dr. timir mazumder
 dr. timir mazumder
 dr. timir mazumder

FAQs :


Are large blood clots during one's period bad ?


During my period recently, my body's been creating blood clots of a serious size. Is it possible that I'm doing something that's causing this? Is it unhealthy or is it normal? Should I see a doctor ?

Menstrual blood varies in color and consistency throughout your period. However, certain changes such as clotting can indicate a problem and it is very important to see your primary care provider or gynecologist to be evaluated. Many women experience clots occasionally during their periods, usually during the heaviest flow days. Your body releases anticoagulants to prevent clots but sometimes if your period is heavy the anticoagulants don't have time to work and clots are able to form. A small amount of small clots are usually considered normal, but any clots larger than a quarter or excessive clotting is abnormal and needs evaluation by a doctor. There are multiple causes of clots ranging from benign to more serious. Uterine fibroids are non-cancerous growths that can cause increased bleeding and clots. A miscarriage also causes large clots so if there is any chance you are pregnant seek medical attention. Menopause, large changes in weight, endometriosis, and certain medications can also cause large clots. Large clots can also be a symptom of endometrial cancer. Significant blood loss can occur over time leading to anemia which is characterized by fatigue, lightheadedness, and pale skin. I recommend that you see a gynecologist for a workup which will likely include a pelvic exam, vaginal ultrasound and blood work.


Ovarian cyst causing tension


I'm 25, and I just found out that several women in my family have had ovarian cysts. Now I'm trying to learn as much as I can about them. What causes a cyst to grow on an ovary in the first place ?

Cysts on ovaries can be normal, or can be a sign of disease. I would recommend that you discuss this with your OB / GYN. This requires follow up with your doctor. There are many different types of cysts, but the most common are functional cysts. During the normal menstrual cycle, the body produces hormones that cause the eggs to mature. As the eggs mature they grow in the ovary. At each ovulation period (which occurs half way between each menstruation period) the egg is released, however the cyst in which it grew remains in the ovary. These are sometimes bigger than they should be and can be seen on an ultrasound. These however are normal and we know that they go away later in the menstrual period. That is why the first step if these are found is to simply repeat the ultrasound in a few weeks to see what has happened to them. There are other types of cysts. Some occur during pregnancy. Some occur because of other hormonal disorders (known as Polycystic Ovarian Syndrome which is related to diabetes). A minority of them occur from cancer. There are also some cysts that are caused be endometriosis. Talk to your OB/GYN. Most cysts grow from normal female hormones and are not important, but some can be a sign of disease.


What causes a uterus to become enlarged


I am a 41- year - old woman, and a month ago I began having unusual cramping and vaginal bleeding. I've done a lot of research, and I'm pretty sure I have the symptoms of an enlarged uterus. What could cause a uterus to become enlarged?

The symptoms you are having could be one of several things. An enlarged uterus is not actually a diagnosis, however there are several uterine conditions which could cause your symptoms of unusual cramping and vaginal bleeding along with an enlarged uterus. The best type of physician for you to see about this is an OBGYN. Common conditions that cause unusual cramping and vaginal bleeding include uterine fibroids and adenomyosis. Both of these can also cause an enlarged uterus. Uterine fibroids are basically benign uterine tumors that form in many women. They almost never progress to cancer but they can cause pelvic pain and excessive bleeding. Adenomyosis is an abnormal growth of the inner lining of the uterus into the outer lining. It also can cause pelvic pain, abnormal bleeding and an enlarged uterus. The treatment for these two depends on the severity of your symptoms and if you have desire for more kids. Finally and more rarely, uterine cancer (called endometrial cancer) can cause these symptoms. Only this requires a uterine biopsy for diagnosis. I suggest that you schedule an appointment with your OBGYN. He or she can take a detailed history of your pelvic symptoms and perform a through pelvic exam including an ultrasound. If the diagnosis is in question, then you may need a uterine biopsy. Hopefully, you get get a diagnosis and treatment plan quickly.


Are multiple cysts on an ovary a sign of cancer ?


My doctor recently diagnosed me as having several cysts on one of my ovaries. I understand that a cyst is different from a tumor, but could they be caused by cancer? Does this up my chances for getting ovarian cancer later ? Are the two related at all ?

Any time you receive a new diagnosis, in this case of the ovarian cysts, it is important to fully understand the condition. To that end, I think it is best you speak to your primary doctor about these questions. Alternatively, an ob/gyn could be of help as a specialist in the field. In general, ovarian cysts are separate and mostly unrelated to ovarian cancer. Ovarian cysts, depending on your age, are often functional. That is, the form during the high estrogen stage of your menstrual cycle and then disappear during the later stage of the cycle. They can become painful and / or bleed--but these normally resolve on there own. Often your doctor will recommend a repeat ultrasound in a few months to make sure they do reduce or disappear. Other causes of ovarian cysts can be from a benign malgrowth--such as a dermoid cyst. Other possibilities include endometriomas--which is when the uterine lining is out of position in the ovary. Finally, if your ovaries have multiple cysts- your may have Polycystic Ovarian Syndrome--which is an endocrinological disorder that is related to diabetes. Around 15-20% of reproductive age women have cysts. Cancers are often solid and not cystic (cyst implies hollow). Rarely cancers can be cystic. Your doctor may have you get a repeat ultrasound to see if the cyst does not go away (which may be more concerning). In general, if the cyst are functional--this does not change your risk for ovarian cancer and would be unrelated to cancer. Ovarian cancer is a rare but important disorder. In general, cysts alone would be an unusual, but not impossible, presentation for cancer. Discuss this with your doctor.


Is it safe for diabetics to have children ?


I'm a 31 yr old woman with type 1 diabetes, and I do want to have a child before I get too old. But now I'm starting to consider the effects of my disease. What are the complications of being diabetic and pregnant? Is childbearing safe for diabetics ?

