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Women's life Phases: a Gynecological perspective

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Adolescent years
Adolescence is the period when a girl gradually achieves reproductive maturity. Growth of breast bud, rapid growth in length, coarse hair growth in underarms & pubic region and ultimately menstruation marks the onset of adulthood. However timing & rate of maturing is unique for every women and may vary depending on various factors like body fat content & racial/ familial factors.
Menstruation is often irregular & painful during this phase and do not necessarily indicate a disease. Most important is to teach these young girls about menstrual hygiene and other life style modifications to make a healthier future. They should be talked about contraception and about STDs and how to prevent that. However, PCOS, endometriosis, ovarian cyst etc are becoming increasingly common amongst this age group and need to be excluded if symptomatic.
Some congenital defect of gynecological organs may be detected at this phase of life. Common is imperforate hymen or some blockage in the genital tract. Presentation is with periodic severe pain abdomen with no menstruation. Uterine anomalies may also present with severe pain during menstruation but may not be detected at all unless reviewed by a good Gynecologist & an USG examination is done.
So, although the teen age girls are always reluctant to see a Gynecologist they should not ignore their problems and serious problems to be excluded. Most of the congenital anomaly can be tackled by Vaginal surgery. (NO CUT NO HOLE)

Reproductive period
This is the time when a girl become mature enough to get pregnant. Most of the women get pregnant within one year of marriage (if contraception not used). Pre-pregnancy check up is important as all women should be immune to rubella and chiken pox before getting pregnant. Patients should also be tested for genetic disorders e.g. thalassemia etc. Patient’s nutrition status should also be checked.
Sometimes there are some sexual problem which can be solved by counseling in most of the time. Other important issue is contraception & prevention of STI s. Many women do not know what contraception is best for them and rely on rumors & hearsay. All the women should have cervical screening on regular basis (3 yearly) to prevent the risk of killer cervical cancer. Menstrual problems ( heavy bleeding, frequent / infrequent bleeding/ pain during bleeding) are common and in most cases get settled naturally but should be reported to the Gynaecologist and any serious problem to be excluded. Fortunately, most of the problems can be sorted out by simple medications without surgical intervention.
Pregnancy
Pregnancy is always a special experience. A planned pregnancy always bring an unparallel shower of happiness. It is also mixed with anxiety and worry about the future.
The most important thing about pregnancy is to understand that it is not a disease but a altered physiological state. Most of the common symptoms during pregnancy (nausea& vomiting, dizziness, pains & aches, weakness, difficulty in breathing, swelling of legs etc) are physiological and need simple reassurance. However, they can be the first symptom of very grave problems (like thyroid problem, anemia, abruption, pulmonary thrombosis, pre-eclamptic toxemia). This is why it is most important to be under care of an experienced Gynaecologist & Obstetrician who have the clinical insight to decide what to do.
High risk pregnancies ( e.g. with diabetes , with hypertension, and with epilepsy and any other medical problems) need special care and close monitoring because some of these problems get aggravated by pregnancy and some affect pregnancies adversely. Some of the problem may develop during pregnancy as well.
Fetal wellbeing during pregnancy is always a concern of the whole family. Genetic screening during 1st trimester & 2nd trimester should be done to exclude chromosomal anomaly. This can be offered to all pregnant women and is a must for pregnant women above the age of 35 years. Atleast three ultrasound scan is mandatory during pregnancy. First is dating scan done in 1st trimester. The second USG is done at approximately 20th week of pregnancy and ensure fetal anatomical normalcy. Although this confers about 75 % accuracy to ensure complete fetal normalcy but in a good hand any major anomaly can be excluded with confidence. Monitoring of fetal growth is done by serial clinical examination and by ultrasonography scan at 3rd trimester.
What happens during 1st twelve week of pregnancy?
This is the most important period of a pregnancy as the baby is anchored to mother’s womb happens in this phase and development and organogenesis (formation of different organs of the baby) happen in this phase.
The process of formation of the fetus or infant in humans begins with the process of intercourse (coitus) between men and women. Only one sperm fertilize an egg. The egg that has been fertilized called zygote and will move through the fallopian tube to be attached to the uterine wall.
The zygote will undergo several phases-
• Phase morulla. In this phase, the zygote divides by mitosis in a row so to 2-4-8-16 and finally 32 pieces cell.
• Phase blastulla. In phase blastulla tagged by the formation of the body cavity and networks.
• Phase gastrulla. In this phase of the formation of the 3 layers, the ectoderm, mesoderm, and endoderm.
Furthermore, the zygote formed embryos are enveloped by amnion, alantonis, and chorion. After all membranes and placenta is formed, the embryo can be called a fetus or fetuses. The fetus obtain food and oxygen from mother and give the rest of metabolism of these substances into the maternal blood for disposal.
