Overview

Uterine fibroids are common growths of the uterus. Uterine fibroids are not cancer, and they almost never turn into cancer. Fibroids vary in number and size. You can have a single fibroid or more than one and the size can be small or very large. They can make a person look pregnant.

Many people have uterine fibroids sometime during their lives. But you might not know you have them, because they often cause no symptoms. 

Symptoms

Many people who have uterine fibroids don't have any symptoms. In those who do, symptoms can be influenced by the location, size and number of fibroids.

The most common symptoms of uterine fibroids include:

• Heavy menstrual bleeding or painful periods.
• Longer or more frequent periods.
• Pelvic pressure or pain.
• Frequent urination or trouble urinating.
• Growing stomach area.
• Constipation.
• Pain in the stomach area or lower back, or pain during sex.

Rarely, a fibroid can cause sudden, serious pain when it outgrows its blood supply and starts to die.

Often, fibroids are grouped by their location. Intramural fibroids grow within the muscular wall of the uterus. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids form on the outside of the uterus.

See your health care provider if you have:

• Pelvic pain that doesn't go away.
• Heavy or painful periods that limit what you can do.
• Spotting or bleeding between periods.
• Trouble emptying your bladder.
• Ongoing tiredness and weakness, which can be symptoms of anemia, meaning a low level of red blood cells.

Causes

The exact cause of uterine fibroids isn't clear. But these factors may play roles:

• Gene changes. Many fibroids contain changes in genes that differ from those in typical uterine muscle cells.

Hormones. Estrogen and progesterone seem to help fibroids grow.Fibroids tend to shrink after menopause due to a drop in hormone levels.

• Other growth factors. Substances that help the body maintain tissues, such as insulin-like growth factor, may affect fibroid growth.
• Extracellular matrix (ECM). This material makes cells stick together, like mortar between bricks. ECM is increased in fibroids and makes them fibrous. ECM also stores growth factors and causes biologic changes in the cells themselves.

Research suggests that uterine fibroids may develop from a stem cell in the smooth muscular tissue of the uterus. A single cell divides over and over. In time it turns into a firm, rubbery mass distinct from nearby tissue.

Fibroids that form during pregnancy can shrink or go away after pregnancy, as the uterus goes back to its usual size.

Risk factors

There are few known risk factors for uterine fibroids, other than being a person of reproductive age. These include:

• Race. All females of reproductive age who  could develop fibroids. But Black people are more likely to have fibroids than are people of other racial groups. Black people have fibroids at younger ages than do white people. They're also likely to have more or larger fibroids, along with worse symptoms, than do white people.
• Family history. If your mother or sister had fibroids, you're at higher risk of getting them.
• Other factors. Starting your period before the age of 10; obesity; being low on vitamin D; having a diet higher in red meat and lower in green vegetables, fruit and dairy; and drinking alcohol, including beer, seem to raise your risk of getting fibroids.

Complications

Uterine fibroids often aren't dangerous. But they can cause pain, and they may lead to complications. These include a drop in red blood cells called anemia. That condition can cause fatigue from heavy blood loss. If you bleed heavily during your period, your doctor may tell you to take an iron supplement to prevent or help manage anemia. Sometimes, a person with anemia needs to receive blood from a donor, called a transfusion, due to blood loss.

Pregnancy and fibroids

Often, fibroids don't interfere with getting pregnant. But some fibroids — especially the submucosal kind — could cause infertility or pregnancy loss.

Fibroids also may raise the risk of certain pregnancy complications. These include:

• Placental abruption, when the organ that brings oxygen and nutrients to the baby, called the placenta, separates from the inner wall of the uterus.
• Fetal growth restriction, when an unborn baby doesn't grow as well as expected.
• Preterm delivery, when a baby is born too early, before the 37th week of pregnancy.

Prevention

Researchers continue to study the causes of fibroid tumors. More research is needed on how to prevent them, though. It might not be possible to prevent uterine fibroids. But only a small percentage of these tumors need treatment.

You might be able to lower your fibroid risk with healthy lifestyle changes. Try to stay at a healthy weight. Get regular exercise. And eat a balanced diet with plenty of fruits and vegetables.

Some research suggests that birth control pills or long-acting progestin-only contraceptives may lower the risk of fibroids. But using birth control pills before the age of 16 may be linked with a higher risk.

 

 

Down's syndorme

Introduction

Down syndrome (DS) is a genetic disorder caused by the presence of all or part of the third copy of chromosome 21. It is typically associated with physical growth delays, characteristic facial features, and mild to moderate intellectual disability. 