As you know diabetes is a complicated life long disease, and asking questions like this is important to make sure that you continue to do everything possible to be healthy. The best physician to ask this question to is your OBGYN who has certainly dealt with many pregnant diabetic women. Having Type 1 diabetes is not a reason that someone can't have children. Many type 1 diabetics have normal pregnancies and deliver healthy children without any complications. However, you probably need more intense oversight by your physicians during that time. Pregnancy may make your blood sugars harder to control requiring more frequent checks and perhaps even the addition of a different type of insulin. Women that have excellent blood sugar control during there pregnancy often have entirely normal deliveries and normal infants. However, women with poor blood sugar control can have compilations. For example having a baby too large for vaginal deliver is a complication of poorly controlled diabetes. Infants born will often have to have supplemental glucose shortly after delivery to make sure their blood sugars don't go too low. I would schedule and appointment with your OBGYN so that he or she can give you more detailed information about diabetes in pregnancy. I think after that appointment you'll have a plan on how to have a healthy baby with your diabetes. Good luck.


How do laparoscopic and abdominal hysterectomies differ ?


Are laparoscopic hysterectomies really better than abdominal hysterectomies? I'm 45 and my doctor just recommended I get one. It would be more convenient to get an abdominal hysterectomy, because I'd have to go out-of-network for the laparoscopic kind, so I'm just weighing my options.

Laparoscopic and abdominal hysterectomies are different techniques for removing the uterus, and sometimes the cervix, fallopian tubes, and ovaries. They both serve the same function, but have different risks and levels of post-operative pain and scaring. The abdominal hysterectomy is the original surgical method where an incision is made along the abdomen for access to the organs when they are removed. The only advantage to doing it this way is if major complications were to happen (such as brisk bleeding), then they can be dealt with faster. The major downside is that they result in longer hospital stays, potentially more pain, and a larger scar across lower abdomen. Laparoscopic surgical removal involves placing three small incisions where a camera, and 2 surgical tools are inserted. The exact same procedure is then performed. The only disadvantage to this technique is that in a very small percentage of cases, the surgery needs to be converted to an abdominal technique to deal with complications that cannot be handled by the laparoscopic tools. The major advantage (and why its considered the best option for most patients) is that it results in shorter hospital stays, less pain, and much less scaring. So the answer to your question is that yes laparoscopic surgeries are preferred over open abdominal hysterectomies for most situations. I would schedule an appointment with the doctor you would like to do the operation and have him or her go through all the risks and benefits specific to your situation . Good luck .


Is it OK to take antibiotics while pregnant ?


I'm 6 months pregnant, and I've developed a rather bad infection underneath one of my toenails. The doctor took one look at it and prescribed antibiotics, but that is really frightening to me. Is it safe to take antibiotics while pregnant? I'd much rather find a natural way to deal with it.

Any questions about medication safety during pregnancy are best answered by an obstetrician. Physicians may also work with pharmacists when evaluating the safety of particular medications for an individual patient. Some medications can be taken safely during pregnancy, including many antibiotics. It is not uncommon for the physiological changes of pregnancy to make a woman more susceptible to certain kinds of infections, and effectively treating a bacterial infection almost always requires some kind of antibiotic. However, there are some medications that should not be taken by pregnant women. This group of medications does include some antibiotics. In order to determine whether a given medication is safe in pregnancy, it is important to only take medications that are prescribed by an obstetrician or by a specialist who is aware of the pregnancy. Some women do prefer not to take any medications at all, if possible, during their pregnancy. However, for certain medical conditions, including bacterial or fungal infections, treating the infection requires the use of an antibiotic. This can be done safely. However, because some medications are not safe during pregnancy, with any health concerns during pregnancy it is always best to seek care from an obstetrician who can provide guidance about the safety of a given medication.


How much weight should a pregnant woman gain ?


My wife if 6 months pregnant and her weight gain hasn't really leveled off at all. The only thing I can compare it to is her previous pregnancy, but it seemed like she took on less weight then. What is a healthy amount of weight for a woman to gain during pregnancy,and what is too much? She's a pretty small woman, by the way.

Questions about pregnancy are best answered by an obstetrician. Depending on the circumstances, a specialist in high-risk pregnancies can also be consulted. Weight gain is normal and healthy during pregnancy. The approximate amount of weight a woman should gain depends on her pre-pregnancy weight. A woman who was of average weight (defined as a BMI between 18.5-25) before she became pregnant should gain between 25-35 pounds with a singleton pregnancy. A woman who was underweight before pregnancy (BMI less than 18.5) should gain approximately 28-40 pounds while pregnant. Finally, a woman who was overweight before pregnancy (BMI greater than 25) should gain 15-25 pounds during pregnancy. There is a weight range associated with each category, to account for the many degrees of healthy variation in an individual woman's body type, pre-pregnancy state, and pregnancy itself. In addition, non-singleton pregnancies (twins, triplets, etc) will result in greater weight gain. Gaining excessive amounts of weight during pregnancy can be harmful for both mother and baby. Likewise, the same is true of insufficient weight gain. Any concerns about healthy weight gain during pregnancy should be discussed with an obstetrician. This will help ensure the best outcome for both mother and baby.


How soon after a C - Section can one exercise ?


My son was born nearly a month ago. After a complicated labor, I opted to birth him by C-section. The healing process has come along nicely for me, but I don't want to rush it. When is it safe for me to do some vigorous exercise, like running or swimming ?

