What is infertility?

In general, infertility is defined as not being able to get pregnant (conceive) after one year of unprotected sex. Women who do not have regular menstrual cycles, or are older than 35 years and have not conceived during a 6-month period of trying, should consider making an appointment with a reproductive endocrinologist—an infertility specialist. These doctors may also be able to help women with recurrent pregnancy loss—2 or more spontaneous miscarriages.

Pregnancy is the result of a process that has many steps.

To get pregnant—

• A woman’s body must release an egg from one of her ovaries (ovulation).
• A man's sperm must join with the egg along the way (fertilize).
• The fertilized egg must go through a fallopian tube toward the uterus (womb).
• The fertilized egg must attach to the inside of the uterus (implantation).

Infertility may result from a problem with any or several of these steps.

Impaired fecundity is a condition related to infertility and refers to women who have difficulty getting pregnant or carrying a pregnancy to term.

Is infertility a common problem?

Yes. About 6% of married women 15–44 years of age in the United States are unable to get pregnant after one year of unprotected sex (infertility).
Also, about 12% of women 15–44 years of age in the United States have difficulty getting pregnant or carrying a pregnancy to term, regardless of marital status (impaired fecundity).

Is infertility just a woman's problem?

No, infertility is not always a woman's problem. Both men and women contribute to infertility.
Many couples struggle with infertility and seek help to become pregnant; however, it is often thought of as only a women’s condition. A CDC study analyzed data from the 2002 National Survey of Family Growth and found that 7.5% of all sexually experienced men younger than age 45 reported seeing a fertility doctor during their lifetime—this equals 3.3–4.7 million men. Of men who sought help, 18% were diagnosed with a male-related infertility problem, including sperm or semen problems (14%) and varicocele (6%).

What causes infertility in men?

Infertility in men can be caused by different factors and is typically evaluated by a semen analysis. A specialist will evaluate the number of sperm (concentration), motility (movement), and morphology (shape). A slightly abnormal semen analysis does not mean that a man is necessarily infertile. Instead, a semen analysis helps determine if and how male factors are contributing to infertility.
Conditions that can contribute to abnormal semen analyses include— 

• Varicoceles, a condition in which the veins on a man’s testicles are large and cause them to overheat. The heat may affect the number or shape of the sperm.
• Medical conditions or exposures such as diabetes, cystic fibrosis, trauma, infection, testicular failure, or treatment with chemotherapy or radiation.
• Unhealthy habits such as heavy alcohol use, testosterone supplementation, smoking, anabolic steroid use, and illicit drug use.
• Environmental toxins including exposure to pesticides and lead.

What causes infertility in women?

Women need functioning ovaries, fallopian tubes, and a uterus to get pregnant. Conditions affecting any one of these organs can contribute to female infertility. Some of these conditions are listed below and can be evaluated using a number of different tests.
Ovarian Function (presence or absence of ovulation and effects of ovarian “age”):

• Ovulation. Regular predictable periods that occur every 24–32 days likely reflect ovulation. Ovulation can be predicted by using an ovulation predictor kit and can be confirmed by a blood test to see the woman’s progesterone level. A woman’s menstrual cycle is, on average, 28 days long. Day 1 is defined as the first day of “full flow.”
• A woman with irregular periods is likely not ovulating. This may be because of several conditions and warrants an evaluation by a doctor. Potential causes of anovulation include the following:
  • Polycystic ovary syndrome (PCOS). PCOS is a hormone imbalance problem that can interfere with normal ovulation. PCOS is the most common cause of female infertility.
  • Functional hypothalamic amenorrhea (FHA). FHA relates to excessive physical or emotional stress that results in amenorrhea (absent periods).
  • Diminished ovarian reserve (DOR). This occurs when the ability of the ovary to produce eggs is reduced because of congenital, medical, surgical, or unexplained causes. Ovarian reserves naturally decline with age.
  • Premature ovarian insufficiency (POI). POI occurs when a woman’s ovaries fail before she is 40 years of age. It is similar to premature (early) menopause.
  • Menopause . Menopause is an age-appropriate decline in ovarian function that usually occurs around age 50. It is often associated with hot-flashes and irregular periods.
• Ovarian function. Several tests exist to evaluate a woman’s ovarian function.
• No single test is a perfect predictor of fertility.
• The most commonly used markers of ovarian function include follicle stimulating hormone (FSH) value on day 3–5 of the menstrual cycle, anti-mullerian hormone value (AMH), and antral follicle count (AFC) using a transvaginal ultrasound.

Tubal Patency (whether fallopian tubes are open, blocked, or swollen):

• Risk factors for blocked fallopian tubes (tubal occlusion) can include a history of pelvic infection, history of ruptured appendicitis, history of gonorrhea or chlamydia, known endometriosis , or a history of abdominal surgery.
• Tubal evaluation may be performed using an X-ray which is called a hysterosalpingogram (HSG), or by chromopertubation (CP) in the operating room at time of laparoscopy, a surgical procedure in which a small incision is made and a viewing tube called a laparoscope is inserted.
  • Hysterosalpingogram (HSG) is an X-ray of the uterus and fallopian tubes. A radiologist injects dye into the uterus through the cervix and simultaneously takes X-ray pictures to see if the dye moves freely through fallopian tubes. This helps evaluate tubal caliber (diameter) and patency.
  • Chromopertubation is similar to an HSG but is done in the operating room at the time of a laparoscopy. Blue-colored dye is passed through the cervix into the uterus and spillage and tubal caliber (shape) is evaluated.

Uterine Contour (physical characteristics of the uterus):

• Depending on a woman’s symptoms, the uterus may be evaluated by transvaginal ultrasound to look for fibroids or other anatomic abnormalities. If suspicion exists that the fibroids may be entering the endometrial cavity, a sonohystogram (SHG) or hysteroscopy (HSC) may be performed to further evaluate the uterine environment.

What things increase a woman's risk of infertility?

Female fertility is known to decline with—

• Age. Many women are waiting until their 30s and 40s to have children. In fact, about 20% of women in the United States now have their first child after age 35, and this leads to age becoming a growing cause of fertility problems. About one-third of couples in which the woman is older than 35 years have fertility problems. Aging not only decreases a woman's chances of having a baby but also increases her chances of miscarriage and of having a child with a genetic abnormality.
• Aging decreases a woman's chances of having a baby in the following ways—
  • Her ovaries become less able to release eggs.
  • She has a smaller number of eggs left.
  • Her eggs are not as healthy.
  • She is more likely to have health conditions that can cause fertility problems.
  • She is more likely to have a miscarriage.
• Smoking.
• Excessive alcohol use.
• Extreme weight gain or loss.
• Excessive physical or emotional stress that results in amenorrhea (absent periods).

How long should women try to get pregnant before calling their doctors?

Most experts suggest at least one year for women younger than age 35. However, women aged 35 years or older should see a health care provider after 6 months of trying unsuccessfully. A woman's chances of having a baby decrease rapidly every year after the age of 30.
Some health problems also increase the risk of infertility. So, women should talk to a health care provider if they have—

• Irregular periods or no menstrual periods.
• Very painful periods.
• Endometriosis.
• Pelvic inflammatory disease.
• More than one miscarriage.

It is a good idea for any woman and her partner to talk to a health care provider before trying to get pregnant. They can help you get your body ready for a healthy baby, and can also answer questions on fertility and give tips on conceiving. Learn more at the CDC's Preconception Health Web site. 

How will doctors find out if a woman and her partner have fertility problems?

Doctors will begin by collecting a medical and sexual history from both partners. The initial evaluation usually includes a semen analysis, a tubal evaluation, and ovarian reserve testing.

