Miscarriage

A miscarriage is the loss of a baby before the 20th week of pregnancy.

More than 80% of miscarriages occur within the first three months of pregnancy. They are less likely to occur after 20 weeks’ gestation; if they do, they are called late miscarriages.

What Are the Symptoms of Miscarriage?

Symptoms of a miscarriage include:

  • Bleeding that progresses from light to heavy
  • Cramps
  • Abdominal pain
  • Fever
  • Passing of tissue

If you’re pregnant and experience the symptoms listed above, contact your obstetric health care provider.

What Causes Miscarriage?

The causes of miscarriage are not well understood. Most of the miscarriages that occur in the first trimester of pregnancy are caused by chromosomal abnormalities in the baby.

Miscarriages are also caused by a variety of other factors, including:

  • Infection
  • Exposure to environmental and workplace hazards, such as high levels of radiation or toxic agents
  • Hormonal problems
  • Uterine abnormalities
  • Incompetent cervix (the cervix begins to widen and open too early, in the middle of pregnancy, without signs of pain or labor)
  • Lifestyle factors, such as smoking, drinking alcohol, or using illegal drugs
  • Disorders of the immune system, including lupus
  • Severe kidney disease
  • Congenital heart disease
  • Diabetes that is not controlled
  • Thyroid disease
  • Radiation
  • Certain medications, such as the acne drug Accutane
  • Severe malnutrition.

How Is a Miscarriage Treated?

Your doctor will perform a pelvic exam and an ultrasound test to confirm the miscarriage. If the miscarriage is complete and the uterus is clear, then no further treatment is usually required.

If a miscarriage was not confirmed, but you had symptoms of a miscarriage,bed rest is often prescribed for several days, and you may be admitted to the hospital overnight for observation.

Blood tests, genetic tests, or medication may be necessary if a woman has more than two miscarriages in a row (called repeated miscarriage). Some diagnostic procedures used to evaluate the cause of repeated miscarriage include:

  • Endometrial biopsy
  • Hysterosalpingogram
  • Hysteroscopy
  • Laparoscopy

How Do I Know if I Had a Miscarriage?

Spotting and mild discomfort are common symptoms after a miscarriage. If you have heavy bleeding, fever, chills or pain, contact your health care provider . These may be signs of an infection.

Can I Get Pregnant Following a Miscarriage?

Yes. At least 85% of women who have miscarriages have subsequent normal pregnancies and births. Having a miscarriage does not necessarily mean you have a fertility problem. On the other hand, about 1%-2% of women may have repeated miscarriages (three or more). Some researchers believe this is related to an autoimmune response.

If you’ve had two miscarriages in a row, you should stop trying to conceive, use a form of birth control and ask your doctor to perform diagnostic tests to determine the cause of the miscarriages.

When Can I Try to Get Pregnant After a Miscarriage?

Discuss the timing of your next pregnancy with your doctor. Some doctors recommend waiting a certain amount of time (from one menstrual cycle to 3 months) before tying to conceive again. To prevent another miscarriage, your doctor may recommend treatment with progesterone, a hormone needed for implantation in the uterus.

Taking time to heal both physically and emotionally after a miscarriage is important. Above all, don’t blame yourself for the miscarriage. Counseling is available to help you cope with your loss. Pregnancy loss support groups may also be a valuable resource to you and your partner. Ask your doctor for more information about these resources.

Can a Miscarriage Be Prevented?

Usually a miscarriage cannot be prevented and often occurs because the pregnancy is not normal. However, if the problem is related to the woman’s cervix, such as an incompetent cervix, surgical treatments may helpful.

 

Menstrual Problem

What Are Menstrual Problems?

Menstrual cycles often bring about a wide array of uncomfortable symptoms leading up to your period. Premenstrual syndrome (PMS) encompasses the most common issues, such as mild cramping and fatigue, but the symptoms usually go away when your period begins.

However, other, more serious menstrual problems may also arise. Menstruation that is too heavy or light, or a complete absence of a cycle, all signal issues that can contribute to an abnormal menstrual cycle. It is important to stay in tune with your body and call your doctor right away if you notice any significant changes to your menstrual cycle.

Premenstrual Syndrome

PMS occurs one to two weeks before your period begins. Some women experience a range of physical and emotional symptoms. Others experience few symptoms or none at all. PMS can cause:

  • bloating
  • backaches
  • headaches
  • breast soreness
  • acne
  • food cravings
  • excessive fatigue
  • depression
  • anxiety
  • feelings of stress
  • insomnia
  • constipation
  • diarrhea
  • mild stomach cramps

You may experience different symptoms every month, and the severity of these symptoms can also vary. PMS is uncomfortable, but it is generally not worrisome unless it interferes with your normal activities.

Heavy Periods

Another common menstrual problem is a heavy period. Also called menorrhagia, heavy periods cause you to bleed more than normal. You may also have your period for longer than the average of five to seven days.