Return to an exercise program after an abdominal surgery is a complex decision, one which is best managed in consultation with an OB/GYN physician or the surgeon who performed the surgery. Generally, your OB/GYN physician will recommend an office visit about 6 weeks after the caesarean section. This visit is designed to assess healing of the wound and determine guidelines for return to exercise. Most likely, your physician will advise you to avoid any exercise program prior to this office visit, although gentle stretching and light activity, such as slow walking, will likely be ok. Following the 6 week office visit, your physician will develop some individualized recommendations on when and how much you may exercise. Generally, it will be ok to increase your activity level gradually after 6 weeks, but many OB / GYN physicians will still discourage a rigorous exercise program such as weight lifting for an additional 6 weeks. Most physicians will advise that you begin with lower impact activities such as swimming. The risk of resuming vigorous exercise too quickly is that the surgical scar may not heal well or even, in severe cases, may open up again completely. As always, specific recommendations on activity after caesarean section will require a physical examination by your personal physician. It is recommended that you make an appointment with your OB/GYN doctor to discuss the issue.


Is pelvic pain normal during pregnancy ?


I'm 5 months pregnant with my first child (I'm 20), so naturally I have a bunch of worries and questions. The most important is about my pelvis, which has been hurting more and more over the last 3 weeks. Is it normal for a pregnant woman to feel pelvic pain as the baby bears down on her bones ?

Pelvic pain during pregnancy is quite common and is generally benign. However at times it can require medical treatment. The physician best qualified to discuss this issue with you is your OB / GYN doctor. There are many causes of pelvic pain, some of which are not related to pregnancy. For example, sexually transmitted infections can cause pelvic pain; these causes are checked for during the routine prenatal care of every patient. Similarly, ovarian cysts or torsion and occasionally appendicitis can present as pelvic pain which is general severe in nature. Bleeding behind the placenta or other serious threats to the pregnancy can also present as pelvic pain, often accompanied by vaginal bleeding and loss of fetal movement. The most common cause of pelvic pain during pregnancy, however, is much more benign and is caused by relaxation of the pelvic ligaments as a natural part of the pregnancy. Generally this is characterized by intermittent twinges of pelvic discomfort which do not require any treatment. However, if the pain becomes quite severe, it can represent a more severe form known as symphysis pubis dysfunction, which is often treated by specialized obstetric physiotherapy. As always the diagnosis and management of your specific condition will require a physical examination by your personal physician. Scheduling a visit with your OB / GYN doctor is highly recommended.


What does high blood pressure during pregnancy indicate ?


I'm a pregnant woman, 30, in my first trimester. I just took my own blood pressure and found that it's significantly higher than it used to be. Does this signify some kind of serious problem? I know that being pregnant causes all kinds of changes in your bodily systems, so I'm trying to not assume that anything's wrong.

High blood pressure during pregnancy can be a serious problem requiring medical evaluation and treatment. The doctors best qualified to discuss this issue with you include your OB / GYN doctor. High blood pressure in pregnancy is a serious finding that needs to be evaluated quickly by your physician. High blood pressure can be the first sign of a condition called preeclampsia, which can also include other symptoms, such as headache, blurry vision, abdominal pain, and swelling of the face, hands, or feet. Preeclampsia is a dangerous condition, as it can progress to eclampsia, which can result in seizures, organ damage, and damage to the baby or even death of either the mother or baby. Your physician will likely recheck your blood pressure. If it is elevated or if there are other concerning signs, some basic laboratory tests as well as an ultrasound might be indicated to determine if their are signs of preeclampsia and if they need to be treated with rest, medications, or other treatments as determined by your physician. As always, the diagnosis and management of your specific condition will require a physical examination with your personal physician. Scheduling an appointment with your OB / GYN doctor as soon as possible is strongly recommended.


How should a pregnant woman's skin care routine change ?


How should the skin care routing or a woman change when she gets pregnant? My wife is newly pregnant, and I'm trying to do research to help her cope with the changes, but I can't find any one clear plan for dealing with the ongoing hormonal impacts of pregnancy on the skin. Is there a consensus ?

First, let me say congratulations. Having a healthy, uncomplicated pregnancy is every couple's dream. Make sure to involve your wife's doctor in every aspect of it so that he or she can take care of your wife at an optimal level. There are no absolute recommended skin care routines for women that are pregnant. While pregnancy can be associated with many skin changes, the most common are the linea nigra (dark line down the center of woman's abdomen) and stretch marks. Stretch marks are the most concerning to women. Some studies suggest that using various types of lotions on the belly daily can help prevent them. Discuss this issue with your doctor before starting any. I suggest that you go with your wife to her next appointment with your OBGYN that will be delivering the new baby. Write down a list of questions you have about the best things to do for your wife's health and the health of the fetus. Skin care is just one on a long list of things you should consider doing. Remember, do not try any of the so called herbal or natural remedies without first checking with her OBGYN. Many of these products contain hundreds of untested chemicals with unknown effects on the body. Good luck.


If a woman has sex the day before or the day of her period, can that result in pregnancy ?


I had sex around the day that I normally get my period and I haven't had one since.

Although typically the best time to get pregnant during your menstrual cycle is when a woman is ovulating (the egg is being released from the ovaries and starting to travel down in to the womb), it is possible to get pregnant at any time in the cycle. If you have missed a menstrual period I would absolutely check a pregnancy test as it is always possible to get pregnant. It is also a good idea to discuss your concerns with your primary care doctor or gynecologist. If you do not want to be pregnant, depending on what state you live in, there are some options for emergency contraception; One possibility, if it has been less than 5 days (or ideally less than 2 days) since you had unprotected sex, is a drug called Plan B. This is sometimes also known as the morning after pill. If you are interested, you should contact your doctor about taking this. In some states its available over the counter, but make sure to check with your doctor or pharmacist so that you're sure there is no medical reason for you not to take it. If you are not looking to be pregnant there are many different options for birth control depending on who you are and what your goals are. Please be sure to talk to your primary care doctor or gynecologist about these different options. Also remember that it is important to protect against sexually transmitted diseases when having intercourse; The best way to do this is by using condoms every time you have sex.