How do doctors treat infertility?

Infertility can be treated with medicine, surgery, intra-uterine insemination, or assisted reproductive technology. Many times these treatments are combined. Doctors recommend specific treatments for infertility based on—

• The factors contributing to the infertility.
• The duration of the infertility.
• The age of the female.
• The couple’s treatment preference after counseling about success rates, risks, and benefits of each treatment option.

What are some of the specific treatments for male infertility?

Male infertility may be treated with medical, surgical, or assisted reproductive therapies depending on the underlying cause. Medical and surgical therapies are usually managed by an urologist who specializes in infertility. A reproductive endocrinologist may offer intrauterine inseminations (IUIs) or in vitro fertilization (IVF) to help overcome male factor infertility.

What medicines are used to treat infertility in women?

Some common medicines used to treat infertility in women include—

• Clomiphene citrate (Clomid®*) is a medicine that causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. This medicine is taken by mouth.
• Human menopausal gonadotropin or hMG (Repronex®*; Pergonal®*) are medicines often used for women who don't ovulate because of problems with their pituitary gland—hMG acts directly on the ovaries to stimulate ovulation. It is an injected medicine.
• Follicle-stimulating hormone or FSH (Gonal-F®*; Follistim®*) are medicines that work much like hMG. It causes the ovaries to begin the process of ovulation. These medicines are usually injected.
• Gonadotropin-releasing hormone (Gn-RH) analog are medicines often used for women who don't ovulate regularly each month. Women who ovulate before the egg is ready can also use these medicines. Gn-RH analogs act on the pituitary gland to change when the body ovulates. These medicines are usually injected or given with a nasal spray.
• Metformin (Glucophage®*) is a medicine doctors use for women who have insulin resistance and/or PCOS. This drug helps lower the high levels of male hormones in women with these conditions. This helps the body to ovulate. Sometimes clomiphene citrate or FSH is combined with metformin. This medicine is usually taken by mouth.
• Bromocriptine (Parlodel®*) is a medicine used for women with ovulation problems because of high levels of prolactin. Prolactin is a hormone that causes milk production.

*Note: Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
Many fertility drugs increase a woman's chance of having twins, triplets, or other multiples. Women who are pregnant with multiple fetuses have more problems during pregnancy. Multiple fetuses have a high risk of being born prematurely (too early). Premature babies are at a higher risk of health and developmental problems.

What is intrauterine insemination (IUI)?

Intrauterine insemination (IUI) is an infertility treatment that is often called artificial insemination. In this procedure, specially prepared sperm are inserted into the woman’s uterus. Sometimes the woman is also treated with medicines that stimulate ovulation before IUI.
IUI is often used to treat—

• Mild male factor infertility.
• Couples with unexplained infertility.

What is assisted reproductive technology (ART)?

Assisted Reproductive Technology (ART) includes all fertility treatments in which both eggs and sperm are handled outside of the body. In general, ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman. The main type of ART is in vitro fertilization (IVF).

How often is assisted reproductive technology (ART) successful?

Success rates vary and depend on many factors, including the clinic performing the procedure, the infertility diagnosis, and the age of the woman undergoing the procedure. This last factor—the woman’s age—is especially important.
CDC collects success rates on ART for some fertility clinics. According to the CDC’s 2012 ART Success Rates, the average percentage of fresh, nondonor ART cycles that led to a live birth were—

• 40% in women younger than 35 years of age.
• 31% in women aged 35–37 years.
• 22% in women aged 38–40 years.
• 12% in women aged 41–42 years.
• 4% in women aged 43–44 years.
• 2% in women aged 44 years and older.

Success rates also vary from clinic to clinic and with different infertility diagnoses
also vary from clinic to clinic and with different infertility diagnoses.
ART can be expensive and time-consuming, but it has allowed many couples to have children that otherwise would not have been conceived. The most common complication of ART is a multiple fetus pregnancy. This is a problem that can be prevented or minimized by limiting the number of embryos that are transferred back to the uterus. For example, transfer of a single embryo, rather than multiple embryos, greatly reduces the chances of a multiple fetus pregnancy and its risks such as preterm birth.

What are the different types of assisted reproductive technology (ART)?

Common methods of ART include—

• In vitro fertilization (IVF), meaning fertilization outside of the body. IVF is the most effective and the most common form of ART.
• Zygote intrafallopian transfer (ZIFT) or tubal embryo transfer. This is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.
• Gamete intrafallopian transfer (GIFT), involves transferring eggs and sperm into the woman's fallopian tube. Fertilization occurs in the woman's body. Few practices offer GIFT as an option.
• Intracytoplasmic sperm injection (ICSI) is often used for couples with male factor infertility. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg as opposed to “conventional” fertilization where the egg and sperm are placed in a petri dish together and the sperm fertilizes an egg on its own.

ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who cannot produce eggs. Also, donor eggs or donor sperm are sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.
Surrogacy
Women with no eggs or unhealthy eggs might also want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man's sperm and her own egg. The child will be genetically related to the surrogate and the male partner.
Gestational Carrier
Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn't become pregnant because of a serious health problem. In this case, a woman uses her own egg. It is fertilized by her partner’s sperm and the embryo is placed inside the carrier's uterus.

Related Links

• How Do I Know If I Have an Infertility Problem? (Resolve: The National Infertility Association)
• Trying to Get Pregnant? (March of Dimes)
• Infertility (MedlinePlus)
• American Fertility Association The American Fertility Association (AFA) is a national consumer organization that offers support for men and women dealing with infertility. Their purpose is to educate the public about reproductive disease, and support families during struggles with infertility and adoption.
• RESOLVE: The National Infertility Association RESOLVE is a national consumer organization that offers support for men and women dealing with infertility. Their purpose is to provide timely, compassionate support and information to people who are experiencing infertility and to increase awareness of infertility issues through public education and advocacy.
• American Society for Reproductive Medicine The American Society for Reproductive Medicine (ASRM) is a multidisciplinary organization that provides information, education, advocacy, and standards in reproductive medicine.
• Society for Assisted Reproductive Technology The Society for Assisted Reproductive Technology (SART) promotes and advances the standards for the practice of assisted reproductive technology to the benefit of patients, members, and society at large.
• Human Cell, Tissues and Cellular and Tissue-Based Products Listing of ART clinics registered with FDA. 

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How to get all Gynaecology Services - including emergencies

The gynaecology service at Gyncentre Clinics provide comprehensive care for women with a wide range of gynaecology issues. The service provides inpatient, outpatient and emergency services through its mobile doctors and consultants country wide.

Outpatient clinics

We run a wide range of general and specialist clinic including:

• suspicion of cancer rapid access clinic (strict referral criteria)
• cancer follow-up clinic 
• Pregnancy crisis including termination of pregnancy with fetal abnormalities after imaging.
• multi-disciplinary oncology clinic
• colposcopy clinics
• continence and urodynamic service
• reproductive medicine clinic
• recurrent miscarriage service
• outpatient procedure clinics
• menopause clinic for women experiencing a problematic menopause or those requiring HRT (hormone replacement therapy) advice 
• laparoscopic sterilisation clinic offeings counselling to women requesting sterilisation as a contraception option
• hormone dysfunction clinic
• minimally invasive surgery
• endometriosis clinics

Emergency services clinic

 It provides assessment and treatment for women presenting with complications of early pregnancy and acute gynaecological conditions.

The majority are managed on an outpatient basis, but can be admitted to the Gynaecology Ward or the Day Surgery Unit as appropriate.

Services we offer

• Conservative and surgical management of miscarriage
• Surgical and medical management of ectopic pregnancy
• Investigation and management of all gynaecological emergencies.

