Let's Talk About It

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May 1

Today, I am going to dive into the world of hormone replacement therapy (HRT) and talk about the different formulations of oestradiol and their effects on blood oestradiol levels.

· Oestradiol is a hormone that is naturally produced by the ovaries in women. It plays a key role in regulating the menstrual cycle, bone health, and overall well-being. However, as women age and approach menopause, their levels of oestradiol decrease, which can lead to a range of symptoms such as hot flushes, mood swings, and vaginal dryness.

· HRT involves the use of hormones to replace those that are no longer produced in sufficient quantities by the body. Oestradiol is one of the most commonly used hormones in HRT, and it comes in a variety of different formulations, including pills, patches, creams, and injections.

· Each formulation has its own benefits and drawbacks, and they can affect blood oestradiol levels in different ways. For example, oral oestradiol pills are absorbed by the liver, which can result in higher levels of oestradiol in the bloodstream. Transdermal patches, on the other hand, deliver a steady stream of oestradiol over a longer period of time, resulting in more stable blood levels.

· It's important to note that the goal of HRT is not necessarily to achieve a specific blood oestradiol level, but rather to alleviate symptoms and improve overall quality of life. That being said, blood tests can be useful in few situations to monitor hormone levels and adjusting treatment as needed.

· If one is considering HRT, it's important to talk to your healthcare provider about the different options available and which one may be best for you based on your individual needs and medical history.

· Remember, HRT is a personal decision and not everyone will choose to pursue it. But for those who do, it can be a valuable tool in managing symptoms and improving overall health and well-being.
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#hrt #hormonereplacementtherapy #ert #hotflushes #memoryloss #bonehealth #osteoporosis

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Apr 13

Did you know that endometriosis can have a hereditary component and be transmitted from mother to daughter? According to several studies, the risk of developing endometriosis is higher in women with a first-degree relative (mother, sister, daughter) who has the disease compared to those without such a family history. For example, a meta-analysis of 13 studies found that the odds ratio for endometriosis in daughters of affected mothers was 2.54 (95% CI: 1.63-3.97), indicating a significant association (Machado et al., 2018). Another study reported that the incidence of endometriosis in sisters of affected probands was 7.6%, compared to 1.8% in sisters of unaffected probands (Treloar et al., 1999).

However, the exact mode of inheritance and the specific genes involved in endometriosis are still under investigation, and the disease is likely to be multifactorial, with both genetic and environmental factors playing a role. For example, a recent study identified several genetic loci associated with endometriosis susceptibility, including some involved in cell adhesion, inflammation, and hormone signaling (Sapkota et al., 2017).

If you have a family history of endometriosis or if you experience symptoms such as pelvic pain, painful periods, or infertility, it's important to talk to your doctor and get an accurate diagnosis and treatment plan. Early intervention can improve your quality of life and prevent complications. Let's raise awareness about endometriosis and support each other! 💛👭 #endometriosisawareness #hereditary #transmissibility #genetics #familyhistory #pelvicpain #infertility #research #healtheducation
#endometriosis #adenomyosis

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Apr 9

Different types of skin closure techniques ….

If you’re pregnant and preparing for a C-section delivery, you may be wondering about the different types of skin closure techniques that can be used. These techniques can affect how your scar looks and how quickly it heals. Here are some of the most common types of skin closure techniques:

Staples: Staples are sometimes chosen if keloid formation is a concern as metal in the staples usually is less immunogenic compared to other sutures for closing C-section incisions. They are quick to apply and remove, and they create a very secure closure. However, some women find them uncomfortable and prefer a different closure method.
Sutures: Sutures, or stitches, are another common choice for closing C-section incisions. They are typically made of dissolvable material and don’t need to be removed. This can be a more comfortable option for some women, and it can result in a smaller, less noticeable scar.
Glue: Some doctors may use skin glue to close C-section incisions. This can be a good choice for women who are allergic to sutures or who have sensitive skin. It can also result in a less noticeable scar, but it may not be as secure as staples or sutures.
Steri-strips: Steri-strips are small adhesive strips that can be used to hold the skin together after a C-section. They are typically used in conjunction with sutures or staples, and they can help reduce scarring.
It’s important to talk to your doctor about which skin closure technique is best for you. They can take into account factors such as your skin type, sensitivity, and any allergies you may have. Ultimately, the goal is to ensure that your incision heals properly and that you are comfortable during the healing process.
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#scar #csection #csectionscar #cesareanbirth #caesarean #baby #delivery #mum #mother #operation #plasticsurgery

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Apr 7

🚨 Pelvic pain diagnosis can take up to 7 years! 🚨
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Ultrasound and MRI are commonly used to diagnose pelvic pain, but they're not always reliable.
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In fact, even experts can miss the cause of pelvic pain up to 40% of the time using ultrasound.
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That means patients may be told everything is normal when they actually have a problem.
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Laparoscopy is considered the gold standard test for endometriosis, but it's invasive and has risks.
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Some patients can experience damage, and there's a small chance of death ( 5 to 8 per 10000 risk of death from keyhole surgery)
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But, even with laparoscopy, the diagnosis can still be missed up to 10% of the time because endometriosis is a microscopic condition.
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But there's hope! Gene sequencing has a diagnostic accuracy of 99%, and a French team of experts has developed a saliva-based test that uses Next Generation Sequencing and artificial intelligence.
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This means women don't have to put their lives at risk to get an accurate diagnosis of their pelvic pain.
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If you're experiencing pelvic pain, don't wait years for a diagnosis.
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Ask your doctor about these new developments and take control of your health! 💪 #pelvicpain #endometriosis #diagnosis #genesequencing #salivatest #health #womenhealth

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Apr 3

* Fibroids are benign growths that develop in or around the uterus.

