WOMEN’S HEALTH
PREPARED BY MR. ABHIJIT DAS
POLYCYSTIC OVARY SYNDROME
Polycystic ovary syndrome (PCOS) is a hormonal
disorder that affects women of reproductive age. It is characterized by the
presence of multiple cysts on the ovaries, irregular menstrual cycles, and an
excess of male hormones (androgens) in the body.
ETIOPATHOGENESIS
Some of the key factors involved in the development
of PCOS include:
1.
Insulin resistance: Insulin is a hormone
that helps regulate blood sugar levels in the body. Women with PCOS often have
insulin resistance, which means their cells are less responsive to insulin,
leading to increased insulin levels in the blood. This can cause the ovaries to
produce more androgens, leading to PCOS symptoms.
2.
Hormonal imbalances: Women with PCOS
often have an imbalance of hormones, including excess androgens (male hormones)
and luteinizing hormone (LH) levels, and decreased follicle-stimulating hormone
(FSH) levels. These hormonal imbalances can disrupt the normal functioning of
the ovaries and lead to the development of cysts.
3.
Genetic factors: There appears to be a
genetic component to PCOS, as the condition tends to run in families.
4.
Environmental factors: Certain
environmental factors, such as exposure to endocrine-disrupting chemicals
(EDCs) and a high-calorie diet, may also contribute to the development of PCOS.
CLINICAL MANIFESTATIONS
1.
Irregular menstrual cycles: PCOS is
characterized by irregular menstrual cycles, which may be absent, infrequent,
or heavy. Women with PCOS may have fewer than eight menstrual cycles per year,
or they may experience periods that last for several weeks.
2.
Hirsutism: Hirsutism is the excessive
growth of hair on the face, chest, and back. Women with PCOS may experience
increased hair growth due to high levels of androgens.
3.
Acne: Women with PCOS may develop acne
due to the high levels of androgens. The acne may be severe and difficult to
treat.
4.
Obesity: Many women with PCOS are obese
or overweight. Obesity can worsen the symptoms of PCOS, including insulin
resistance and menstrual irregularities.
5.
Insulin resistance: Insulin resistance
is a condition in which the body's cells become resistant to insulin, a hormone
that regulates blood sugar levels. Women with PCOS may have insulin resistance,
which can lead to diabetes and other health problems.
6.
Infertility: PCOS is a common cause of
infertility in women. The irregular menstrual cycles and high levels of
androgens can make it difficult for women with PCOS to ovulate.
7.
Mood disorders: Women with PCOS may
experience mood disorders, such as depression and anxiety.
NON-PHARMACOLOGICAL MANAGEMENT
1.
Weight loss: Many women with PCOS are
overweight or obese, and losing weight can improve symptoms such as irregular
menstrual cycles, hirsutism, and insulin resistance. Even a modest weight loss
of 5-10% of body weight can be beneficial.
2.
Regular exercise: Exercise is an
important part of managing PCOS, as it can help with weight loss, improve
insulin resistance, and reduce stress. Aim for at least 30 minutes of
moderate-intensity exercise, such as brisk walking, most days of the week.
3.
Healthy diet: A healthy diet that is
rich in whole grains, fruits, vegetables, and lean protein can help with weight
loss and improve insulin resistance. Avoiding processed foods, sugary drinks,
and high-fat foods is important.
4.
Stress reduction: Stress can worsen the
symptoms of PCOS, so it's important to find ways to reduce stress. This could
include meditation, yoga, deep breathing, or other relaxation techniques.
5.
Sleep hygiene: Getting enough sleep is
important for managing PCOS. Aim for 7-8 hours of sleep per night and establish
a regular sleep routine.
PHARMACOLOGICAL MANAGEMENT
1.
Oral Contraceptives: Oral contraceptives
(birth control pills) are often prescribed to regulate menstrual cycles and
lower androgen levels in women with PCOS. These medications contain estrogen
and progesterone, which can help regulate the menstrual cycle and reduce acne
and hirsutism.
2.
Anti-Androgens: Anti-androgens, such as
spironolactone, can block the effects of androgens in the body. These
medications can help reduce acne and hirsutism in women with PCOS.