Early pregnancy complications (Usually 5 to 16 weeks gestation)

• Any Vaginal bleeding or abdominal pain
• Miscarriage
• Ectopic pregnancy
• Post termination complications
• Pregnancy of unknown location

Gynaecological causes of acute abdominal pain

• PID (if too acute to be managed by GUM)
• Ovarian cyst accidents
• Abdominal / pelvic masses (associated with acute pain)

Very heavy vaginal bleeding

• Severe menstrual bleeding
• Associated with all genital tract pathology

Others

• Bartholin’s / vulval abscess
• Post gynaecological surgery complications. (within six
  weeks of surgery).

• Pregnancy complications occurring beyond the first 16 weeks and before six weeks post-partum.
• Hyperemesis/vomiting in pregnancy.
• For termination of pregnancy.
• For STI screening.

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Urinary Tract Infection

Definition

A urinary tract infection (UTI) is an infection in any part of your urinary system for example your urethra,bladder,ureters, and kidneys.Most infections occur in the lower urinary tract  involving the bladder and the urethra.
Women are more susceptible of developing a urinary tract infection than men. Infection limited to your bladder can be painful with discomfort.Serious complication can occur if  the infection spreads to your kidneys.
Doctors usually treat urinary tract infections with antibiotics. But you can take steps to prevent your chances of contracting a UTI in the first place.

Symptoms

Urinary tract infections don't always cause signs and symptoms, but when they do they may include:

• A persistent urge to urinate
• A burning sensation when urinating
• Passing urine frequently and in small amounts
• Urine that appears red, bright pink or cola-colored — a sign of blood in the urine
• Cloudy bad smelling urine
• Lower back pain

UTIs may be overlooked or mistaken for other conditions in older adults.

 

 

 Types of urinary tract infection

 UTIs may result in more-specific signs and symptoms depending on the type, as per part of your urinary tract  infected.

Part of urinary tract affected	Signs and symptoms
Kidneys infection (acute pyelonephritis)	Upper back and side pain Raised fever Shaking and chills Nausea and vomiting
Bladder infection (cystitis)	Pelvic pressure Lower abdominal discomfort Frequent or painful urination Haematuria(Blood in urine)
Urethra infection (urethritis)	Burning sensation while urinating Discharge

Illustrated image of the urinary tract

 

 

Causes

Urinary tract infections typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder. Although the urinary system is designed to keep out such microscopic invaders, these defenses sometimes fail. When that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract.
The most common UTIs occur mainly in women and affect the bladder and urethra.

• Bladder infection (cystitis). This type of UTI is usually caused by Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal (GI) tract. However, sometimes other bacteria are responsible. Sexual intercourse may lead to cystitis, but you don't have to be sexually active to develop it. All women are at risk of cystitis because of their anatomy — specifically, the short distance from the urethra to the anus and the urethral opening to the bladder.
• Urethra infection (urethritis). Occurs when gastrointestinal bacteria spread from the anus to the urethra. Also, because the female urethra is close to the vagina, sexually transmitted infections, such as herpes, gonorrhea, chlamydia and mycoplasma, can cause urethritis.

 Risk Factors

Urinary tract infections are common in women, and many women experience more than one infection during their lifetimes. Risk factors specific to women for UTIs include:

• Use of catheter. People who can't urinate on their own and use a tube (catheter) to urinate have an increased risk of UTIs. This may include people who are hospitalized, people with neurological problems that make it difficult to control their ability to urinate and people who are paralyzed.
• Urinary tract  procedure. Recent surgery or an exam of your urinary tract  involving medical instruments can increase your risk of developing a urinary tract infections.

• Menopause. Progressive decline in circulating estrogen after menopause in the body, causes changes in the urinary tract that make you more vulnerable to infection.
• Female anatomy. A woman has a shorter urethra than a man does hence rectum and urethra are close to each other, thus making infection more likely.
  
  UTIs are more common in women because the rectum and urethra are close to each other, making infection more likely. - See more at: http://www.bidmc.org/YourHealth/Conditions-AZ/Urinary-tract-infection-UTI.aspx#sthash.WyAkk6sY.dpuf
• Sexually active.  Having a new or multiple sexual partner also increases your risk.
• Use of IUD and diaphragms as birth control method by women. Use of Intra Uterine Devices and diaphragms for birth control increase risk of contracting UTIs , as well as women who use spermicidal agents.

• Anatomical abnormalities of the Urinary tract. Babies born with urinary tract abnormalities that don't allow urine to leave the body normally or cause urine to back up in the urethra have an increased risk of UTIs.
• Urinary tract blockages. Kidney stones or an enlarged prostate can trap urine in the bladder and increase the risk of UTIs.
• Weak immune system. Pregnancy,diabetes,sickle cells and other diseases that impair the immune system — the body's defense against germs — can increase the risk of UTIs.

 

Complications

When treated promptly and properly, lower urinary tract infections rarely lead to complications. But left untreated, a urinary tract infection can have serious consequences.
Complications of a UTI may include:

• Recurrent infections, especially in women who experience three or more UTIs.
• Permanent kidney damage from an acute or chronic kidney infection (pyelonephritis) due to an untreated UTI.
• Increased risk in pregnant women of delivering low birth weight or premature infants.
• Urethral narrowing (stricture) in men from recurrent urethritis, previously seen with gonococcal urethritis.
• Sepsis, a potentially life-threatening complication of an infection, especially if the infection works its way up your urinary tract to your kidneys.

 

Test and Diagnosis

Tests and procedures used to diagnose urinary tract infections include:

• Urine sample analysis. Your doctor may ask for a urine sample for lab analysis to look for white blood cells, red blood cells or bacteria. To avoid potential contamination of the sample, you may be instructed to first wipe your genital area with an antiseptic pad and to collect the urine midstream.
• Urine culture. Laboratory urine analysis is sometimes followed by a urine culture. This test reveals bacteria causing your infection and which medications will be most effective.
• Imaging.Recommended if having frequent infections suspected to be caused by an abnormality in your urinary tract, you may have an ultrasound, a computerized tomography (CT) scan or magnetic resonance imaging (MRI). Contrast dye can be used to highlight structures in your urinary tract.
• Cystoscopy. A procedure using a long, thin tube with a lens (cystoscope) is inserted in your urethra and passed through to your bladder to have a clear view of the urinary tract.

 

Treatment and Drugs

Antibiotics usually are the first line treatment for urinary tract infections. Which drugs are prescribed and for how long depend on your health condition and the type of bacteria found in your urine.

  

 

Uncomplicated or simple infection

Drugs commonly recommended for simple UTIs include:

• Trimethoprim/sulfamethoxazole
• Nitrofurantoin
• Ciprofloxacin
• Levofloxacin
• Cephalexin
• Ceftriaxone
• Azithromycin
• Doxycycline

Often, symptoms clear up within a few days of treatment. But you may need to continue antibiotics for a week or more. Take the entire course of antibiotics as prescribed.
For a simple UTI that occurs when you're otherwise healthy, your doctor may recommend a shorter course of treatment,like for 1-3 days of which depends on your particular symptoms and medical history.
Pain medication (analgesic) can be administered by your doctor to numb your bladder and urethra to relieve burning while urinating, though pain is usually relieved soon after starting an antibiotic.

 

 

Frequent infections

If you have frequent UTIs, your doctor may make some treatment recommendations, as follows:

• Low dose antibiotics, initially for six months but sometimes longer
• A single dose of antibiotic after sexual intercourse if your infections are related to sexual activity is recommended
• Vaginal estrogen therapy if you're past menopause

 

 

Complicated or Severe infection

In case of complicated urinary tract infection, you may need treatment with intravenous antibiotics in a hospital.

