ASK THE DOC...
Hormonal imbalance causes many problems. The gynaecologist on our panel answers queries from readers.
This week's questions are answered by Dr. D. Pushpalatha, Chairperson, Family Welfare Committee, Federation of Obstetric and Gynaecological Societies of India, Hyderabad.
WHEN and why is the amniotic fluid test conducted? What are the repercussions when it is lower/higher than normal?
Answer: The foetus grows in the amniotic sac, which contains the amniotic fluid. The fluid originates from foetus (by way of urination, from the lungs and umbilical cord). The mother's contribution is from membranes surrounding the foetus. The amniotic fluid protects the foetus from injuries, maintains temperature, provides drinking water and allows free movement. The volume of the fluid volume is a marker of placental perfusion and indirectly of the foetal condition. The fluid's volume is measured by Ultrasound and expressed as Index . If amniotic fluid is less, it is called Oligo Hydramnios. This may be due to leaking of fluid or associated with foetal abnormalities and growth retardation. When amniotic fluid is more it is called Poly Hydramnios and is associated with twins, foetal anomalies and gestational diabetes. Amniotic fluid tested by aspiration is indicated for neural tube defects, chromosomal anomalies, and to know lung maturity of foetus.
I AM 20, weight 85 kg, height 5.2'. I take Eltroxin 100mcg one/day. I don't have periods for several months at a stretch. When given medicines, it starts and continues for months as spotting until I take medicine to stop it. I am on folic acid (5 mg) daily and Globac-z on alternate days. My estrogen level is 76.22 (during spotting); T3 is112 microgm/dl; T4 is 9.40 microgm/dl; TSH is 1.58 microIU/mL (by C.L.I.A method-Thyrocare)
An ultrasonography was done and the report was as follows: Normal size anteverted uterus with central endometrial canal echo. Endometrial thickness is normal. Bilateral large ovaries with multiple surface follicles-suggestive of poly cystic ovaries. Superior to and inseparable from the left ovary, there is evidence of medium size cystic lesion without internal sepation or echogenic projection measuring 8.8x6.4 cm,sugesstive of large para ovarian cyst. Transabdominal ultrasound guided aspiration of the cyst may be done. Mild hepatomegaly with Grade I fatty changes. No focal lesion in liver.
As I am unmarried, what are the latest modes of treatment besides Laproscopy? A. Sharin
Answer: You are suffering from endocrinological imbalance of multiple organs. Proper hormonal evaluation and an ultrasound of the pelvis will help in deciding the treatment. Proper diet, exercise, and appropriate medication are needed. Hypothyroidism has to be corrected by replacement of Thyroid hormone under supervision. Polycystic ovaries may be the cause for irregular periods and this can be regularised with cyclic hormone tablets. The para aortic cyst may require laparoscopic surgical intervention. Please consult an endocrinologist and a gynaecologist.
I AM suffering from polycystic ovarian disease. I am taking aldactone 25 mg for three years. Is it all right or should I change it? My periods are regular but I have facial hair, which have reduced a bit but not much. I have reduced weight. I am 26 years and unmarried. Will I be able to bear a child and will there be any complications? My doctor has asked me to continue with the medicine for some more time. After marriage will I need to continue with this medicine? Are there any diet requirements I should follow?
Answer: Polycystic ovarian syndrome is due to hormonal imbalance. Diagnosis is confirmed by estimation of hormone levels. Ultrasonography reveals small cysts around the periphery of ovaries. The exact cause of PCOS is not known. Women with PCOS make too much insulin (which is essential for carbohydrate metabolism). The ovaries react by making too many male hormones called androgens. This can lead to acne, excessive hair growth, weight gain and ovulation problems. Aldactone can be continued to decrease facial hair. Low dose birth control pills and newer drugs as Ethynyl estradiol cyproterone Acetate 2mg can be used but only under a doctor's advice. Check with your gynaecologist when you are considering having a child.
MY friend, who is 31 and married with a child, got a copper T inserted about eight months ago. For the past few months her periods are irregular, with more spotting. She had spotting for more than a month. We consulted a gynaecologist and she was prescribed many a medicine and finally Primolut N which worked. But in August, she was due for her periods on August 5 but did not get it. There was spotting on August 2 and 3 and also some symptoms of periods like back pain. Is this normal?
Answer: Ask your friend to get CuT position checked up both by examination and by Ultrasound. If it is intrauterine (normal position) cyclic hormone pills for three months will control the spotting and pain. If it is displaced it has to be removed.
MY daughter is 19. She has severe pain during periods lasting for four days. Her menstrual cycle is irregular. When she underwent a scan it was found that she had chocolate cysts on her right ovary 5.3x3.1. She is taking the 21-day tablet. Is it dangerous? What are the treatment options?
Answer: Your daughter is probably suffering from a condition known as Endometriosis. In this condition there will be deposition of endometrial tissue (which is found as lining of the womb), outside the uterus. It is a common, poorly understood, extremely debilitating, benign, gynaecological condition. It is diagnosed by clinical history and diagnostic laparoscopy. The cycles will be painful and may lead to infertility. Cyclic treatment with hormones combined with analgesic and antispasmodic pills for the pain are ideal. After marriage if the pain and chocolate cysts persist and pregnancy does not occur, intervention with laparoscopy is indicated.
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