Endometrial hyperplasia is overgrowth of endometrium. EH is caused by excess estrogen without progesterone. TYPES OF EH : *simple without atypia :1%risk of uterine cancer. *complex without atypia :3%risk of uterine cancer. *simple with atypia :8%risk of uterine cancer. *complex with atypia :29%progress to cancer. Endometrial thickness in a reproductive age woman: *during menstruation 2-4mm. *initial proliferative 5-7mm. *late proliferative 11 mm. *secretory period 8-16mm. Here in this patient 30 year old , sterilised, obese, secondary amenorrhoea ,no pcod give progesterone. patient will have withdrawal bleeding. start low dose ocp's for 6 months.
WHEN THERE IS A EH BETTER AVOID OC PILLS.CAN GIVE P IN SEQUENTIAL MANNER FROM 16 TH ONWARDS FOR IO DAYS. THE BEST IS CONFIRMATION OF EH BY ENDO BIOPSY THROUGH HYSTEROSCOPE.IF CONFIRMED FOLLOWUP IS IMPORTANT EVERY 6MONTHS USG &IF NEEDS BIOPSY.
get her thyroid and sugar profile endometrial biopsy to rule out ca or hormonal disturbances. if biopsy report normal can be put on progesterone fr some time
PID with endometriosis Oflaxacin + Tinidazole BD Aceclofenac Paracetamol saeropeptidase BD. pantaprazole OD. multivitamins OD. colposcopy pap smear test. TFT. Regular exercise. D& C if required.
Does she have menorrhagia or prolonged cycles,if not then scan her on day 5 of menses for endometrial thickness ,if less then5 mm ,no active treatment required,if more ,rule out polyp.Pain and weight gain has nothing to do with TL,rule out nongyn causes of pain
medical curettage with progesterone ..and 30 years ..18 mm is normal . .what's her wt as on now .whats Her BMI .do thyroid profile . any colitis or cystitis also can cause ..where is the exact location of pain ?is it vague or localised or radiated ..
Rule out hypothyroidism.
D&C n biopsy, antispasmodic.tsh,Prl,FSH,LH.,AMH,sr estradiol assay
there seems no relation with tubal ligation and current symptoms usg shows endometrial hyperplasia, but if no menstrual complaints then observation, as she is 30. may get a tsh for weight gain and sympyomatic treatment for pain
EH mostly due to excessive oestrogen level Go for D&C hormonal profile also And put patient on low dose of hormones fr regulation of periods and hormonal imbalance obesity is another factor to be checked As obesity cause insulin resistance nd pcod both again cause iregular periods nd hormonal imbalance nd this cycle keeps on going
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A obese patient age 40 yrs,weight 113kg has a following report. plz suggest a remedy for the patient for losing his weight and get rid from the obesityDr. Astha Agarwal1 Like30 Answers
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ENDOMETRIOTIC CYST IN OVARY cured with homeopathic medicines without surgery 2 Large Endometriotic Cyst in Ovary measuring 3.8 x 3.6 x 2.2cms and 2.5 x 2.3 x 1.6cms Cured without surgery with Homeopathic medicines By Dr Deepan P Shah at Dr Shah’s Homeopathy. THE OVARIAN CYSTS RESOLVED IN JUST 60 DAYS First consultation on 10/4/2018 Patient has endometriotic cyst both ovaries, till one year ago she had only on one side. h/o medicines for hypothyroidoism which she had stopped. Prolactin Elevated, h/o occasional oozing of fluid from nipples, only on pressing nipples, patient used to have sensitive nipples even before menarche, this oozing was first noticed when her dermatologist examined nipple and on pressure fuild oozed out. PCOD detected in jan 2014 H/o acne, hairfall Patient also has H/o severe pain in pelvis and lower back in 2017 at that time patient was not even able to sit due to pain, after which she got detected with endometriotic cyst in right ovary then later on left ovary as well. Then patient sarted allopathic hormonal medicines but still she has a constant pain in pelvis but has reduced by 80% Menstrual Functions Menarche at around 14-15 yrs Cycle regular 28 days Initial 10 yrs menstrual bleeding phase used to last for 7 days with heavy flow, her mother used to have similar pattern. Other notable factors Hyperacidity and Constipation since 10 yrs. Patient lost her younger brother 10 yrs ago. Patient follows regular meal pattern. Patient has c/o mild to moderate allergic respiratory affections especially sneezing and rhinorrhoea which Aggravates even on draft of air, needs covering. Lower Backache , pain in Nape of Neck Axillary lymphomegally Renal Stones No Record of Hypertension , Diabetes Mellitus, drug reactions RX PULSATILLA 200 SINGLE DOSE WAS ADMINISTERED AND PATIENT WAS ADMINISTERED SAC LAC Later on after 3 weeks based on her symptoms, she was administered with Conium Mac 200 single dose and left on placebo NOW AFTER ENDOMETRIOTIC CYST HAS BEEN CURED PATIENT IS STILL CONTINUING TREATMENT FOR PCOS WHICH IS ALTOGETHER A DIFFERENT ENTITY Note Reports attached before and after treatment.Dr. Rajesh Gupta16 Likes18 Answers