 

 Lifestyle and Home Remedies

Urinary tract infections can be painful, but you can take steps to ease your discomfort until antibiotics treat the infection. Follow these tips:

• Drink plenty of water. Helps to dilute your urine and flush out bacteria.
• Avoid drinks that may irritate your bladder. Do not take coffee, alcohol, and soft drinks containing citrus juices or caffeine until your infection has cleared. They can irritate your bladder and tend to aggravate your frequent or urgent need to urinate.
• Use a heating pad. Applying a warm heating pad to your abdomen minimizes discomfort.
• Avoid using douches and feminine hygiene spray
• If you are a woman,always wipe from the front to the back after a bowel movement
• Keep genital clean daily

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Definition

A urinary tract infection (UTI) is an infection in any part of the urinary system. Most UTIs start in the lower urinary tract in the bladder or urethra. The urethra is the tube that carries urine out of the body. A UTI can also include an infection in the upper urinary system, including the kidneys.
There are different names for infections in different parts of the urinary system, including:

• Uretheral infection—urethritis
• Bladder infection—cystitis
• Kidney infection—pyelonephritis

The infection may also occur in the tube connecting the bladder to the kidney (ureter). All of these infections are considered to be UTIs.

The Urinary Tract

Copyright © Nucleus Medical Media, Inc.

Causes

UTIs are caused by bacteria that most often come from the digestive tract or rectal area. The bacteria cling to the opening of the urethra and begin to multiply. If the infection is not treated right away, bacteria may move up the urinary system to the kidneys.
Most infections are caused by a bacteria that normally lives in the colon. The bacteria may move from the rectal area to the urethra.
UTIs can also be sexually transmitted. This type of infection usually does not spread past the urethra. Both partners need to be treated.

Risk Factors

UTIs are more common in women because the rectum and urethra are close to each other, making infection more likely.
Other factors that may increase your chance of a UTI include:

• Being sexually active
• Using a diaphragm for birth control
• Menopause
• Diabetes
• Kidney stones
• Enlarged prostate
• Weak immune system
• Abnormalities of the urinary system, such as vesicoureteral reflux or polycystic kidneys
• Paraplegia or quadriplegia
• Sickle-cell anemia
• History of kidney transplant
• Bladder catheter in place, or recent device inserted into the urinary system
• Pregnancy

Symptoms

UTIs may cause:

• Frequent and urgent need to urinate
• Passing small amounts of urine
• Pain in the abdomen or pelvic area
• Burning sensation during urination
• Cloudy, bad-smelling urine
• Increased need to get up at night to urinate
• Leaking urine
• Fever and chills
• Nausea and poor appetite

An infection in the kidney can be more serious. Call your doctor right away if you have symptoms of a kidney infection, such as:

• Bloody urine
• Low back pain or pain along the side of the ribs
• High fever and chills

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will also be done. A sample of your urine will be tested for blood, pus, and bacteria.
In general, children and men are less likely to get UTIs. Their infections are more likely to be caused by structural problems of the kidneys, bladder, or tubes. As a result, children and men may need more testing to determine the cause of a UTI.

Treatment

UTIs are treated with antibiotics. Standard medical care for a UTI includes taking antibiotics for 3 days. You will probably start to feel better after 1-2 days. It is important that you continue to take the entire course of medication, even if you feel better.
You may have your urine checked after you finish taking the antibiotics. This is to make sure that the infection is truly gone. If you have recurrent infections, you may be referred to a specialist.
The infection may cause pain and spasms in the bladder. Your doctor may recommend a medication called phenazopyridine. It may turn your urine, and sometimes your sweat, an orange color.
Severe UTIs may need a strong initial dose of antibiotics. You may be given antibiotics through an IV or an injection.

Prevention

To help keep bacteria out of your urinary tract:

• Drink plenty of fluids throughout the day. Cranberry juice is a good choice.
• Urinate when you feel the need and do not resist the urge.
• Empty your bladder completely and drink a full glass of water after having sex.
• Wash genitals daily.
• If you are a woman, always wipe from the front to the back after having a bowel movement.
• Avoid using douches and feminine hygiene sprays.

RESOURCES:

• Urology Care Foundation http://www.urologyhealth.org
• National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov

CANADIAN RESOURCES:

• Canadian Urological Association http://www.cua.org
• Women's Health Matters http://www.womenshealthmatters.ca

References:

• American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 91: Treatment of urinary tract infections in nonpregnant women. Obstet Gynecol. 2008;111(3):785-794.
• Jepson RG, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2008;(1):CD001321.
• Uncomplicated urinary tract infection (UTI) (pyelonephritis and cystitis). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 24, 2015. Accessed September 1, 2015.
• Urinary tract infections in adults. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=47. Accessed September 1, 2015.
• Urinary tract infections in adults. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult. Updated May 24, 2012. Accessed September 1, 2015.
• Urinary tract infection (UTI) in men. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 27, 2014. Accessed September 30, 2014.
• 12/5/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Pohl A. Modes of administration of antibiotics for symptomatic severe urinary tract infections. Cochrane Database of Syst Rev. 2007;(4):CD003237.
• 5/6/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Barbosa-Cesnik C, Brown MB, Buxton M, Zhang L, DeBusscher J, Foxman B. Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial. Clin Infect Dis. 2011;52(1):23-30.

- See more at: http://www.bidmc.org/YourHealth/Conditions-AZ/Urinary-tract-infection-UTI.aspx#sthash.WyAkk6sY.dpuf

Definition

A urinary tract infection (UTI) is an infection in any part of the urinary system. Most UTIs start in the lower urinary tract in the bladder or urethra. The urethra is the tube that carries urine out of the body. A UTI can also include an infection in the upper urinary system, including the kidneys.
There are different names for infections in different parts of the urinary system, including:

• Uretheral infection—urethritis
• Bladder infection—cystitis
• Kidney infection—pyelonephritis

The infection may also occur in the tube connecting the bladder to the kidney (ureter). All of these infections are considered to be UTIs.

The Urinary Tract

Copyright © Nucleus Medical Media, Inc.

Causes

UTIs are caused by bacteria that most often come from the digestive tract or rectal area. The bacteria cling to the opening of the urethra and begin to multiply. If the infection is not treated right away, bacteria may move up the urinary system to the kidneys.
Most infections are caused by a bacteria that normally lives in the colon. The bacteria may move from the rectal area to the urethra.
UTIs can also be sexually transmitted. This type of infection usually does not spread past the urethra. Both partners need to be treated.

Risk Factors

UTIs are more common in women because the rectum and urethra are close to each other, making infection more likely.
Other factors that may increase your chance of a UTI include:

• Being sexually active
• Using a diaphragm for birth control
• Menopause
• Diabetes
• Kidney stones
• Enlarged prostate
• Weak immune system
• Abnormalities of the urinary system, such as vesicoureteral reflux or polycystic kidneys
• Paraplegia or quadriplegia
• Sickle-cell anemia
• History of kidney transplant
• Bladder catheter in place, or recent device inserted into the urinary system
• Pregnancy

Symptoms

UTIs may cause:

• Frequent and urgent need to urinate
• Passing small amounts of urine
• Pain in the abdomen or pelvic area
• Burning sensation during urination
• Cloudy, bad-smelling urine
• Increased need to get up at night to urinate
• Leaking urine
• Fever and chills
• Nausea and poor appetite

An infection in the kidney can be more serious. Call your doctor right away if you have symptoms of a kidney infection, such as:

• Bloody urine
• Low back pain or pain along the side of the ribs
• High fever and chills

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will also be done. A sample of your urine will be tested for blood, pus, and bacteria.
In general, children and men are less likely to get UTIs. Their infections are more likely to be caused by structural problems of the kidneys, bladder, or tubes. As a result, children and men may need more testing to determine the cause of a UTI.

