Understanding Menopause

Menopause is the permanent end of menstruation and fertility, defined as occurring 12 months after your last menstrual period.

Menopause is a natural biological process, not a medical illness. Even so, the physical and emotional symptoms of menopause can disrupt your sleep, sap your energy and — at least indirectly — trigger feelings of sadness and loss.

Even though menopause is not a disease, you shouldn't hesitate to seek treatment for severe symptoms. Many effective treatments are available, from lifestyle adjustments to hormone therapy.

Technically, you don't actually "hit" menopause until it's been one year since your final menstrual period. In the United States, that happens at about age 51, on average.

But in the months or years leading up to that point, you might experience these signs and symptoms:

·         Irregular periods

·         Decreased fertility

·         Vaginal dryness

·         Hot flashes

·         Sleep disturbances

·         Mood swings

·         Increased abdominal fat

·         Thinning hair

·         Loss of breast fullness

When to see a doctor
Schedule regular visits with your doctor during the years leading up to menopause (perimenopause) and the years after menopause (postmenopause) for preventive health care as well as care of medical conditions that may occur with aging.

If you've skipped a period but aren't sure you've started the menopausal transition, you may want to see your doctor to determine whether you're pregnant. Always seek medical advice if you have bleeding from your vagina after menopause.

Menopause can result from:

·         Natural decline of reproductive hormones. As you approach your late 30s, your ovaries start making less estrogen and progesterone, the hormones that regulate menstruation. During this time, fewer potential eggs are ripening in your ovaries each month, and ovulation is less predictable. Also, the post-ovulation surge in progesterone — the hormone that prepares your body for pregnancy — becomes less dramatic. Your fertility declines, partially due to these hormonal effects.

These changes become more pronounced in your 40s. Your menstrual periods may become longer or shorter, heavier or lighter, and more or less frequent, until eventually, your ovaries stop producing eggs, and you have no more periods. It's possible, but very unusual, to menstruate every month right up to your last period. More likely, you'll experience some irregularity in your periods.

·         Hysterectomy. A hysterectomy that removes your uterus, but not your ovaries, usually doesn't cause menopause. Although you no longer have periods, your ovaries still release eggs and produce estrogen and progesterone. But an operation that removes both your uterus and your ovaries (total hysterectomy and bilateral oophorectomy) does cause menopause, without any transitional phase. Your periods stop immediately, and you're likely to have hot flashes and other menopausal signs and symptoms.

·         Chemotherapy and radiation therapy. These cancer therapies can induce menopause, causing symptoms such as hot flashes during the course of treatment or within three to six months.

·         Primary ovarian insufficiency. Approximately 1 percent of women experience menopause before age 40. Menopause may result from primary ovarian insufficiency — when your ovaries fail to produce normal levels of reproductive hormones — stemming from genetic factors or autoimmune disease, but often no cause for primary ovarian insufficiency can be found.

Several chronic medical conditions can develop after menopause:

·         Cardiovascular disease. When your estrogen levels decline, your risk of cardiovascular disease increases. Heart disease is the leading cause of death in women as well as in men.

·         Osteoporosis. This condition causes bones to become brittle and weak, leading to an increased risk of fractures. During the first few years after menopause, you may lose bone density at a rapid rate, increasing your risk of osteoporosis. Postmenopausal women are especially susceptible to fractures of their hips, wrists and spine.

·         Urinary incontinence. As the tissues of your vagina and urethra lose their elasticity, you may experience a frequent, sudden, strong urge to urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing or lifting (stress incontinence). Strengthening pelvic floor muscles with Kegel exercises or using a topical vaginal estrogen may help relieve symptoms of incontinence.

·         Weight gain. Many women gain weight during the menopausal transition. You may need to eat less — perhaps as many as 200 to 400 fewer calories a day — and exercise more, just to maintain your current weight.

Ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) usually occurs as a result of taking hormonal medications that stimulate the development of eggs in a woman's ovaries. These injectable fertility drugs may be prescribed to treat infertility. In ovarian hyperstimulation syndrome, your ovaries become swollen and painful.