Why am I experiencing more heart burn now that I am pregnant ?


I never experienced heart burn before I was pregnant, but now that I am six months along I definitely feel it. I was a bit scared initially, as the feeling was quite painful. When I asked my friends about it they also admitted that pregnancy gave them much more frequent heart burn. The pain is especially noticeable immediately after I eat foods with tomatoes and after I drink the occasional cup of coffee. Why do pregnant women experience such intense heart burn, and is there any way I can make it stop ?

This is a great question, because it highlights one of the very common changes that occurs during pregnancy. It is important to discuss it with your OB GYN doctor, who can help you with this issue. Heartburn increases during pregnancy for two different reasons. The first is that some of the hormones associated with the pregnancy cause the muscle between the esophagus and stomach to be more relaxed; this leads to acid more easily escaping out of the stomach and causing heartburn. The second reason is that, as the baby is growing, there is less and less room inside the abdomen, and the uterus starts to put pressure on the surrounding organs, such as the stomach. The reason that you notice that the symptoms are worse with coffee or with tomatoes is that both of these foods also can contribute to relaxation of the muscle between the esophagus and stomach and they can also increase acid production in the stomach. The most straight forward way to help with heartburn is to avoid the foods that you notice cause it. In your case these are at least tomatoes and coffee, and potentially others as well! It is also a good idea to talk to your OB GYN doctor who can help you decide whether medication to reduce stomach acid might also be needed.


What are some recommendations for trying to get pregnant ?


I am 34 years old and trying to have my second child. I have been trying for the last 4 months. This is my info my luteal phase is 14 days with a 26 day cycle for this last cycle I ovulated on the on the 7th of Aug. and did the baby dance on the 4th, 5th and 7th ovulation day. my overies were swollen and I was a little tight can still be pregnant? What are your recommendations Thank you

I would suggest you schedule an appointment with your OB/GYN for further help with this. The most important thing you can do when it comes to increasing your chances of getting pregnant, is to have intercourse at the right time. Since you are have already had a child, and we know that you do not have primary infertility. One thing he did not mention is whether or not your first child was with your current partner. That would be helpful to know, because if it was not with your current partner then it might be that there is an issue with him. For now, what you need to do is have intercourse at the right time. The best way to determine when to have intercourse is with an ovulation detector which can be purchased at most grocery stores. This is a device that detects the hormone LH which spikes just prior to ovulation. It's important to have intercourse within five days of population. This is because sperm can live inside the woman for about five days whereas the ovum after ovulating only lives outside the ovary for 24 hours. You should have intercourse every other day starting shortly after you enter. For the next 10 days to two weeks. This ensures that you have intercourse during the timeframe where you are ovulating. Again, I would suggest you schedule an appointment with your OB/GYN for further help with this.


Vulvar itching, what could be wrong ?


I went to the doctor for very heavy and thick greenish yellow discharge and vulvular irritation including itching and burning. She did a std panel and treated me for chlamydia and gonorrhea because she thought that's what was wrong. My labs came back and I was clean of chlamydia gonorrhea and trichomoniasis along with yeast (which I was also treated for). She said it must just be bv although it typically does not cause the irritation. She treated me with 7 day antibiotic of flagyl and it did nothing and I feel my "issue" is getting worse. What could be wrong? She doesn't seem to have a clue

The most common causes of vulvar itching are infections, specifically a yeast infection (candida), trichomonas and occasionally BV, though as you mention BV typically does not cause itching. STDs such as gonorrhea and chlamydia are also possible though typically present with discharge rather than itching. Other possible causes of vaginal itching and discharge include a retained foreign body (such as a tampon, toilet paper, or even a piece of condom), inflammatory skin conditions such as lichen sclerosis, irritation from productions such as spermicides, gels, douches, or laundry detergent, other skin conditions such as a fungal infection or psoriasis, or irritation due to vaginal atrophy if you are past menopause. Less common would be a fistula (a tract) from the colon to the vagina. The most important first step in figuring out what is wrong is a pelvic exam with a prep of the vaginal secretions. If your doctor hasn't done this yet you need to go back to her and have this done, which will also make sure that there isn't anything retained in your vagina. If you have already had a pelvic exam and it was not revealing, the next person to see would be a gynecologist who can examine you for any of the other causes I listed. If you develop fevers, shaking chills, or unable to eat or drink, or otherwise feel sick you should go to the doctor even sooner to make sure you don't have a systemic infection.


What is adenomyosis ?


I'm 25 and I just had an ultrasound to determine why I was having problems with menstruation and intercourse. My obgyn decided that I have adenomyosis. She tried to explain, but I could not understand what this is. And will I have to get a hysterectomy?

Adenomyosis is a disorder in which uterine glands are present in the muscle of the uterus and this can cause the uterine muscle to swell and get larger. Some women have enlargement of the whole uterus and others have areas that swell and get larger. It is unclear how this happens and is thought to involve some abnormal signals from estrogen and progesterone. Due to the swollen uterus, women can have heavy menstrual bleeding and chronic pelvic pain. There are ways to assess this condition with a pelvic MRI or pelvic ultrasound but definitive diagnosis can only be made by looking at the cells from the uterus under the microscope. Sometimes, these cells can be sampled by a small needle. This technique can have sampling error, however, because the entire uterus may not be involved and there may be areas that are "skipped' and appear normal under the microscope. The only way to treat this condition definitively is to get a hysterectomy, or remove the uterus. Hormonal manipulation and oral contraceptives have been attempted but are less successful. Some women use these therapies for symptomatic relief. There is also the possibility of myometrial ablation or excision, but the long term follow-up on this is difficult and the surgery is technically challenging. You should discuss additional treatment options with your doctor prior to proceeding with a hysterectomy, which will limit your ability to have children


What is an HSG test ?