Treatment

UTIs are treated with antibiotics. Standard medical care for a UTI includes taking antibiotics for 3 days. You will probably start to feel better after 1-2 days. It is important that you continue to take the entire course of medication, even if you feel better.
You may have your urine checked after you finish taking the antibiotics. This is to make sure that the infection is truly gone. If you have recurrent infections, you may be referred to a specialist.
The infection may cause pain and spasms in the bladder. Your doctor may recommend a medication called phenazopyridine. It may turn your urine, and sometimes your sweat, an orange color.
Severe UTIs may need a strong initial dose of antibiotics. You may be given antibiotics through an IV or an injection.

Prevention

To help keep bacteria out of your urinary tract:

• Drink plenty of fluids throughout the day. Cranberry juice is a good choice.
• Urinate when you feel the need and do not resist the urge.
• Empty your bladder completely and drink a full glass of water after having sex.
• Wash genitals daily.
• If you are a woman, always wipe from the front to the back after having a bowel movement.
• Avoid using douches and feminine hygiene sprays.

- See more at: http://www.bidmc.org/YourHealth/Conditions-AZ/Urinary-tract-infection-UTI.aspx#sthash.WyAkk6sY.dpuf

Definition

A urinary tract infection (UTI) is an infection in any part of the urinary system. Most UTIs start in the lower urinary tract in the bladder or urethra. The urethra is the tube that carries urine out of the body. A UTI can also include an infection in the upper urinary system, including the kidneys.
There are different names for infections in different parts of the urinary system, including:

• Uretheral infection—urethritis
• Bladder infection—cystitis
• Kidney infection—pyelonephritis

The infection may also occur in the tube connecting the bladder to the kidney (ureter). All of these infections are considered to be UTIs.

The Urinary Tract

Copyright © Nucleus Medical Media, Inc.

Causes

UTIs are caused by bacteria that most often come from the digestive tract or rectal area. The bacteria cling to the opening of the urethra and begin to multiply. If the infection is not treated right away, bacteria may move up the urinary system to the kidneys.
Most infections are caused by a bacteria that normally lives in the colon. The bacteria may move from the rectal area to the urethra.
UTIs can also be sexually transmitted. This type of infection usually does not spread past the urethra. Both partners need to be treated.

Risk Factors

UTIs are more common in women because the rectum and urethra are close to each other, making infection more likely.
Other factors that may increase your chance of a UTI include:

• Being sexually active
• Using a diaphragm for birth control
• Menopause
• Diabetes
• Kidney stones
• Enlarged prostate
• Weak immune system
• Abnormalities of the urinary system, such as vesicoureteral reflux or polycystic kidneys
• Paraplegia or quadriplegia
• Sickle-cell anemia
• History of kidney transplant
• Bladder catheter in place, or recent device inserted into the urinary system
• Pregnancy

Symptoms

UTIs may cause:

• Frequent and urgent need to urinate
• Passing small amounts of urine
• Pain in the abdomen or pelvic area
• Burning sensation during urination
• Cloudy, bad-smelling urine
• Increased need to get up at night to urinate
• Leaking urine
• Fever and chills
• Nausea and poor appetite

An infection in the kidney can be more serious. Call your doctor right away if you have symptoms of a kidney infection, such as:

• Bloody urine
• Low back pain or pain along the side of the ribs
• High fever and chills

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will also be done. A sample of your urine will be tested for blood, pus, and bacteria.
In general, children and men are less likely to get UTIs. Their infections are more likely to be caused by structural problems of the kidneys, bladder, or tubes. As a result, children and men may need more testing to determine the cause of a UTI.

Treatment

UTIs are treated with antibiotics. Standard medical care for a UTI includes taking antibiotics for 3 days. You will probably start to feel better after 1-2 days. It is important that you continue to take the entire course of medication, even if you feel better.
You may have your urine checked after you finish taking the antibiotics. This is to make sure that the infection is truly gone. If you have recurrent infections, you may be referred to a specialist.
The infection may cause pain and spasms in the bladder. Your doctor may recommend a medication called phenazopyridine. It may turn your urine, and sometimes your sweat, an orange color.
Severe UTIs may need a strong initial dose of antibiotics. You may be given antibiotics through an IV or an injection.

Prevention

To help keep bacteria out of your urinary tract:

• Drink plenty of fluids throughout the day. Cranberry juice is a good choice.
• Urinate when you feel the need and do not resist the urge.
• Empty your bladder completely and drink a full glass of water after having sex.
• Wash genitals daily.
• If you are a woman, always wipe from the front to the back after having a bowel movement.
• Avoid using douches and feminine hygiene sprays.

RESOURCES:

• Urology Care Foundation http://www.urologyhealth.org
• National Kidney and Urologic Diseases Information Clearinghouse http://kidney.niddk.nih.gov

CANADIAN RESOURCES:

• Canadian Urological Association http://www.cua.org
• Women's Health Matters http://www.womenshealthmatters.ca

References:

• American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 91: Treatment of urinary tract infections in nonpregnant women. Obstet Gynecol. 2008;111(3):785-794.
• Jepson RG, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2008;(1):CD001321.
• Uncomplicated urinary tract infection (UTI) (pyelonephritis and cystitis). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 24, 2015. Accessed September 1, 2015.
• Urinary tract infections in adults. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=47. Accessed September 1, 2015.
• Urinary tract infections in adults. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult. Updated May 24, 2012. Accessed September 1, 2015.
• Urinary tract infection (UTI) in men. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 27, 2014. Accessed September 30, 2014.
• 12/5/2007 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Pohl A. Modes of administration of antibiotics for symptomatic severe urinary tract infections. Cochrane Database of Syst Rev. 2007;(4):CD003237.
• 5/6/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Barbosa-Cesnik C, Brown MB, Buxton M, Zhang L, DeBusscher J, Foxman B. Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial. Clin Infect Dis. 2011;52(1):23-30.

- See more at: http://www.bidmc.org/YourHealth/Conditions-AZ/Urinary-tract-infection-UTI.aspx#sthash.WyAkk6sY.dpuf

Polycystic ovary syndrome

Introduction 

Polycystic ovary syndrome (PCOS) is a condition in which a woman has an imbalance of female sex hormones hence affecting the normal work of the ovaries.
The three main features of PCOS are:

• cysts that develop in your ovaries (polycystic ovaries)
• your ovaries not regularly releasing eggs (ovulating)
• high levels of "male hormones" called androgens in your body

 

Polycystic ovaries

Polycystic ovaries contain a large number of harmless cysts up to approximately 8mm  in size. The cysts are under-developed sacs in which eggs develop. In PCOS, these sacs are often unable to release an egg, which means that ovulation doesn't take place.

 

 Signs and symptoms

  

Irregular Periods.  Not getting a period after you have had one or more normal ones during puberty also called secondary amenorrhea.Irregular periods that may come and go, and be very light to very heavy

Excess androgen.This may result in development of male characteristics, due to elevated levels of male hormones (androgens) ,may result in physical signs, such as excess facial and body hair (hirsutism), adult acne or severe adolescent acne, and male-pattern baldness (androgenic alopecia).