 

Manifestations and disabilities of Down syndrome 

Those with Down syndrome nearly always have physical and intellectual disabilities. As adults, their mental abilities are typically similar to those of an 8- or 9-year-old. They also typically have a poor immune function and generally reach developmental milestones at a later age. They have an increased risk of a number of other health problems, including congenital heart disease, leukemia, thyroid disorders, and mental illness. 

 

Physical characteristics 

People with Down syndrome may have some or all of these physical characteristics: a small chin, slanted eyes, poor muscle tone, a flat nasal bridge, a single crease of the palm, and a protruding tongue due to a small mouth and large tongue. Instability of the atlantoaxial joint occurs in about 20% and may lead to spinal cord injury in 1-2%. 

Growth in height is slower, resulting in adults who tend to have short stature—the average height for men is 154 cm (5 ft 1 in) and for women is 142 cm (4 ft 8 in). Individuals with Down syndrome are at increased risk for obesity as they age. 

Mental subnormality in Down syndrome 

Most individuals with Down syndrome have mild (IQ: 50-70) or moderate (IQ: 35-50) intellectual disability with some cases having severe (IQ: 20-35) difficulties. 

Many developmental milestones are delayed. 

Commonly, individuals with Down syndrome have better language understanding than the ability to speak. They typically do fairly well with social skills. 

Behavior problems are not generally as great an issue as in other syndromes associated with intellectual disability. While generally happy, symptoms of depression and anxiety may develop in early adulthood. 

 

Other manifestations 

Children and adults with Down syndrome are at increased risk of seizures Many (15%) who live 40 years or longer develop dementia of the Alzheimer's type. 

Hearing and vision disorders occur in more than half of people with Down syndrome. Even a mild degree of hearing loss can have negative consequences for speech, language understanding, and academics. 

The rate of congenital heart disease in newborns with Down syndrome is around 40%. 

Cancers of the blood are 10 to 15 times more common in children with Down syndrome. 

Low thyroid hormone levels occur in almost half of all individuals with Down syndrome. This is treatable with oral thyroxine. Constipation also occurs in nearly half of people with Down syndrome and may result in changes in behavior. 

Males with Down syndrome usually do not father children, while females have lower rates of fertility relative to those who are unaffected. 

 

Screening 

Guidelines recommend screening for Down syndrome to be offered to all pregnant women, regardless of age. If screening is positive, invasive tests like amniocentesis or chorionic villous sampling are required to confirm the diagnosis. Screening in both the first and second trimesters is better than just screening in the first trimester. 

Several blood markers can be measured to predict the risk of Down syndrome during the first or second trimester along with ultrasound results. 

The diagnosis can often be suspected based on the child's physical appearance at birth. An analysis of the child's chromosomes is needed to confirm the diagnosis, and to determine if a translocation is present, as this may help determine the risk of the child's parents having further children with Down syndrome. 

 

Management 

Efforts such as early childhood intervention, screening for common problems, medical treatment where indicated, a good family environment, and work-related training can improve the development of children with Down syndrome. Education and proper care can improve the quality of life. Typical childhood vaccinations are recommended. 

Health screening 

Hearing at 6 months, 12 months, then yearly and in adults every 3-5 years 

Thyroid test at 6 months, then yearly 

Eyes at 6 months, then yearly 

Dental check-up at 2 years, then yearly 

Neck X-rays - Between 3 and 5 years of age 

Heart - electrocardiogram and ultrasound of the heart at birth. 

Surgical repair of heart problems may be required as early as three months of age. 

Cognitive development 

Hearing aids or other amplification devices can be useful for language learning in those with hearing loss. Speech therapy may be useful and is recommended to be started around 9 months of age. As those with Down's typically have good hand-eye coordination, learning sign language may be possible. Education programs before reaching school age may be useful. School-age children with Down syndrome may benefit from inclusive education (whereby students of differing abilities are placed in classes with their peers of the same age), provided some adjustments are made to the curriculum. 

 

Outlook 

Although many Down syndrome children have physical and mental limitations, they can live independent and productive lives well into adulthood. The level of intellectual disability varies but is usually moderate. Adults with Down syndrome have an increased risk of dementia. 

Severe heart problems or certain types of leukemia can cause early death in patients with Down syndrome. 

 

Prevention 

A woman's risk of having a child with Down syndrome increases as she gets older. The risk is significantly higher among women age 35 and older. Hence, all pregnant women, especially those older than 35 years should be screened for Down syndrome in the baby. 

Couples who already have a baby with Down syndrome have an increased risk of having another baby with the condition and need genetic counseling. Tests can be done on a fetus during the first few months of pregnancy to check for Down syndrome.