About one-fourth of women who take injectible fertility drugs get a mild form of ovarian hyperstimulation syndrome, which goes away after about a week. If you become pregnant after taking one of these fertility drugs, however, your symptoms of ovarian hyperstimulation syndrome may last several weeks. A small proportion of women taking fertility drugs develop a more severe form of ovarian hyperstimulation syndrome, which can cause rapid weight gain, abdominal pain, vomiting and shortness of breath.

Symptoms

In most cases, the symptoms of OHSS begin within 10 days after you take medications to stimulate ovulation. The severity of OHSS symptoms varies, and symptoms may worsen or improve over time.

Moderate OHSS

·         Mild to moderate abdominal pain that may come and go

·         Abdominal bloating or increased girth

·         Nausea

·         Vomiting

·         Diarrhea

·         Tenderness in the area of your ovaries

Severe OHSS

·         Rapid weight gain, such as an increase of 5 to 10 pounds in one to two days, or weight gain of more than 10 pounds in three or more days

·         Severe abdominal pain

·         Severe, persistent nausea and vomiting

·         Decreased urinary frequency

·         Dark urine

·         Shortness of breath

·         Tight or enlarged abdomen

·         Dizziness

When to see a doctor
If you have any symptoms of ovarian hyperstimulation syndrome, tell your doctor. Even if you have a mild form of the syndrome, your doctor will want to observe you for weight gain or worsening symptoms. If your symptoms are severe, last longer than a week or get worse, seek medical attention.

Causes

Ovarian hyperstimulation syndrome develops after you take a type of fertility medication that acts directly on your ovaries, stimulating them to produce multiple eggs. This treatment is more likely to cause symptoms of ovarian hyperstimulation than is the more common approach to inducing ovulation — treatment with clomiphene (Clomid, Serophene), a medication that's given as a pill you take by mouth. Your doctor might prescribe oral medication at first before moving on to injectible medications because oral medications are easier to take and they're less expensive.

The hormonal drugs most likely to be involved with developing OHSS are:

·         Follicle-stimulating hormone (FSH), which stimulates the formation of multiple fluid-filled cysts (follicles) on the ovaries

·         Luteinizing hormone (LH), which supports egg maturation and triggers ovulation

·         Human menopausal gonadotropin (hMG), which has both LH and FSH

·         Human chorionic gonadotropin (HCG), a stand-in for the LH surge that, in natural cycles, causes the follicle to release the egg

OHSS usually happens after the follicle-stimulating phase of a fertility therapy, when you receive an injection of HCG to trigger ovulation. Typically, signs and symptoms appear within the first 10 days after the injection, when the ovarian blood vessels have an abnormal reaction to the hormone and begin to leak fluid. This fluid can swell the ovaries and sometimes moves into the abdomen in large amounts.

Some women may even develop OHSS during a pregnancy achieved following ovulation induction, as pregnancy itself causes a natural increase in HCG levels.

Risk factors

Factors that increase the risk of developing OHSS include:

·         Polycystic ovary syndrome — a common reproductive disorder that causes irregular menstrual periods, excess hair growth and unusual appearance of the ovaries on ultrasound examination

·         Large number of follicles

·         Young age

·         Low body weight

·         High or steeply increasing level of estradiol (estrogen) before an HCG shot

·         Previous episodes of OHSS

·         Migraine headache

·         Becoming pregnant with multiple babies at one time

Young women with polycystic ovary syndrome who have many follicles are at highest risk of ovarian hyperstimulation syndrome. But knowing these risk factors doesn't predict exactly who will get OHSS, and sometimes the syndrome affects women with no risk factors.

Complications

About 1 to 2 percent of women undergoing ovarian stimulation develop a severe form of ovarian hyperstimulation syndrome. Complications of severe OHSS may include:

·         Fluid collection in the abdomen (ascites) and sometimes the chest

·         Electrolyte disturbances (sodium, potassium, others)

·         Blood clots in large vessels, usually in the legs

·         Kidney failure

·         Twisting (torsion) of an ovary

·         Rupture of a cyst in an ovary, which can lead to serious bleeding

·         Breathing problems (acute respiratory distress syndrome)

Some of these complications may be life-threatening, but OHSS is unlikely to be fatal. Severe OHSS may increase the chance of pregnancy loss, either through miscarriage or termination because of complications.