Polycystic ovaries.Polycystic ovaries become enlarged and contain numerous small fluid-filled sacs which surround the eggs

Causes of polycystic ovary syndrome 

Doctors don't know what causes polycystic ovary syndrome, but it's thought to be related to abnormal hormone levels.Here are some of the factors:

Excess insulin
Insulin is a hormone produced by the pancreas to control the amount of sugar in the blood. It helps to move glucose from blood into cells, where it's broken down to produce energy.
If you have Insulin resistance,it means the body's tissues are resistant to the effects of insulin. The body therefore has to produce extra insulin to compensate.
High levels of insulin cause the ovaries to produce too much testosterone, which interferes with the development of the follicles (the sacs in the ovaries where eggs develop) and prevents normal ovulation.
Insulin resistance also results in excessive weight gain, which worsens symptoms of PCOS, because having excess fat causes the body to produce even more insulin.

Hormone imbalance

Many women with PCOS are found to have an imbalance in certain hormones, including:

• raised levels of testosterone, a hormone often thought of as a male hormone, although all women usually produce small amounts of it
• raised levels of luteinising hormone (LH) ,this stimulates ovulation, but may have an abnormal effect on the ovaries if levels are too high
• low levels of sex hormone-binding globulin (SHBG) ,a protein in the blood, which binds to testosterone and reduces the effect of testosterone
• raised levels of prolactin (only in some women with PCOS) ,  hormone that stimulates the breast glands to produce milk in pregnancy

Researchers also are still looking into exact reason why these hormonal changes occur . It's been suggested that the problem may start in the ovary itself, in other glands that produce these hormones, or in the part of the brain that controls their production. The changes may also be caused by the resistance to insulin.

Heredity

PCOS sometimes runs in families. If any relatives, such as your mother, sister or aunt, have PCOS, then the risk of you developing it is often increased.
 Researchers also are looking into the possibility that certain genes are linked to PCOS.

Tests and diagnosis

There's no specific test to definitively diagnose polycystic ovary syndrome. The diagnosis is one of exclusion, which means your doctor considers all of your signs and symptoms and then rules out other possible disorders.
During this process, you and your doctor will discuss your medical history, including your menstrual periods, weight changes and other symptoms. Your doctor may also perform certain tests and exams:

• Physical exam. During your physical exam, your doctor will note several key pieces of information, including your thyroid gland,skin,hair, height, weight, blood pressure and Body Mass Index.
• Pelvic exam. During a pelvic exam, your doctor visually and manually inspects your reproductive organs for signs of masses, growths or other abnormalities.
• Blood tests. Your blood may be drawn to measure the levels of several hormones to exclude possible causes of menstrual abnormalities or androgen excess that mimic PCOS. Additional blood testing may include fasting cholesterol and triglyceride levels and a glucose tolerance test, in which glucose levels are measured while fasting and after drinking a glucose-containing beverage.

      
  Some of the hormonal test are:

•  Human chorionic gonadotropin (hCG), detects pregnancy pregnant.
• Testosterone,is an androgen. At high levels blocks ovulation and may cause acne, male-type hair growth on the face and body, and hair loss from the scalp.
• Prolactinhormone, play a part in a lack of menstrual cycles or infertility.
• Cholesterol and triglycerides
• Thyroid-stimulating hormone (TSH) checks for an overactive or underactive thyroid.
• Adrenal gland hormones, such as DHEA-S or 17-hydroxyprogesterone. An adrenal abnormalities  cause symptoms much like PCOS.
• Glucose tolerance and insulin levels, shows presence of insulin resistance.

• Ultrasound. An ultrasound exam can show the appearance of your ovaries( which might show enlarged ovaries with small cysts) and the thickness of the lining of your uterus.

 Treatments and drugs

 There's no cure for PCOS, but the symptoms can be treated. Speak to your GP if you think you may have the condition.

 

Lifestyle changes

In overweight women, weight loss is recommended through a low-calorie diet combined with moderate exercise activities. Even a modest reduction in your weight — calculating your body mass index (BMI)
shows the progress in weight loss thus improving your condition.

 

Medications

Your doctor may prescribe a medication to:

• Regulate your menstrual cycle. To regulate your menstrual cycle, your doctor may recommend combination birth control pills — pills that contain both estrogen and progestin. These birth control pills decrease androgen production and give your body a break from the effects of continuous estrogen, lowering your risk of endometrial cancer and correcting abnormal bleeding. As an alternative to birth control pills, you might use a skin patch or vaginal ring that contains a combination of estrogen and progestin. During the time that you take this medication to relieve your symptoms, you won't be able to conceive.
  If  combination birth control pills do not work well with you, an alternative approach is to take progesterone for 10 to 14 days every one to two months. This therapy regulates your periods and offers protection against endometrial cancer, though it does not improve androgen levels and it would not prevent pregnancy. The progestin-only minipill or progestin-containing intrauterine device are better choices if you also wish to avoid pregnancy.
  Your doctor also may prescribe metformin (Glucophage, Fortamet, others), an oral medication for type 2 diabetes that improves insulin resistance and lowers insulin levels. This drug may help with ovulation and lead to regular menstrual cycles. Metformin also slows the progression to type 2 diabetes if you already have prediabetes and aids in weight loss if you also follow a diet and an exercise program.
  
• Fertility Treatment.If you are trying to concieve a baby, Clomiphene (Clomid, Serophene)  an oral anti-estrogen medication is administered. Its taken in the first part of your menstrual cycle. If clomiphene alone isn't effective, metformin may be added to help induce ovulation.
  If you don't become pregnant using clomiphene and metformin, gonadotropins — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) medications are administered by injection. Another medication that your doctor may have you try is letrozole (Femara). Doctors don't know exactly how letrozole works to stimulate the ovaries, but it may help with ovulation when other medications fail.
  When taking any type of medication to help you ovulate, it's important that you work with a reproductive specialist and have regular ultrasounds to monitor your progress and avoid problems.
  
• Reduce excessive hair growth. Doctors may recommend  combined oral contraceptive tablets (such as co-cyprindiol, Dianette, Marvelon and Yasmin) to decrease androgen production, or  spironolactone (Aldactone) that blocks the effects of androgens on the skin. Spironolactone can cause birth defects, effective contraception is required when using the drug, and it's not recommended in pregnancy or if planning to become pregnant.Other drugs includes: cyproterone acetate,flutamide ,finasteride and  Eflornithine (Vaniqa)  cream is another medication possibility;it slows facial hair growth in women.

Preparing for your appointment

For PCOS, you might first see your family doctor or primary care provider. However, you may be referred to a gynecologist,endocrinologist (one who specializes in hormone disorders) or reproductive endocrinologist (one who specializes in treating infertility).Facebook

Abnormal Menstruation

What is abnormal menstruation?

Most women have menstrual periods that last four to seven days. A woman's period usually occurs every 28 days, but normal menstrual cycles can range from 21 days to 35 days.
Examples of menstrual problems include:

• Periods that occur less than 21 days or more than 35 days apart
• Missing three or more periods in a row
• Menstrual flow that is much heavier or lighter than usual
• Periods that last longer than seven days
• Periods that are accompanied by pain, cramping, nausea, or vomiting
• Bleeding or spotting that happens between periods, after menopause, or following sex

Examples of abnormal menstruation include the following:

• Amenorrhea is a condition in which a woman’s periods have stopped completely. The absence of a period for 90 days or more is considered abnormal unless a woman is pregnant, breastfeeding, or going through menopause (which generally occurs for women between ages 45 and 55). Young women who haven't started menstruating by age 15 or 16 or within three years after their breasts begin to develop are also considered to have amenorrhea.
• Oligomenorrhea refers to periods that occur infrequently.
• Dysmenorrhea refers to painful periods and severe menstrual cramps. Some discomfort during the cycle is normal for most women.
• Abnormal uterine bleeding may apply to a variety of menstrual irregularities, including: a heavier menstrual flow; a period that lasts longer than seven days; or bleeding or spotting between periods, after sex, or after menopause.

