Why Post-Menopausal Women Should Still Visit The Gynaecologist

Dr Radha Pandiyan, Consultant Gynaecologist

With the cessation of the monthly menstrual periods, there is a big sigh of relief and feeling of release from visiting the Gynaecologist.

But there could be many reasons why still you need to see her/ him again. Listed below are common reasons why you should visit them and get a periodic check-up done.

Blood spotting:

The most important symptom, which should not be neglected at all, is the reappearance of blood or spotting through the vaginal passage. Though there could be many innocent ( benign) reasons for it, it is mandatory to have a thorough gynaecologist check up to rule out the possibility of malignancy in the reproductive tract.

Also read: Thyroid and fertility- how are they related? 

Hormonal imbalance:

Another common cause for bleeding is the irregular use of hormones. Dryness of the vulval and vaginal tissues make them prone to injury and infection, which can also contribute to the bleeding. Rarely, forgotten intrauterine devices or foreign bodies like pessaries in the vagina may also cause bleeding.

Vagina/uterus descent:

Another common problem in this age group is the descent of vagina and or the uterus, due to the slackening of muscular and ligament supports. This is aggravated by a chronic cough and constipation, which are usually present in this age group.

Timely attention and correction of this problem give enormous relief from this misery. Frequent urinary symptoms and leak of urine during stress require combined gynaec and urological consultations. Hormone replacement therapy may also be required.

Due to the decline in female hormones, withdrawal of calcium from the bony tissues makes them soft and vulnerable for easy fractures with trivial falls. Along with calcium supplements, Hormone replacement therapy is required. In some,  increased hair growth is noticeable due to the dominant Androgens( male hormones).

Also read: Depression in post-menopausal women

Things to remember:

Regular dietary habits, good exercises and periodic visits to the doctor help a lot to maintain good health beyond menopause.

Mental Health & The Stigma Surrounding Us- Why It Needs To Change

Mental Illness- No! Not me!

This is the most frequent response we get when we talk to people about mental illness. This group of disorders, as frequent as hypertension or arthritis, just as or even less chronic than diabetes and as amenable to treatment as any other physical ailment has always been considered as the “other man’s problem” says Dr.R.Thara, Director, Schizophrenia Research Foundation SCARF.

Disorders of the mind are not just sequelae of the stress of the modern era. As early as around 1500 BC, description of insanity as ” unmada” was found in the Atharva Veda, the most ancient authentic Indian medical scripture. Ancient epics as Ramayana and Mahabharata describe several emotional states such as depression and the Bhagavad Gita is probably a classic example of “ crisis intervention psychotherapy”.


Despite all this, awareness and understanding of mental illnesses among the general public and even among the medical fraternity remains abysmally low. The stigma attached to them is great leading to delayed and incomplete treatment. It is also for this reason that religious and magical modes of treatment are being sought, very often leading to increasing severity of these illnesses.

When one talks of mental illness, thanks to the associaed stigma, it is often the picture of an ill clad, unkempt person on the streets who can be aggressive, violent or the giggly, incoherent woman, clinging to a doll as portrayed in films that comes to one’s mind. This is far from actual reality.

While severe mental disorders such as schizophrenia and manic-depressive disorders affect nearly 1% of the population, it is common mental disorders such as depression and anxiety, which are widely prevalent. It has been estimated that about 30% of patients who go to general physicians have some kind of emotional problems.

These are either responsible for the symptom itself or aggravate it. Chronic headaches, back aches, stomach problems, giddiness, vomiting, lack of sleep, poor appetite, menstrual irregularities, feelings of weakness and tiredness are some of the conditions that can be either caused or worsened by emotions disorders. It is essential for the treating physicians to be aware of this and for the family to be receptive to suggestions of seeking professional help to sort them out.

There is a large body of evidence that depression and anxiety are disabling conditions for a variety of reasons. It can lead to problems in attention and concentration, poor motivation, increased irritability, impaired judgement all of which can affect the completion of everyday tasks. The association between depression and women’s health should also be borne in mind. Puberty, pregnancy, childbirth, menopause can all be associated with increased emotional and psychological problems.