Tests and diagnosis

The diagnosis of ovarian hyperstimulation syndrome is based on your symptoms rather than on any test. During treatment with fertility drugs, your doctor will regularly evaluate your ovaries with a vaginal ultrasound exam. This procedure uses sound waves to create an image of the inside of your ovaries. The ovarian follicles show up as dark, circular areas. If you have OHSS, the ultrasound may show that your ovaries are swollen, with large fluid-filled cysts where the follicles developed.

Treatments and drugs

Ovarian hyperstimulation syndrome usually goes away on its own within a week or two, or somewhat longer if you're pregnant. Treatment is aimed at keeping you comfortable, decreasing ovarian activity and avoiding complications.

Moderate OHSS
If your symptoms worsen rapidly or last longer than a week, call your doctor. Treatment for moderate OHSS may involve:

·         Taking either anti-nausea medication or prescription painkillers or both

·         Having frequent physical exams and ultrasound exams

·         Weighing yourself each day and measuring your abdominal girth, noting any changes

·         Measuring your urine output each day

·         Seeing your doctor to get blood tests to monitor for dehydration, electrolyte imbalance and other problems

·         Drinking large amounts of fluids, such as sports drinks

·         Draining excess fluid via a needle inserted in your abdominal cavity

·         Staying as active as possible and wearing support stockings to help prevent blood clots

Severe OHSS
If you develop signs or symptoms of severe illness, you may need to be hospitalized for careful monitoring and more aggressive treatment, including intravenous (IV) fluids. Serious complications may require further treatments, such as surgery for a ruptured ovarian cyst or intensive care for liver or lung complications. Treatment also may include anticoagulant medications to decrease the risk of forming blood clots in your legs.

Lifestyle and home remedies

Most women who develop OHSS can continue their day-to-day routine. For mild symptoms, follow these recommendations:

·       Avoid sexual intercourse, as it may be painful and can cause a cyst in your ovary to rupture.

·      Maintain a light physical activity level, but avoid strenuous or high-impact activities.

·      Weigh yourself on the same scale and measure around your abdomen each day; tell your doctor about any rapid or unusual weight gain, or any increase in abdominal size.

·      Call your doctor if your signs and symptoms get worse.

Prevention

To lessen the chance that you'll develop ovarian hyperstimulation syndrome, your doctor will create an individualized plan for your fertility medications, taking into account any risk factors you have for OHSS. Your doctor will also carefully monitor each treatment cycle with frequent or daily ultrasound exams to view the development of follicles, and with blood tests to check your estradiol level.

Your doctor may use a variety of strategies to help prevent ovarian hyperstimulation syndrome:

·         Adjusting medication dosage. Your doctor will use the lowest possible dose of gonadotropins to achieve the goals of stimulating your ovaries and triggering ovulation.

·         Coasting. If your estradiol levels are high or a large number of follicles have developed, your doctor may stop your gonadotropin injections and wait a few days before giving HCG, which triggers ovulation. This is known as "coasting."

Top foods that boost breast milk production (Lactation)

Motherhood is a lifelong achievement or rather you may define it as a lifelong "responsibility"! Your hair will turn grey, but still you will find your child as a "child" even if he has become an adult in the eyes of the outer world. An "upcoming" motherhood marks the beginning of a long, dutiful journey. Nutrition will play an important part in your care-giving. Your nutrition will have an impact on your baby's nutrition as well when you are pregnant and after you give birth. Often women complain about low breast milk production and this is a serious issue since a baby will primarily feed on his mother's milk within the first few months of his birth.Breast milk production is directly related to what you eat and drink on a daily basis. Drinking plenty of water is vital, but food is another essential factor. Lactogenic foods can help increase the milk supply. Eating sufficient calories and getting an abundant supply of nutrients may support lactation, but there are some foods which contain substances that interact with or support the chemistry of lactation. These substances include phytoestrogen, natural plant sedatives, plant sterols, saponins and tryptophan. In addition, a rich supply of minerals and a good balance of fats ensure the optimal functioning of your cells and nerves. So what are the best foods and herbs which help to stimulate the production of breast milk? The list goes this way:

·         Fennel (Saunf): This herb is well known for its ability to boost milk supply. The seeds are stronger agents and have been used by women for centuries as a galactagogue (a substance that promotes lactation). Fennel is rich in hormone-altering compounds like anethole, dianethole and photoanethole. According to a 1980 report published in the Journal of Ethnopharmacology, these medicinal compounds can stimulate the production of estrogen and prolactin, which are necessary for breast milk production.  Fennel can be eaten raw or cooked, for instance, steamed, or sauteed in butter and then simmered in a bit of water. As per experts' recommendations, fennel should be used only for a couple of weeks or for alternate weeks.