* Fibroids can range in size from a pea to a melon and usually develop during a woman's reproductive years.

* Around 1 in 3 women in the UK develop fibroids at some point in their life, and symptomatic fibroids are the number one reason for hysterectomy in the UK.

* Sonata is the ONLY treatment option for uterine fibroids that integrates imaging guidance (ultrasound) and therapy (radiofrequency) into a single, transcervical delivery system.

* Sonata offers a revolutionary alternative to more invasive options, such as hysterectomy or myomectomy, and procedures such as uterine artery embolisation.

* Due to its unique minimally invasive system, Sonata® can be performed in an outpatient setting, thus providing a quick recovery for patients.

* In comparison to abdominal hysterectomy and open myomectomy, a clinical study found that as many as 50% of those treated with Sonata returned to normal activity within one day of the procedure.

* The early and long-term benefits for patients are established, with significant improvements in symptom severity and quality of life for patients reported by three months after treatment and durable through 36 months.

* If you or someone you know is suffering from uterine fibroids, consider talking to your doctor about Sonata as a treatment option.
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We are so grateful for our patient who volunteered to share her experience of Sonata treatment of fibroids under local anesthesia in our NHS hospital
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She was amazed at how quickly she recovered, and how easy the procedure was.
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She was able to return to her normal activities the next day and experienced significant improvements in her symptoms within weeks.
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Sonata truly is a game-changer for women suffering from fibroids, and we are proud to offer this innovative treatment option to our patients.
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PS - I have no conflicts to declare
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#fibroid #sonata #myoma #noninvasivefibroidtreatment #uterinearteryembolization #tcrf #myomectomy

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Apr 2

There is evidence to suggest that wearing tight-fitting clothes, particularly tight-fitting pants, or tight-fitting underwear, may increase the risk of bacterial vaginosis (BV).

BV is a common vaginal infection caused by an overgrowth of certain bacteria that can lead to symptoms such as vaginal discharge, itching, and odour.

One study published in the Journal of Lower Genital Tract Disease found that wearing tight-fitting pants was associated with an increased risk of BV. The study concluded that wearing tight-fitting pants may increase vaginal temperature and moisture, leading to an environment that is more favourable for the growth of BV-associated bacteria*

Another study published in the Journal of Obstetrics and Gynaecology Canada also found that wearing tight-fitting pants or tight-fitting underwear was associated with an increased risk of BV.

The study suggested that tight-fitting clothing may contribute to the development of BV by creating an environment that is more conducive to the growth of anaerobic bacteria**.

However, it’s worth noting that these studies only demonstrate an association between tight-fitting clothing and BV, and do not necessarily prove a causal relationship.

Other factors such as sexual behaviour, contraceptive use, and personal hygiene may also play a role in the development of BV.

In summary, there is some evidence to suggest that wearing tight-fitting clothes may increase the risk of bacterial vaginosis.

Women who are prone to BV or have a history of BV may want to consider wearing looser-fitting clothing, particularly during periods of high heat or humidity, to reduce their risk of infection.

References:
*Klebanoff MA, Andrews WW, Yu KF, et al. Can Med Assoc J. 2001;165(10):1317-1322.

**Nasioudis D, Linhares IM, Ledger WJ, et al. J Low Genit Tract Dis. 2016;20(2):141-146

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Mar 28

Navigating the Medical Challenges of Diagnosing Perimenopause 🌸⚖️🩺

Today, I am going to dive into the world of perimenopause…

.Perimenopause marks the period leading up to menopause, when a woman's hormone levels fluctuate and cause various symptoms. But did you know that diagnosing perimenopause can be quite tricky? 🤔
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Here are some of the key challenges:
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Different for everyone 🌈:

.Every woman experiences perimenopause differently, with a unique combination of symptoms. This diversity can make it hard to pinpoint a clear-cut set of diagnostic criteria.
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Wide age range 📆:
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.Perimenopause typically occurs between the ages of 45 and 55, but it can start as early as the mid-30s or as late as the early 60s, complicating the diagnostic process.
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Overlapping symptoms 🧩:
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Many perimenopausal symptoms can also indicate other medical conditions, like thyroid disorders or hormonal imbalances, leading to potential misdiagnoses.
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Fluctuating hormone levels ⚖️:
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.Hormone levels can change dramatically during perimenopause, making it difficult to rely on blood tests alone for an accurate diagnosis.
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Subjective experiences 💭: Many perimenopausal symptoms, such as mood changes and sleep disturbances, are subjective, making it challenging for healthcare providers to assess their presence and severity.
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Cultural and social factors 🌍:

.Women from different cultural backgrounds may have varying expectations and experiences of perimenopause, affecting how they report and interpret their symptoms.
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To address these challenges, healthcare professionals use a combination of clinical history, physical examination, and laboratory tests to diagnose perimenopause.
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Open communication and patient education are essential for helping women understand and manage this complex life stage. 🤝🌟

So, if you suspect you might be going through perimenopause, be proactive!
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Your journey through this transition is unique, and understanding it can make all the difference. 💗🌸
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#Perimenopause #WomensHealth #DiagnosisChallenges #MenopauseTransition #HormoneFluctuations #HealthJourney #Empowerment