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A case female have infertility problem last 7 years. one child age 5 years. follicular study is given below .plz suggest treatmentDr. M. Shameem Akhtar Khan1 Like7 Answers
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Today my topic is on #Infertility #Infertilitywomen #pregnancy problem.Most of the peoples are worrying about this I will try to give solutions. Infertility in females Infertility means you cannot get pregnant (conceive). There are 2 types of infertility: • Primary infertility refers to couples who have not become pregnant after at least 1 year having sex without using birth control methods. • Secondary infertility refers to couples who have been able to get pregnant at least once, but now are unable. Causes Many physical and emotional factors can cause infertility. It may be due to problems in the woman, man, or both. FEMALE INFERTILITY Female infertility may occur when: • A fertilized egg or embryo does not survive once it attaches to the lining of the womb (uterus). • The fertilized egg does not attach to the lining of the uterus. • The eggs cannot move from the ovaries to the womb. • The ovaries have problems producing eggs. Female infertility may be caused by: • Autoimmune disorders, such as antiphospholipid syndrome (APS) • Birth defects that affect the reproductive tract • Cancer or tumor • Clotting disorders • Diabetes • Drinking too much alcohol • Exercising too much • Eating disorders or poor nutrition • Growths (such as fibroids or polyps) in the uterus and cervix • Medicines such as chemotherapy drugs • Hormone imbalances • Being overweight or underweight • Older age • Ovarian cysts and polycystic ovary syndrome (PCOS) • Pelvic infection resulting in scarring or swelling of fallopian tubes (hydrosalpinx) or pelvic inflammatory disease (PID) • Scarring from sexually transmitted infection, abdominal surgery or endometriosis • Smoking • Surgery to prevent pregnancy (tubal ligation) or failure of tubal ligation reversal (reanastomosis) • Thyroid disease For Infertility in Women 1. For Infertility in Females due to Acid Vaginal Discharges: Borax and Natrum Phos are top-grade medicines for infertility in females due to acid vaginal discharges. 2. For Infertility in Females due to too Profuse or Prolonged Periods (menorrhagia): Two excellent medicines for infertility in females from profuse or prolonged periods are Calcarea Carb and Aletris Farinosa. Calcarea Carb is mainly used when a female with infertility has too profuse and too long lasting periods. 3. For Infertility in Females with Short, Scanty Periods: Pulsatilla and Sepia are suitable medicines for infertility in females resulting from short, scanty periods. 4. For Infertility in Females with Decreased Sexual Desire: Agnus Castus and Sepia are prominently indicated medicines for infertility in females with decreased sexual desire. 6. For Infertility in Females due to Non Retention of Sperms: Among the various medicines for infertility in females from non-retention of sperms Natrum Carb occupies highest rank.Dr. Rajesh Gupta4 Likes7 Answers
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Dyspareunia Pain Having Sex:- Dyspareunia is a term used for pain felt in the genital area or pelvis during or after having sex (intercourse). Nobody really knows exactly how common it is, as many women never seek medical help. However, questionnaires asking women if they have symptoms suggest that somewhere between 1 and 4 out of 10 women experience it. Most commonly, this is early in their sexual lives or around the menopause. There are many causes of dyspareunia, most of which are not serious or damaging in nature, but all can be detrimental to your sex life and ultimately may lead to relationship difficulties. It can be a vicious circle, with pain leading to nervousness about having sex, and nervousness leading to dryness and further pain. It's also not uncommon for dyspareunia to remain after the cause has been treated, particularly if things have been left untreated for a while. For this reason, it is important to seek help early, so that treatable causes can be