·         Fenugreek (Methi):This herb is a natural galactogogue that stimulates the ducts in the breast to produce more milk. According to the University of Wisconsin School of Medicine and Public Health, fenugreek is usually used to boost milk supply for the short term. But this herb can be used safely over a long period of time as well. Women may use this herb till their milk supply becomes sufficient.

·         Turmeric (Haldi): It has lactogenic properties and can also be taken to help prevent inflammatory conditions.

·         Sesame Seeds (Til): Large, black sesame seeds are used to increase breast milk production across Asian countries. Husked, light-colored sesame seeds are also effective and are easier to digest.

·         Apricots (Khubani): The University of Wisconsin School of Health and Public Medicine recommends to include apricots in the diet to boost breast milk supply. Apricots are high in vitamin C and other vitamins that are also beneficial for the baby.

·         Carrot, Beet and Yam (Shakharkand): These reddish vegetables are full of beta-carotene which is needed in extra amounts during lactation. Carrot seed has been used as a galactagogue, and the vegetable, also containing the volatile oils and phytoestrogen, acts as a gentler support.

·         Dark Green Leafy Vegetables: Dark leafy green vegetables are another food recommended by the University of Wisconsin for boosting breast milk supply as they are potent sources of minerals, vitamins, enzymes and phytoestrogen that support lactation.

·         Parsley (Ajmooda): It is a herb that boosts breast milk production.

·         Green Foods: Barley grass is classified as one of the "green foods". They are able to increase the fat content of the mother's milk, resulting in a creamier, more nutrient-rich and filling diet for her baby. It is also reputed to increase the volume of milk in some lactating women.

·         Barley (Jau) Water: It is also used as a galactagogue.

·         Garlic: It is famous for its medical benefits and has a long history as a galactagogue, but it should be taken in moderation as some people have low tolerances for garlic. In one study, babies were seen to latch on better, suckle more actively and drink more milk when the mother had garlic prior to nursing.

·         Ginger: It is helpful for the letdown and milk flow.

·         Green Papaya: It is taken as a galactagogue across Asia. It is a superb source of enzymes, vitamins and minerals, including vitamins C, A, B and E. Green papaya is the unripe fruit and it needs to be simmered until soft. Green papaya can also be taken in the form of a supplement.

·         Grains and Legumes: They have a long history as galactagogues. The most commonly used grains include oats, millet, barley and rice. Legumes that need to be included in your diet are chickpea, mung beans and lentils.

·         Nuts: Nuts that support milk supply include almonds, cashews and macadamias. Raw nuts should be preferred over the roasted or the salted ones.

·         Fats and Oils: Healthy fats play a vital role in cellular and neural metabolism. The kinds of fats a mother eats will influence the composition of fats in her milk. Make sure to eliminate the unhealthy fats such as partially hydrogenated vegetable oils and trans fatty acids from your diet, as these will also enter your milk.

·         Oats (Jaee or Avena sativa): It is one of the most nutritious foods containing proteins, vitamins, minerals and trace elements that nourish the nerves, support the metabolism of fats and uplift our spirit. It is another potential way to boost milk supply. According to some lactation consultants, oats may support lactation because they are rich in iron, they are comforting and share properties with some other common galactogogues like alfalfa. Like other galactagogues, oats act as antidepressants and antispasmodics and they also increase perspiration.

·         Spirulina: It is a non-toxic variety of blue-green algae reputed to increase the milk supply and the fat content of milk in some lactating mothers. It is valued for its proteins, enzymes, minerals, vitamins, chlorophyll and essential fatty acids. Spirulina's nutrients are easily absorbed, even when a person's digestion is not up to par.

·         Beverages: Lactogenic beverages include water, commercial lactation teas, ginger ale, non alcoholic beer, natural herbal root-beers and any imitation coffee containing chicory, dandelion or malt.

