Women In Your Life : Menopause

The life expectancy rate is slowly increasing all over the world. Nepal’s Life expectancy has increased as well.  The average life span for men is 64 years and for females it is 67 years. With the increase in life span, old age related problems are increasing as well.

One of the most common problems that women face very often in old age is Menopause. Many women are not aware of this condition. They sit in their home; they get depressed by minor trivial issues like household chores and relationships. They blame the old age and they silently wait for a miracle to cure their ailing age problem.

Menopause is condition that women experience usually during the age of 46-51 years. Menopause appears early in females who smoke and who have done a prior gynecological surgery.  Men also experience something similar called Andropause. Menopause is the period in a women’s reproductive life when she does not have regular periods or menses for more than 12 months.

When women reach the end of their reproductive period there is decrease in the function of Ovaries. Gradually when one nears menopause, there is a decrease in the release of ovum and henceforth, one of the most important hormones called Oestrogen which is realized from the ovaries also decreases. Oestrogen plays a very vital role in a women’s body.

Due to the estrogen deficiency, women usually experience different manifestations. The typical presentation like having hot flushes, mood swings, irritability, sudden tears, trouble sleeping, dry vagina, weight gain, crashing fatigue, loss of libido, anxiety. Oestrogen receptors are present in different parts of the body. They are present in the skin, eyes, brain, urinary and genitalia area. When estrogen receptors are not activated, functional alternations takes place in these areas. The skin loses its tough, taut nature and wrinkles appear. Likewise, in the Brain, memory loss, migraine headache and mood swings occur.

Managing Menopause requires knowledge about the disease. Most women in Nepal are unaware about the condition but the few people that know about this condition are managing it with ease. Exercise is a must, at least 45 minutes every day.  Practices like Yoga, meditation, walking is highly recommended.   Women who smoke should quit.

One cares less for diet when they reach old age. It’s likely that these women lose interest in eating due to different factors like having decease sense of taste, smell, sight, hearing and touch.  Ensuring that women get calcium rich diet enriched with Vitamin D is a must and people should carefully monitor their intake.  Women are very venerable to bone break also known as osteoporosis. Usually young people are encouraged to stay in the Sun to synthesize Vitamin D but in old age, Vitamin D can’t be synthesized and one has to synthetically obtain from medication.  Hormone replacement therapy is also available for those that do not have any contraindications.

The other day a 60 years old woman described her regular gynecological examination. I was perplexed as she said that it was her first regular check up; she called the experience to be cold and penetrative. She was know to suffer from Vaginitis. Women seldom understand the importance of routine gynecological examinations. Routine checkup seem bothersome and the cost is also not feasible.  Women should make regular visits to screen diseases like breast, endometrial and cervical cancer.  How can I force women? When they like to save that money for regular check up for a child’s fee who is abroad. It’s sad.

People need to treat their grandmothers, mothers and aunts with respect. Old age will haunt you eventually, care for them, and ensure that they get all the essential nutrients. Motivate them to exercise. Talk and counsel them for an issue that they get bothered by. Educate and care for the women that are in your life, you have no idea how valuable they are!


Get Your Fertility Facts Right!


She is just 23 years old, admitted for sub-fertility. They are doing a laparoscopic surgery to check out her internal genital organs, to discover the cause. We took her history and must say she was very cooperative (well, I kind of told her that she was of our age and so she was comfortable with sharing details of her sexual life.)


It’s very hard to classify someone as being infertile, I am still working on my “how to break the bad news”  chapter.

So what’s infertility? What’s sterility? What’s impotence? What’s frigidity /Timidity?

Infertility is the inability to conceive after one year of unprotected sex.

Fertility is relative rather than an absolute state. Nobody can be extremely fertile or extremely infertile. Most couples fall within an average fertile group, if one has low fertility, then, that can be overcomed by the corresponding partner.

If both partners fall within the low fertility group then change your life/love partner, chances are that you can overcome this infertility problem. (Like it’s easy to leave someone in love just to conceive, but we bluntly present this option to you)

Fertility is a much hyped up topic states a doctor, it’s not like old times, where couples were ashamed of stating their problems. Now –a- day’s people give a detailed sexual history and they want more facts.

Sterility: It’s an absolute state when one can’t conceive at all.

Impotence: Failure to perform sexual intercourse. (Yup, folks this happens and men seem to be responsible for this in most cases)

Just to wake you: (I kind of imagine my readers sleeping as they read my posts due to boredom)


A couple complains of infertility, later on, a detailed sexual history was taken and it was found out that the couple did not consummate their marriage.(People don’t know how to have sex, this is even possible but rare, only 1-2 % people come with this problem.) It’s called aparenunia and dyspareunia.


