GYNAECOLOGICAL PROBLEMS WITH WORKING WOMEN

By

Dr. Ranjit ChakrabortiDirector, Gynaecology & Obstetrics

Woodlands Hospital Bhagirathi Neotia Hospital

Parkland Chambers

Steel Women Aspirational Team Initiative

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From the standpoint of a practicing Obstetrician – Gynaecologist , certain

gynaecological problems are of interest as affecting the women work force and

mostly stem out of these Lifestyle diseases

THE REALITY AMONG WORKING WOMEN

• 68% Indian working women suffer lifestyle diseases

• While two-third of working women suffer from lifestyle diseases, 53 per cent of them skip meals and go for junk food due to work pressure and deadlines

• According to a survey conducted by the Associated Chamber of Commerce and Industry (Assocham), 68 per cent of working women in the age bracket of 21-52 years were found to be afflicted with lifestyle ailments such as obesity, depression, chronic backache, diabetes and hypertension

The report further said that as 27 per cent of females in urban India were employed, their health issues are a major concern both for society and business

INTRODUCTION

Most quantitative assessments of women’s health status are still based on maternal health measures:Indicators such as the Maternal Mortality Ratio (MMR), the proportion of births attended by a skilled attendant and the percent of women who attend an antenatal check up.

WOMEN HEALTH INDICATORS

Exposure to industrial pollutants Environmental toxins Poor quality of sleep Lack of exercise Less sunlight exposure, Poor nutrition, Excessive intake of alcohol and drug abuse Long working hours and deadlines Anxiety & insecurity

FACTORS WHICH MOSTLY AFFECT

Breast CancerInfertility

Menstrual DisordersSTD’s

High risk pregnancy

THE TOP 5 PROBLEMS WOMEN SHOULD BE CAREFUL ABOUT ARE:

PREVENTION OF GYNAECOLOGICAL DISORDERS

• Proper Pre-Employment Check up• Preventive Health Check ups

• Regular Check up with Corporate Medical Officer• Health Awareness Programmes

• Breast Examination (Self Breast Examination)• Examination of Pelvis (By USG,internal examination)

• Mammography/Sono-Mammography• Vaginal Examination

• Menstrual Disorders• Vaginal Discharge• Pelvic Pain

• Polycystic Ovarian Disease• Uterine Fibroid

• High Risk Pregnancy

COMMON GYNAE DISORDERS

Another disease that women have to be knowing about and have to be careful about is the breast cancer. After the menopause, most of the hormones in the women's body stop secreting.

As ever, the women, try not to give much importance to their personal health. They stop exercising. Now a days many women, just like men have started smoking, chewing pan etc which have changed the entire life style which in turn have increased the vulnerability of women to breast cancer.

After 30 years, every women should go for a mammogram to check whether they have breast cancer. But all at the same time, it will be better for women to keep themselves abstained from smoking and pan.

BREAST CANCER

Infertility is a disease of the reproductive system that impairs one of the body's most basic functions: the conception of children..

INFERTILITY

• Age• Causes of failure to ovulate• Premature menopause

• Scarred ovaries• PID

• Poorly functional fallopian tubes

CAUSES THAT PLAY A MAJOR ROLE IN INFERTILITY

ENDOMETRIOSIS AND INFERTILITYStudies indicate that women with endometriosis take longer to conceive and are less

likely to conceive than women in general.

Many women with endometriosis have children without difficulty and

many others become pregnant eventually it may take time and

may require the help of surgery or assisted reproductive technologies

or both.

CAUSE & TREATMENT OF ENDOMETRIOSIS

• Ovaries and Fallopian Tubes in abnormal places due to adhesion

• Newly released egg cannot find a way to Fallopian Tubes• No evidence of Endometriosis causing repeated miscarriages

Treatment

• Hormonal & Surgical Management• Hormonal treatment effective for Mild Cases• Moderate to Severe Cases requires Laparoscopic Surgery

Conception is a complicated process that depends upon many factors:

On the production of healthy sperm by the man and healthy eggs by the woman;

unblocked fallopian tubes that allow the sperm to reach the egg;

the sperm's ability to fertilize the egg when they meet;

the ability of the fertilized egg (embryo) to become implanted in the woman's uterus; and sufficient embryo quality.