·         Brewer's Yeast: It can help increase milk supply as well as introduce essential nutrients like vitamins B, B12 and protein into the breast milk. Brewer's yeast also contains protein and good levels of phytoestrogens.

Your nutrition will affect your baby's nutrition. After all, he is one of your body parts, which have got detached in due course of time and as per the laws of the Nature. And he is a living body part which will require the same support that you and other living beings will require to sustain life!

Menstrual cycle: What's normal, what's not

Source: Mayo Clinic

Your menstrual cycle can say a lot about your health. Understand how to start tracking your menstrual cycle and what to do about irregularities.

Do you know when your last menstrual period began or how long it lasted? If not, it might be time to start paying attention. Tracking your menstrual cycles can help you understand what's normal for you, time ovulation and identify important changes — such as a missed period or unpredictable menstrual bleeding. While menstrual cycle irregularities usually aren't serious, sometimes they can signal health problems.

What's the menstrual cycle?

The menstrual cycle is the monthly series of changes a woman's body goes through in preparation for the possibility of pregnancy. Each month, one of the ovaries releases an egg — a process called ovulation. At the same time, hormonal changes prepare the uterus for pregnancy. If ovulation takes place and the egg isn't fertilized, the lining of the uterus sheds through the vagina. This is a menstrual period.

What's normal?

The menstrual cycle, which is counted from the first day of one period to the first day of the next, isn't the same for every woman. Menstrual flow may occur every 21 to 35 days and last two to seven days. For the first few years after menstruation begins, long cycles are common. However, menstrual cycles tend to shorten and become more regular as you age. Your menstrual cycle may be regular — about the same length every month — or somewhat irregular, and your period may be light or heavy, painful or pain-free, long or short, and still be considered normal. Within a broad range, normal is what's normal for you.

How can I track my menstrual cycle?

To find out what's normal for you, start keeping a record of your menstrual cycle. Begin by tracking your start date every month for several months in a row to identify the regularity of your periods. If you're having problems or you're concerned about the timing, flow or discomfort of your periods, then also make note of the following every month:

·         End date. How long does your period typically last? Is it longer or shorter than usual?

·         Flow. Record the heaviness of your flow. Does it seem lighter or heavier than usual? How often do you need new sanitary protection?

·         Pain. Describe any pain associated with your period. Does the pain feel worse than usual?

What causes menstrual cycle irregularities?

Menstrual cycle irregularities can have many different causes, including:

·         Pregnancy or breast-feeding. A delayed or missed period can be an early sign of pregnancy. If you haven't had your period in six weeks and you've been sexually active, take a pregnancy test. Breast-feeding typically delays the return of menstruation following pregnancy.

·         Eating disorders, extreme weight loss or excessive exercising. Eating disorders — such as anorexia nervosa — extreme weight loss and increased physical activity can disrupt menstruation.

·         Polycystic ovary syndrome (PCOS). This common hormonal disorder may cause small cysts — fluid-filled sacs or pockets — to develop in the ovaries along with irregular periods.

·         Premature ovarian failure. Premature ovarian failure refers to the loss of normal ovarian function before age 40. Women who have premature ovarian failure may not have periods or may get them irregularly.

·         Endometriosis. This disorder causes tissue that normally lines the inside of your uterus to grow outside your uterus. Endometriosis can cause pain — sometimes severe — especially during your period.

·         Pelvic inflammatory disease (PID). This infection of the reproductive organs may cause irregular menstrual bleeding.

·         Uterine fibroids. Uterine fibroids are noncancerous growths of the uterus. They may cause heavy menstrual periods and bleeding between periods.

What can I do to prevent menstrual irregularities?

For some women, use of birth control pills can help regulate menstrual cycles. However, some menstrual irregularities can't be prevented. Regular pelvic exams can help ensure that problems affecting your reproductive organs are diagnosed as soon as possible.

In addition, consult your health care provider if:

·         Your periods suddenly stop for more than 90 days

·         Your periods become erratic after having been regular

·         You bleed for more than seven days

·         You bleed more heavily than usual — soaking through more than one pad or tampon every hour or two

·         Your periods are less than 21 days or more than 35 days apart

·         You bleed between periods

·         You develop severe pain during your period

·         You suddenly get a fever and feel sick after using tampons