 

 

Infertility is the inability to conceive after one year of regular, unprotected intercourse (or six months for women over 35). It affects many couples worldwide, with both men and women potentially contributing to the causes. Here’s a comprehensive look at infertility, including causes, types, diagnosis, and treatment options.

 

Types of Infertility

 

1. Primary Infertility: When a couple has never been able to conceive.

 

2. Secondary Infertility: When a couple has had at least one previous successful pregnancy but is now unable to conceive.

 

Causes of Infertility

 

Female Infertility

 

1. Ovulation Disorders: Issues with ovulation account for about 25% of female infertility cases.

• Common causes include polycystic ovary syndrome (PCOS), hypothalamic dysfunction, premature ovarian failure, and hyperprolactinemia.

 

2. Fallopian Tube Damage or Blockage: Blocked or damaged fallopian tubes prevent sperm from reaching the egg or block the fertilized egg from reaching the uterus.

• Often caused by pelvic inflammatory disease (PID), endometriosis, or past surgeries.

 

3. Endometriosis: A condition where tissue similar to the uterine lining grows outside the uterus, causing inflammation, scarring, and interference with egg release and implantation.

 

4. Uterine or Cervical Abnormalities: Conditions like uterine fibroids, polyps, and structural abnormalities can impact fertility. Cervical mucus abnormalities may also prevent sperm from passing through the cervix.

 

5. Age: Women’s fertility naturally declines with age, especially after 35, due to decreased egg quality and quantity.

 

6. Hormonal Imbalances: Thyroid disorders (hypothyroidism or hyperthyroidism) and other hormonal issues can affect the menstrual cycle and ovulation.

 

7. Lifestyle Factors: Factors like stress, excessive exercise, being underweight or overweight, smoking, alcohol consumption, and poor nutrition can all contribute to infertility.

 

Male Infertility

 

1. Low Sperm Production: Issues like low sperm count, poor sperm motility, or abnormal sperm shape can impact fertility.

• Causes include genetic factors, hormonal imbalances, infections, varicocele (enlargement of veins in the scrotum), and exposure to environmental toxins.

 

2. Ejaculation Issues: Problems such as retrograde ejaculation, where semen enters the bladder instead of exiting through the penis, can hinder conception.

 

3. Lifestyle Factors: Smoking, alcohol, drug use, stress, obesity, and certain medications can negatively impact sperm production and quality.

 

4. Environmental Factors: Exposure to pesticides, heavy metals, radiation, and other environmental toxins can impair sperm health.

 

Diagnosis of Infertility

 

1. Medical History and Physical Exam: A doctor will review both partners’ medical history, lifestyle factors, and any symptoms.

 

2. Ovulation Testing: Blood tests measure hormone levels to confirm ovulation.

 

3. Hysterosalpingography (HSG): An X-ray of the uterus and fallopian tubes to check for blockages or abnormalities.

 

4. Ovarian Reserve Testing: Tests to assess the quantity and quality of eggs, especially in women over 35.

 

5. Hormone Testing: Blood tests for hormones like FSH, LH, estrogen, and testosterone to identify potential issues.

 

6. Semen Analysis: Analyzes sperm count, motility, morphology, and other factors in male partners.

 

7. Imaging: Ultrasounds or laparoscopy may be used to diagnose conditions like fibroids, endometriosis, or blocked tubes.

 

Treatment Options

 

1. Medications:

• Clomiphene Citrate (Clomid) / Letrozole: Stimulates ovulation. 

• Gonadotropins: Hormone injections that stimulate the ovaries to produce multiple eggs.

• Metformin: Used in women with PCOS to improve insulin sensitivity and ovulation.

 

2. Surgical Procedures:

• Laparoscopic Surgery: To treat endometriosis, remove fibroids, or open blocked fallopian tubes.

• Varicocelectomy: Surgery to correct varicoceles in men, which may improve sperm quality.

 

3. Intrauterine Insemination (IUI):

• Sperm is placed directly into the uterus around the time of ovulation. This method is often used for mild male infertility, cervical issues, or unexplained infertility.

 

4. In Vitro Fertilization (IVF):

• Eggs are retrieved and fertilized with sperm in a lab, and then the embryo(s) are implanted into the uterus. IVF is commonly used for blocked tubes, severe male infertility, or after other methods fail.

 

5. Intracytoplasmic Sperm Injection (ICSI):

• A single sperm is injected directly into an egg during IVF, used in cases of severe male infertility.

