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Obstetrics & Gynaecology

MENSES

Question 1

I’ve been having menstrual problems whereby I will have menses once in every two weeks. Is it normal or a sign of disease? I’ve been having this problem for almost 2 months now. I was told that it is due to unstable hormones. Will it affect my health?

Answer 1

If normally you have menses every month but suddenly you have once in two weeks, it is abnormal. A lot of factors can be the cause, for example:

  • Stress or other psychological problems.
  • Medical problems such as Thyroid disease.
  • Unstable hormone.

I advise you to see a gynecologist and undergo further investigation to rule out the medical conditions stated above. Hormone treatment such as taking family planning pills can normalize the menstrual cycle but it should be done after consulting a doctor.

PREGNANCY

Question 2

I have been married for 1 year and have tried various ways to bear a child, since my spouse and I got married late in our 40’s. I would like to get your opinion and advice on what my spouse and I should do to have a child.

Answer 2

Many procedures should be undertaken before determining the best treatment. Initially, you and your spouse will be examined to make sure that your health is good. Then, both husband and wife will have to undergo a few procedures:

For the husband, the doctor will ensure his fertility by physical examination of the genitalia and semen.

For the wife, the doctor will ensure her fertility from the point of egg production and also ensure obstruction or disease of the reproductive passages (vagina, uterus, tubes and ovary).The level of fertility could be determined by hormonal examination (hormones progesterone and FSH/LH). If the menstrual cycle is regular, blood test to know the level of serum progesterone should be done on the 21st day of the cycle (1st day of cycle is the 1st day of having menses). This is to ensure whether ovulation is taking place or not. FSH/LH hormone level is to rule out PCOS (Polycystic Ovarian Syndrome) and will only be done if the patient is presented with the following features: overweight, excessive hair growth at face and body and irregular menstrual cycle. Blood test to confirm this condition can be taken at any time and there is no specific day.

If the wife is told to be infertile, she will be recommended to take fertility medications starting with pills. If this does not work, injections will be used. These medications will only work through correct administration and great patience. If other problems occur, IVF (In Vitro Fertilization) or ICSI (Intracytoplasmic Sperm Injection) will be recommended.

However, the process of child bearing through ‘modern way’ requires a long time and therefore you are advised to be patient and go through the processes, step by step.

Question 3 

I had a miscarriage 10 months ago. My pregnancy was 6 weeks old at that time. How long should I wait to get pregnant again? If I do get pregnant, what are the complications? Thank you.

Answer 3

Most miscarriages do not recur unless you have uterine abnormalities or chronic diseases such as diabetes, renal disease and others. You can try to get pregnant again as soon as you are ready mentally and physically. In terms of modern medicine, you can get pregnant three months after a miscarriage.

Question 4

I had a miscarriage two years ago and I’m not able to get pregnant until now. Does miscarriage affect the chances of getting pregnant?

Answer 4

Miscarriage does not normally cause infertility, unless the patient develops Pelvic Inflammatory Disease or other infections complicating the miscarriage. This will lead to damage or obstruction of the Fallopian Tubes thus making it difficult to get pregnant normally. The Fallopian Tube can be examined by “Hysterosaphingogram”, a method whereby the tube is filled with liquid and examined using x-ray or by a small operation at the abdomen. Very rarely, Evacuation of Retained Products of Conception – ERPOC that is done very aggressively can lead to adhesions (sticks or scarred) which will make a patient difficult to get pregnant. Usually these patients won’t have menses or will only produce very little menstrual blood after the procedure.

You are still young at the age of 28 yrs old. If you still have problem bearing a child after 2 years of having a miscarriage, do consult a gynecologist. There is a 30% chance of your Fallopian Tube being obstructed or damaged. However, your spouse and you still have a good chance of bearing children due to availability of gynecologists and obstetricians in government and private hospitals who can offer specialised services, including the test-tube method.

Question 5

I would like to know the symptoms of ectopic pregnancy. What are the risks of having ectopic pregnancy and can it be detected through urine test?

Answer 5

Below are the symptoms of ectopic pregnancy:

  • Absence of period/ menses.
  • Symptoms of pregnancy.
  • Lower abdominal pain; pain can be intermittent or persistent.
  • Vaginal bleeding.

More serious symptoms include:

  • Shoulder tip pain.
  • Dizziness and fainting

Urine test is used to confirm pregnancy but CANNOT determine the location of foetus. The risk of ectopic pregnancy if not treated (via operation) is persistent bleeding leading to death. Other risks include infertility and the chance of recurrent ectopic pregnancy (20%).

Question 6

I just went through laparoscopic operation for the removal of endometrioma two weeks ago. The doctor advised me to undergo hormone therapy treatment but I am not willing to do it due to the side effects. I’m also planning to get pregnant soon. Therefore I am afraid that the treatment will affect my fertility.

Can I try to get pregnant without hormone therapy, as I was told that pregnancy can help to treat endometriosis as there is no menstrual cycle during pregnancy.

Answer 6

There are a few types of hormones for treatment of endometriosis. The examples are progestegens, danazole, gestrinone, GnRH agonist like gosereline, leoprolide, triptorelin and family planning pills. Due to the nature of the disease which is chronic, long-standing and recurrent, hormone therapy treatment is used to kill or destroy the disease especially those that couldn’t be seen by the naked eye. The therapy helps to create pseudo-pregnancy or pseudo-menopause state. The treatment usually lasts between 4 to 6 months only.

Hormone treatment after operation, depends on a few factors like the stage or severity of the disease. Usually, hormone is given to patients with stage 3 or stage 4. Sometimes, it is also given at stage 1 or stage 2, especially if the symptoms of the disease persist. This treatment can also help to treat infertility. You are advised to further discuss with your gynecologist regarding the reason you need to take hormone therapy treatment.

Yes, pregnancy can cure endometriosis. But, on the other hand, pregnancy can also cause infertility. Therefore, if left alone without further treatment, it may take you quite some time to get pregnant as endometriosis is not treated completely. Please consider your decision after discussing with your doctor.

FIBROID

Question 7

What is fibroid, the cause of it and the treatment methods? Can it cause harm to the baby in the womb?

Answer 7

Uterine fibroid is a non-cancerous growth of the womb. It is estimated that 20 – 50% of women will have fibroids in their life. It usually occurs in women in their thirties and forties. The exact cause of fibroids is unknown. Small fibroids, usually do not cause any trouble to most women. However, bigger fibroids can cause excessive menstrual bleeding and other problems.

Fibroid in pregnancy usually does not cause any trouble and very rarely could cause harm to the foetus or mother. The problem that can arise is the inappropriate foetal position during 8 months and above of pregnancy. During pregnancy, the fibroid can suddenly become enlarged leading to interrupted blood supply and cause pain for a few days. This condition is known as red degeneration. However, it shall not cause harm to the mother.

Sometimes, fibroid causes bleeding more than normal during child birth.

Last Reviewed: 30 January 2012

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