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Mar 27

Sometimes intrauterine device can get misplaced. The threads can make a U-turn, or the arms of the device can penetrate the uterine muscle or rarely make a hole inside the uterus and enter into the abdominal cavity, even though these complications are rare, but they’re not uncommon

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Mar 26

As an AI language model, Chat-GPT can do a lot of things, but there are some limitations to what it do in the medical world.
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While Chat-GPT has been trained on a vast amount of medical data, it cannot replace the knowledge and expertise of trained medical professionals.
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Chat-GPT cannot diagnose or treat medical conditions, nor it can provide personalised medical advice based on a patient's unique medical history and symptoms.
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Medical decisions should always be made in consultation with a qualified medical professional who has the expertise to properly evaluate medical conditions and recommend appropriate treatments.
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Additionally, while Chat-GPT can understand medical terminology and jargon, it may not always be able to accurately interpret complex medical concepts or understand the context in which medical information is being presented.
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Medical data is often complex, and medical professionals are trained to critically evaluate the quality and reliability of information.
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Lastly, there are ethical considerations to be made when using AI language models in the medical field.
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Confidentiality and privacy are paramount when dealing with medical information, and it's important to ensure that patient data is kept secure and confidential.
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So while Chat- GPT can be a useful tool in the medical field, there are certain limitations to what it can do.
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Always remember to seek advice from qualified medical professionals for your health needs.

Please don’t google and make self diagnosis….and self treat…

#ChatGPT #AIinMedicine #MedicalAdvice #StayHealthy
#google #selfdiagnosis #selftreat

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Mar 26

As social media continues to grow, so does the influence of social media influencers.
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While many influencers provide valuable content and insights into various topics, it's important to be aware of the potential pitfalls when it comes to medical advice.
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Medical information is a complex field, and even with the best of intentions, social media influencers may make mistakes when writing about medical topics.
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Here are some common mistakes to watch out for:
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❌ Spreading misinformation: Without proper medical training, influencers may not have the full knowledge and understanding of medical conditions, medications, and treatments. This can lead to the spread of inaccurate information, which can be dangerous or even deadly.
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❌ Lacking scientific evidence: Medical advice should always be based on scientific evidence and research conducted by qualified medical professionals. Social media influencers may rely on personal experience or anecdotal evidence, which can be biased or incomplete.
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❌ Conflicts of interest: Influencers may be influenced by financial incentives, sponsorships, or other conflicts of interest that can affect the information they present to their followers.
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So, what should you do when you come across medical advice on social media?
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Always remember to consult with qualified medical professionals and reputable sources to ensure that you're getting accurate and reliable information.

Don't rely solely on social media influencers or unverified sources for your health information.
Stay safe and stay healthy! 💙 #medicalmistakes #socialmediainfluencers #healthinformation #healthadvice #consultaprofessional #stayhealthy #stayinformed
#influencer #influencers

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Mar 25

. Short cervix refers to a condition where the cervix, which is the lower part of the uterus that connects to the vagina, is shorter than usual.
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Typically, the cervix measures between 3-4 cm in length during pregnancy, but if it's less than 2.5 cm, it's considered short. 😯
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Why is this important? Because having a short cervix can increase the chances of having a baby too early (before 37 weeks), which can lead to health problems for the baby🤰
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There are some conditions that can make a woman more likely to have a short cervix during pregnancy,
such as ….
previous surgery on the cervix ( cone biopsy, LLETZ, LEEP)
infections of the cervix or vagina ( Chlamydia, BV, Myocplasma)
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previous preterm birth or miscarriage,
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carrying twins or triplets
having an abnormally shaped uterus.
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But it's important to note that not all women with these conditions will have a short cervix, and some women without these conditions can still have a short cervix. 👩‍⚕️
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If a short cervix is suspected, healthcare providers typically use transvaginal ultrasound to confirm the diagnosis.
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Depending on the severity of the short cervix and the gestational age at diagnosis, woman may need interventions such as
- close monitoring,
- cervical cerclage (a surgical procedure to reinforce the cervix),
- progesterone supplementation (medication to help prevent preterm birth),
- or bed rest.
Cervical cerclage and progesterone supplementation have both been shown to significantly reduce the risk of preterm birth in women with short cervix.

In summary, Short cervix during pregnancy is a common condition that can increase the risk of preterm birth.

Early detection and appropriate management can improve outcomes for both the mother and baby.
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Cervical cerclage and progesterone supplementation are effective interventions that can reduce the risk of preterm birth in women with short cervix.❤️

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Mar 22

Preventing future growth restriction in babies involves a combination of prenatal care, maternal health, and lifestyle choices. Here's a summary of evidence-based recommendations:

✅ Early and regular prenatal care: Attending prenatal visits allows healthcare providers to monitor the baby's growth and maternal health, helping to identify and address any potential issues 🩺 (ACOG, 2020).

✅ Nourish your body: Eat a balanced diet full of fruits, veggies, whole grains, lean proteins & low-fat dairy 🥗🥑🍎 (Ramakrishnan et al., 2012).

✅ Folic acid supplements: Take these before & during pregnancy for better growth 🌱(De-Regil et al., 2015).

✅ Stay away from alcohol, tobacco & illicit drugs: Keep your baby safe from harm caused by these substances 🚭🍷❌ (ACOG, 2013; WHO, 2014).