 

6. Lifestyle and Behavioral Changes:

• Recommendations for diet, exercise, stress management, quitting smoking, and limiting alcohol intake can improve fertility.

 

7. Third-Party Reproduction:

• Options like donor eggs, donor sperm, or surrogacy can be considered when needed.

 

Coping with Infertility

 

Infertility can be emotionally challenging, and many people benefit from counseling, support groups, or therapy. Partner communication and understanding can also play a crucial role in coping with the stress and emotional impact of fertility treatments.

 

Understanding the causes and options for treatment can help those facing infertility make informed decisions and explore available support and resources.

 

 

FAQs

Q Is infertility just a woman’s problem?
No, infertility is not only due to female factors. Both women and men can have problems that cause infertility. About one-third of infertility cases are caused by female factors. Another one third of infertility problems are due to male factors. The other cases arecaused by a combination of male and female factors or by unexplained problems.

 

Q What factors increase a woman’s risk of infertility?

Female age – we know that after the age of 35, the chances of falling pregnant naturally start to decline exponentially and egg quality decreases substantially. Smoking and excessive alcohol use can have a negative impact by damaging the egg quality.

Lifestyle factors such as stress, poor diet and excessive athletic training can increase the chances of infertility.

Being overweight or underweight, as this will affect ovulation.

 

Q How does age affect a woman’s ability to have children?
Due to many women waiting until their 30s and 40s to have children today, we are seeing an increased number of patients who require assistance to fall pregnant. Science has well established that aging decreases a woman’s chances of having a baby due to the following reasons:

Egg quality decreases with age (at age 40, 3 in every 4 eggs will be abnormal, despite regularovulation).

Egg reserve gets less with age.

Miscarriages are more likely due to increased DNA damage, leading to abnormal eggs.

 

Endometriosis

What is Endometriosis?

Endometriosis is a condition where tissue similar to the lining of the womb (endometrium) is found outside the womb. About 1 out of 10 women of childbearing age may have endometriosis and symptoms typically present between the ages of 25 and 40.

Endometriosis tissue are responsive to hormones produced by the ovary. When the lining of the womb thickens and grows each month and breaks down as a period in response to the ovarian hormones, endometriosis tissue does the same and this cause accumulation of blood and inflammatory material near the endometriosis tissue.  Endometriosis is not a malignant disease (not cancerous), and disappears after menopause.

 

What Causes Endometriosis?

The exact cause of endometriosis is not known. There are many theories that includes, backflow of tissue shed with menses in to the pelvis through the fallopian tubes (retrograde menstruation); or a genetic cause because in some women it is found in other close relatives (mother, aunts, daughters etc.).

 

What are the symptoms?

Some women who have endometriosis have no symptoms; however common symptoms include:

Pain before the period starts

Pain during periods (dysmenorrhoea)

Pain during intercourse (dyspareunia)

Heavy periods (menorrhagia)

Infertility – difficulty getting pregnant

Uncommon symptoms include pain when bowels have opened, pain in the lower

abdomen when passing urine and blood in the urine or faeces. Very rarely, patches of endometriosis can occur in other sites of the body. This can cause unusual pains in various parts of the body that occur at the same time as period pains.

 

How is Endometriosis Diagnosed?

There are no blood tests used in the clinic to diagnose endometriosis.

Ultrasound scans and MRI scans can suggest a diagnosis of particular types of endometriosis, such as endometriosis cysts in the ovaries or severe endometriosis involving bowels, but may not always diagnose the common form of mild endometriosis.

Definite diagnosis of endometriosis can be made by examining the pelvis during surgery (usually laparoscopy or key hole surgery), when the spots/patches/ ovarian cysts made by endometriosis tissues are seen and can be biopsied and tested in the lab.

Active areas of endometriosis can be seen as red vesicles (blisters), or blue spots where altered blood collected in these and white or brown patches represent older or inactive endometriosis. Extensive adhesions, lumps of endometriosis tissue (nodules) and endometrioma (endometriosis cysts on the ovaries) can also be seen during a laparoscopy surgery carried out to diagnose the disease.

 

How does Endometriosis Progress?

The natural cause of endometriosis is currently unknown. The available limited evidence from research studies suggest that untreated endometriosis may get better in 3 out of 10 women; becomes worse in 3 out of 10 women; whilst remain unchanged in the remaining women without treatment.

At present there are no curative treatment for endometriosis or associated symptoms, and when offering treatments to women with endometriosis, doctors cannot predict who are likely to have their endometriosis worsened if untreated. Even with treatment,

endometriosis can recur, but some women with severe untreated endometriosis may be at risk of complications such as obstruction or blockage of the ureter (the tube between the kidney and bladder). These issues need to be considered when choosing the treatment options.