My boyfriend and I have been consulting with a fertility doctor who recommended that I get an HSG test. What is an HSG test exactly, and how can it help with my fertility problems? Are they painful? What kind of results does a person typically get from an HSG test?

Infertility, the inability to conceive after twelve months of unprotected intercourse, is a very frustrating condition that approximately 10% of women face. Part of the work up for infertility can include the HSG test. An HSG test stands for hysterosalpingogram which is an x-ray test to look at the inside of the uterus and fallopian tubes. During the test, a dye is put through a thin tube that is inserted into the vagina and uterus. The pictures can pinpoint a problem such as a blockage or abnormal structure within the uterus or fallopian tubes. The test should be performed 2-5 days after your period has ended to ensure that you are not pregnant. The test may cause some cramping, but usually causes minimal discomfort. To ease this cramping, take ibuprofen thirty minutes before the test. You may also experience some leakage of the dye from your vagina as well as mild bleeding. Of course, every patient is different and it is only after evaluating your personal medial history, that the proper work up can be decided upon. As such, it is recommended that you visit your ob/gyn to further evaluate and decide upon the most appropriate work up for your infertility


What is endometriosis ?


I'm 31 and I was having pain and irregular menstrual bleeding before I got diagnosed as having endometriosis. I didn't at all understand the doctor's description or the websites I've found. In plain english, what is endometriosis and what does it mean for me to have it?

Endometriosis can present as different symptoms and often times can be diagnosed by a family practitioner, general internist and more accurately by a gynecologist. Endometriosis, the word is derived from greek, meaning "inside the womb." The womb is the part of the female anatomy that contains the fertilized egg or the embryo. The embryo eventually becomes the baby. Normally the womb or uterus is made of cells that are called "endometrial cells". These cells line the inside of the womb and serves as a cellular layer to prevent the uterus from sticking to itself. It also allows the egg to properly implant into the womb. Endometriosis means that these normal endometrial cells which are supposed to be confined to the Uterus, are found in ANY place outside of the uterus such as in you ovaries or abdominal cavity. The endometrial cells are very responsive to female hormones and tend to proliferate during a woman's period. Problems associated with endometriosis can involve pain with sex, pain with defecation, pain with periods and pain with urination. In order to come to a diagnosis of endometriosis it is important to be evaluated by a gynecologist to discuss diagnostic tests and further management.


What is menorrhagia ?


I self diagnosed with menorrhagia because I always seem to bleed way more heavily on my periods than the average woman does. But when I tried to learn more about menorrhagia, it seemed like the sort of problem you can't learn anything from, because it could be caused by so many other medical problems. What should I do now

Many women have concerns about menstrual flow and what constitutes normal. The doctors who are well qualified to discuss this issue with you include your primary care doctor or your OB / GYN doctor. Menorrhagia is simply defined as heavy menstrual bleeding. It can be caused by many things, but it is also important to remember that there is a lot of variation between women in how much they bleed. So, if there are no other symptoms of too much bleeding, such as fatigue or anemia, this may be normal for you. Causes of menorrhagia include bleeding disorders where the blood does not clot normally. There is often a family history of heavy periods or other bleeding problems. Another cause is problems with irregular ovulation, such as polycystic ovarian syndrome and thyroid disease. The workup of these possibilities requires a series of blood tests as determined by your doctor. In women with normal ovulation, the most common cause of menorrhagia is some anatomic cause. For example, commonly fibroids, or small benign muscle tumors, in the uterus cause menorrhagia. As always the diagnosis and the management of your specific concern will require a physical examination by your personal physician. Scheduling a visit with your primary care doctor or your OB / GYN doctor is recommended.


What is Polycystic Ovarian Syndrome ?


What is polycystic ovary syndrome, and how dangerous is it? I am having symptoms I am told are ""classic"" symptoms of Polycystic Ovary Sydrome, and I am going in for a doctor's appointment tomorrow to get an ultrasound. If I do, in fact, have Polycystic Ovary Syndrome, what does this mean for my health? How dangerous is it?

This is the type of health problem which can be dealt with by your primary care physician or OBGYN, whomever you are most comfortable with. Polycystic ovarian syndrome (PCOS) comprises several features. 1. Overweight, 2. irregular menstruation with anovulation (don't ovulate regularly) 3. difficulty getting pregnant, 4. excess androgens causing hair growth on the face (known as hirsutism) and acne, 5. insulin resistant diabetes. The cysts that are in the ovaries are often seen, but are not actually needed to have polycystic ovarian syndrome (I know that makes no sense). PCOS cannot be cured, but it can be treated. The treatment is complex and will need an extensive discussion with your doctor. The general focus is 1. weight loss, 2. control of blood sugars, 3. menstrual and hormonal regularity with oral contraceptives. If pregnancy is desired and you are having trouble getting pregnant, a consultation with at fertility specialist is helpful. PCOS can be dangerous if the diabetes and weight are not controlled. I imagine you will receive this answer after your appointment with your doctor. Hopefully I was able to give you additional information you can use, or perhaps provide you with questions you can ask your doctor at your next visit. Good luck.


What causes vaginal burning after sex ?


Why would a woman experience sensations of vaginal burning after sex? I don't think this could be a disease, because I don't have any other symptoms (blood, discharge, etc), and the pain never begins until AFTER sex, which also seems strange. What kind of problem am I dealing with?