Finally, for the pregnancy to continue to full term, the embryo must be healthy and the woman's hormonal environment adequate for its development. When just one of these factors is impaired, infertility can result

CONCEPTION

Menstrual Disorders include • Amenorrhea• Menorrhagia

• Irregular bleeding• Dysmenorrhe

MENSTRUAL DISORDER

• Stress• Hormonal imbalance,

• Diet • Birth control pills

• Uterine polyps or fibroids• Endometriosis

• PCOS.

CAUSES

• Amenorrhea is the absence of menstrual periods.

• There are two types of amenorrhea, – Primary amenorrhea – Secondary amenorrhea.

AMENORRHEA

Heavy Periods• Passage of more than 80 ml of blood each period (it is seldom realistic or practical. However to actually measure

the blood loss and doctors rely on the women’s description of her period)

CAUSE : • Temporary Imbalance in Young, eventually cured with Age• Hormonal Imbalance• Symptom of any underlying disease to be excluded

MENORRHAGIA

Dysmenorrhea is the name for painful menstrual cramps.

There are two types of dysmenorrhea,◦ primary dysmenorrheal and ◦ secondary dysmenorrheal.

Primary dysmenorrhea is the most common with cramping pain in the lower abdomen occurring at the onset of menstruation in the absence of identifiable pelvic disease. It must be distinguished from secondary dysmenorrhea, which refers to painful menses resulting from pelvic pathology such as endometriosis.

DYSMENORRHEA

PCODPCOD

Patients suffering from polycystic ovarian disease (PCOD) have multiple small cysts in their ovaries (the word poly

means many). These cysts occur when the regular changes of a normal menstrual cycle are disrupted. The ovary is

enlarged; and produces excessive amounts of androgen and estrogenic hormones. This excess, along with the absence of ovulation, may cause infertility. Other names for PCOD are Polycystic Ovarian Syndrome (PCOS) or the Stein-Leventhal

syndrome.

A schematic, comparing a polycystic ovary with a normal ovary

We don't really understand what causes PCOD, though we do know that it has a significant hereditary component, and is often transmitted from mother to daughter . We also know that the characteristic polycystic ovary emerges when a state of anovulation persists for a

length of time. Patients with PCO have persistently elevated levels of androgens and estrogens, which set up a vicious cycle. Obesity can aggravate PCOD because fatty tissues are hormonally active and they produce estrogen which disrupts ovulation . Overactive adrenal glands can also produce excess androgens, and these may also contribute to PCOD. These

women also have insulin resistance ( high levels of insulin in their blood, because their cells do not respond normally to insulin) of androgens and estrogens in PCOD

WHAT IS THE CAUSE OF PCOD ?

Fig 2. The self-perpetuating vicious cycle of elevated levels of androgens and estrogens in PCOD

HOW IS PCOD TREATED ?

TreatmentTreatment of PCOD for the infertile patient will usually focus on inducing

ovulation to help them conceive.

Weight loss:

• It is an effective tool• Long term Weight Loss Plan• Regular monitoring by dietician or weight Loss Clinic• Increasing Physical Activity• Walking, Jogging, Swimming • Avoid Junk foods• Do this in groups of 2-3 ladies for better results

WHAT ARE FIBROIDS?

Non-Cancerous tumors growing around womb Varies in Size

Made up of muscle and fibrous tissue Also referred as uterine myomas or fibromyomas.

A TYPICAL PICTURE OF A FIBROID

HOW ARE FIBROIDS TREATED?

Fibroids do not cause symptom and treatment is not required.Overtime it will often shrink and disappear without any treatment.Around 1 in 3 working women experience symptom from fibroids.Such as pain or heavy bleeding. In such cases medication may bePrescribed. If this doesn’t work, other techniques, including surgery

WHO IS AFFECTED?

Fibroids are common with around 40% of women developing them at some stage in their life. They most occur in women who are from 30-50 years old.it is also thought that they occur more often in heavier women as a result of higher oestrogen levels.

• Exact cause is unknown• Mainly Hormonal Cause

• Female Hormone Oestrogen• Usually occurs in Reproductive

Age (16-50 yrs)

CAUSES FOR FIBROIDS

• Pelvic inflammatory disease (or PID) is an infection that occurs in some part of the female reproductive organs. One of the symptoms of PID is a foul-smelling discharge from the vagina

• It may also be accompanied by irregular menstrual periods or pain during sex. The most common cause for PID is by coming into contact with a sexually transmitted disease. PID is a serious illness that may damage the fallopian tubes and prevent future pregnancies.