 

Why & How is Endometriosis Staged?

The amount of the endometriosis tissue present in the pelvis is usually described by doctors in a certain way to standardise their assessment for doctors and patients to consider surgical treatment and other treatment options. Many doctors use the classification provided by the American Society for Reproductive Medicine to assess the severity and extent of the disease. This system gives points based on where the endometriosis tissue is and how deep beneath the surface they extends to, so it can assist in staging the extent of endometriosis.

How is Endometriosis Treated?

There is no known cure for endometriosis; the aim of the treatment is to manage and improve the symptoms associated with the condition. This can be done medically and / or surgically. There are some lifestyle changes that may also help to alleviate symptoms.

 

Medical Treatment

Medical treatment is simulating the hormonal background of either pregnancy or menopause, because symptoms associated with endometriosis, settle during those times. The available treatments are;

The combined oral contraceptive pill (OCP) or progestogen only pill (POP) (to mimic pregnancy). These treatments will reduce the number of menses so will reduce the pain and symptoms associated with endometriosis.

Gonadotrophin releasing hormones (GNRH)(to mimic menopause) this treatment is usually given for 6 months, during which you won’t have periods. Endometriosis tissue is expected to dry out when you are on treatment. The menopause symptoms that some women experience can be reduced by using a low dose hormone replacement therapy – or add-back as necessary (although this is a hormone based treatment is does not reduce the efficiency of the medication). This treatment offers temporary relief but some women experience benefit for many months/years even after treatment. Since using this treatment for long periods can make bones thin (osteoporosis) it is not used for longer periods.

 

Surgical Treatment

Endometriosis can be surgically removed and this is favourably done using key-hole surgery called a laparoscopy (see separate Laparoscopy patient information leaflet). Laparoscopy may provide symptom control and may improve fertility in some women. For mild endometriosis in particular, surgical excision does not provide any additional benefit over medical therapy in symptom relief or return of symptoms after treatment.

Occasionally bigger operations are offered to separate adhesions and remove endometriosis cysts from ovaries. The women who need extensive and complex surgeries for endometriosis should be done in specialist centres, where they are discussed at

regular multidisciplinary team meetings involving other specialist than gynaecologists (bowel surgeons, urologists, radiologists and pain specialists) and these specialists will decide that final surgery may need to be done by the appropriate team of surgeons with specific skills. As a last resort removal of the uterus, cervix, fallopian tubes and ovaries (hysterectomy and bilateral salpingo-oophorectomy – please see separate leaflet) may be offered, this is usually reserved for women who have completed their family and is often a technically difficult procedure. The important points to consider with surgical treatments are that there is no guarantee of symptom relief even with these extensive operations; the complications associated with surgery; permanent loss of fertility with some surgeries (e.g. hysterectomy or removal of both ovaries); and the fact that current research suggests that approximately 35% of women will develop recurrence of their endometriosis after surgery and may consider further and repeated surgery. Repeated surgery for endometriosis excision is potentially more risky with increase possibility of serious complications.

 

Endometriosis and Fertility

The relationship between endometriosis and fertility is not yet fully established or understood. There are many women with endometriosis who become pregnant without difficulty, but endometriosis is found in 1 in 4 women who are undergoing investigations such as a laparoscopy for subfertility investigation (Cochrane 2002).

There are no preventative surgical treatments that have shown to be effective to improve future fertility, yet for those women who are having difficulties in getting pregnant; consultation with an infertility expert is initially needed for particular advice for treatment for endometriosis.

 

 

 

Cervical cancer is a type of cancer that starts in the cervix. The cervix is a hollow cylinder that connects the lower part of a woman’s uterus to her vagina. Most cervical cancers begin in cells on the surface of the cervix.

Symptoms of cervical cancer

Many women with cervical cancer don’t realize they have the disease early on because it usually doesn’t cause symptoms until the late stages. When symptoms do appear, they’re easily mistaken for common conditions like menstrual periods and urinary tract infections (UTIs).

Typical cervical cancer symptoms are:

• unusual bleeding, like in between periods, after sex, or after menopause
• vaginal discharge that looks or smells different than usual
• pain in the pelvis
• needing to urinate more often
• pain during urination

Cervical cancer causes

Most cervical cancer cases are caused by the sexually transmitted human papillomavirus (HPV). This is the same virus that causes genital warts.

There are about 100 different strains of HPV. Only certain types cause cervical cancer. The two types that most commonly cause cancer are HPV-16 and HPV-18.