Any symptom that you experience associated with sex can be a source of a lot of distress. Physicians that can help you with this issue include obstetricians and gynecologists and primary care physicians such as family doctors or internal medicine doctors. Vaginal burning and discomfort can have a lot of different causes. Certain vaginal infections such as vaginal candidiasis, trichomoniasis, and bacterial vaginosis are three infections that cause vaginal burning, itching, and discharge. It does not sound like this is your problem since you are not having any discharge, and your are only experiencing the pain till after sex. More than likely you are suffering from vaginal irritation from friction during sex. Anything you do to increase lubrication may help with vaginal irritation after sex (ie KY jelly). I suggest that you schedule an appointment with your primary care physician or OBGYN whoever you see for your feminine health. He or she can take a more detailed history of your symptoms and perform a thorough physical exam. Your physical exam will likely include a pelvic exam with microscopic examination of any vaginal discharge. Likely, you will be cleared and given some advice on how to make sex more comfortable for you. Good luck


What is a complex ovarian cyst ?


My wife has just heard from her gynecologist that she has a 'complex' ovarian cyst. I've heard of ovarian cysts before (and thought they weren't too dangerous??) but what does it mean for a cyst to be complex? Do we have to get it therapy before we have it treated, or what ?

Ovarian cysts are a very common problem. Most of the time, ovarian cysts are completely benign and represent a normal variation on changes the ovaries go through during the menstrual cycle. Rarely, ovarian cysts are cancerous. There are some types of ovarian cysts that are more likely to be cancerous. These cysts, rather than appearing like simple fluid filled bags, often have internal structures in the fluid. These cysts are referred to as 'complex cysts.' Most complex cysts are still benign, not cancerous. However, because they have a higher risk, they usually are watched closely. In young women at a low overall risk of ovarian cancer, this may just mean repeating an ultrasound in a month or two. In older women, it may include some blood work and, even, in some cases surgical removal of the cyst. As always the diagnosis and the management of your wife's particular concerns will require a physical examination by her personal physician. Talking about your questions with her gynecologist is highly recommended.


Should pregnant women monitor TSH levels ?


I have been on medication for my hypothyroidism for years, and I just discovered that I'm pregnant. I would imagine that your thyroid can have a lot to do with the health and development of your baby - so does it make sense to monitor my TSH levels while I am pregnancy ?

By asking important questions like this one and staying as informed as possible, you are well on your way to increasing your chances of having a healthy pregnancy. The best type of physician to to consult with about this issue is an OBGYN. As you know it is important for your health to have an appropriate level of thyroid hormone. Your TSH level is the most sensitive measure of your thyroid needs. Having too much or too little thyroid hormone levels can be bad for your pregnancy. In addition, your metabolic needs will change with your pregnancy possibly changing the amount of thyroid hormone needed by the body. Your TSH level will change if the thyroid hormone you are taking is too much or too little for your body's need. I suggest that you schedule an appointment with your OBGYN that you will use for your pregnancy. Ask him or her how often you should routinely have your TSH checked. This will depend partially on how difficult your thyroid function has been to control, and what type of hypothyroidism you have. Of course if you have any change in your symptoms, you should inform your doctor right away. Good luck with your pregnancy.


Can uterine fibroids grow cancerous tumors ?


I had a uterine fibroid diagnosis a few months ago that I've been fretting about, despite being told by my gynecologist that I shouldn't worry, that it would probably go away on its own. She also said definitively that it's not cancerous - but can't it become cancerous, or give rise to a new kind of growth that is cancerous?

Any tumor, regardless of what our doctors say about it can be a source of distress. I will try and give you some information that will hopefully allow you to approach this matter with the appropriate amount of worry (which should be very little). Your gynecologist told you correctly that the uterine fibroids are benign tumors that are actually very common. They do often go away on their own, but even if they don't, they aren't treated unless you have unacceptable symptoms. Fibroids always give the people that have them anxiety out of fear that they will become cancer. Fibroids that convert into cancer have been reported, but this happens so rarely, that the presence of fibroids does not increase your risk for any cancer. I suggest that you schedule another appointment soon to meet with your OBGYN. The two of you can discuss what the fibroid means for your future, but most likely nothing will be done at this time unless you have symptoms. If you are done having kids, then you will probably be best served by waiting until your OBGYN thinks your situation warrants removal of your uterus. Typical symptoms that necessitate hysterectomy include heavy menstrual bleeding and abdominal pain. Good luck.


Are abdominal ultrasounds safe while pregnant ?


How safe is it to have an abdominal ultrasound while you're pregnant? My OBGYN wants to do this with me, and she assures me it's completely normal. But doesn't radiation build up in the body over time? And isn't a developing fetus more sensitive to radiation than even adults?

Being concerned about exposing the growing baby to unnecessary radiation is a very important concern. As you know, radiation can cause growth problems and birth defects in developing babies. Fortunately ultrasounds, which are used as the primary form of imaging technique during pregnancy, are used principally because they do not use any radiation at all! The ultrasound works by emitting sound waves like a sonar in a ship. These sounds waves do not carry any risk to the developing baby at all. On the other hand, various imaging techniques that do involve radiation include simple x-rays and computed tomography (CT scan). These techniques are generally avoided in pregnancy unless there is a very important indicated (such as the life of the mother) that merits their use despite their risks to the baby. As always the management of your prenatal care is best done in collaboration with your OB / GYN doctor. Setting up an office visit to discuss your concerns is highly advised.


Why do pregnant women have food cravings ?


My wife is pregnant for the first time and asking for some very strange things. What is it with pregnant women and food?