Menorrhagia is mostly caused by imbalances in hormone levels, especially progesterone and estrogen. Other causes of heavy or irregular menstrual bleeding include:

  • puberty
  • vaginal infections
  • inflammation of the cervix
  • underactive thyroid gland (hypothyroidism)
  • noncancerous uterus tumors (fibroids)
  • changes in diet or exercise

Absent Periods

In some cases, women may not get their periods. Amenorrhea occurs when you don’t get your period by the time you reach the age of 16. This may be caused by an issue with the pituitary gland, a congenital defect of the female reproductive system, or a delay in puberty.

Another common problem with teens is secondary amenorrhea. This occurs when you start your cycle, but it suddenly stops for three months or more.

Common causes of amenorrhea and secondary amenorrhea include:

  • anorexia
  • overactive thyroid gland (hyperthyroidism)
  • ovarian cysts
  • sudden weight gain or loss
  • stopping birth control
  • pregnancy

The causes of a lack of periods differ in adults. These may include:

  • premature ovarian failure
  • pelvic inflammatory disease (a reproductive infection)
  • pregnancy
  • breastfeeding
  • menopause

A missed period could mean you’re pregnant. If you suspect you could be pregnant, be sure to take a pregnancy test. Drugstore pregnancy tests are the least expensive way to determine whether you are pregnant. To get the most accurate results, wait until you have missed your period by at least one day before taking the test.

Painful Periods

Not only can your period be lighter or heavier than normal, but it can also be painful. Cramps are normal during PMS, and they also occur when your uterus contracts as your period begins. However, some women experience excruciating pain. Also called dysmenorrhea, extremely painful menstruation is likely linked to an underlying medical problem, such as:

  • fibroids
  • pelvic inflammatory disease
  • abnormal tissue growth outside of the uterus (endometriosis)

Diagnosing Menstrual Problems

The first step in diagnosing menstrual problems is to see your doctor for a pelvic exam. Your doctor can tell if your vagina or cervix is inflamed at this time. A Pap smear will also be performed to rule out the possibility of cancer or other underlying conditions.

Blood tests can help determine whether hormonal imbalances are causing your menstrual problems. If you suspect that you may be pregnant, your doctor or nurse practitioner will perform a blood or urine pregnancy test during your visit.

Treating Menstrual Problems

The type of treatment your doctor recommends depends on what’s causing problems with your menstrual cycle. Birth control pills can help relieve symptoms of PMS as well as regulate heavy flows. If a heavier or lighter than normal flow is related to a thyroid or other hormonal disorder, you may experience more regularity once you start hormone replacements.

Dysmenorrhea may be hormone-related, but you may also require further medical treatment to address the problem. For example, antibiotics are used to treat pelvic inflammatory disease.

 

Menopause

Menopause is defined as occurring 12 months after your last menstrual period and marks the end of menstrual cycles. Menopause can happen in your 40s or 50s.

Menopause is a natural biological process. Although it also ends fertility, you can stay healthy, vital and sexual. Some women feel relieved because they no longer need to worry about pregnancy.

Don’t hesitate to seek treatment for symptoms that bother you. Many effective treatments are available, from lifestyle adjustments to hormone therapy.

Symptoms

In the months or years leading up to menopause (perimenopause), you might experience these signs and symptoms:

  • Irregular periods
  • Vaginal dryness
  • Hot flashes
  • Night sweats
  • Sleep problems
  • Mood changes
  • Weight gain and slowed metabolism
  • Thinning hair and dry skin
  • Loss of breast fullness

When to see a doctor

Starting at perimenopause, schedule regular visits with your doctor for preventive health care and any medical concerns. Continue getting these appointments during and after menopause.

Preventive health care can include recommended screenings at menopause, such as a colonoscopy, mammography, lipid screening, thyroid testing if suggested by your history, and breast and pelvic exams.

Always seek medical advice if you have bleeding from your vagina after menopause.

Causes

  • Natural decline of reproductive hormones
  • Hysterectomy
  • Chemotherapy and radiation therapy
  • Primary ovarian insufficiency

Complications

  • Heart and blood vessel (cardiovascular) disease
  • Osteoporosis
  • Urinary incontinence
  • Sexual function
  • Weight gain

Tests and diagnosis

Tests typically aren’t needed to diagnose menopause. But under certain circumstances, your doctor may recommend blood tests to check your level of:

  • Follicle-stimulating hormone (FSH) and estrogen (estradiol), because your FSH levels increase and estradiol levels decrease as menopause occurs
  • Thyroid-stimulating hormone (TSH), because an underactive thyroid (hypothyroidism) can cause symptoms similar to those of menopause

Treatments and drugs

Menopause requires no medical treatment. Instead, treatments focus on relieving your signs and symptoms and preventing or managing chronic conditions that may occur with aging. Treatments may include:

  • Hormone therapy
  • Vaginal estrogen
  • Low-dose antidepressants
  • Gabapentin
  • Medications to prevent or treat osteoporosis

 

High Risk Pegnancy

What is a high-risk pregnancy?