PID

• A high risk pregnancy is one in which some condition puts the mother, the developing foetus or both at higher than normal risk for complications during or after the pregnancy and birth.

• CAUSE : A pregnancy can be considered a high risk pregnancy for a variety of reasons. Factors can be divided into maternal and fetal. more than in high risk pregnancy can happen bleeding during the third trimester, abnormalities of reproductive tract, urine fibroids hypertension, RH incompatibility. Gestational Diabetes,fever,cancer,tuberculosis,mumps,syphlis,folic acid smoking are the causes of high risk pregnancy.

WHAT IS HIGH RISK PREGNANCY?

HIGH RISK PREGNANCY

Puts the mother and developing foetus for complications before or after delivery

Reasons can both be maternal or Foetal

Bleeding in 3rd trimester of Pregnancy

Hypertension, Uterine Fibroid

Anomalies of Reproductive Tract

Rh-incompatibity

Diabetes,Chicken-Pox,Fever,Mumps,Syphillis

Smoking or Drinking

• Working Women nowadays are ambitious and career oriented• Late Marriage • Planning to conceive late because of career• Fast & Stressful Lifestyle• Long Hours of Work in IT/BPO Sector/Shifting Duty • Junk Food Habits• Smoking & Drinking• Stress related hypertension and Diabetes• Ideal age for conceiving is 26-30 yrs• Conceiving after 35 yrs leads to complications

HIGH RISK PREGNANCY RELATED TO WORKING WOMEN

TREATMENT : Treatment varies widely with the type of disease, the effect that pregnancy has on the disease additional tests may help determine the need for changes in medication or additional treatment.

PREVENTION : A pregnant women need regular heath check up and close monitoring. – Her medication should also be taken care off– Avoiding Stress

HIGH RISK PREGNANCY

MENOPAUSE & TREATMENT OF.....

Menopause is the permanent end of menstruation in that case menstruation is less frequent and eventually stop altogether.

Treatment of Hormonal Disorders

– Medication– Hormone Replacement Therapy

– Birth Control Bills– Overdose of Cosmetics & Non-Organic Animal

Products– Medical Causes– Genetic Causes– Obesity– Sedentary Life-Style– Pregnancy

CAUSE:There are multiple causes for hormone imbalance. Common causes include birth control pills, stress, overuse of cosmetics, and non organic animal products. Other medical causes include genetics, obesity and tumors. Other causes include lack of exercise, pregnancy, and sedentary lifestyle.

CAUSES OF HORMONAL IMBALANCE

Fatigue Skin Problems Mood Swing Overweight or Loosing Weight Diminished Sex Drive Loss of Memory Arthritis Anxiety Attacks

SYMPTOMS: Some of the most commonly shared symptoms includes fatigui,skin problem,mood swings,weight problem,diminished sex drive and no memory.The disorder include Arthritis,chronic fatigue syndrome,fibromyalgia and anxiety attacks.

MENOPAUSE : Menopause is the permanent end of menstruation fertility in that case menstruation is less frequent and eventually stop altogether.

TREATMENT : There are two types of therapy for its treatment like prescription therapy and HRT combination therapy.

SYMPTOMS OF HORMONAL IMBALANCE

If the problems are severe, bleeding may be regulated by medications

Hormonal treatment include the contraceptive pills and danazols

Non hormonal treatment include tranexamic acid

Hysterectomy-the removal of the uterus is commonly performed for heavy periods

If diagnosis of an underlying condition is made then the treatment will be tailored towards that condition

If the women is anaemic iron or folic supplements may be needed

TREATMENT

Cause

The exact cause is usually unknown. The risk of developing ovarian cancer appears to be affected by several factors. The more children a woman has, the lower her risk of ovarian cancer. Early age at first pregnancy, older age of final pregnancy and the use of low dose hormonal contraception have also been shown to have a protective effect.

OVARIAN CANCER…..THE SILENT KILLER

Following factors form the risk in ovarian cancer:

(i) family history of cancer (ii) personal history of cancer (iii) age over 55 years(iv) never pregnant

RISK FACTORS

Highlighting the fact that women play vital and multiple roles, especially those who are employed, a correct work –life balance has become absolutely necessary

TO WISH TO BE WELL IS PART OF BECOMING WELL

To insure good health: Eat

lightly, breathe deeply, live moderately, cultivate cheerfulness, and maintain an interest in life.

TO CONCLUDE

What a wonderful world!!

Stay Healthy and Enjoy It