3.
Metformin: Metformin is an oral
medication used to treat diabetes, but it is also used to treat insulin
resistance in women with PCOS. This medication can help regulate menstrual
cycles, lower androgen levels, and improve fertility in women with PCOS.
4.
Gonadotropins: Gonadotropins are
injected hormones that stimulate ovulation in women with PCOS who are trying to
conceive. These medications are often used in combination with intrauterine
insemination (IUI) or in-vitro fertilization (IVF).
5.
Weight Loss Medications: Weight loss
medications, such as orlistat, may be prescribed to women with PCOS who are
obese or overweight. These medications can help with weight loss and improve
insulin resistance.
DYSMENORRHEA
DEFINITION
Dysmenorrhea is a medical condition characterized by
painful menstrual cramps experienced by some women during menstruation. The
pain typically occurs in the lower abdomen and can be accompanied by other
symptoms such as nausea, vomiting, headaches, and fatigue.
ETIOPATHOGENESIS
1.
Prostaglandins: Dysmenorrhea is
associated with the release of prostaglandins, which are hormones that cause
the uterus to contract during menstruation. High levels of prostaglandins can
lead to stronger and more painful uterine contractions, causing menstrual
cramps.
2.
Hormonal imbalances: Hormonal
imbalances, particularly of estrogen and progesterone, can contribute to
dysmenorrhea. These imbalances can cause abnormal uterine contractions and
inflammation, leading to pain and discomfort during menstruation.
3.
Endometriosis: Endometriosis is a
condition in which the tissue that normally lines the inside of the uterus
grows outside of it. This tissue can cause inflammation and pain during
menstruation.
4.
Uterine fibroids: Uterine fibroids are
noncancerous growths that can develop in the uterus. They can cause pain and
discomfort during menstruation, especially if they are located near the lining
of the uterus.
5.
Psychological factors: Stress, anxiety,
and depression can exacerbate menstrual pain by causing muscle tension and
altering hormonal levels.
CLINICAL MANIFESTATIONS
1.
Pain during menstruation: Pain is
typically located in the lower abdomen and may radiate to the back or thighs
2.
Nausea and vomiting: Some women with
dysmenorrhea may experience nausea and vomiting, particularly if the pain is
severe.
3.
Headaches: Dysmenorrhea can cause
headaches, especially in the days leading up to menstruation.
4.
Fatigue: Women with dysmenorrhea may
experience fatigue, weakness, and lethargy, which can interfere with daily
activities.
5.
Diarrhea or constipation: Dysmenorrhea
can affect the digestive system, leading to diarrhea or constipation.
6.
Mood changes: Hormonal changes
associated with dysmenorrhea can cause mood swings, irritability, and anxiety.
7.
Heavy bleeding: Some women with
dysmenorrhea may experience heavy bleeding during menstruation, which can
worsen the pain and discomfort.
NON-PHARMACOLOGICAL MANAGEMENT
1.
Heat therapy: Applying heat to the lower
abdomen or back can help to relax the muscles and relieve pain. A heating pad,
warm water bottle, or warm bath can be used for this purpose.
2.
Exercise: Regular exercise, particularly
aerobic exercise, can help to reduce menstrual pain by releasing endorphins and
reducing tension in the muscles.
3.
Dietary changes: Some women find that
making dietary changes, such as reducing caffeine and alcohol intake, and
increasing consumption of fruits, vegetables, and whole grains, can help to
alleviate menstrual pain.
4.
Stress management: Stress can exacerbate
menstrual pain, so managing stress through relaxation techniques such as deep
breathing, meditation, or yoga can be helpful.
5.
Acupuncture: Acupuncture, a traditional
Chinese medicine practice involving the insertion of needles into specific
points on the body, has been shown to be effective in reducing menstrual pain.
6.
Massage therapy: Massage therapy, particularly
of the lower back and abdomen, can help to relieve muscle tension and reduce
pain.
PHARMACOLOGICAL MANAGEMENT
1.
Nonsteroidal anti-inflammatory drugs
(NSAIDs): NSAIDs such as ibuprofen, naproxen, and aspirin are often used to
relieve pain and reduce inflammation during menstruation.