 

What causes abnormal menstruation?

There are many causes of abnormal periods, ranging from stress to more serious underlying medical conditions:

• Stress and lifestyle factors. Gaining or losing a significant amount of weight, dieting, changes in exercise routines, travel, illness, or other disruptions in a woman's daily routine can have an impact on her menstrual cycle.
• Birth control pills. Most birth control pills contain a combination of the hormones estrogen and progestin (some contain progestin alone). The pills prevent pregnancy by keeping the ovaries from releasing eggs. Going on or off birth control pills can affect menstruation. Some women have irregular or missed periods for up to six months after discontinuing birth control pills. This is an important consideration when you are planning on conception and becoming pregnant. Women who take birth control pills that contain progestin only may have bleeding between periods.
• Uterine polyps or fibroids. Uterine polyps are small benign (noncancerous) growths in the lining of the uterus. Uterine fibroids are tumors that attach to the wall of the uterus. There may be one or several fibroids that range from as small as an apple seed to the size of a grapefruit. These tumors are usually benign, but they may cause heavy bleeding and pain during periods. If the fibroids are large, they might put pressure on the bladder or rectum, causing discomfort.
• Endometriosis. The endometrial tissue that lines the uterus breaks down every month and is discharged with the menstrual flow. Endometriosis occurs when the endometrial tissue starts to grow outside the uterus. Often, the endometrial tissue attaches itself to the ovaries or fallopian tubes; it sometimes grows on the intestines or other organs in the lower digestive tract and in the area between your rectum and uterus. Endometriosis may cause abnormal bleeding, cramps or pain before and during periods, and painful intercourse.
• Pelvic inflammatory disease. Pelvic inflammatory disease (PID) is a bacterial infection that affects the female reproductive system. Bacteria may enter the vagina via sexual contact and then spread to the uterus and upper genital tract. Bacteria might also enter the reproductive tract via gynecologic procedures or through childbirth, miscarriage, or abortion. Symptoms of PID include a heavy vaginal discharge with an unpleasant odor, irregular periods, pain in the pelvic and lower abdominal areas, fever, nausea, vomiting, or diarrhea.
• Polycystic ovary syndrome. In polycystic ovary syndrome (PCOS), the ovaries make large amounts of androgens, which are male hormones. Small fluid-filled sacs (cysts) may form in the ovaries. These can often been seen on ultrasound. The hormonal changes can prevent eggs from maturing, and so ovulation may not take place consistently. Sometimes a woman with polycystic ovary syndrome will have irregular periods or stop menstruating completely. In addition, the condition is associated with obesity, infertility, and hirsutism (excessive hair growth and acne). This condition may be caused by a hormonal imbalance, although the exact cause is unknown. Treatment of PCOS depends on whether a woman desires pregnancy. If pregnancy is not a goal, then weight loss, oral contraceptive pills, and the medication Metformin® (an insulin sensitizer used in diabetes) can regulate a woman’s cycles. If pregnancy is desired, ovulation-stimulating medications can be tried.
• Premature ovarian insufficiency. This condition occurs in women under age 40 whose ovaries do not function normally. The menstrual cycle stops, similar to menopause. This can occur in patients who are being treated for cancer with chemotherapy and radiation, or if you have a family history of premature ovarian insufficiency or certain chromosomal abnormalities. If this condition occurs, see your physician.

Other causes of abnormal menstruation include:

• uterine cancer or cervical cancer
• medications, such as steroids or anticoagulant drugs (blood thinners)
• medical conditions, such as bleeding disorders, an under- or overactive thyroid gland, or pituitary disorders that affect hormonal balance
• complications associated with pregnancy, including miscarriage or an ectopic pregnancy (the fertilized egg is implanted outside the uterus; for example, within the fallopian tube)

 

How is abnormal menstruation diagnosed?

If any aspect of your menstrual cycle has changed, you should keep an accurate record of when your period begins and ends, including the amount of flow and whether you pass large blood clots. Keep track of any other symptoms, such as bleeding between periods and menstrual cramps or pain.
Your doctor will ask you about your menstrual cycle and medical history. He or she will perform a physical examination, including a pelvic exam and sometimes a Pap test. The doctor might also order certain tests, including the following:

• blood tests to rule out anemia or other medical disorders
• vaginal cultures, to look for infections
• a pelvic ultrasound exam to check for uterine fibroids, polyps, or an ovarian cyst
• an endometrial biopsy, in which a sample of tissue is removed from the lining of the uterus, to diagnose endometriosis, hormonal imbalance, or cancerous cells. Endometriosis or other conditions may also be diagnosed using a procedure called a laparoscopy, in which the doctor makes a tiny incision in the abdomen and then inserts a thin tube with a light attached to view the uterus and ovaries.

When should you seek medical attention for abnormal menstruation?

Contact a doctor or medical professional if you have any of the following symptoms:

• severe pain during your period or between periods
• unusually heavy bleeding (soaking through a sanitary pad or tampon every hour for 2 or 3 hours) or passing large clots
• an abnormal or foul-smelling vaginal discharge
• high fever
• a period lasting longer than 7 days
• vaginal bleeding or spotting between periods or after you have gone through menopause
• periods that become very irregular after you have had regular menstrual cycles
• nausea or vomiting during your period
• symptoms of toxic shock syndrome, such as a fever over 102 degrees, vomiting, diarrhea, fainting, or dizziness

You should also see a doctor if you think you might be pregnant.

 

How is abnormal menstruation treated?

The treatment of abnormal menstruation depends on the underlying cause:

• Regulation of the menstrual cycle: Hormones such as estrogen or progestin might be prescribed to help control heavy bleeding.
• Pain control: Mild to moderate pain or cramps might be lessened by taking an over-the-counter pain reliever, such as ibuprofen or acetaminophen. Aspirin is not recommended because it might cause heavier bleeding. Taking a warm bath or shower or using a heating pad might help to relieve cramps.
• Uterine fibroids: These can be treated medically and/or surgically. Initially, most fibroids that are causing mild symptoms can be treated with over-the-counter pain relievers. If you experience heavy bleeding, an iron supplement might be helpful in preventing or treating anemia. Low-dose birth control pills or progestin injections (Depo-Provera®) may help to control heavy bleeding caused by fibroids. Drugs called gonadotropin-releasing hormone agonists may be used to shrink the size of the fibroids and control heavy bleeding. These drugs reduce the body’s production of estrogen and stop menstruation for a while. If fibroids do not respond to medication, there are a variety of surgical options that can remove them or lessen their size and symptoms. The type of procedure will depend on the size, type, and location of the fibroids. A myomectomy is the simple removal of a fibroid. In severe cases where the fibroids are large or cause heavy bleeding or pain, a hysterectomy might be necessary. During a hysterectomy, the fibroids are removed along with the uterus. Other options include uterine artery embolization, which cuts off the blood supply to the active fibroid tissue.
• Endometriosis: Although there is no cure for endometriosis, over-the-counter or prescription pain relievers may help to lessen the discomfort. Hormone treatments such as birth control pills may help prevent overgrowth of uterine tissue and reduce the amount of blood loss during periods. In more severe cases, a gonadotropin-releasing hormone agonist or progestin may be used to temporarily stop menstrual periods. In severe cases, surgery may be necessary to remove excess endometrial tissue growing in the pelvis or abdomen. A hysterectomy might be required as a last resort if the uterus has been severely damaged.

