Normal blood loss during menstrual cycle is about 50-80 ml and usually do not exceed 100 ml. Menorrhagia is excess menstrual bleeding for longer duration without any alteration in the menstrual cycle i.e. menstrual cycle is unaltered but duration of menstrual bleeding and quantity of menstrual blood loss is increased. Menorrhagia is not a disease itself but a symptom.
The underlying cause of menorrhagia is difficult to detect. But the causes of menorrhagia can be grouped as (a) causes due to general diseases (b) due to local cause in pelvis (c) due to endocrine disturbance and (d) hormonal causes.
Diagnosis of menorrhagia:
- Finding out the cause of menorrhagia may be very difficult. The patient of menorrhagia must be investigated carefully due to the difficulty in detection of the underlying cause of menorrhagia and its symptoms. History of the patient should be taken carefully to find out the onset, duration, quantity of blood loss, the character of blood and the cyclical feature of menstrual cycle. Any preceding history like recent delivery, abortion or IUCD (intra-uterine contraceptive device) should be elicited.
- A full gynecological examination should be done, which should include thyroid profile, blood count and bi-manual pelvic examination.
- A diagnostic curettage should be done to obtain samples for histological examination.
- Ultrasound examination of should be done to exclude extra uterine pathology.
- Instead of all the above investigations, if nothing comes out as the cause of menorrhagia, a hysterosalphingogram should be done and it may reveal some cause like polyp, fibroid etc.
Contraception is any preventive method for women to avoid unwanted pregnancy. They include all measures either temporary or permanent, to prevent pregnancy. Due to the ever increasing world population, in the last few years, revolution is occurring in contraception and contraceptive methods and man are trying to interfere with ovulation cycle. Unfortunately there is not much research done in male contraception and by the word contraception we understand female contraception. Except for male sterilization there is no other effective male contraceptive method, although depot hormonal preparations are available but used infrequently.
The contraceptive methods can be broadly categorized into two:
(1) spacing methods.
(2) terminal sterilization.
Spacing methods can be further divided and sub-divided into the following:
(1) Barrier methods (they are subdivided into physical barrier, chemical barrier and combined barrier).
(2) IUCDs intra-uterine contraceptive devices.
(3) Hormonal methods.
(4) post-conceptional methods.
(5) Miscellaneous.
Terminal methods can be divided into male sterilization and female sterilization. Male sterilization is called vasectomy and female sterilization is called tubectomy. The male sterilization or vasectomy is much cheaper, easier and has lesser side effects than tubectomy. But much more tubectomies are done every year in compare to vasectomy. One great advantage of male sterilization or vasectomy is that it is easily reversible and when the vasectomized male want to bear child again the vas deference can be easily re-canalized and it is highly successful and without any side effects. In case of tubectomy the re-canalization can be successful, but it has many potentially fatal consequences like tubal pregnancy.
Present day is the day of internet (high tech world), almost all services are available online including online doctors consultation. Medical consultation online (telemedicine or telehealth) for any medical problem has many advantages, like the easier accessibility, affordability (cheap and sometimes it may be free), 24 hours service etc. to name a few advantages. You can get consultations, drug prescriptions, and other health services by means of email, telephone, video, and Internet. Telemedicine is slowly becoming a future trend and it is picking up its momentum.
Online consultation for women’s health problem is slowly increasing these days. The reason is, some women may not feel comfortable explaining their problems to someone, but they have no hesitation in explaining their health problems to an online doctor. It is easier to get medical consultation by expert and qualified gynecologists, medical specialists, child specialists, skin doctors and many more specialties.
Another reason why online medical consultation is gaining popularity is because it is seen that more than two third of the visits to doctor is for consultation only and these consultations can be handled easily over phone or by email or by other means of telecommunication. Due to the success of online consultations these days many hospitals are investing in telemedicine. The number of online medical consultations is increasing day by day.
There is no problem in securing a Doctors Excuse notes online. Telemedicine or medical consultation online can give you some non medical use also, like getting a doctors excuse notes or a medical certificate in simple term. These doctors excuse notes can be used for negative consequences of missing work or scheduled legal obligation.
Some women experience certain premenstrual symptoms called premenstrual tension about 7-10 days before the start of menstrual bleeding. These premenstrual symptoms include irritability, malaise, lassitude, headache, gastrointestinal upset like constipation and spasm of colon, feeling of fullness of the breasts and abdomen, frequency of urination etc. There may also be feeling of congestion in the feet and face. In some women these symptoms become exaggerated and form a well marked psychosomatic disorder.
In some of the cases of premenstrual tension water retention can be demonstrated by an increase of body weight up to 5 kilos which is accompanied by pedal edema. This is more marked if the patient has history of phlebothrombosis. The fullness of breasts can be prominent symptom and can be accompanied by breast tenderness. On examination of breasts, there is hardness and lumpy feeling and there is also tenderness. Some women with premenstrual tension suffer from migraine headache which disappear if the woman become pregnant.
The cause or etiology of premenstrual tension is not clear. It is suggested (but not proved) that premenstrual tension may be due to excess production of estrogen and abnormal or disturbance in adrenal function, because there is always an increase of extra-cellular water throughout the body. This is because estrogen is recognized to cause water and sodium retention as seen in carcinoma of prostate, where there is excess production of estrogen. But presence of large amount of estrogen does not always produce water retention as seen in granulose cell tumor. Adrenal cortical steroids and progesterone (progesterone containing oral contraceptive pills may are well known for their water retention properties) can also cause water retention, so it may not be always due to estrogen excess.