✅Manage chronic health conditions: Take care of yourself by ruling out occult diabetes, blood pressure or autoimmune disorders which can affect placental function. Proper management of these conditions is critical 🩹 (ACOG, 2013; WHO, 2014).

✅Infection prevention: try and rule out bacterial vaginosis, mycoplasma and or GBS bacteriuria. Preventing and promptly treating infections during pregnancy, including sexually transmitted infections, can help reduce the risk of growth restriction 🦠🚫(Silver, 2018).

✅Optimal weight gain during pregnancy: Gaining an appropriate amount of weight, based on pre-pregnancy BMI, supports healthy fetal growth (IOM, 2009).
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Together, one can ensure a brighter, healthier future for our babies! 🌟💕
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Share these tips with other expecting moms and let's support each other on this beautiful journey. 🤗
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#PregnancyTips #HealthyBaby #GrowthRestrictionPrevention #BabyLove #MomtoBe #PrenatalCare #NutritionMatters

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Mar 19

🚨 Let's talk about Genital Herpes - an STI one should know about!
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🚨 Swipe left to learn more about how it spreads, symptoms, and prevention. 👉
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Stay safe, and remember to consult a healthcare professional if you suspect you have genital herpes or any other STI. Your health is important! 💖

#GenitalHerpes #STIAwarenes
#sexualhealth
#herpes
#aciclovir

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Mar 18

When I asked AI to write a story about Bacterial Vaginosis - also called as Gardnerella Vaginalis

Once upon a time, in a small town named Floraville, there lived a community of microorganisms, all coexisting peacefully within the delicate ecosystem of a young woman named Sophie. In this well-balanced environment, the helpful and friendly Lactobacilli bacteria, who were the majority, worked diligently to maintain harmony by producing lactic acid to keep the pH level low, making it difficult for harmful bacteria to grow.

However, one day, a group of mischievous bacteria called the Gardnerella found their way into Floraville. These newcomers started to disrupt the balance by multiplying rapidly, causing the Lactobacilli to struggle in maintaining the pH level.

As the Gardnerella bacteria grew in numbers, they became more daring, forming a sticky film over the entire town, a biofilm that protected them from any attempts to control their growth. This situation led to the once-thriving Floraville becoming a place of disharmony and discomfort for Sophie.

Sophie started experiencing the effects of this bacterial invasion, such as an unpleasant odor and mild itching. Worried about her well-being, she decided to consult her doctor, Dr. Harmony, who was an expert in maintaining the balance between microorganism communities.

Dr. Harmony carefully examined Sophie and diagnosed her with bacterial vaginosis, caused by the overgrowth of the disruptive Gardnerella bacteria. She advised Sophie to take a course of antibiotics to help the Lactobacilli regain control of Floraville and restore the balance.

Sophie followed Dr. Harmony's advice and began her treatment. As she took her antibiotics, the Gardnerella bacteria started to decrease, and the Lactobacilli began to regain their strength, slowly restoring the pH level and breaking down the biofilm.

With each passing day, the Lactobacilli worked tirelessly to bring Floraville back to its original harmonious state. Eventually, peace was restored, and Sophie felt a sense of relief and comfort as her symptoms vanished.

From this experience, Sophie learned the importance of maintaining a balanced and healthy life style…
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#BV

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Mar 15

Adenomyosis is a chronic inflammatory condition of the uterus whose trajectory usually is one way unless necessary actions are taken in a timely fashion…

.Increase intake of fruits, vegetables, and whole grains: A vegan diet is typically high in plant-based foods, which are excellent sources of antioxidants, fiber, and essential nutrients that may help reduce inflammation and pain associated with adenomyosis.

* Incorporate omega-3 fatty acids: Since vegans don't consume fish, it's important to obtain omega-3 fatty acids from other sources such as flaxseeds, chia seeds, hemp seeds, and walnuts.
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* Include soy products: Soy products such as tofu, tempeh, and soy milk contain phytoestrogens that may help regulate hormone levels and reduce symptoms of adenomyosis.
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* Avoid processed foods: Processed foods are often high in saturated fats and additives that can exacerbate inflammation and pain. Stick to whole, unprocessed foods as much as possible.
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* Consider supplements: If it's challenging to get enough nutrients from diet alone, consider taking supplements such as vitamin D, omega-3 fatty acids, and magnesium, as they may help alleviate symptoms of adenomyosis.
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#adenomyosis
#endometriosis
#veganuk
#vegan

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Mar 11

When a perfect analysis and forecasting are aligned for the best outcome…..is what keeps me going…thank you to my patient and wish her and her unborn the best….🙏🏽
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#baby
#Mother
#mum
#dad
#father

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Mar 10

Since endometriosis is a chronic condition and takes at least 7 years to diagnose the condition precisely, many things could be happening internally….

Endometriosis patients can end up with central sensitization, if so…,
. In such patients……
the removal of the endometriotic lesions is unlikely to result in adequate pain relief owing to continued activation of the central nervous system.

Put simply, if a woman has been troubled with chronic pelvic pain symptoms because of severe endometriosis, then, one in three chance that, she may find undergoing such a major surgery was a futile exercise…… This continued pain is explained by established pathological pain pathways which won’t be interrupted by surgery…..
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#endometriosis #pain #chronicpain

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Mar 8

#miscarriage
#threatenedmiscarriage
#progesterone
#progesteroneinpregnancy

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Mar 3

What keeps me going…..

