis.

Treatment of Amenorrhea

The basic treatment of amenorrhea depends on the underlying problem causing the condition. Some common treatment options include – medications, surgery, lifestyle changes, or all of these. Lifestyle changes include:

  • Maintaining a healthy weight
  • Controlled exercise
  • Reduction of stress
  • Eating a healthy diet

Surgery may be done to remove scar tissues in the uterus, cure genetic defects and eliminate the noncancerous pituitary tumour. Medications may be advised to control thyroid issues, premature ovary failure, and other hormonal issues etc.

That said, amenorrhea can be treated or managed if medical care is received timely; however, some cases might be beyond treatment and can suffer from related complications.

PMDD (PREMENSTRUAL DYSPHORIC DISORDER) EPIDEMIOLOGY AND TREATMENT

Premenstrual dysphoric disorder – PMDD, is a severe form of premenstrual syndrome that causes mood disorders due to hormonal changes, leading to multiple psychological symptoms around the time of the monthly menstruation cycle. This is a more severe and disabling form of PMS – Premenstrual syndrome and can occur anytime during the reproductive age of a woman, though it is expected to occur at the age of 26 years. PMDD causes heightened irritability, depression or anxiety in a week or more before the start of the period when the hormone levels start to fall post ovulation and continue even after two days of the start of the period. PMDD can cause such serious symptoms that could disrupt normal life and strain relationships. 

Symptoms of PMDD

PMDD can be categorised based on emotional and physical symptoms such as below:

Emotional symptoms include

  • Extreme anxiety
  • Severe agitation and nervousness
  • Crying outbursts
  • Losing control
  • Memory problems
  • Loss of interest in life and relationships
  • Irritability
  • Mood swings
  • Panic attacks
  • Paranoia
  • Sadness
  • Hopelessness
  • Depression
  • Suicidal thoughts

Physical symptoms include

  • Acne
  • Chronic backache
  • Bloating
  • Swollen and tender breasts
  • Gastrointestinal issues
  • Abdominal cramps
  • Light-headedness
  • Nausea
  • Headache
  • Heart palpitations
  • Fluctuations of appetite
  • Extreme joint or muscle pain
  • Muscle spasms
  • Pain during periods
  • Reduced desire to have sex
  • Lack of energy
  • Trouble in focusing
  • Trouble in sleeping
  • Paranoia and issues with self-image
  • Backache
  • Vision problems
  • Reduced libido
  • Easy bruising
  • Increased sensitivity

These symptoms, especially emotional factors, cause a huge problem in everyday life, work, relationships, health, etc. Moreover, these symptoms tend to fade on their own at the start of the period and begin upon the next ovulation cycle.

Causes of PMDD

Though the exact cause PMDD is not known yet, it is attributed to the shifting hormone levels during the menstrual cycle and before. Some women are more sensitive to the changing levels of estrogen and progesterone and tend to experience symptoms of PMDD.

Risk Factors of PMDD

Certain factors increase the risk of women experiencing PMDD, such as:

  • Environmental: Environmental factors such as stress, surroundings, personal trauma, as well as seasonal fluctuations, tend to affect premenstrual dysphoric disorder.
  • Genetics: Family history or genes play an important role in the premenstrual dysphoric disorder.
  • Oral contraceptives: Women who take oral contraceptives are known to have lesser premenstrual dysphoric disorders.

Diagnosis of PMDD

Apart from understanding the symptoms of PMDD, the doctor will conduct a physical exam, understand medical history, and also analyse risk factors, including family history. That said, the symptoms must correlate with the menstrual cycle for a minimum of two consecutive cycles to consider it as a case of PMDD. Moreover, the symptoms of PMDD:

  • Must last till the beginning of menses
  • Fade out on their own within the first few days of the period
  • Interfere with the normal functioning of life

Treatment of PMDD

Though there is no set treatment to cure PMDD completely, efforts are made to prevent or manage symptoms. Some of the treatment options include:

  • Antidepressants: Antidepressants, as suggested by the doctor, can reduce emotional symptoms, including fatigue, excessive hunger, and sleep problems.
  • Birth control pills: Regular birth control pills without any break or a short break, can greatly impact PMS and PMDD symptoms for women.
  • Nutritional supplements: Nutritional supplements for calcium, vitamin B, etc. can help with PMDD symptoms.
  • Diet and Lifestyle changes: Regular physical exercise, less caffeine, limited alcohol, no smoking, enough sleep, less stress, balanced relaxation, and other techniques such as meditation, yoga, warm bath, etc. can greatly impact PMDD symptoms. Moreover, keeping yourself hydrated, eating clean food, maintaining sugar levels, etc. also helps to treat PMDD.

A combination of two or more factors can be used to treat symptoms. Moreover, the effectiveness of the treatment also depends on the internal motivation of the person suffering from PMDD. Further, if non-invasive methods fail to manage symptoms of PMDD, the doctors might suggest surgery as an option to cure PMDD. The surgery will involve removing the ovaries to relieve the symptoms; though it will cause women to stop ovulating and also experience menopause that might bring along different symptoms. However, surgery is a very critical and complex decision, one which must be made after careful consideration and only if all other methods of treatment have failed and the situation is worsening with time.

UNDERSTAND PREMENSTRUAL SYNDROME (PMS)

Premenstrual syndrome (PMS) is a condition involving physical and emotional symptoms that women usually experience in a week or two before the menstrual period. These symptoms affect emotional and physical health, as well as the behaviour of women during the menstrual cycle – before the beginning of the period.