Being infected with a cancer-causing strain of HPV doesn’t mean you’ll get cervical cancer. Your immune system eliminates the vast majority of HPV infections, often within 2 years.

HPV can also cause other cancers in women and men. These include:

• vulvar cancer
• vaginal cancer
• penile cancer
• anal cancer
• rectal cancer
• throat cancer

HPV is a very common infection. Find out what percentage of sexually active adults will get it at some point in their lifetime.

Cervical cancer treatment

Cervical cancer is very treatable if you catch it early. The four main treatments are:

• surgery
• radiation therapy
• chemotherapy
• targeted therapy

Sometimes these treatments are combined to make them more effective.

Surgery

The purpose of surgery is to remove as much of the cancer as possible. Sometimes the doctor can remove just the area of the cervix that contains cancer cells. For cancer that’s more widespread, surgery may involve removing the cervix and other organs in the pelvis.

Radiation therapy

Radiation kills cancer cells using high-energy X-ray beams. It can be delivered through a machine outside the body. It can also be delivered from inside the body using a metal tube placed in the uterus or vagina. 

Chemotherapy

Chemotherapy uses drugs to kill cancer cells throughout the body. Doctors give this treatment in cycles. You’ll get chemo for a period of time. You’ll then stop the treatment to give your body time to recover.

Targeted therapy

Bevacizumab (Avastin) is a newer drug that works in a different way from chemotherapy and radiation. It blocks the growth of new blood vessels that help the cancer grow and survive. This drug is often given together with chemotherapy.

If we discovers precancerous cells in your cervix, they can be treated. 

Cervical cancer stages

After you’ve been diagnosed, we will assign your cancer a stage. The stage tells whether the cancer has spread, and if so, how far it’s spread. Staging your cancer can help us recommend the right treatment for you.

Cervical cancer has four stages:

• Stage 1: The cancer is small. It may have spread to the lymph nodes. It hasn’t spread to other parts of your body.
• Stage 2: The cancer is larger. It may have spread outside of the uterus and cervix or to the lymph nodes. It still hasn’t reached other parts of your body.
• Stage 3: The cancer has spread to the lower part of the vagina or to the pelvis. It may be blocking the ureters, the tubes that carry urine from the kidneys to the bladder. It hasn’t spread to other parts of your body.
• Stage 4: The cancer may have spread outside of the pelvis to organs like your lungs, bones, or liver.

 

 

 

Causes of vaginal discharge

Vaginal discharge is a healthy bodily function resulting from natural changes in estrogen levels. The amount of discharge can increase from the likes of ovulation, sexual arousal, birth control pills, and pregnancy.

The color, smell, and texture of vaginal discharge can be adversely affected by changes to the vagina’s bacterial balance. That’s because when the number of harmful bacteria increases, vaginal infections are more likely. 

Here are some of the possible infections to be aware of.

Bacterial vaginosis

Bacterial vaginosis is a common bacterial infection. It causes increased vaginal discharge that has a strong, foul, and sometimes fishy odor. Discharge may also look gray, thin, and watery. In some cases, the infection produces no symptoms.

Although bacterial vaginosis isn’t transmitted via sexual contact, you have a higher risk of developing it if you’re sexually active or have recently gotten a new sexual partner. The infection can also put you at a higher risk of contracting a sexually transmitted infection (STI). 

Trichomoniasis

Trichomoniasis is another type of infection caused by a parasite. It’s usually spread by sexual contact, but can also be contracted by sharing towels or bathing suits.

Up to half of the people affected have no symptoms. Those who do will often notice a yellow, green, or frothy discharge with an unpleasant odor. Pain, inflammation, and itching around the vagina as well as when urinating or having sex are also common signs. 

Yeast infection

A yeast infection occurs when yeast growth increases in the vagina. It produces a thick and white discharge that looks similar to cottage cheese. This discharge doesn’t usually smell.

Other symptoms include burning, itching, and other irritation around the vagina along with soreness during sex or when urinating.

The following can increase your likelihood of yeast infections:

• stress
• diabetes
• use of birth control pills
• pregnancy
• antibiotics, especially prolonged use over 10 days
• immune suppression

Gonorrhea and chlamydia

Gonorrhea and chlamydia are STIs that can produce an abnormal discharge due to infecting the cervix. It’s often yellow, greenish, or cloudy in color.

You may also experience:

• pain when urinating
• lower stomach/pelvic pain
• bleeding after penetrative vaginal sex
• bleeding between periods

But some people may have zero symptoms. 

Genital herpes

This STI can lead to thick vaginal discharge with a strong smell, particularly after sex. Sores and blisters lloking like a clod sore can appear around the genitals along with bleeding between periods and a burning sensation when urinating. 

