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Well Women (Gynaecologic Services)

Gynaecology is the medical practice dealing with the female health and its reproductive systems (vagina, uterus and ovaries) and the breasts. It means "the science of women".
Here the consultation for all women health related problems is offered with evidence based treatment and women is also provided with the information which aims to help women make informed decisions about the treatment choices . The most common problems dealt are;

Heavy Bleeding

• Excessive menstrual bleeding affects one in five women. The amount of blood lost in each period in terms of the amount, length, and frequency of bleeding. A heavy period for one woman may be normal for another.

• Menstrual bleeding is defined as heavy (and call it menorrhagia) when periods last longer than seven days or more than 80ml of blood is lost during a period. However, the way that a woman perceives the heaviness of her period is as important as any clinical measurements.

Clots

When menstrual bleeding is heavy, clotting can also occur. Losing large clots can be extremely upsetting and even painful if they are large because they can cause cramping as they pass through the cervix.

What causes heavy bleeding?

• If your periods have changed, it's very important to see doctor.The doctor will investigate possible causes and offer the appropriate treatment.

• But in about half the women with heavy bleeding, no cause can be found.

• Some causes of heavy menstrual bleeding

o Fibroids - these benign (not cancerous) growths in the muscular wall of the uterus are a common cause of heavy bleeding.

o Polyps - these benign growths of the lining of the uterus may cause heavy bleeding but more commonly lead to spotting between or after periods.

o Pelvic inflammatory disease - an infection in the reproductive tract which can cause infertility and chronic pain if untreated.

o Endometriosis - a painful condition in which the lining of the uterus grows outside the uterus.

o Endometrial hyperplasia - thickening of the lining of the uterus, leading to heavier bleeding.

o Endometrial cancer - cancer of the lining of the uterus, causing heavy periods, bleeding between periods and blood-stained vaginal discharge. Rare, but more common in women after the menopause.

o Hormone Imbalances - can stop ovulation (egg release) leading to build-up of endometrium and heavier periods.

o Hypothyroidism - an underactive thyroid gland can cause heavier periods.

o Blood clotting disorders.

o Use of anticoagulant drugs. Unexplained - for half of all cases no cause can be found.

o Contraceptive coil (IUD) – multiload or copper T coil can cause heavier, longer periods.

• Millions of women in India suffer from the problem of heavy bleeding during their periods. This not only causes extreme inconvenience, discomfort, loss of work days and exclusion from religious activities but also severe weakness and anaemia.

• Many of these women in their 30’s and 40’s are suffering from dysfunctional uterine bleeding (DUB) where the womb (Uterus) is normal, yet they have heavy menses.

• Endometrial sampling may be suggested to rule out cancer or precancerous condition of uterine lining .

Treatment options for Heavy Bleeding:

• Medical science developments have made medicines which are having excellent results in management of heavy menses..

• A simple, non surgical method of treating heavy menses is to insert a hormonal intrauterine device (LNG _ IUD). This is a small shaped T ’device, which looks like a Copper T or loop but has hormone inside it. This can be placed inside the uterus in five minutes, usually without any anaesthesia and once inside the womb, it reduces or stops bleeding during menses for a period of 5 years in most of the patients. This also gives contraceptive benefit to women . This is a temporary method and the device can be removed at any time.

• This device is simple and safe and gives good results in well selected patients, though results may take time to reflect in terms of cyclic flow and pain.

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