Author: mygynaec

Menopausal Transition-Take Care, Don’t Pause

20.12.18

Hello friends,

As this topic ‘Menopausal Transition’ is a vast topic and we want to bring understanding to this topic in as simple a language as possible such that it can be easily understood by everyone, we are starting an article series.The introductory article will give you a glimpse about how will we go about it.

Let’s start

-The   menopausal transition is a progressive endocrinological continuum that takes reproductive aged women from regular cyclic and predictable menses that are characteristic of ovulatory cycles to a final menstrual period associated with ovarian senescence.

-The term menopause refers to a point in time that follows one year after the   cessation of menstruation.

– The post menopause describes those years following this point. The average age of women experiencing their final menstrual period is 51-52 years.

–  The hormonal changes begin to happen a few years earlier to cessation of menses and extend to one year after that. These years are referred to as menopausal transition.

– We will discuss the changes that happen during this period that will include: –

– Physiological changes- under this head we will discuss hormonal changes that occur in hypothalamus, pituitary, ovary and adrenal glands.

– Endometrium is the lining of the uterus, that sheds with menses.  We will discuss menstrual disturbance patterns and fertility potential during menopausal transition

-The woman experiences thermoregulatory changes or vasomotor symptoms   such as hot flushes. We will discuss what causes it and its treatment part.

– Female hormones – Especially estrogen is very essential for maintaining strength of bones. When estrogen levels fall with menopause, skeletal disorders like osteopenia and osteoporosis may set in.

-We will discuss pathophysiology, diagnosis, prevention and treatment of these disorders.

– Menopausal transition and hormonal changes associated with it for changes in other systems too like, cardiovascular system, weight gain and fat distribution, skin changes, breasts changes, sleep disorder, psychosocial changes and sexual dysfunction.

-Along with this we will also discuss physical examination and lab testing for these disorders.

-So, friends you do get an idea of what all things we will cover under this topic ‘Menopausal Transition’

-In next update of article of this series we will take one of the above listed topics and bring more clarity on that

-Keep a watch on this article itself as a dated update will arrive soon.

Pre-Cancerous Lesions of the Lower Genital Tract of Women

20.12.18

Hello friends,

As this topic ‘Preinvasive/Pre-Cancerous Lesions of the Lower Genital Tract of Women’ is a vast topic and we want to bring understanding to this topic in as simple a language as possible such that it can be easily understood by everyone,we are starting an article series.

The introductory article will give you a glimpse about how will we go about it.

Let’s start

-Pre-invasive lesions of the genital tract also is referred to as intraepithelial neoplasia which essentially means that the pathology or lesions are diagnosed by biopsy and histologic evaluation.

– These lesions include squamous epithelium or superficial surfaces of cervix, vagina, vulva, perineum and anus.

-In this series we will talk about the grading of these lesions and their terminology.

-In brief we will discuss pathology of external genitalia and vagina.

– However, we will discuss in detail the pathology involving cervix.

– I would like to mention that the formation and dynamics of cervix is such that squamo-columnar junction plays a big part in its pathology.

– This junction undergoes changes depending upon age, hormonal status and many other factors which we will discuss.

– Transformation zone which is the origin point of cervical cancer usually lies near to squamo-columnar junction. We will discuss relation between them.

-Human papilloma virus also known as HPV is the causative factor of cervical cancer.

-About HPV we will discuss its life cycle, types of virus, HPV transmission, outcome, natural history, diagnosis, treatment and prevention of HPV infection.

-While discussing cervical intraepithelial neoplasia we will talk about it incidence, natural history and risk factors.

-For its diagnosis cervical cytology also popularly known as Pap’s smear, HPV testing and colposcopy is used. We will discuss the guidelines and various procedures involved.

-Biopsy means microscopic evaluation of a piece of cervix. We will discuss its procedure.

-In management of cervical intraepithelial neoplasia, we will discuss ablative and excisional methods along with post treatment surveillance.

-For lesion involving vagina, vulva and anus we will discuss their pathophysiology, risk factors, diagnosis, treatment and prognosis.

-So, friends you do get an idea of what all things we will cover under this topic ‘Preinvasive/Precancerous Lesions of The Lower Genital Tract of Women’

-In next update of article of this series we will take one of the above listed topics and bring more clarity on that

-Keep a watch on this article itself as a dated update will arrive soon.

Pelvic Mass in Women: Let’s Bring Clarity

20.12.18

Hello friends,

As this topic ‘Pelvic Mass in Women’ is a vast topic and we want to bring understanding to this topic in as simple a language as possible such that it can be easily understood by everyone, we are starting an article series.