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Feb 23

Embryo freezing and egg freezing are two effective methods of fertility preservation that have some key differences.
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Egg freezing allows women to preserve their fertility independently and decide what eventually happens to their eggs, while embryo freezing involves a joint decision between two people.
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The success rate between the two practices depends on factors such as retrieval age and volume; however, they typically share similar success rates.
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Over 95% of embryos survive the vitrification process, while 90% of eggs also have good freeze-thaw survival rates.
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Embryo freezing provides more information upfront about how many healthy eggs were fertilized and developed successfully after being frozen
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Egg freezing is simpler for single women or those who are uncertain about their co-parent options.
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Moreover, egg freezing is generally less expensive than embryo freezing, making it a more accessible option for those seeking to preserve their fertility.
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If you're considering postponing starting a family for any reason — particularly if there's a family history of premature menopause — it's best to get a fertility check-up

.This will help ensure that your chosen method of fertility preservation is suitable for you and offers the highest probability of success in the future.
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Finally, it's important to note that both embryo and egg freezing can have risks associated with them due to unforeseen developments such as changing circumstances or breakups between partners.
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It's worth considering these potential outcomes before making an informed decision regarding which process is right for any given person
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#eggfreezing #embryofreezing #egg #embryo #baby

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Feb 22

Understanding the underlying mechanisms associated with recurrent miscarriages may provide invaluable insights into why certain couples experience repeated miscarriages
and ultimately help us develop better ways to prevent future occurrences.

As has been demonstrated in the research conducted by Imperial College London, men whose partners have experienced recurrent miscarriages typically have a significantly higher level of reactive oxygen species (ROS) in their semen compared to the control group.

This leads to an increase in DNA damage within their sperm cells, further signifying a potential link between ROS and increased miscarriage risk.
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In addition, evidence from previous studies has suggested that sperm quality is essential for the formation of the placenta, which is essential for providing oxygen and nutrients to the foetus during pregnancy.
. Put simply progesterone supplementation is not the answer for all miscarriage prevention….
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Poor semen quality may also lead to an increased risk of chromosomal abnormalities which can result in spontaneous miscarriages or birth defects.

.The implications of this are that male health must be considered when exploring potential causes of recurrent miscarriage and that better understanding these complex relationships could enable us to identify potential solutions.
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More research is clearly needed if we are to effectively understand and manage issues related to fertility, miscarriages and preterm births. Scientists should continue conducting high-quality studies with larger sample sizes in order to further explore any associations between ROS levels, DNA fragmentation in sperm cells and recurrent miscarriage rates.
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Additionally, new technologies such as genomics could potentially provide more accurate measurements of sperm parameters such as motility and count than traditional methods which may give us greater insight into these relationships.
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Ultimately, gaining a deeper knowledge about how male fertility impacts recurrent miscarriage will allow medical practitioners to better inform couples about their risks of having a successful pregnancy
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#recurrentmiscarriage

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Feb 20

Urinary tract infections in women are one of the most common infections occurring at various stages of woman’s life.
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Women are more prone for Recurrent urinary tract infections than men, this is mainly due to female lower urinary tract anatomy, and its proximity to the urethra, Vaginal opening as well as Anal opening.
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The female urethra is relatively short, reducing the distance for bacterial migration from the urethra to the bladder as compared to men
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Also, the female urethra opens into the Vaginal introitus

The urethra opens into the upper end of wall, wall, vestibule, and the Volvo festival light is in which I like.
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The sexual activity as well as excessive use of intimate hygiene products can interfere with natural vaginal microbiome are often to blame.
The proximity of the anus facilitates, the colonisation of both reproductive organs, and the distal part of the urinary tract by E. coli ( serious bug) enterococcus faecalis and streptococcus species
.hormone deficiency such as menopause can make women more prone for UTI
. Use of intrauterine devices such as Copper IUD can also affect Vaginal microbiome
- In any UTI, it’s always a good practice to try and understand which bacteria is the cause and not to take empirical antibiotic
. Probiotics - jury is not out
.Uro-Vaxom - oral capsule which contain 18 uropathogenic E. coli strains is not licensed in the UK, it’s a three months course, and three ten days booster thereafter
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#recurrentUTI
#uti

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Feb 7

Diagnostic accuracy of different investigative modalities in Endometriosis
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#endometriosis
#salivatest
#salivatestforendometriosis
#noninvasivetestforendometriosis

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Jan 29

.Bioidentical hormones – The term "bioidentical hormone" technically refers to a hormone with the same molecular structure as a hormone that is endogenously produced (eg, 17-beta oestradiol- a hormone produced by the ovary).
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However, in popular culture, the term typically refers to the use of custom-compounded, multihormone regimens with dose adjustments based upon serial hormone monitoring.
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Most expert organisations advise against this approach.
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Natural versus synthetic – This term "natural" is often used to refer to oestrogens that are derived from plant sources.
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Virtually all oestrogens used in medical HRT are derived from plant sources. No more pregnant horses urine…
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However, these same oestrogens can also be considered "synthetic" because the plant precursors must be extracted and converted to the desired oestrogen through a multistep process.
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For example, 17-beta oestradiol is synthesized from diosgenin, a compound naturally occurring in plants (Mexican Dioscorea ( Yam)). Diosgenin is then converted to oestrone and hydrogenated to 17-beta oestradiol
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The custom-compounded bioidentical industry claims that their products are "natural" and "plant-derived," and that commercially available oestrogens that are regulated and approved in most countries are synthetic and not "plant-based." In fact, all of the hormones used for their products are synthesized using the same process as described above for regulated and approved hormones, i.e., precursors are extracted from plant sources, and the plant precursor is then converted to oestrogen in the lab. However, quality controls for these processes vary widely
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The safety and efficacy of these compounds have not been tested in randomized trials.
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However, there are potential risks associated with not following standard dosing guidelines for established therapies. For example, excessive oestrogen exposure increases the risk of endometrial hyperplasia, and breast cancer and DVT
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In addition, there is evidence that some custom-compounded hormones contain different amounts of active ingredients than stated on the label.
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#hrt #mht #ht #bioidenticalhormones #bht #synthetichrt