Frigidity: lack to desire to have sexual intercourse with your partner, this term applies to females and likewise, Timidity is for males.

Is your desire to have children more than your figure and career? The book states that women’s desire to have children is greater than any desire in the world.  (It’s a very emotional book, full of sensitive paragraphs, if you are interested; we read a book by Jeffcoate’s , read that!)Do you agree with the above statement?

For many years women were targeted and cursed as being the “infertile one” but Men are equally responsible for infertility, only the Greek people understood that in the past.

Common causes of infertility in women:

Ovarian factors: Irregular menstrual cycle

Tubal factors: due to previous infection, your fallopian tubes (it’s a tube that transmits the ovum to the uterus) becomes tough (stricture formation) as a result its motility is lost and proper transmission of the ovum does not takes place for the fertilization to take place.

Uterine factors:  due to Hypo-functional uterus

Cervical factors: inability of the cervix to pass the semen.

Vaginal factors: Inability of the vagina to receive the semen, due to any tumor.

Coital Errors:

Coitus (having sex) has to take place every 48 hours during the fertile period to offer the optimum chance of conception. Too frequent sex rarely, if ever, accounts for infertility.

Lubrication: stop using any kind of lubrication, lubricants contain acid which kills the sperms and some paraffin containing lubricants bring spermatozoa to a standstill.

Some Misconceptions:

  • Orgasm: it’s unnecessary for women to have orgasm to conceive.
  • Let the semen flow (Effluvium Seminis): after complete ejaculation, if some semen flows from the vagina, then don’t worry, most of the required amount of semen has already travelled to the uterus by then.
  • Anxiety and apprehension: Nervous temperament, particularly extreme anxiety to conceive lowers fertility.
  • Diet: stop dieting, you need some nutrients like Vit A, Vit E , especially in men to actively secrete secretions.
  • Occupation and settlements : rural women and urban women, mental work and physical activity also contributes to fertility.

Men, you are also equally responsible for infertility. Check out some reasons in tomorrow’s post!

Stay fit people and stay fertile!

A Look At Vaginal Discharge: Normal Or Not ?

Vagina as we all know is one of the important organs of reproduction. It receives the semen and it’s also the organ of copulation.

Vaginal Discharge normally consists of discharges from different glands in the genital tract.

Let’s look at some causes of the discharge:

It could be Physiological; normally this happens after you reach a certain age:

• During Puberty

• During Menopause

• During Sexual Excitement

• During Pregnancy

• If You use Combined Oral Contraceptive Pills

It could be Pathological due to:

• Infection

• Malignancy

• Foreign Body ( use of IUCD, Intara-Uterine Contraceptive Devices )

• Atrophic Vaginitis (Inflammation of the Vagina ), happens in postmenopausal women.

How would you know that you are having either one of these discharges?

Check the color of the discharge, the frequency and the amount secreted in a day.


• Curdy white: indicates fungal Infection

• Greenish: Parasitic Infection

• Yellowish: Bacterial infection

• Bloody: Menstrual blood or maybe due to cancer


several times in a day


Do you have to use sanitary pads to contain the discharge? If Yes then , You should Consult!

 Consistency of the discharge: Is it ?

• watery

• Frothy

• Curd Like

What are the associated symptoms?

  • Itching
  • Burning pain during Micturation

What should you do?

Calm down! Most people freak out by this but it happens due to an infection which is treated with antibiotics.

Also, you need to give a proper sexual history so that the partner can also be treated for some cases.

The important fact that you should consider is that If You have such discharges on a regular basis and If You get bloody ones besides the normal menstrual blood then Please consult with your gynecologist!

Happy Checking People!

UTI : Do You Have It ?

Urinary Tract Infection is  one of the most common infections for females. It is usually defined as the infection of the kidney, urethra, bladder and the urethra.

Females are more prone to this disease because:

• Close anatomical proximity of the anus with the urethra

• Females don’t have prostate, which in men secrete prostatic fluid which has anti bacterial property

• Women have shorter urethra than males

• The colonization of the vagina by normal flora ( Bacteria and other organisms that normally reside in the human body)

What are the symptoms?

• Dysuria ( Extreme Pain During Micturation )

• Frequency of micturation

• Burning Sensation during Micturation

• Curdy or whitish clot appearing with the urine

• Fever ( always not present )

• Pain in the lower part of the abdomen

What are the agents that cause this?

Escherichia Coli (almost 90 % cases) are caused by this bacterium; other agents can also cause this infection like Candia Albicans.

Who are the susceptible people?