There are other procedural options which can help heavy menstrual bleeding. A 5 year contraceptive intrauterine device (IUD), called Mirena®, has been approved to help lessen bleeding, and can be as effective as surgical procedures such as endometrial ablation. This is inserted in the doctor’s office with minimal discomfort, and also offers excellent contraception. Endometrial ablation is another option. It uses heat or electrocautery to destroy the lining of the uterus. It is usually only used when other therapies have been tried and failed. This is because scar from the procedure can make monitoring the uterus more difficult if bleeding persists in the future.

 

How can the risk of abnormal menstruation be reduced?

Here are some recommendations for self-care:

• Try to maintain a healthy lifestyle by exercising moderately and eating low-fat foods. If you have to lose weight, do so gradually instead of turning to diets that drastically limit your calorie and food intake.
• Make sure you get enough rest.
• Practice stress reduction and relaxation techniques.
• If you are an athlete, cut back on prolonged or intense exercise routines. Excessive sports activities can cause irregular periods.
• Use birth control pills or other contraceptive methods as directed.
• Change your tampons or sanitary napkins approximately every 4 to 6 hours to avoid toxic shock syndrome and prevent infections.
• See a doctor for regular check-ups. Facebook

Painful Sex (dysparaunia)

 

 Definition

Painful intercourse can occur for a variety of reasons — ranging from anatomical problems to psychological problems. A number of  women have painful intercourse experience at some point in their lives.
The medical term for painful intercourse is dyspareunia (dis-puh-ROO-nee-uh) — which is persistent or recurrent genital pain that occurs just before, during or after intercourse.

 

 Symptoms

If you experience painful intercourse, you may feel:

• New pain after previously pain-free intercourse
• Burning pain or aching pain
• Throbbing pain, lasting hours after intercourse  
• Pain only at sexual penetration (entry)
•  Pain with every penetration, even while putting in a tampon 
• Deep pain during thrusting

 

 

Entry Pain 

 Physical causes of painful intercourse differ, depending on whether the pain occurs at entry or with deep thrusting. Emotional factors can be associated with many types of painful intercourse.

1.Injury, trauma or irritation. This includes injury or irritation from an accident, pelvic surgery, female circumcision or a cut made during childbirth to enlarge the birth canal (episiotomy).
2.Vaginismus. Involuntary spasms of the muscles of the vaginal wall (vaginismus) can make attempts at penetration very painful.
3.Congenital abnormality. A problem present at birth, such as the absence of a fully-formed vagina (vaginal agenesis) or development of a membrane that blocks the vaginal opening (imperforate hymen), could be the underlying cause of dyspareunia.
4. Insufficient lubrication. This is often the result of not enough foreplay. Insufficient lubrication is also commonly caused by a drop in estrogen levels after menopause, after childbirth or during breast-feeding. Certain medications are known to inhibit desire or arousal, which can decrease lubrication and make sex painful. These include antidepressants, high blood pressure medications, sedatives, antihistamines and certain birth control pills. 
5. Inflammation, infection or skin disorder. An infection in your genital area or urinary tract can cause painful intercourse. Eczema or other skin problems in your genital area also can be the problem.

Deep Pain 

 

Deep pain usually occurs with deep penetration and may be more likely with certain postures at time of intercourse. Causes include:

Surgeries or medical treatments. Scarring from pelvic surgery, including hysterectomy,can sometimes cause painful intercourse. Medical treatments for cancer, such as radiation and chemotherapy, can cause changes that make sex painful. Emotional Factors Emotions are deeply intertwined with sexual activity and may play a role in any type of sexual pain.
Infections and conditions. The list includes endometriosis, pelvic inflammatory disease, uterine prolapse, retroverted uterus, uterine fibroids, cystitis, irritable bowel syndrome, hemorrhoids and ovarian cysts.

Emotional factors 

The are a number of emotional factors leading to painful sexual experience,they include:
1.History of sexual abuse. Most women with dyspareunia don't have a history of sexual abuse,but if you have been abused, it may play a role. Sometimes, it can be difficult to tell whether psychological factors are associated with dyspareunia. Initial pain can lead to fear of recurring pain, making it difficult to relax,which can lead to more pain.
2.Stress. Your pelvic floor muscles tend to tighten in response to stress in your life. This can contribute to pain during intercourse.
3.Psychological problems. Anxiety, depression, concerns about your physical appearance, fear of intimacy or relationship problems can contribute to a low level of arousal and a resulting discomfort or pain. ny pain in your body, you might start avoiding the activities that you associate with the pain.

Tests and diagnosis

A medical evaluation for dyspareunia usually consists of:

• A thorough medical history. Your GP may ask about onset of pain,site, intensity of pain, and if it happens with every sexual partner and every sexual position, any surgical history and past childbirth experiences.
  
  
• A pelvic exam. Done to check for signs of skin irritation, infection or anatomicalanomalies. Your GP may also try to identify the location of your pain by applying gentle pressure to your genitals and pelvic muscles.
  Some women who experience painful intercourse are also uncomfortable during a pelvic exam, no matter how gentle the doctor is. You can ask to stop the exam at any time if it's too painful.
  
• Other tests. If your doctor suspects certain causes of painful intercourse, he or she might also recommend a pelvic ultrasound.

 

Treatments and drugs

Treatment options vary, depending on the  cause of the pain.

Medications

If an infection or medical condition contributes to your pain, treating the underlying cause may resolve your problem. Changing medications known to cause lubrication problems also may eliminate your symptoms.
For many women who have undergone menopause, painful sexual intercourse is caused by inadequate lubrication resulting from low estrogen levels. Often, this can be treated with topical estrogen applied directly to your vagina.
The drug ospemifene (Osphena) was recently approved by the Food and Drug Administration to treat moderate to severe dyspareunia in women who have problems with vaginal lubrication. Ospemifene acts like estrogen on the vaginal lining, but doesn't seem to have estrogen's potentially harmful effects on the breasts or the lining of the uterus (endometrium). Drawbacks are that the drug is expensive, it may cause hot flashes, and it has a potential risk of stroke and blood clots.

Therapy

Different types of therapy may be helpful, including:

• Desensitization therapy. During this therapy, you learn vaginal relaxation exercises that can decrease pain. Your therapist may recommend pelvic floor exercises (Kegel exercises) or other techniques to decrease pain with intercourse.
• Counseling or sex therapy. If sex has been painful for a long time, you may experience a negative emotional response to sexual stimulation even after treatment. If you and your partner have avoided intimacy because of painful intercourse, you may also need help improving communication with your partner and restoring sexual intimacy. Talking to a counselor or sex therapist can help resolve these issues.
  Cognitive behavioral therapy also can be helpful in changing negative thought patterns and behaviors.
  

Lifestyle and home remedies

You and your partner may be able to minimize pain with a few changes to your sexual routine:

• Communicate. Talk about what feels good and what doesn't. If you need your partner to go slow, say so.
• Don't rush. Longer foreplay can help stimulate your natural lubrication. And you may reduce pain by delaying penetration until you feel fully aroused.
• Use lubricants. A personal lubricant can make sex more comfortable. Try different brands until you find one you like. 
• Switch positions. If you experience sharp pain during thrusting, the penis may be striking your cervix or stressing the pelvic floor muscles, causing aching or cramping pain. Changing positions may help. You can try being on top of your partner during sex. Women usually have more control in this position, so you may be able to regulate penetration to a depth that feels good to you.

Coping and support

Until vaginal penetration becomes comfortable, you and your partner might find other ways to be intimate. Sensual massage, kissing and mutual masturbation offer alternatives to intercourse that might be more comfortable, more fulfilling and more fun than your regular painful routine.

 
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