discovered and managed. This leaflet discusses the types and possible causes of dyspareunia. What is dyspareunia? Dyspareunia is pain felt in the genital area or pelvis during or after having sex (intercourse). It may be thought of as either superficial dyspareunia or deep dyspareunia. They have different causes and treatments and, although it's possible to experience both at the same time, most women find that their dyspareunia is predominantly one or the other type. Superficial dyspareunia This is pain felt in the lips of the vagina (labia), at the vaginal entrance (introitus) and the lower part of the vagina. It typically begins with penetration or very early on after intercourse has begun. It is sore and instant. It is usually quickly relieved by stopping penetration, although you may be sore to the touch afterwards for a little while. The causes of superficial dyspareunia are usually local problems of the labial, vaginal and perineal skin (the perineum is the area of skin between the vaginal opening and the back passage). Deep dyspareunia This is the term for pain felt deeper in the pelvis during or after intercourse. It can also spread to involve the fronts of the thighs. It may be sharp or dull, may stop when penetration stops or can continue for minutes or even hours. The causes of this type of pain usually lie rather deeper in the pelvis. Causes of superficial dyspareunia Skin bridge Formation of a little bridge of scar tissue at the very back of the vaginal entrance (introitus) is common after childbirth, particularly if you have had a cut between the vagina and back passage (anus) - a procedure called episiotomy. The scar tissue contains nerve endings and is very sensitive, and so it causes pain on penetration. The pain tends to become worse as having sex (intercourse) continues, as the skin bridge becomes rubbed by the continuing rubbing of penetration. Intact hymen The hymen is a membrane that lines the vaginal opening. Early in your sex life the hymen is broken down by the act of having sex. In many young women it will already have been stretched by use of tampons. The name 'intact hymen' is misleading, as the hymen does in fact have a small hole in it from birth. This hole becomes larger little by little as girls grow older. However, the hymen can be quite thick and the hole not quite large enough. This can mean that early in her sexual life a woman my feel pain from the hymen as it is forced open the first time she has intercourse. The pain is superficial, felt at the entrance to the vagina as soon as penetration is attempted and may prevent it from taking place. Vaginismus Vaginismus causes a powerful and often painful contraction of the muscles around the entrance to the vagina, which makes penetration painful or impossible. It may also prevent the use of tampons and any sort of gynaecological examination. The spasm of vaginismus is not something you can cause deliberately; it's completely outside your control. It may seem to begin for no reason but can also result from a painful or worrying experience of sex, when it becomes a kind of protective reflex. However, vaginismus is upsetting and dispiriting for both halves of a couple, as it can prevent the enjoyment of sex for many years and can prevent sex completely. Once it has begun, fear of failure and nervousness about not being able to have sex make it worse. It's important to seek help to break the cycle of anxiety and pain. Vaginismus is not difficult to treat but your doctor may need to refer you to a psychologist or specialist physiotherapist. Bartholinitis Bartholin's glands are a pair of glands on either side of the vagina, in the tissues of the wall. They can become inflamed and tender causing Bartholinitis and this will lead to pain during sex. Occasionally, the glands swell during sex, so that it starts off as painless but then becomes painful as it continues. See separate leaflet called Bartholin's Cyst and Abscess for more details. Vulvodynia This is a very troublesome condition where the vulval area becomes painful and extremely sensitive to pressure and touch. It can be accompanied by severe pain on attempted penetration. It can also cause the vulval area to be painful touched and during activities of everyday living. It can lead to frustration and depression, as symptoms can be very long-standing. The causes are uncertain but may involve the nerves in the area becoming much more sensitive than normal and the way the brain communicates wtih these nerves changing in