• Diabetic persons have more chances of developing this

• Neuropathy of any sort

• Uterine Prolapse ( the uterus has prolapsed or lost its normal anatomical position)

• Vesico- ureteric reflux( meaning: the urine flows from the bladder to the urethra )

• People admitted in hospital who use catheter for urine excretion for several days.

Why does this happen?

Urine is a favorable site for bacterial growth, when urinary outflow is obstructed by any means like a stone or any kind of urinary out flow failure (uterine prolapse, diabetic neuropathy, use of urinary catheter). The bacteria from the lower part of the body i.e. from the urethra enters the bladder in ascending fashion, colonizes and starts creating the above mentioned problems.

What should be done?

If the above mentioned symptoms match consult a physician, he will prescribe an antibiotic for the course of 3 days.

How can You Protect Yourself?

• Drink plenty amount of water, coconut juice, Cranberry Juice is extremely helpful during this time.

• Maintain a clean hygiene.

• Avoid whipping your anus after defecation from the backward to forward direction, If You do that than the bacteria from the anus might enter the urethra.  [in the above mentioned picture, the bladder is in-front ( Right side of picture) of your body and the anus is backward (Left side ) ]

• Avoid taking any bath but go for shower instead

• Avoid using any products which are perfumed in the genital area

• It is advised not to use Tampons, use sanitary pads instead.

• For Post Menopausal women, estrogen creams have shown to decrease the risk

• Avoid Bath Oil

• Life Changes especially when you have had this once, chances that the symptoms may reoccur.

What are the Complications?

Most cases are asymptomatic, only detected in routine checkups which usually regress on its own.

If the bacteria are virulent then the bacteria may cause infection of the kidney (pyelonephritis) which may even lead to kidney failure.

For Pregnant women, UTI may be serious as chances of neonatal meningitis are increased during birth.

Get prepared girls, you are bound to get this once in your life time.

Get Informed People!

Care To Learn About Delivery ?

I was told that I came from the stomach and that I was brought in this world by my mother. I believed that until the time they showed me a reality series in BBC, the actual birth process. It was unbearable; my jaws were practically open when I viewed that one hour video. A woman was screaming and blood was spouting out, I was actually shocked. The procedure was painful but at the end of it, the mother had a big smile on her face like nothing in this world mattered, getting that baby in her arms was all that she cared of.

Delivery of the fetus is the end stage of pregnancy when the fetus is expelled after a term of 37-42 weeks. I quote my teacher “any woman who dies during labor is considered as a martyr, the pain that she undergoes is one of the most terrible pains that anyone can face”. Her classes are my favorite especially when she quotes the subject in those terms.

So basically the labor pain starts when the membrane ruptures, this membrane surrounds the fetus, which protects it all throughout the time. People usually say “I think I broke my water “, well it means that they have entered the first stage of labor. Women are expected to report to the hospital at this time. The first stage ends when the complete dilatation of the cervix takes place.

The second stage of labor starts when the dilated cervix (the part that comes after the uterus) expels the fetus. This time is the most crucial moment for the mother as well as the fetus. Several methods are used to assess the condition of the fetus. Questions that come across are : Can a normal delivery be possible? What type of delivery should we prefer for the mother? There are basically two methods: the vaginal method and the abdominal method ( Caesarian section). It usually depend the engagement of the fetus, decent and also the general condition of the mother.

The actual process of the positioning of the fetus is very interesting; the fetus undergoes several rotations. Usually the fetus is positioned in such a way that his or her head is facing the outlet which is also called the Cephalic presentation. Decent is the uterine contractions that are continuous in nature and which are aided by the abdominal muscles. This phase in any women requires constant support and encouragement, words like “Push Push” and “Come On You Can Do It” can actually help her.

The third stage starts when the placental membrane gets expelled from the mother. Delivery and intranatal care requires 3 ‘C’ – Clean surface, Clean Cord Cutting and Clean hands! It’s even common for med students to get a vasovagal attack when they view delivery for first time. But this part of life and you should understand the pain that your mother has to bare to bring you to this world!

After the delivery of the fetus, a crying baby makes the doctor happy. If not, tactile stimuli is used by slapping the baby in the back to induce respiration. The baby is cleaned and any mucus and membranes from the eyes and body are removed. There are several ways to deliver a baby, some people in the States prefer to do delivery in hot water bath and the reason behind  doing this is that the warm water prevents the shock that the baby has to go when he experiences the cold outer world. They have a point and I actually consider this method but a hospital delivery is much safer.

Appreciate your mother, your wife and your girlfriend; she just did a remarkable thing!

Happy Delivery People!