In the first month of human embryonic development is characterized by means of an important body has begun to take shape and have started functioning, although not perfect. The feet and hands have not been formed in the first month of pregnancy. Similarly, the fetal brain is still not clearly developed. The length of the embryo in the gestational age of one month around 2.5 to 6 mm.
Next, in the second month of pregnancy the embryo has formed feet and hands, genitals inside, which still form the framework of cartilage, tools facades and a few other important tools. The length of the embryo in the womb two months of age is between 25 to 40 mm.
In the third month of age almost all organs in full has been formed, including the external genitals. The length of the fetus at this stage about 70 to 100 mm.
Then in the fourth month of pregnancy a woman, the fetus begins to form skin, hair, sweat glands and eyelids. Fetal movement has been felt by the mother. The length of the fetus when it is about 145 mm.
In these early days it is really important not to be exposed to the environmental toxins which include pestisides, many medication, chemicals from smoking or car exhausts etc. Amount of food is not important but vitamins (folic acid) & minerals (zinc) play very important role. Another important advise is to continue to take water so that nausea & vomiting do not make you dehydrated (dry). Most of the nausea and vomiting can be managed by simple vitamins & sympathetic behavior. An obstetrician will advise an USG scan to confirm the dating and to exclude twin pregnancy and ensure smooth development.
What happens during 2nd trimester of pregnancy?
This is time when the fetus reach age of viability that means it may be possible for a fetus to remain alive ( chance of survival at 25 week birth is about 3 in 10) if the birth is after 24 th week. This is time when your start to look pregnant with tummy coming up.
There is a lot going on with your baby in this phase. Your baby's intestines are migrating from the umbilical cord into his or her abdomen. The villi are also forming in the intestines, and these help in peristaltic movements and digestion. The liver begins to secrete bile and the pancreas is even secreting insulin! All twenty teeth have formed and are waiting under the gums, while your baby has begun to practice swallowing by taking in the surrounding amniotic fluid and passing it back in his urine. Skin , hair, even sweat glands get developed. The different systems start to work and baby can form own blood cells now. Your baby can smile and his vocal cords also get developed too. He looks more and more human as his eyes move closer together and the ears are beginning to move to what will be their normal positions. Your baby weighs between approximately 13 and 20 grams at 13 week to 1 kg at 25 week of pregnancy.
Would be mother feel more tired and aches & pains become common. Fetal movement can be perceived easily & numerous times. Pelvic floor exercise with light exercise can continue. If any inherent medical problem is there it becomes apparent during this phase of pregnancy. Other problems which may appear are constipation, piles, tiredness etc. skin darkening, breast fullness, appearance of stretch marks are other common problem during this phase. Blood sugar and thyroid hormone level should be checked during this phase.
What about third trimester of pregnancy?
This phase of pregnancy is a preparation for delivery of the fetus which should not happen before 38 weeks. With the size of the baby bump increasing, mother may find it difficult to maintain regular activities. All the problems of 2nd trimester (constipation, stretch marks, darkening of skin, constipation, heartburn etc.) may increase during this phase. Uterus may show some tightening (Braxton hicks contraction) during this phase. However, if the contractions become painful before term (38th week), a gynecologist need to be consulted as soon as possible. Same analogy applies in case of vaginal discharge. A slight amount is normal in late pregnancy but may be a sign of early labour. Many women develop swelling of legs. Blood pressure may also rise which is a dreaded disease called pre-eclamptic toxemia. Sometimes there is a tendency that growth of the baby become really slow (it is called IUGR/ intra uterine growth retardation). These conditions may be dangerous for both mother and babies. . An ultrasound with or without Doppler flowmetry of umbilical artery of fetus is a very helpful tool to monitor these babies to decide on optimum time of delivery.
Menopause & perimenopause
Menopause is the period of women’s life when ovaries stop to produce oestrogen & progesterone.The period when oestrogen in the female body is low but not as low as in menopause is called perimenopause. Just like puberty it is a time of change in a women’s life. Unfortunately, most women perceive menopause as a very negative thing in their life. But menopause does not mean stoppage of relationship or sexual activity. Moreover, this period is free of fear of pregnancy & hassale of contraception.
There are mainly three types of problems women report to a gynecologist during this phase.
First--Generalized problem etc due to lack of hormone in the whole body [Vasomotor symptoms/ osteoporosis]
Second--Genital area problem due to lack of hormone & pelvic floor muscle weakness [different types of Prolapse, urinary incontinence etc.)
Third-- Increasing risk of genital tract cancer (especially ovarian & endometrium) due to increasing age [need regular check up to reduce this risk]
During this phase surgical treatments is relatively preferred because of the increasing risk of malignancies and structural problems of the pelvic floor.

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