Understanding and managing

female reproductive health

Dr Suma Shet Purushan
PMS
• PMS (premenstrual syndrome) is the name for the symptoms women
can experience in the weeks before their period. Most women have
PMS at some point. You can get help if it affects your daily life.
• Symptoms of PMS
• Each woman's symptoms are different and can vary from month to
month.
• The most common symptoms of PMS include:
• mood swings
• feeling upset, anxious or irritable
• tiredness or trouble sleeping
• bloating or tummy pain
• breast tenderness
• headaches
• spotty skin
• greasy hair
• changes in appetite and sex drive
DO

• exercise regularly
• eat a healthy, balanced diet – you may find that eating frequent smaller
meals (every 2-3 hours) suits you better than eating 3 larger meals a
day
• get plenty of sleep – 7 to 8 hours is recommended
• try reducing your stress by doing yoga or meditation
• take painkillers such as ibuprofen or paracetamol to ease the pain
• keep a diary of your symptoms for at least 2 to 3 menstrual cycles –
• Don’t
• do not smoke
• do not drink too much alcohol
• Treating PMS
• As well as changes to your lifestyle
• hormonal medicine – such as the combined contraceptive pill
• cognitive behavioural therapy – a talking therapy
• antidepressants
• dietary supplements
• If you still get symptoms after trying these treatments, you may be referred
to a specialist.
• This could be a gynecologist, psychiatrist or counsellor.
• Complementary therapies and dietary supplements
• Causes of PMS
• It's not fully understood why women get PMS.
• But it may be because of changes in their hormone levels during the
menstrual cycle.
• Some women may be more affected by these changes than others.
• Premenstrual dysphoric disorder (PMDD)
• A small number of women may experience more severe symptoms of
PMS known as premenstrual dysphoric disorder (PMDD).
• Symptoms of PMDD are similar to PMS but are much more intense
and can have a much greater negative impact on your daily activities
and quality of life.
FIBROIDS
• Fibroids are non-cancerous growths that develop in or around the
womb (uterus).
• The growths are made up of muscle and fibrous tissue, and vary in
size. They're sometimes known as uterine myomas or leiomyomas.
• Many women are unaware they have fibroids because they do not have
any symptoms.
• Women who do have symptoms (around 1 in 3) may experience:
• heavy periods or painful periods
• tummy (abdominal) pain
• lower back pain
• a frequent need to urinate
• constipation
• pain or discomfort during sex
Why fibroids develop

• The exact cause of fibroids is unknown, but they have been linked to
the hormone oestrogen.
• Oestrogen is the female reproductive hormone produced by the
ovaries (the female reproductive organs).
• Fibroids usually develop during a woman's reproductive years (from
around the age of 16 to 50) when oestrogen levels are at their
highest.
• They tend to shrink when oestrogen levels are low, such as after the
menopause when a woman's monthly period stops.
Who gets fibroids?

• Fibroids are common, with around 2 in 3 women developing at least 1

fibroid at some point in their life. They most often occur in women
aged 30 to 50.
• It's also thought they occur more often in overweight or obese women
because being overweight increases the level of oestrogen in the body.
• Women who have had children have a lower risk of developing
fibroids.
Types of fibroids

• Fibroids can grow anywhere in the womb and vary in size

considerably. Some can be the size of a pea, whereas others can be the
size of a melon.
• The main types of fibroids are:
• intramural fibroids – the most common type of fibroid, which develop
in the muscle wall of the womb
• subserosal fibroids – fibroids that develop outside the wall of the
womb into the pelvis and can become very large
• submucosal fibroids – fibroids that develop in the muscle layer
beneath the womb's inner lining and grow into the cavity of the womb
• In some cases, subserosal or submucosal fibroids are attached to the
womb with a narrow stalk of tissue. These are known as pedunculated
fibroids.
Treating fibroids

• Fibroids do not need to be treated if they are not causing symptoms.

After the menopause, they'll often shrink without treatment.
• If you do have symptoms caused by fibroids, medicine to help relieve
the symptoms will usually be recommended first.
• There are also medications available to help shrink fibroids. If these
prove ineffective, surgery or other, less invasive procedures may be
recommended.
• The average gap between periods starting (the menstrual cycle) is 28
days. It can sometimes be a bit shorter or longer.
• A woman's periods are irregular if the gap between them is less than
21 days or more than 35 days.
• Irregular periods can affect anyone who has periods.
• It's more likely for your periods to be irregular when they first start
during puberty, and when you're nearing menopause.
• Using an app or a diary to keep track of your periods can help you see
if they're irregular.
• Day 1 of your menstrual cycle is the first day of your period. The last
day of your cycle is the day before your next period.
Causes of irregular periods

• Common causes of irregular periods include:

• puberty, when you start your periods
• the start of menopause (usually between the ages of 45 and 55)
• pregnancy – a missed period is often an early sign of pregnancy
• hormonal contraception like the progestogen-only pill,
contraceptive injection and intrauterine system (IUS)
• losing or gaining a lot of weight
• stress and anxiety
• exercising too much
• Sometimes, conditions like polycystic ovary syndrome (PCOS) and
an underactive thyroid gland can cause irregular periods.
When to contact Gynaecologist
• your periods are irregular
• your periods last longer than 7 days
• you have irregular periods and other symptoms like weight gain,
tiredness, hair growth on your face and dry or oily skin
• your periods are irregular and you're struggling to get pregnant
• Polycystic ovary syndrome (PCOS) is a common condition that affects
how a woman's ovaries work.
• The 3 main features of PCOS are:
• irregular periods – which means your ovaries do not regularly release eggs
(ovulation)
• excess androgen – high levels of "male" hormones in your body, which may
cause physical signs such as excess facial or body hair
• polycystic ovaries – your ovaries become enlarged and contain many fluid-
filled sacs (follicles) that surround the eggs (but despite the name, you do not
actually have cysts if you have PCOS)
• If you have at least 2 of these features, you may be diagnosed with PCOS.
Polycystic ovaries