PMS is a very common condition and affects more than 90 per cent of women who menstruate. The symptoms of PMS last for 10 days and eventually fade out at the start of the period. Symptoms also tend to recur in set patterns; however, the intensity of the symptoms depends on person-to-person – from non-significant to intense. However, PMS can easily be managed provided one understands the reasons for it, the types of PMS, causes, risks, and treatment options.

Symptoms of Premenstrual Syndrome (PMS)

Almost all women experience one or more symptom of PMS in a month before menses. However, the type of symptom and the intensity varies from person-to-person. In many cases, women do not experience any PMS symptoms and carry on with their normal life. That said, some of the general symptoms that might indicate PMS are:

Physical symptoms of PMS include:

  • Swelling or tenderness in breasts
  • Unexplained weight gain
  • Abdominal bloating
  • Menstrual cramps
  • Digestive issues – constipation or diarrhoea
  • Headache
  • Fatigue
  • Nausea
  • Oily skin
  • Acne or any other breakout
  • Alcohol intolerance

Some psychological symptoms of PMS include:

  • Low mood
  • Anger
  • Unexplained irritability
  • Depression
  • Sadness
  • Anxiety
  • Stress
  • Sleeping problems
  • Difficulty in concentrating
  • Appetite changes such as increased food cravings
  • Mood swings
  • Decrease in libido
  • Crying sessions
  • Social withdrawal

Moreover, women with health conditions such as diabetes, depression, or inflammatory bowel disease will experience worsened health during PMS. 

Causes of Premenstrual Syndrome (PMS)

The exact cause or reason that triggers PMS in women is unknown; however, certain factors that contribute towards the problem are:

  • Changes in hormones: Hormonal fluctuations such as a decrease in estrogen and an increase in progesterone cause PMS symptoms in women.
  • Chemical changes in the brain: Changes in certain chemicals such as serotonin, responsible for mood swings, can trigger PMS. Lack of serotonin in the right amount can cause food cravings, depression, sleep issues, etc. before the periods.
  • Depression: Women suffering from depression experience worsened PMS conditions. In many women, depression is not diagnosed yet and hence, PMS continues to trouble.

Risk Factors of Premenstrual Syndrome (PMS)

Certain conditions or factors make some women more prone to experience PMS than others. These factors include, but are not limited to:

  • Smoking
  • Excessive stress
  • Lack of physical exercise
  • Lack of enough sleep
  • Excessive alcohol
  • Increased intake of sodium, red meat or sugar

Treatment of Premenstrual Syndrome (PMS)

The type of symptoms and the intensity of PMS symptoms vary by each woman and hence, there is no specific treatment, though the symptoms of PMS can easily be managed through dietary changes, lifestyle changes, self-care, medications, etc. Some of the general treatment methods include:

Medication

Over-the-counter medicines and prescribed drugs by doctors can help relived PMS symptoms such as menstrual cramps, headache, nausea, fatigue, digestive issues, abdominal bloating, and others. Pain killers, non-steroidal anti-inflammatory drugs, as well as diuretics, help to manage symptoms.

In case of severe PMS cases, birth control pills may be suggested to control the fluctuating hormonal levels of estrogen and progesterone in the body.

Calming Techniques and Therapies

Emotional and some of the physical PMS syndrome can also be easily managed through calming techniques and therapies that work to relax the body. Women can involve themselves in hobbies or undertake meditation and breathing exercises to relax the body. Moreover, other methods that can work wonders to manage symptoms of PMS include:

  • Yoga
  • Physical workout
  • Stretching
  • Taking a bath
  • Walking in nature
  • Listening to songs
  • Writing
  • Sharing feelings with friends or family
  • Aromatherapy
  • Counselling

Controlled Physical Exercise

Exercising regularly helps to balance hormonal fluctuations of estrogen and progesterone in the body. The controlled physical movements increase these hormonal levels and reduce PMS symptoms such as nausea, constipation, diarrhoea, swollen breasts, bloating, increased appetite, etc.

Relieve Bloating

Abdominal bloating is a very disturbing symptom of PMS and can be easily managed through some quick and easy home remedies and steps such as:

  • Reducing the intake of salt to avoid water retention
  • Eating foods such as bananas that are rich in potassium
  • Drinking a lot of fluids
  • Engaging in light exercises

Ease Menstrual Cramps

Home remedies work wonders to ease menstrual cramps that cause a lot of pain. Remedies such as applying heat to the abdomen, engaging in light physical exercise, massaging, as well as applying essential oils can help reduce the pain and cramps.

Changes in diet

Changes in diet, such as increased intake of nutritional food and focus more on healthy food items, can effectively help manage symptoms of PMS. Some nutrients that must be included in the diet are:

  • Magnesium: Obtained through green leafy vegetables such as kale, spinach, etc.
  • Fatty acids: Sources such as fish, nuts, green leafy vegetables, etc. help to reduce abdominal cramps.
  • Calcium: Apart from bone strength, calcium helps to ease sleep disorders, regulate mood swings and also balance food cravings.

Apart from these – folic acid, Vitamin B, etc. also really help to manage PMS symptoms.

In all, PMS is common in women of all reproductive ages and has varied symptoms depending per case; however, it is possible to manage PMS by controlling symptoms through effective methods.

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