Cravings for unusual and special types of food are very common during pregnancy. In fact, most pregnant women probably experience one type of craving or another at least at some point during the pregnancy. The exact reason that cravings happen is not known. Some researchers have hypothesized that cravings may be related to the body seeking out some specific nutritional need. So, for example, a woman whose body is deficient in calcium may crave ice cream. However, most cravings have no clear relationship to any specific nutritional need, so this may not actually be what is going on. Another possibility is that women crave foods as part of a more generalized phenomenon of being in tune with their bodies during the pregnancy. They pay close attention to every physical stimulus, including hunger, and this may lead to a desire for specific types of foods. Finally, there is probably a very strong cultural factor. We all grow up learning that craving foods is something that pregnant women do. Therefore, we learn that this is a socially expected part of being pregnant, and this subconscious learning goes on to affect our future behavior. Regardless of the cause, food cravings are very common and are not dangerous!


Why am I having period-like cramping even though I'm not on my period ?


Hi im 27/f, married. Lately I have been having period like cramping the past 4 days but I am not on my period. My period ended 2 weeks ago. Also with this cramping I am having a clear jelly like discharge; it doesn't have an odor. Sometimes I have pelvic pain when I go pee or have a bowel movement. I had a CT of my abdomen and pelvis 4 months ago for stomach pain (I was constipated I guess) otherwise it was normal. I am not pregnant; I know that for a fact. I had an emergency C-section 8 months ago so I have a C-section scar. I am really worried; could this be cancer? I have an OBGYN appointment in 1.5 weeks but want an ease of mind; I always think worst case scenario

Cramping in the lower abdomen is a symptom of many underlying medical conditions, some of which do require prompt medical evaluation and treatment. I recommend that you visit your primary care physician. A thorough history would be helpful in evaluating your condition. Are you on hormone therapy such as birth control pills? Is this abdominal pain recurring every month or is it only started the past 4 days? If it is cyclical, there are several causes of pelvic or lower abdominal pain that relate to reproductive system. Endometriosis is a condition in which tissues from the lining of the uterus appear outside of the uterus on other organs in the body (i.e., abdominal cavity). It can cause very painful menstrual cramps that may get worse over time. Similarly, fibroids which are benign (not cancerous) muscular tumors that grow in the wall of the uterus can also cause this type of pain. Are you having pain that presents with nausea and vomiting and abdominal distention? It may be the signs and symptoms of partial small bowel obstruction. Patients with previous abdominal procedures or surgery will form scars in the abdomen which can predispose to having a bowel obstruction that sometimes can cause pain. Some sexually transmitted infections such as gonorrhea and chlamydia commonly cause cramping, menstrual-like pain between periods. Lastly, your constipation may be another cause of abdominal cramping pain. Please see your primary care physician to evaluate the exact nature of your condition and get a referral to a OB/GYN or surgeon if warranted.


Is it dangerous to have low blood pressure while pregnant ?


My sister is recently pregnant and I'm worried about her because she has always had high blood pressure. Now it seems like it's getting even worse, because she gets faint so easily. Is this dangerous to her or the baby? Is it something she should talk about with the obgyn

Blood pressure is an important sign that we as doctors follow. It is a "vital sign" as it is important regardless of if the patient is pregnant. If there is any concern I would STRONGLY recommend your sister see her OB/GYN. Both high and low blood pressure can be a problem. Blood pressure is the ultimate end product of the cardiovascular system (heart + blood vessels). The blood pressure is important because it is the driving force that allows for the blood to bathe and supply the organs of the body. If it is too high--it can damage the organs. This is specifically important in pregnancy as it can damage the placenta--the food source of the baby. This can result in growth retardation. The flipside, or low blood pressure is also very concerning. This not enough blood is getting to the organs. The fact that she gets faint can suggest she is not getting appropriate blood to her brain. If there is not enough blood to the placenta again problems can occur. Keep in mind blood changes during pregnancy because of all the hormones. Regardless of the cause if she is having symptoms--this is a problem. Also note, high blood pressure in the later parts of pregnancy can be consistent with preeclampsia--a serious condition. I strongly encourage you to talk to your doctor.


What are the normal reasons for not being able to get pregnant ?


Me and my partner have been trying to get pregnant for over 6 months, and we haven't been able to yet. What is the most likely cause of this? Is it more likely because of me or him? Should I see a doctor ?

Having trouble getting pregnant can be very distressing. From a physicians point of view, you need to try to get pregnant for at least a year unsuccessfully before there is a need to look into the issue. On average, about 1/3 of cases of couple infertility is a male issue and 2/3 is a female issue. In terms of male infertility (assuming there is normal sexual function), a low sperm count is the main cause. There are multiple causes of female infertility. An infection with gonorrhea or chlamydia, or endometriosis can scar the fallopian tubes preventing the egg from getting to the uterus. A syndrome called polycystic ovarian syndrome prevents ovulation. There are many other possible causes which would be too extensive to discuss here. I suggest you schedule an appointment with your OBGYN. He or she can review your medical history and determine if there is an obvious cause that could be preventing you from getting pregnant (ie: history of an STD, pelvic pain, or irregular periods), then one of those causes can be investigated. If you do not have any obvious reason that you would not be able to get pregnant, then your doctor may opt to wait until you have been trying to conceive for more than 12 months unsuccessfully before initiating an infertility work up of you and your partner.


"How can I increase my chances of fertility" ?


I am 28 year old female. I have three children, ages 7, 6, and almost 2 years old. I did not have any issues conceiving them and had healthy pregnancies. My husband and I are trying to conceive our fourth and have been actively trying for the past six months. We have tried the natural rythm method and charting. On average we have sexual intercourse 3-4 times a week and increase that during peek times of ovulation. We have not been to our mdiwife or tried any sort of medications such as Clomid. What is a natural/organic way to improve our fertility ?