some way. Treatment includes the use of emollient soap substitutes, creams that numb the area, medicines that lessen pain, physiotherapy and cognitive behavioural therapy. Lichen sclerosus This is a scarring skin condition which may affect women of any age, including children. It can affect men too. It results in thinning of the skin of the genital area, together with formation of white patches. It may be caused by the immune system. It causes itching and pain, which can last for a very long time. It's often mistaken for thrush as it can be very itchy and sometimes slightly sore. Lichen sclerosus carries a small risk risk of cancer of the genital skin. For this reason it should be diagnosed and treated - treatment is usually with regular application of creams. Female genital mutilation Female genital mutilation (which used to be known as female circumcision), involves varying degrees of mutilating surgery to the genitals of a girl. In the more extreme forms, the vagina is stitched shut. Following genital mutilation there is usually permanent scarring, which may lead to damaged nerves and pain. Any of these issues can cause pain on penetration and may make sex impossible. Vaginal abnormalities Very rarely, abnormalities of the vagina itself make sex painful or even impossible. These include pieces of extra tissue inside the vagina which are present at birth (vaginal septa). Causes of superficial and deep dyspareunia Vaginal trauma The vagina is pretty flexible and strong and usually recovers well from the stretch and (sometimes) small tears of childbirth. However, more significant injury to the vagina - for example, from difficult childbirth or mutilation - can lead to scarring and then to pain and difficulty during sex (intercourse). Vaginal or genital infection Infections of the vagina and the area around it cause inflammation of the tissues and so commonly cause pain on having sex. Infection may be with thrush (candida - a yeast that often lives in the bowel), with viruses such as herpes and with germs (bacteria). A wide range of bacterial infections can infect the vagina. Some (but by no means all) are sexually transmitted. The vagina is not always sore and itchy before sex but becomes so afterwards. There is often a coloured discharge and you may notice an offensive smell. Vaginal dryness Sometimes pain during sex is due to lack of lubrication, meaning that the vagina is too dry. Normally, the vagina produces secretions which keep it moist and these increase when you become sexually aroused. If there isn't enough foreplay, or you are not aroused enough, you may not produce enough secretions to make penetration comfortable. However, it isn't always as simple as that. There may be reasons why you don't produce the secretions that you should. These can include psychological reasons such as nervousness because sex has previously been uncomfortable; anxiety around becoming pregnant; or anxiety around waking your sleeping children. Dryness can also be for physical reasons - the vagina tends to be drier after the menopause (see below). Some medicines can cause vaginal dryness, including some contraceptive methods. Vaginal dryness is also associated with a condition called Sjögren's syndrome, in which the body's secretions are generally rather reduced. Finally, pregnancy itself can make the vagina dry during intercourse (although it can also have the opposite effect). Vaginal atrophy After the menopause the levels of hormones in your body fall - particularly the level of oestrogen. Oestrogen is the hormone that keeps the vaginal wall strong and resistant. It increases the blood supply and the level of secretions and makes the wall softer and more stretchy. Therefore, when oestrogen levels fall after the menopause, the tissues become thinner, less stretchy and less well lubricated. Sometimes they can become as fragile and delicate as the vaginal tissues of young girls (who have not yet reached puberty and started their periods). There are lots of very effective treatments for this problem. Causes of deep dyspareunia Deep dyspareunia can be caused by the genital organs themselves but may also be caused by other structures in the tummy (abdomen) that can be easily knocked during sex (intercourse). There are therefore many possible causes of deep pain in the tummy during sex. Cervical pain The neck of the womb (cervix) should not normally be painful. However, if can become infected by many of the organisms which can infect the vagina - particularly