Also read: Depression in menopausal women is real- read about it

While on one hand, non-recognition of psychiatric problems is a concern, the increasing use of tranquillizers by general physicians is equally worrying. A WHO study reported that 10% of primary care attendees in a city in India were prescribed tranquillisers, a figure similar to that of European and North American centres. Another finding was the unnecessary use of tonics, often at the insistence of the patient or the family. It is absolutely imperative that we avoid a cocktail of medicines of little therapeutic value. Adjuvants such as yoga, meditation, physical exercise, relaxation and leisure activities should be actively considered.

The stigma associated with mental illness: 

Finally, a word about stigma. Fifteen years ago, leprosy was considered a dreaded disease. Today it is not so. We understand that it is caused by a pathogen and if treated early and adequately can be completely cured. The same holds good for mental disorders.

They are either due to some imbalance in the brain functioning or an inability of the individual to cope with stress or both. If diagnosed early, many of them can be completely cured.

A positive healthy family and social environment will go a LONG WAY in ensuring a speedy recovery. A society, which is able to tolerate crime, violence, cheating fraud and corruption from so-called normal persons should well be able to understand the problems of a disturbed mind and come forward to accept them in its fold. The media should also be more responsible and stop portraying the mentally as comical, reprehensible or violent persons thereby reinforcing a negative stereotype.

What Senior Citizens Need To Know About Air Travel

The younger generation in most families have migrated in search of greener pastures and overseas air travel has become a must for the elderly in most families (whether they like it or not!) Here are a few suggestions to make air travel safe and smooth for them.

Health tips for senior citizens- click here.

Points to remember:

  • Carry enough of all of your medicines in your carry-on luggage. Ask your doctor whether you should change your dosages if your eating and sleeping times will change at your destination. Bring enough medicine to last your whole trip. Take extra medicine with you in case your return trip is delayed.
  • If you have diabetes or epilepsy, carry a notification and identification card. Have the name and phone number of your doctor with you in case of an emergency. Remember to bring along the names and dosages of all of your medicines.
  • Make sure you intake nonalcoholic, decaffeinated beverages and water during flight travel to avoid becoming dehydrated.

Tackling Jet lag:

  • Get adequate sleep before the travel.
  • Avoid drinking alcohol.
  • Eat well-balanced meals.
  • Avoid overeating.
  • Exercise as much as you can on your trip.
  • Use sleep medicines for only a few days.

Get used to a new time zone by going along with the local meal and bedtime schedules.

Are you a frequent air traveller? Here’s what you should know about DVT

elderly and air travel

Pain in the ears:

If your ears hurt when you fly, try taking a decongestant medicine before you get on the plane. You can also swallow often and chew gum during the flight. Babies can suck on bottles or pacifiers during the flight.

Even healthy people can get blood clots in their legs after long flights. Try to walk at small intervals during your flight (unless the crew tells you not to). It also helps to drink enough water, to stretch your calf muscles while you’re sitting and to wear support stockings.

If you have any other useful tip that you practise during your long distance flight, tell us in the comments below.

Pic courtesy: nytimes.com

Breast Cancer Awareness Special: Basic facts about Breast Cancer

The basics of cancer that everyone needs to be aware of.

By Professor G Sivakumar

Breast cancer is the most common type of cancer in women. Conservative, Orthodox Indian women are confused and have contrasting views about breast cancer. This global disease has good cure and survival if diagnosed and treated at the early stage.

In India, the incidence of breast cancer is increasing, with an estimated 80,000 new cases diagnosed annually. The incidence of breast cancer increased by approximately 50% in the last two decades. Much of this increase may be associated with greater urbanization and improved life expectancy.  In addition, age at puberty and pregnancy-related factors, such as parity, age at giving birth to the first baby, and number of children, are factors possibly related to breast cancer. The age of puberty is now around 10 to 12 years compared to 14 to 16 in the last century.

Etymology and history of cancer:

Few studies of diet and breast cancer in India have been published. Cancer has afflicted humans throughout recorded history. Cancers are not new to the then medical practitioners. Some of the earliest evidence of cancer is found among fossilized bone tumors, human mummies in ancient Egypt, and ancient manuscripts.