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Jan 27

Menopause is a natural life stage for women, usually occurring in their late 40s or early 50s.
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At this time, hormone levels of oestrogen decrease drastically and Follicle stimulating hormone (FSH) levels go up considerably, leading to physical and psychological symptoms such as hot flushes, night sweats, vaginal dryness, mood swings, and insomnia.
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However, it has been found that neither FSH nor serum oestradiol levels accurately reflect the severity of menopausal symptoms.
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Rather than relying on these blood tests to diagnose menopause and adjust hormone therapy doses, it is important to consider symptom management as the primary focus when treating menopausal women.
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Hormone therapy should be tailored to each woman’s individual needs using the lowest effective dose to reduce symptoms to an acceptable level.
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An overly high dose of hormone therapy may cause more harm than good and can lead to more severe side effects.
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Thus, it is important for healthcare providers to consider symptom management as the primary focus when treating menopausal women and adjust doses accordingly.
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Doing so will ensure that each woman receives the best possible care during this life stage.
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Offering blood tests does not fit in with NICE guidance for those who practice in the UK
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In conclusion, the frequency and severity of menopausal symptoms do not correlate to the levels of either follicle-stimulating hormone (FSH) or serum estradiol, progesterone or Testosterone.
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Therefore, hormone therapy should be tailored to each woman’s individual needs using the lowest effective dose to reduce symptoms to an acceptable level.
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The flip side of using blood levels to adjust hormone therapy may result in higher doses of hormone therapy than are needed to reduce and manage symptoms.Women may end of developing other gynaecological side effects such as postmenopausal bleeding leading to cancer scare, uterine polyps, resurgence in growth of atrophic fibroids, breast lumps, adenomyosis, endometriosis
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#healthcare #hrt #hormonereplacementtherapy #hormones #hormonedeficiency

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Jan 15

I am really impressed with ChatGPT generating a letter to my patient with sympathy and empathy
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#chatgpt #sympathy #empathymatters #empathy #letter #empathyletter #sympathyletter

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Jan 14

Performance of ChatGPT when it was challenged to write a letter to a patient with polycystic ovarian syndrome - PCOS

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Jan 13

When I don’t know where to start… stick the basics and I have to believe in what I’m saying and make my patient believe, when both are aligned, then there’s no stopping….
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Thank you to my patient and well deserved results 🙏🏽
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#pcos #pregnancy #baby

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Jan 13

.Food and contrasting emotions and both of them have one thing in common…. Guess….?

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.#food #eatingdisorder #obesity #anorexia

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Jan 12

Human papillomavirus (HPV) remains the most common sexually transmitted infection in the
in adults,

- with 45% of women and 40% of men tested having positive test results.

- Unfortunately, there has been sharp increase in the rate of HPV diagnosis in men over the past several years, and this will likely eventually surpass the infection rate in women.

.Many HPV infections can be transient

. But, 10–20% of infections can persist and eventually progress to various forms of cancer.

. The HPV vaccine provides primary prevention against more than 90% of HPV infections and consequently prevents most HPV-associated cancers in a cost-effective manner
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#hpv #persistenthpv

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Jan 5

Why weight gain in PCOS?

.PCOS makes it difficult for the body to use the hormone insulin

.Insulin normally helps convert food sugars and starches into energy.

.To maintain normality of blood sugars, the body pumps more insulin into circulation. The overall situation now is insulin resistance.

.In insulin resistance, both insulin and blood sugar can go up, i.e., high insulin and high blood sugar

.Now, imagine a side kick, High insulin levels ( to suppress this one can consider inositol, going Vegan) are known to increase the production of male hormones called androgens ( This is where use of Dianette helps to suppress androgens)

.High androgen levels or excessive sensitivity ( created by high insulin) levels can lead to symptoms such as body hair growth, acne, irregular periods -- and weight gain.

.Because the weight gain is triggered by male hormones, it is typically in the abdomen

.That is where men tend to carry weight ( remember – Beer belly).

.So, instead of having a 🍐 shape, women with PCOS have more of an 🍏 shape.

.Among all the body fats, abdominal fat is the most dangerous fat. This is because, excess abdominal fat is associated with an increased risk of heart disease

.When one has PCOS, shedding just 10% of her body weight can bring periods back to normal. Dropping weight can also help relieve some of the symptoms of polycystic ovary syndrome.