The introductory article will give you a glimpse of how will we go about it. Let’s start:

– Pelvic masses are a common finding.

– In this series, we are going to talk about gynaecological reasons for these masses, their symptoms, evaluation and treatment.

– The pathology of pelvic masses differs with each age group namely- pre-pubertal girls, adolescents, reproductive-aged women and post-menopausal women.

– We will have a discussion age group vies about concerned pathologies.

– In the discussion of uterine causes, we will discuss leiomyoma or commonly known as fibroid.

We will discuss is the pathology, hormone effects, risk factors, classification, symptoms, management options- which include drug therapy and many modalities of surgery like myomectomy and hysterectomy and their routes like hysteroscopy, laparoscopy and laparotomy.

– We will talk about adenomyosis- its pathogenesis, risk factors, symptoms, diagnosis and management.

– We are going to discuss masses arising from the ovary.

An ovarian mass is a vast group. Our discussion will be mainly on ovarian cystic masses and functional ovarian cysts.

– In this, we will discuss its pathogenesis, risk factors, symptoms, diagnosis and management.

– In tubal pathology, we will have a discussion on hydrosalpinx.

– In the next update of the article of this series, we will take one of the above-listed topics and bring more clarity on that

– Keep a watch on this article itself as a dated update will arrive soon.

Techniques Used for Imaging in Gynaecology

20.12.18

Hello friends,

We are starting a new series of write ups that will give information & knowledge about a major Gynaecology related topic,the first of which being

-Techniques used for imaging in gynaecology 

-The first modality is sonography

-We will discuss about the routes of sonography that are trans- abdominal and trans- vaginal

– Doppler Technology which is study of blood flow through blood vessels in pelvic organs

-We will tell you about the normal sonographic findings of female reproductive tract organs and normal condition of endometrium and evaluation of pelvic floor

-We will discuss clinical applications of sonography in determining pathological condition of uterus like fibroids and adenomyosis,endometrial abnormalities

-Pathological conditions of ovaries that include tumors and torsion

– Pelvic inflammatory disease -Benefits of 3D sonography

-We will discuss HSG or hysterosalpingography as fallopian tube’s patency test in infertility cases 

-Discussion on CT scan will include

-Normal pelvic anatomy

-Importance of CT scan after gynaec surgery and gynaec malignancy

-Discussion on MRI will include 

-Normal findings on MRI

-Uterine abnormalities like fibroids and adenomyosis

-Congenital anomalies of genital tract

-Adnexal masses

-Gynecologic malignancies of cervix, endometrium and ovaries

– so friends, you do get an idea of what all things we will discuss

-In next article update of this series we will take one of the above listed topics and have a discussion on that

All the diagnostic and imaging techniques are a great benefit in aiding  a clinician to arrive at a diagnosis timely.Opinion of an expert Radiologist means a lot. Some of these investigations like sonography/ ultrasound/ doppler sonography and MRI are free from radiation. Others like HSG and C T -Scan involve radiation .Some investigative techniques can be operated in OPD setting and others require a specialized set up

-So, friends you do get an idea of what all things we will cover under this topic ‘Preinvasive/Precancerous Lesions of The Lower Genital Tract of Women’

-In next update of article of this series we will take one of the above listed topics and bring more clarity on that

-Keep a watch on this article itself as a dated update will arrive soon.

Gestational Trophoblastic Disease-a Strangely Abnormal Pregnancy

20.12.18

Hello friends,

As this topic ‘Gestational Trophoblastic Disease’ is a vast topic and we want to bring understanding to this topic in as simple a language as possible such that it can be easily understood by everyone,we are starting an article series.The introductory article will give you a glimpse about how will we go about it.

Let’s start

-Gestational trophoblastic disease or GTD refers to a spectrum of interrelated but histologically distinct tumors originating from the placenta.

– These diseases are characterized by a reliable tumors marker beta HCG   and have varying tendencies towards local invasion and spread.

-Gestational trophoblastic neoplasia or GTN refers to the subset that develops malignant and cancerous sequelae.

-We will discuss incidence and risk factors of GTD.

– Hydatidiform mole or molar pregnancy is the subset which is benign or non- cancerous in nature.

-It is divided into two complete and partial hydatidiform mole. In this discussion we will see karyotype pattern, microscopic and macroscopic findings and clinical findings.

– Diagnosis of  mole is usually done by beta HCG estimation, trans- vaginal sonography and histopathology.

– Management requires suction evacuation of molar pregnancy and post molar surveillance by serial beta HCG level estimation. We will have a discussion on that.