The origin of the word cancer is credited to the Greek physician Hippocrates (460-370 B.C.), considered the “Father of Medicine.” Hippocrates used the terms carcinos and carcinoma. In Greek these words refer to a crab, because of the finger-like spreading projections of the cancer resembling the shape of a crab.

Hippocrates believed that the body contained 4 humors (body fluids) – blood, phlegm, yellow bile, and black bile. A balance of these fluids resulted in a state of health.  An excess of black bile collecting in various body sites was thought to cause cancer. This theory of cancer remained unchallenged for over 1300 years.

Also read: What women need to know about breast cancer 

Tumours and carcinogens:

Cancer occurs when cells become abnormal and begin dividing and forming more cells without any control or order. A cancerous cell develops when it ceases to respond to growth-inhibiting signals and gains the ability to multiply uncontrollably. If the cells divide when new ones are not needed, they form a mass of excess tissue called a tumour. This tumour, in turn, can damage healthy tissue in its area.

Cancers have many different causes and sources. One of these sources is a group of chemicals called carcinogens. These carcinogens have been found in industrial pollutants, pesticides, and food additives. People who are exposed to these carcinogens through their occupation or other activities have been known to be more susceptible to cancer. The development of cancer also has been closely linked to heredity. Genetic factors are very significant in the development of breast cancer.

Statistics reveal that breast cancer is rapidly increasing in its incidence in India and it has overtaken cancer of the cervix. The ICMR’s recent data shows that breast cancer is the commonest cancer to affect Indian females in metropolitan cities. Breast cancer is a disease of the old age, the peak incidence is in the fifth and sixth decades. But in India the disease is seen a decade earlier, probably because of shorter longevity in Indian females.

Although breast cancer is known to affect women, it also can be equally devastating to men. Male breast cancer accounts for 1% of all diagnosed breast cancer. An interesting study shows that second generation of Indian migrant women become as vulnerable to breast cancer as their counterparts in the USA. Probably, environmental factors take time to bring about the required changes in the chromosomal level.

Case-control studies that compared non-vegetarian and vegetarian diets and alcohol and tobacco use in India have reported that vegetarians have a reduced risk of oral, oesophageal, and breast cancers. Vegetarian diets rely on pulses as a source of protein, and pulses have been significantly associated with reductions in cancer.

Surgical concepts have changed and big mutilating cancer surgeries are a thing of the past. A cancer diagnosis is by no means a death sentence; it is the necessary first step toward beginning treatment and regaining your health. Medical research has made remarkable advances in cancer care, and today, well over half of all people diagnosed with cancer are cured.

Also read: Role of monoclonal antibodies in cancer treatment 

While some forms of the disease are difficult to treat, modern therapies can significantly improve quality of life and may extend survival. The earlier your cancer is diagnosed and treatment begun, the better your chances of making a full recovery.An individual’s chance for recovery depends upon a number of factors such as, the stage of the cancer, the type of breast cancer, certain characteristics of the cancer cells, patient’s age and weight, menopausal status and overall state of health.

Elderly women after menopause survive breast cancer better than young women who have high hormonal activity. Mastectomy is restricted only to patients to whom breast conservation is not possible. Prior to the discovery of the drug Tamoxifen which is a hormone-blocking drug, ovaries were removed to achieve reduction of hormonal activity.

Surgical management of breast cancer is available today throughout our country and is not restricted to few centers. Adequate awareness about this global disease among women to detect painless lump is very essential. Examination by a doctor, mammogram screening and seeking surgical intervention at the earliest can help the patient to a very great extent.

Obesity & Weight Reduction in Children- The Healthy Way

By Consultant Dietitian, Dharini Krishnan

 Ideal weight for an adult depends on the person’s height, weight, age, the frame of the body and genetic makeup. An average adult of height 160 cms should weigh around 58 to 62 Kgs. Currently, in India, we are facing a problem where children are grossly obese and weight reduction is done the wrong way. The waist-hip ratio of adolescents is out of proportion. The reason for this is lack of exercise and wrong eating habits.

How to prevent your child’s risk of obesity? Find out.

Reasons for overweight starting from Infancy:

Pregnant women do not take care of themselves the right way. Most women are working and hence do not have time to eat a balanced meal. With the advent of nuclear families, women are alone and are not aware of how to handle themselves during pregnancy.