It sounds like you are doing everything right in your attempts to conceive for a fourth time. You are having adequate amounts of intercourse. Since you have had 3 kids before, and (presumably) have not had any health problems since then, there is no reason at this time to suspect that you are having fertility problems. The only piece of advice I could give you is trying one of those home ovulation detection kits. Basically they detect blood levels of Leutinizing hormone (LH), the hormone that causes ovulation. I think using Clomid is very premature here as you have only been trying to get pregnant for 6 months. Physicians will not start an infertility work-up or prescribe medications for fertility until you have tried to get pregnant for at least a year without success. It sounds like you have a midwife that you plan on using for your birth. Most physicians would not object to this as long as your pregnancy was considered low risk and you are planning to have the baby in a hospital. I do think that you should schedule an appointment with an OBGYN just for a consultation. You can bring up the conception issue and at least have a plan to see someone for this issue in 6 months if you still haven't conceived.


Why is my mentrual cycle irregular and is there anything that I can do to regulate it ?


I am a 32 year old female. After I had my last child, my menstrual cycle was absent for one year (due to breastfeeding). During the last seven months that it has resumed, it has been extremely irregular and very unpredictable. Every month it starts on a different date of the month. Is there a reason for this? Is there anything that I can do to make it regular again.

Questions about one's menstrual cycle are best answered by an obstetrician-gynecologist. Overall, the hormonal regulation of the menstrual cycle is quite complex, involving two parts of the brain, the hypothalamus and the pituitary gland, as well as the ovaries and uterus. Pregnancy results in a (perfectly normal) disruption of the signaling cascade that leads to regular, monthly menstrual cycles. It is not unusual for it to take several months for this cycle to return to your pre-pregnancy baseline, but it can be very frustrating to have such irregular periods. In general, it is best to have sustained, irregular periods evaluated by your gynecologist because he or she can do a more detailed history and physical examination, as well as some laboratory testing if indicated, to make sure that there are not signs of any other hormonal or endocrine causes for irregular periods. Thyroid disorders, for example, can cause irregular menstrual cycles. However, if there are no signs or symptoms of any other issues, the easiest way to regulate one's menstrual cycle is to use oral contraceptives. Even if such medications are not specifically being used for contraception they do have the side effect of leading to predictable periods. Not all women wish to take OCPs and this decision is best made after a discussion with you and your physician. However, if you and your doctor decide this is a good option for you, OCPs will lead to very regular cycles.


Is there a medication I can take to increase my breast milk production ?


I am 29 years old. I had a baby via c-section 11 days ago (at 37 weeks gestation). So far my milk production is very minimal. I am exclusively pumping, for about 15 minutes every 2-3 hours, but I can only manage to pump 20-30 cc each session. Is there a medication I can take to increase my production ?

First of all, congratulations on your new baby and congratulations on deciding to try to breastfeed. As you know, breastfeeding is very healthy for the baby and great as well from the mother-baby bond that forms. The most important ways to stimulate milk production are to continue pumping or nursing. It is great that you are pumping, however if you are able to physically nurse you may find that milk production picks up (nursing is a better stimulator of milk production than pumping). If part of your inability to nurse more frequently is due to problems with the baby latching, then you may want to talk to a lactation consultant to improve your success. You should also make sure to drink lots of liquids and get lots of rest as able. Dehydration and fatigue are two common reasons for decreasing milk production. If these strategies do not work for you then you can talk to your OB GYN doctor or your primary care doctor. There are a couple of medications that are available that can be used to stimulate milk production when all else fails. The most commonly used one of these medications is Raglan (metoclopramide), which is available by prescription only.


Why would blood stop after miscarriage and start again week later ?


Is this normal

Menstrual bleeding following a miscarriage can be variable and often concerning for people who experience it. In order for your particular case to be adequately evaluated, I recommend making an appointment to see your gynecologist so that he or she can obtain a complete history, perform a physical examination (including a pelvic exam) and perform any testing that is necessary. Vaginal bleeding resulting from a miscarriage occurs as the products of conception are extruded from the uterus and out of the body. It is important for this to happen to prevent any retained materials from causing an infection, which can then spread throughout the body. It is very difficult to predict the exact pattern of vaginal bleeding that will take place in these cases, and it is entirely possible that the vaginal bleeding you are experiencing is completely normal. However, as mentioned above, the most important thing to ensure is that all of these products are fully removed from the body and not still remaining in the uterus. To rule out this possibility, I strongly suggest you make an appointment to meet with your gynecologist. He or she can both examine the cervix (the opening of the uterus) to see if this is open or closed, and he or she can also perform an ultrasound to examine for any materials retained in the uterus.


What sort of treatment is available to women who have Polycystic Ovarian Syndrome (PCOS) ?


I am a 25 year old woman who has been struggling with PCOS since I was a teenager. I have darkened skin in what should be sensitive skin areas, it seems nearly impossible for me to lose weight, my hair grows at an abnormal rate and I have very dark facial hair. I have tried taking chromium pills and have tried virtually every diet I can get my hands on, but have not found anything that works for me at all.

Polycystic ovarian syndrome (PCOS) is a complex disease and an area of active research in medicine. Though, the exact cause of PCOS is not entirely known, one of the basic features of it is an imbalance of hormones, particularly an increase in male hormones or androgens. These changes are associated with weight gain, skin changes, infertility, and insulin resistance among others. As you have already hinted, the first and best treatment for PCOS is weight loss, though this can be quite challenging. However, if you are not trying to become pregnant, oral contraceptives are a good treatment to help normalize hormones, menstrual cycles and decrease the abnormal growth of hair. Metformin, a medication used in diabetes can also be helpful to treat insulin resistance and has the added benefit of sometimes aiding weight loss and improving menstrual cycles. Another medication, spironolatone which is commonly used as a diuretic, also has anti-androgenic properties and can also help normalize hormone levels and decrease abnormal hair growth. Finally, laser hair treatments and prescription creams can treat the hair growth. As you can see there are many treatments available. Your primary care physician can discuss the best ways to help improve your symptoms and help you find treatments that are right for you. Good luck!