However, it’s more common to have no or mild symptoms. If symptoms do occur, you may experience repeated outbreaks throughout your life. 

Pelvic inflammatory disease

Heavy, foul-smelling discharge and pain in thelower  abndomen, after sex, or while menstruating or urinating may be signs of pelvic inflammatory disease.

This occurs when bacteria move into the vagina and up to other reproductive organs and can be caused by STIs that are left untreated like chlamydia or gonorrhea. 

Human papillomavirus or cervical cancer

The human papillomavirus infection is spread by sexual contact and can lead to cervical cancer. While there may be no symptoms, this type of cancer can result in:

• bloody, brown, or watery discharge with an unpleasant odor
• unusual bleeding occurring between periods or after sex
• pain while urinating or an increased urge to urinate

In rare cases, brown or bloody discharge can also be a sign of endometrial cancer, fibroids, or other growths. 

When to see a doctor or other healthcare professional

If you’re ever worried about your vaginal discharge, talk with a clinician as soon as possible. This is particularly true if your discharge changes color, smell, or consistency or if you’re noticing more of it than usual.

Other symptoms to watch out for include:

• irritation around the vagina
• bleeding between periods, after penetrative vaginal sex, or after menopause
• pain when urinating

• fever

• pain in the abdomen or during penetrative vaginal sex

• unexplained weight loss

• fatigue

• increased urination

 

There are various contraception options available to help prevent pregnancy, and each method offers unique benefits and considerations. The choice depends on individual health, lifestyle, and personal preferences. Here’s an overview of the main types of contraception:

 

1.Hormonal Contraceptives

 

• Birth Control Pills: Daily pills that contain estrogen and progestin or progestin-only to prevent ovulation. Highly effective when taken consistently.

• Birth Control Patch: A skin patch worn on the body that releases hormones to prevent ovulation, replaced weekly for three weeks, with a patch-free week.

• Birth Control Injection (Depo-Provera): A progestin shot given every three months to stop ovulation.

• Birth Control Implant (Nexplanon): A small rod implanted under the skin of the upper arm, releasing progestin and effective for up to 3 years.

• Vaginal Ring (NuvaRing): A flexible ring inserted into the vagina monthly, releasing estrogen and progestin for three weeks.

 

2. Intrauterine Devices (IUDs)

 

• Hormonal IUDs (Mirena, Kyleena, Skyla, Liletta): Small T-shaped devices placed in the uterus that release progestin, effective for 3-6 years depending on the type.

• Copper IUD (ParaGard): A hormone-free IUD that uses copper to create an environment hostile to sperm, effective for up to 10 years.

 

3. Barrier Methods

 

• Condoms: Male and female condoms are placed over the penis or inside the vagina to block sperm. They are also the only method that protects against STIs.

• Diaphragm: A shallow, flexible cup inserted into the vagina to cover the cervix, used with spermicide for added effectiveness.

• Cervical Cap: Similar to a diaphragm but smaller, covering the cervix with spermicide for protection.

• Spermicide: Chemicals that kill sperm, used alone or with other methods like diaphragms and condoms.

 

4. Long-Acting Reversible Contraceptives (LARCs)

 

• Includes IUDs and implants, which are highly effective, low-maintenance, and reversible methods that last for several years.

 

5. Permanent Methods (Sterilization)

 

• Tubal Ligation (for women): Surgical procedure that blocks or cuts the fallopian tubes to prevent egg and sperm from meeting.

• Vasectomy (for men): Minor surgical procedure that cuts or seals the vas deferens, preventing sperm from entering semen.

 

6. Emergency Contraception

 

• Morning-After Pill (Plan B, Ella): Pills taken up to 3-5 days after unprotected sex to prevent ovulation or fertilization.

• Copper IUD: Can be used as emergency contraception if inserted within five days after unprotected intercourse.

 

7. Natural Methods

 

• Fertility Awareness: Tracking the menstrual cycle to avoid sex during fertile days.

• Withdrawal Method: Pulling out before ejaculation; less reliable as it depends on timing and self-control.

• Abstinence: Complete avoidance of sexual intercourse, which is the only method that is 100% effective.

 

8. Dual Protection

 

• Combining methods, such as using condoms with birth control pills or IUDs, for added effectiveness and STI protection.