herpes. If the cervix becomes inflamed then knocking it with the penis during sex may cause deep pain in the pelvis and sometimes across the fronts of the thighs. The cervix may also become tender and sensitive if you have an intrauterine contraceptive device, particularly if it is sitting a little too low or falling out. This can cause sudden sharp pains in the cervix during sex. (Fortunately cervical cancer is very rare and does not usually cause painful sex.) Endometriosis Endometriosis is a condition in which little bits of womb (uterine) lining become embedded in other parts of the body. Most usually this is in the ovaries, the Fallopian tubes that link the womb to the ovaries, and the cervix. These bits of tissue bleed whenever you have a period. This blood tends to cause scar tissue formation with sticking of organs to one another, and the whole pelvis can become painful. Endometriosis is typically found in young women, and may only become apparent when they come off the contraceptive pill if they have been taking it for a while. This is because 'the pill' suppresses it and is, in fact, a treatment for endometriosis. Endometriosis causes pain on sex, typically pain that comes on with deep penetration and continues for some time after penetration is over. It also causes painful periods, and women with endometriosis can find it difficult to get pregnant. Ovarian cysts The presence of cysts on the ovaries can cause pain during sex (intercourse). This is because the ovaries can be knocked by the penis during intercourse and this can cause the cysts to leak fluid. It's not unusual to have cysts on the ovaries, as cyst formation is a normal part of the period (menstrual) cycle. However, these 'physiological cysts' are typically very small. Larger cysts are more likely to leak and cause pain, and can be a sign of endometriosis, especially in younger women. In women who have passed their menopause, ovarian cysts are worrying, as they can be a sign of ovarian cancer. Another, harmless form of pain from the ovary is called 'Mittelschmerz.' This is pain when an egg is released from the ovary. Pain from Mittelschmerz may not be related to sex at all, and typically lasts for two or three days in the middle of the month - but sex may make it worse when it's there. Fibroids and growths in the womb Fibroids are non-cancerous (benign) growths in the muscle of the womb, which can cause the womb itself to become quite bulky. This is not always painful but it can lead to discomfort during sex. Causes related to womb position In some women the womb tilts backwards, rather than forwards; the ovaries then tend to fall backwards too. This can lead to them being knocked in positions involving deep penetration. This can result in deep pain in the pelvis that is more noticeable with deep penetration and which settles slowly when penetration stops or when you change your position. Bowel pain During intercourse the bowel is also knocked and moved. If the bowel is sensitive or tender then this can be the origin of pain during sex. This is particularly likely in women who have Crohn's disease, ulcerative colitis or irritable bowel syndrome, all of which are conditions that cause the bowel to be painful. Pelvic inflammatory disease This is a condition of the Fallopian tubes, the womb and, sometimes, the ovaries. It is caused by infection and makes these organs inflamed. As they tend to move during sex, this is painful. The pain is typically felt deep in the pelvis, is worse with deep penetration and settles slowly when penetration stops. Pelvic inflammatory disease also tends to make you feel unwell, and may cause a temperature and a vaginal discharge. Bladder pain The bladder sits on top of your womb, just behind and above your pubic bone. Like the womb, the bladder moves and gets pressed on during intercourse. So, if the bladder is inflamed, this may hurt. Typical causes include urine infections and interstitial cystitis. This is a condition in which the bladder becomes sensitive and painful. It behaves like a urine infection but no infection is present. Summary Symptoms of dyspareunia (pain felt in the pelvis during or after sex) are distressing and depressing. They can affect your sex life, your fertility and even your relationship. Many of the causes have a very simple solution and it is important to seek help if you are experiencing problems. Any donations are always appreciated for the time and effort https://www.paypal.me/DrnmnooriDr. Ramesh Kumar2 Likes3 Answers