2.
Hormonal contraceptives: Hormonal
contraceptives such as birth control pills, patches, and intrauterine devices
(IUDs) can help to regulate hormonal fluctuations that can contribute to
dysmenorrhea.
3.
Prostaglandin inhibitors: Medications
that inhibit the production of prostaglandins, such as mefenamic acid or
tranexamic acid, can be effective in reducing menstrual pain and heavy
bleeding.
4.
Opioids: In severe cases of
dysmenorrhea, opioids may be prescribed for short-term pain relief, although
they carry a risk of dependence and other side effects.
PREMENSTRUAL SYNDROME
Premenstrual syndrome (PMS) is a medical condition
that refers to a range of physical and emotional symptoms experienced by some
women during the days or weeks before menstruation. The exact cause of PMS is
not fully understood, but it is thought to be related to hormonal changes that
occur during the menstrual cycle. Symptoms of PMS can vary widely between
women, but may include:
1.
Physical symptoms: Breast tenderness,
bloating, fatigue, headache, joint pain, and muscle aches.
2.
Emotional symptoms: Mood swings,
irritability, depression, anxiety, and difficulty concentrating.
3.
Behavioral symptoms: Changes in
appetite, sleep disturbances, and social withdrawal.
ETIOPATHOGENESIS
1.
Hormonal changes: PMS is thought to be
triggered by fluctuations in hormone levels, particularly estrogen and
progesterone, which can affect neurotransmitters and other hormones involved in
mood regulation.
2.
Neurotransmitter imbalances: Serotonin, a
neurotransmitter that plays a role in regulating mood, appetite, and sleep, has
been found to be lower in women with PMS. This may be due to changes in hormone
levels that affect serotonin synthesis and metabolism.
3.
Psychosocial factors: Stress, anxiety, and
other psychosocial factors can exacerbate PMS symptoms, as they can affect
hormone levels and neurotransmitter activity.
4.
Genetic factors: There may be a genetic
predisposition to PMS, as studies have shown that women with a family history
of PMS are more likely to experience the condition.
5.
Nutritional deficiencies: Some studies
suggest that deficiencies in certain vitamins and minerals, such as magnesium,
calcium, and vitamin B6, may contribute to PMS symptoms.
NON-PHARMACOLOGICAL MANAGEMENT
1.
Lifestyle modifications: Eating a
healthy diet, getting regular exercise, and getting enough sleep can help to
reduce stress and improve mood and physical symptoms.
2.
Stress reduction techniques: Stress can
exacerbate PMS symptoms, so practicing stress reduction techniques such as
meditation, yoga, or deep breathing exercises can be helpful in managing
symptoms.
3.
Cognitive-behavioral therapy:
Cognitive-behavioral therapy (CBT) is a type of talk therapy that can help
individuals with PMS learn coping strategies and change negative thought
patterns that may contribute to emotional symptoms.
4.
Nutritional supplements: Certain
nutritional supplements, such as calcium, magnesium, and vitamin B6, may help
to alleviate PMS symptoms.
5.
Alternative therapies: Some women may
find relief from PMS symptoms with alternative therapies such as acupuncture or
massage.
PHARMACOLOGICAL MANAGEMENT
1.
Nonsteroidal anti-inflammatory drugs
(NSAIDs): NSAIDs such as ibuprofen or naproxen can help to alleviate physical
symptoms such as cramps, headaches, and breast tenderness.
2.
Hormonal contraceptives: Oral
contraceptives or other hormonal contraceptives that contain estrogen and
progestin can help to regulate hormone levels and reduce symptoms such as
bloating, breast tenderness, and mood changes.
3.
Selective serotonin reuptake inhibitors
(SSRIs): SSRIs such as fluoxetine or sertraline can help to alleviate emotional
symptoms such as anxiety, irritability, and depression.
4.
Gonadotropin-releasing hormone (GnRH)
agonists: GnRH agonists such as leuprolide may be prescribed for women with
severe PMS who do not respond to other treatments. These medications work by
suppressing ovulation and reducing hormone levels.