It is a new experience for them. Unfortunately today women depend on doctors for advice rather than taking advice from the elder women in the house. Doctors do not have the time to give the dietary advice to the women. Young mothers need a lot of moral support.

Women today due to lack of physical exercise at the home resort to gyms or swimming pools or squash courts to keep their body fit. Most women are worried about losing their fitness due to pregnancy and hence eat too little. This leads to the birth of small infants, and most often premature.
weight reduction in children

To make up for the growth, the infant is fed huge amounts of cereal and top feed. This leads to an increase in fat cells in the children. The total number of fat cells in the body is formed before the age of two. If at this age the fat cells are increased, whatever the adolescent does it would be difficult to reduce the excess weight at adolescence or at adulthood. Women should eat well between the 4th month and 8th month of pregnancy. This will assure proper growth of the infant. An average Indian child should be 6lbs to 7.5 lbs. at birth.

Reasons for pre-schoolers being overweight:

Working mothers often have to leave their two month or 3-month-old infants and go to work. These infants need constant care and are looked after by grandmothers or aayah’s or crèches. And in some cases, when the care isn’t given right, the infant is encouraged to crawl less, or walk less by putting the child in the stroller or play pen, or propped in front of the television. Hence the child’s physical activity is curbed at such a playpen.

 

Toddlers eat every three hours and need a variety in their dietary pattern. Invariably except for one or two meals, instant or fast foods are encouraged. These are rich in calories and fat.

This obese toddler turns out to be an obese school going child. His habits as regards eating patterns or exercise do not change. In fact the child starts demanding more and more junk foods and does less and less physical exercise. It requires a strict parent to give the right combination of foods so that the child grows into a healthy and active child.

How obesity influences weight reduction:

weight reduction in children

Once the child becomes an adolescent the craving “to look good” sets in. Boys want to look smart with a lot of muscle and girls want to be slim and beautiful. For these reasons, they resort to dieting. They pick up clues from the environment. Follow clues which they get through reading. The most commonly followed practices for weight reduction are as follows:

Crash Diets -do they help in weight reduction?

  • Only fruits for 20 or 25 days and then back to normal eating
  • Only protein foods no carbohydrates. Dhals, egg, milk and milk products.
  • Only vegetables other than root vegetables. In raw form or cooked form ( with very little oil),  or home made soups.

 Starving:

  • Living on fruits and fruit juices without sugar.
  • One piece of cheese or fresh vegetable salad are alternatives for one meal. The other meals are skipped.
  • Drinking some mixed juice which claims to contain all the micro-nutrients (vitamins and minerals). It contains some gel which fills the stomach.
  • Any of the above mentioned diets can be followed for a few weeks after which the children or adults get bored and resort to normal eating patterns.

 Side effects of Crash Dieting or Starving:

When the body looses weight and then regains weight there is more harm done to the body than help. The fat in the body does not get removed. Waxing and waning is a trauma for the body. One should follow a regular balanced diet, reduce weight and maintain  the correct weight.

The different types of rice and their benefits 

Tips for weight reduction:

  1. Eat at least two balanced meals per day. Balanced meal should have a main dish prepared form of rice, wheat, ragi(finger millet), bajra, corn etc. Vegetables and protein in the form of dal or non-vegetarian foods (in gravy form and only once a week).
  2. Snack in between with fresh fruits without added sweeteners.
  3. Vegetable salads without any dressings are good in betweens.
  4. Preference for non-vegetarians towards fish or chicken in boiled form. If used in gravy there should be no coconut in the preparation.
  5. Reduce oil in cooking.
  6. Roasted and boiled foods are preferred to baked foods.
  7. Fried foods should be use frugally.
  8. Fill up with thin butter milk, lime juice with salt.
  9. Drink a lot of water between meals.
  10. Sprouts and sundal will make good interesting snacks.
  11. Sprouts can be made interesting by adding onion, tomato, green chillies and lime juice.
  12. Follow a consistent exercise pattern such as 45 minutes walk, or 30 minute non-stop fast swim, or 1 hour work at the gym.