 

 

 

 

 

 

Mental health is an essential aspect of women’s health, significantly influenced by biological, hormonal, and social factors unique to each stage of life. Many mental health issues women experience are directly related to reproductive stages, life events, and societal pressures, making comprehensive and sensitive care vital. Here are some important areas where mental health intersects with women’s health:

 

1. Menstrual Cycle and Mental Health

 

• Premenstrual Syndrome (PMS): Many women experience emotional symptoms such as mood swings, irritability, and anxiety in the days leading up to menstruation.

• Premenstrual Dysphoric Disorder (PMDD): A more severe form of PMS that includes intense mood-related symptoms like depression, anger, and hopelessness, affecting daily life.

• Treatment for PMS and PMDD can include lifestyle changes, therapy, and in some cases, medication (like SSRIs) to help manage severe symptoms.

 

2. Perinatal Mental Health (During and After Pregnancy)

 

• Prenatal Anxiety and Depression: Hormonal changes, body image shifts, and life adjustments can contribute to mental health struggles during pregnancy.

• Postpartum Depression (PPD): Affects about 1 in 7 new mothers, involving persistent sadness, exhaustion, feelings of guilt, and challenges in bonding with the baby.

• Postpartum Anxiety and OCD: Some new mothers experience heightened anxiety and intrusive thoughts about the baby’s safety, leading to obsessive behaviors.

• Postpartum Psychosis: A rare but serious condition involving hallucinations, delusions, and mood swings, requiring immediate medical care.

• Support includes counseling, support groups, and in some cases, medication, with healthcare providers often screening for these issues as part of routine care.

 

3. Fertility Challenges and Mental Health

 

• Stress and Anxiety Related to Infertility: The emotional toll of infertility can lead to depression, anxiety, and feelings of inadequacy or isolation.

• Treatment-Related Stress: Fertility treatments, such as IVF, often come with physical and emotional stress, as well as financial and relational pressures.

• Counseling and support groups can provide a safe space to discuss these challenges and help cope with the emotional aspects of infertility.

 

4. Pregnancy Loss and Grief

 

• Miscarriage and Stillbirth: The grief from pregnancy loss can lead to feelings of sadness, guilt, and depression, affecting mental health significantly.

• Complicated Grief: Sometimes, grief after a loss becomes prolonged and intense, impacting a woman’s ability to function daily.

• Mental health support, including counseling, can help women process their grief and move toward healing.

 

5. Menopause and Mental Health

 

• Mood Swings and Irritability: Hormonal fluctuations during perimenopause can contribute to mood swings, irritability, and difficulty concentrating.

• Anxiety and Depression: Menopause can increase susceptibility to depression and anxiety, influenced by both hormonal changes and life transitions (such as “empty nest syndrome”).

• Hormone replacement therapy, lifestyle adjustments, and mental health counseling can support women through this transition.

 

6. Body Image and Self-Esteem

 

• Body Image Issues: Women often face societal pressures about physical appearance, which can lead to low self-esteem, eating disorders, and body dysmorphia.

• Postpartum Body Changes: The physical changes after childbirth can affect body image and self-confidence.

• Therapy and support groups can help women develop a healthy relationship with their bodies, especially during periods of significant change.

 

7. Sexual Health and Mental Health

 

• Sexual Dysfunction: Issues like pain during intercourse (dyspareunia), low libido, and vaginismus can be distressing and impact relationships.

• Impact of Trauma: Sexual trauma or abuse can have lasting mental health effects, leading to conditions like PTSD, depression, and anxiety.

• Specialized counseling, therapy, and sometimes medication can help women address these concerns and improve their well-being.

 

8. Impact of Societal Expectations and Roles

 

• Balancing Multiple Roles: Managing roles as partners, parents, and professionals can create stress, burnout, and mental strain.

• Pressure to Conform to Gender Norms: Societal pressures regarding femininity, career, and family can lead to stress, impacting mental health.

• Support can include therapy focused on stress management, assertiveness training, and boundary setting.

 

9. Chronic Gynecological Conditions and Mental Health

 

• Endometriosis and PCOS: Conditions like endometriosis, polycystic ovary syndrome (PCOS), and chronic pelvic pain can lead to emotional distress and depression.

• Impact on Daily Life: Chronic pain and hormonal imbalances can affect quality of life, self-esteem, and relationships.

• A comprehensive care approach that includes mental health support can improve overall well-being.

 

10. Mental Health Across the Lifespan

 

• From adolescence to old age, mental health needs evolve in women, affected by hormonal changes, life stages, and shifting personal priorities.

• Addressing these needs through regular mental health screenings, therapy, and support networks can empower women to navigate their health with confidence and resilience.

 

Focusing on mental health as part of women’s health allows for a more holistic approach, improving overall quality of life and helping women cope with the unique challenges they may face.