A high-risk pregnancy is one that threatens the health or life of the mother or her fetus.

For most women, early and regular prenatal care promotes a healthy pregnancy and delivery without complications. But some women are at an increased risk for complications even before they get pregnant for a variety of reasons.

Risk factors for a high-risk pregnancy can include:

  • Existing health conditions, such as high blood pressure, diabetes, or being HIV-positive.
  • Overweight and obesity. Obesity increases the risk for high blood pressure, preeclampsia, gestational diabetes, stillbirth, neural tube defects, and cesarean delivery. Obesity can raise infants’ risk of heart problems at birth by 15%.
  • Multiple births. The risk of complications is higher in women carrying more than one fetus (twins and higher-order multiples). Common complications include preeclampsia, premature labor, and preterm birth. More than half of all twins and as many as 93% of triplets are born at less than 37 weeks’ gestation.
  • Young or old maternal age. Pregnancy in teens and women aged 35 or over increases the risk for preeclampsia and gestational high blood pressure.

Women with high-risk pregnancies should receive care from a special team of health care providers to ensure that their pregnancies are healthy and that they can carry their infant or infants to term.

 

Uterine (endometrial) Cancer

(Also Called ‘Endometrial Adenocarcinoma’)

What is endometrial cancer?

Endometrial cancer, or cancer of the endometrium, is a cancer that develops in the inner lining of the uterus (womb). This lining is called the endometrium. Cancer is the uncontrolled growth of cells that invade and cause damage to surrounding tissue.

What are the risk factors for endometrial cancer?

Some risk factors include:

  • Obesity(being very overweight) .
  • History of not being able to become pregnant or having never given birth – Women who have not been pregnant have a higher risk due to increased exposure to estrogen.
  • Use of tamoxifen – This drug, which is used to treat women with breast cancer, acts like estrogen in the uterus and can increase the risk of endometrial cancer.
  • Estrogen replacement therapy (ERT)- This therapy, involving the use of female hormone estrogen to offset the effects of menopause, can increase endometrial cancer risk if progesterone is not used to protect against precancerous changes in the endometrium.
  • Ovarian diseases – Women who have certain ovarian tumors have higher than normal estrogen levels and lower levels of progestins. The increase in estrogen compared to progestins can increase a woman’s chance of getting endometrial cancer.
  • A diet high in animal fat – A high-fat diet can increase the risk of several cancers, including endometrial cancer.
  • Diabetes – Diabetes has been linked to weight, but some studies suggest that diabetes by itself could be a risk factor for endometrial cancer.
  • Age – As females get older, the likelihood of endometrial cancer increases. Most endometrial cancers occur in women age 50 or older.
  • Early menstruation – If monthly periods begin before age 12, the risk for this cancer might increase as the uterus might be exposed to estrogen for more years.
  • Late menopause – If menopause occurs after age 50, the risk for this cancer might increase as the uterus might be exposed to estrogen for more years.
  • Family history – Endometrial cancer risk is increased some families who are also at risk to develop a certain type of colon cancer.
  • Earlier pelvic radiation therapy – Radiation used to treat some other cancers can damage the DNA of cells, increasing the risk of a second type of cancer.

What are the symptoms of endometrial cancer?

The following symptoms might occur with endometrial cancer or other conditions:

  • Vaginal bleeding between normal periods in pre-menopausal women
  • Vaginal bleeding or spotting in post-menopausal women, even a small amount
  • Lower abdominal pain or pelvic cramping
  • Thin white or clear discharge in post-menopausal women
  • Extremely long, heavy or frequent vaginal bleeding episodes in women over 40

How is endometrial cancer diagnosed?

  • Endometrial biopsy.
  • Transvaginal ultrasound or sonography.
  • Dilation and curettage.
  • Testing of endometrial tissue – Endometrial tissue samples removed by biopsy or D & C are examined under the microscope to determine whether cancer is present.
  • CT or CAT scan (also called computed tomography, computerized tomography, or computerized axial tomography) .
  • MRI (also called magnetic resonance imaging).
  • CA-125 assay .

How is endometrial cancer treated?

Surgery is the main treatment for most women with endometrial cancer, although radiation therapy, hormone therapy, and chemotherapy are other tools that may be used depending upon the stage and the specific type of endometrial cancer cell found. In certain situations, a combination of treatments might be used. The choice of treatment or treatments will depend on the type and stage of the cancer and the overall medical condition of the patient.

Can endometrial cancer be prevented?

Most cases of endometrial cancer cannot be prevented, but women can take some measures to reduce their risk of developing endometrial cancer. Risks might be reduced with:

  • Using oral contraceptives
  • Controlling obesity
  • Controlling diabetes

In addition, women who are considering estrogen replacement therapy should talk to their doctors to assess their risk of endometrial cancer.