• Polycystic ovaries contain a large number of harmless follicles that are

up to 8mm (approximately 0.3in) in size.
• The follicles are underdeveloped sacs in which eggs develop. In
PCOS, these sacs are often unable to release an egg, which means
ovulation does not take place.
Symptoms of polycystic ovary syndrome (PCOS)

• If you have signs and symptoms of PCOS, they'll usually become apparent during your
late teens or early 20s.
• They can include:
• irregular periods or no periods at all
• difficulty getting pregnant as a result of irregular ovulation or no ovulation
• excessive hair growth (hirsutism) – usually on the face, chest, back or buttocks
• weight gain
• thinning hair and hair loss from the head
• oily skin or acne
• PCOS is also associated with an increased risk of developing health problems in later
life, such as type 2 diabetes and high cholesterol levels.
• weight gain
• thinning hair and hair loss from the head
• oily skin or acne
• PCOS is also associated with an increased risk of developing health
problems in later life, such as type 2 diabetes and high cholesterol
levels.
What causes polycystic ovary syndrome (PCOS)?

• The exact cause of PCOS is unknown, but it often runs in families.

• It's related to abnormal hormone levels in the body, including high
levels of insulin.
• Insulin is a hormone that controls sugar levels in the body.
• Many women with PCOS are resistant to the action of insulin in their
body and produce higher levels of insulin to overcome this.
• This contributes to the increased production and activity of hormones
like testosterone.
• Being overweight or obese also increases the amount of insulin your
body produces.
Treating polycystic ovary syndrome
(PCOS)
• There's no cure for PCOS, but the symptoms can be treated. Speak to a
Gynaecologist if you think you may have the condition.
• If you have PCOS and you're overweight, losing weight and eating a
healthy, balanced diet can make some symptoms better.
• Medicines are also available to treat symptoms such as excessive hair growth,
irregular periods and fertility problems.
• If fertility medicines are not effective, a simple surgical procedure
called laparoscopic ovarian drilling (LOD) may be recommended.
• This involves using heat or a laser to destroy the tissue in the ovaries that's
producing androgens, such as testosterone.
• With treatment, most women with PCOS are able to get pregnant.
How does diet affect PCOS?

• People with PCOS are often found to have higher than normal insulin levels. Insulin is a
hormone that’s produced in the pancreas. It helps the cells in the body turn sugar (glucose)
into energy.
• If you don’t produce enough insulin, your blood sugar levels can rise. This can also happen
if you have insulin resistance, meaning you aren’t able to use the insulin you do produce
effectively.
• If you have insulin resistance, your body may try to pump out high levels of insulin in an
effort to keep your blood sugar levels normal. Too-high levels of insulin can cause your
ovaries to produce more androgens, like testosterone.
• Insulin resistance may also be caused by having a higher body mass index. Insulin
resistance can make it harder to lose weight, which is why people with PCOS often
experience this issue.
• A diet high in refined carbohydrates, like starchy and sugary foods, can make insulin
resistance, and therefore weight loss, more difficult to manage.
Foods to add
•high fiber vegetables, like broccoli
•lean protein, like fish
•anti-inflammatory foods and spices, like turmeric and tomatoes
High fiber foods can help combat insulin resistance by slowing down
digestion and reducing the effect
of sugar on the blood. This may be beneficial for people with PCOS.
Here are some examples of high fiber foods:
•cruciferous vegetables, like broccoli, cauliflower, and Brussels sprouts
•greens, including red leaf lettuce and arugula
•green and red peppers
•beans and lentils
•almonds
•berries
•sweet potatoes
•winter squash
•pumpkin
Lean protein sources like tofu, chicken, and fish don’t provide fiber but are a very filling and
nutritious dietary option for people with PCOS.
Foods that help reduce inflammation may also be beneficial. These foods include:
•tomatoes
•kale
•spinach
•almonds and walnuts
•olive oil
•fruits, like blueberries and strawberries
•fatty fish high in omega-3 fatty acids, like salmon and sardines
FOODS TO LIMIT

•foods high in refined carbohydrates, like white bread and muffins

•sugary snacks and drinks
•inflammatory foods, like processed and red meats
Refined carbohydrates cause inflammation, exacerbate insulin resistance,
and should be avoided or
limited significantly. These include highly processed foods like:
•white bread
•muffins
•breakfast pastries
•sugary desserts
•anything made with white flour
Pasta noodles that list semolina, durum flour, or durum wheat flour as their first
ingredient are high in carbohydrates
and low in fiber. Pasta made from bean or lentil flour instead of wheat flour is a
nutritious alternative
• Sugar is a carbohydrate and should be limited on a PCOS diet. When reading food labels,
be sure to look for sugar’s various names, including:
• sucrose
• high fructose corn syrup
• dextrose
• Reduce consumption of beverages like soda and juice, which can be high in sugar, as
well as inflammation-causing foods, like fries, margarine, and red or processed meats.
• However, before removing a number of foods from your diet, it’s best to speak with a
doctor. They can recommend an eating plan that is right for you and your individual
needs.
• Some lifestyle changes can help improve PCOS symptoms.
• Exercise and daily physical movement. When coupled with a limited intake of
refined carbohydrates-At least 150 minutes per week of exercise is ideal.
• Daily activity, low sugar intake, and a low-inflammation diet may also lead to
weight loss. People may experience improved ovulation with weight loss.
• The symptoms associated with PCOS can cause stress. Stress reduction
techniques, which help calm the mind and let you connect with your body, can
help. These include yoga and meditation