#pcos #pcod #pear #apple #pearshaped #appleshaped

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Jan 4

Clinical outcomes in the provision of fertility care are important
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But, emotional well-being and patient experience are also crucial.
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Empathy and effective communication skills are critical to support the couple through all stages of treatment
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In other words, regardless of clinical outcome, empathy and good communication skills are the strongest predictors of patient’s experience.
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The importance of empathy and communication in health care has long been recognized as the cornerstones in end-of-life care.
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For doctors, decreased rates of burnout, higher job satisfaction, and fewer claims of medical malpractice have been associated with empathic care and good communication.
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A physician’s ability to communicate effectively and employ empathy in patient care is recognized as being essential to the delivery of good quality clinical care.
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The question is … can empathy and effective communication skills be taught…?
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Learning of the diagnosis of primary ovarian insufﬁciency or the need for an egg donor or sperm donor or a surrogate may be as equally devastating as a cancer diagnosis.
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Success in infertility treatment is cumulative, although many patients discontinue treatment before achieving a live birth. For many, drop-out from treatment is due to the high ﬁnancial cost; and for many others, it is due to the emotional burden of care.
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One of the most well-known strategies for breaking bad news is the Setting up, Perception, Invitation, Knowledge, Emotions with Empathy, and Strategy or Summary (SPIKES) framework, which is a six-step framework for breaking bad news
….
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#empathy #communication #effectivecommunication

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Jan 4

Instagram post 18004419919558517

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Jan 1

Recurrent Vaginal skin infections…. could diabetes be masquerading….?
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Vulval abscess or Folliculitis or Follicular abscess…
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Vulval abscess (Vulva = Outer part of the female genitalia) is a common gynaecologic problem that has the potential to result in severe illness
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These abscesses typically originate as simple infections that develop in the vulval skin and can spread to deeper layers.
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Spread of infection and abscess formation in the vulval area is facilitated by the loose areolar tissue in the deeper layers of the skin.
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The contiguity of vulval fascial spaces with other anatomic compartments permits spread of infection from the vulva to the inner thigh and abdominal wall
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The causative bacteria of vulval abscesses, are often mixed bacterial infections, consisting primarily of (MRSA) and bacteria which does not need oxygen for their multiplication (anaerobes)
The diagnosis is mainly by inspecting the swelling and feeling the size of it
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Treatment of vulval abscess depends upon the lesion size and the patient's risk factors for failure of therapy..
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Small lesions (<2cms) often resolve with conservative therapy (eg, warm compresses); however, incision and drainage is the mainstay of treatment of vulvar abscesse if it is >2cms
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Antibiotic therapy may be used in combination with conservative measures.
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For patients with a vulvar abscess ≥2 cm, incision and drainage may be needed.
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With hidden diabetes, such recurrent infections are more frequent and also appear to have a poorer response to therapy such as antibiotics and sometimes can progress to severe form of infection like blood poisoning ( sepsis)
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There is good evidence that good control of blood sugar can improve outcomes.
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For women with undiagnosed diabetes or pre-diabetes, vaginal infections may occur often because these organisms multiply unchecked in the high sugar environment.
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Skin health is often a reflection of general health and could be a pointer to issues like diabetes if infections of the skin are a non-resolving issue.
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Also, recurrent fungal skin or vaginal (yeast) infections could be a sign of elevated blood sugar
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#vulvalabscess #abscess

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Dec 31

The so called Detox Diet - or Detoxing - no scientific evidence that such a thing exists, but business opportunities are huge in the name of “Detox” as use of this word drags psychic attention…..
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#detox #detoxdiet

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Dec 29

Inter-pregnancy intervals less than 18 months are associated with higher
risks of adverse pregnancy outcomes.

It is not known whether short intervals are associated with increased risks among older women (>40yrs) to the same extent as among younger women.

Pregnancy spacing (ie, the time interval between one pregnancy and the next) is clinically relevant because it may increase the risk for some adverse pregnancy outcomes.

Short intervals between pregnancies are more commonly associated with adverse effects than long intervals.

The degree to which individual pregnancy spacing alters adverse pregnancy outcomes is unclear, but important, since women have some control over such spacing and thus could potentially reduce adverse outcomes.

Becoming pregnant in order to avoid a long inter-pregnancy interval is more problematic since a desired pregnancy may be precluded by factors such as availability of a partner, subfertility, economic or occupational issues, or illness

Short inter-pregnancy intervals appear to be associated with increased risks for adverse pregnancy outcomes for women of all ages; maternal risks at short intervals may be greater for older women, whereas foetal and infant risks may be greater for
younger women.

An interval of less than 6 months between a first and second pregnancy is associated with the diagnosis of placental abruption in the second pregnancy, irrespective of hypertensive disorders. Placental dysfunction may be one mechanism by which a short IPI increases the risk of preterm birth.

#shortinterpregnancyinterval #pregnancy #pregnancyintervals

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Dec 29

As the country’s largest employer ( NHS) and with 77% of healthcare professionals being women, the NHS should take the lead in supporting its employees who require fertility treatment….BMJ 2022

.Research suggests that women working night shifts in a hospital setting are at greater risk of miscarriage…

.People having fertility treatments will require multiple, unpredictable, and sometimes relentless trips to a fertility clinic.

.Without support, this can increase people's stress and anxiety during a difficult time, and negatively affect their performance at work.
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#nhs #fertility #infertility #subfertility

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Dec 29

Adenomyosis - understanding

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Dec 19

Surgical blades…..

As for a cook, who uses different knife for different item cutting, fruits to breads, surgeons use different blades for different incisions, in some incision has to be precise at the superficial point like underneath the eyes as compared to caesarean skin incision

In caesarean deliveries sharpness of the scalpel is more important as at least four layers tissue needs incising
In comparison to caesarean, in keyhole surgery skin deep and short length is all one aims for in such situations surgeons use sharp but short scalpels blades….
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#blades #scalpelblades

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Dec 19

Messi - A real GOAT

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Dec 15

Always aim for high, my patient says, five star is not enough…

… my teachers who inspired me and my parents who put bet on me and my friends who showed me the path- this review fulfils everyone’s effort to make me who am I….🙏🏽

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Dec 14

Oestrogen deficiency in a nutshell…
Credit to @Innov_Medicine
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#hrt

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Dec 13

What keeps me going…..
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#myomectomy #fibroidsurgery #fibroid #myoma #miomasuterinos

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Dec 11

Effectiveness of Levonorgestrel IUS to control heavy Menstrual bleeding when the cause is not identified…..
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#heavyperiods #heavymenstrualbleeding #heavymenstruation

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Dec 11

During an awake craniotomy for resecting part of her astrocytoma, a patient-investigator faces a high-stakes decision that she will make in collaboration with her neurosurgeon.

Put simply patient is awake during her brain surgery and she can guide her surgeon at what point her surgeon can stop..

This situation reminds me of a patient undergoing awake hysteroscopy, which I use it routinely

In my view, my patients feel, they are empowered, they get to see what’s wrong deep inside their body, they also get to participate in their own journey.

I am using awake hysteroscopy as an example, sometimes, half way through the procedure patient do get an opportunity to say stop, but more importantly some women want everything taken off ( for example a uterine polyp) as some are worried that, it could be a cancer.

As long as the Trust between the surgeon and patient continues to be a partnership and mutually respecting and a feeling that as a patient she can take part in a surgical procedure where she will have an opportunity to understand and has a power to withdraw consent, in my view this is a perfect patient-doctor mutually respecting relationship.

Sometimes, patients have years of infertility, and having a Hysteroscope being awake gives them an instant reason

The future of patient’s treatment and quality of life will be hinged on successful resection of a pathology ( in my case, removal of a sinister looking suspicious polyp) and accurate communication with a tissue biopsy reporting specialist

Awake interventional procedures gives perspectives of their pathology a more closer three dimensional understanding of why they have been troubled with irregular bleeding ( polyp//s or a submucosal fibroid/s ) or infertility. Awake surgical procedure also gives an opportunity for the patient to assess the surgeon’s dexterity, and the challenges faced by the clinician and the staff assisting him/her

I’ll never forget the things I learnt from my mentor - You are the boss and if at any stage, you say stop, my hands will freeze and we stop and that’s guaranteed

#hysteroscopy #awake #consent #polyp #uterinepolyps

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Dec 9

Specially designed for a woman’s needs, the exam is part discussion and part physical exam. It also involves any testing, counseling, or immunizations required depending on your age, lifestyle, and medical history. Your Well Woman Exam is your personal health roadmap. It’s a way to help you stay healthy for the ones you love and care for. Your Well Woman exam can make a world of difference between living and thriving at your personal best.

#wellwoman #wellwomanexam #welleomanscreening

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Dec 6

How MRI helps in understanding it’s relation to womb cavity….
. The fibroids which are smaller than <7cms generally do not need surgical intervention
. The fibroids which do not distort the womb cavity - does not need surgical intervention
. In the given image, the fibroids found are not 7cms in size and do not distort the cavity

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- As a surgeon, if you start thinking of any surgical intervention as the best solution for your patient,
the architectural planning starts with adding 1D +1D+ 1D= 3D

. Put simply, building a ‘3D’ image in the mind and rehearsing it from different angles…

. Here first 1D - patient’s story,

. Second 1D being performing a physical examination
and the final solution to construct 3-D image being combination of ultrasound, or MRI or a Hysteroscopy ( in fibroid surgery)
.
- planning a surgery reminds me of mental visualisation from start to fisniah something like google map…….( hurdles, obstructions, detours, breakdown cover- who will rescue me if I get into trouble), if these cannot be thought of, then one should think twice, ie, whether it’s worth to take such an endeavour

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#fibroids #myoma

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Dec 6

A study published in the green journal found following association…
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. * Active endometriosis was associated with a risk of
* Severe preeclampsia and eclampsia
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* Severe haemorrhage
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* Hysterectomy
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* Cardiac complications
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* Embolism
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* Shock
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* Sepsis
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* Intensive care unit admission
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* Inactive endometriosis was less strongly associated with these outcomes
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* Endometriosis was associated with a greater risk for severe pregnancy complications, especially if active during pregnancy
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* The authors state
These findings suggest that endometriosis has implications beyond common delivery complications

Effective management of active endometriosis and closer follow-up during pregnancy could potentially mitigate these risks
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.#endometriosis #activeendometriosis #pain #sepsis #pet #preeclampsia #hemorrhage

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Dec 5

Lots of women experience this problem and they don’t know whom to talk to and even if they talk to someone there is very little help they obtain. The explanation for tingling numbness following surgery which involves cutting of the skin to get access usually can end up with this uncomfortable situation
Now, think of this human body has nerve endings all over, so when theses are cut ( which surgeon can’t see, they are never aligned or rejoined in the same was they were before. In other words two cut nerve endings will have two blunt ends when skin is closed at the end of the operation
The two cut blunt ends will try to find and rejoin during the leaking phase and this is when, patients start experiencing tingling and numbness.
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#tingling #numbness #surgery#cesarean #hysterectomy #fibroid

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Dec 5

doctors life in a nutshell

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