-Gestational trophoblastic neoplasia include

-Invasive mole

-Gestational  choriocarcinoma

-Placenta like trophoblastic tumor and

-Epithelioid trophoblastic tumor

We will discuss criteria for diagnosis of GTN and their individual features.

– Most GTN cases are clinically diagnosed based on beta HCG levels.Tissue histology is also used.

-After diagnosis patients with GTN undergo thorough pre-treatment assessment including CT scan.

-Staging is done as per Gynaec society and WHO guidelines.

-This disease is divided into non-metastatic and metastatic disease.

– Treatment of GTN is either surgical or with chemotherapy.

-We will also discuss psychological consequences and subsequent pregnancy outcome of this disease.

-So, friends you do get an idea of what all things we will cover under this topic ‘Gestational Trophoblastic Disease’

-In next update of article of this series we will take one of the above listed topics and bring more clarity on that

-Keep a watch on this article itself as a dated update will arrive soon.

Medical Investigations of Couple Seeking Fertility

20.12.18

Hello friends,

As this topic ‘Evaluation of Couple Seeking Fertility’ is a vast topic and we want to bring understanding to this topic in as simple a language as possible such that it can be easily understood by everyone,we are starting an article series. The introductory article will give you a glimpse about how will we go about it.

Let’s start

-Infertility is defined as the inability to conceive after 1 year of unprotected intercourse of reasonable frequency.

– it can be subdivided into primary infertility, that is no prior pregnancies and secondary infertility referring to infertility following at least one prior conception.

– We will look into the definition of fecundability and population studies and its relation to age.

-We will discuss when should we consider investigations in a couple.

– We will have a discussion on etiology

– that is causative factors, both male and female leading to infertility.

– Medical History taking of both partners will be discussed that will include medical, surgical, medication and social aspects.

-Importance of physical examination will be explained.

-There are certain tests which determine specific causes of infertility like-

– Ovulation studies

-Tubal and pelvic factors

-Uterine abnormalities and

-Cervical factors

We will have a discussion on these factors

-We will have a separate discussion on normal and abnormal production of sperms and its evaluation.

-So, friends you do get an idea of what all things we will cover under this topic ‘Evaluation of Couple Seeking Fertility’

-In next update of article of this series we will take one of the above listed topics and bring more clarity on that -Keep a watch on this article itself as a dated update will arrive soon.

 

 

Cervical Cancer- a Leading Cause of Cancer in Women

18.12.18

Hello friends,

As this topic ‘Cervical Cancer‘ is a vast topic concerning women, we want to bring understanding to this topic in as simple a language as possible such that it can be easily understood by everyone,we are starting an article series.

The introductory article will give you a glimpse about how will we go about it.

Let’s start

-Cervical cancer is the most common gynecologic cancer in the women.

– While discussing incidence we will see the age pattern of those women who get this cancer.

-Infection with Human Papilloma Virus also known as HPV is the major risk factor.

-Other risk factors being low socioeconomic status, cigarette smoking, reproductive behaviour and sexual activity.

-In pathophysiology we will discuss how and where tumour cells originate along with it spread to local and distant areas.

-Histology reveals that most common sub-types of cervical carcinoma are squamous cell carcinoma and adenocarcinoma.

– We will discuss these types in detail and also their prognosis comparison.- Diagnosis of cervical cancer is based on its symptoms, physical examination of patient, Pap’s smear, colposcopy and cervical biopsy.

-We will have a detailed discussion on each modality.

– Staging of Cancer helps in deciding the treatment options and prognosis. For cervical cancer staging is done clinically. In easy language we will explain the staging of cancer for everyone’s understanding.

-During evaluation of cervical cancer many tests are needed. They include  -Testing of blood for various parameters

– Radiologic investigations include chest X-ray, IVP, CT Scan MRI and PET scan

-Certain procedures like cystoscopy and proctoscopy may also be needed. We will have discussion on them too.

-We will have discussion on lymph node dissection and prognostic factors.- Procedures required for treatment of cervical cancer depend upon its clinical staging. it includes

– Cervical conization

-Simple or radical hysterectomy

-Trachelectomy

-Lymphadenectomy

-Chemoradiation and

-Palliative chemotherapy

-We will discuss surveillance of patient following surgery for radiotherapy.

– We will also discuss management of cervical cancer during pregnancy.

-So, friends you do get an idea of what all things we will cover under this topic ‘Cervical Cancer’

In next update of article of this series we will take one of the above listed  topics and bring more clarity on that-Keep a watch on this article itself as a dated update will arrive soon

Tuberculosis And Pregnancy

टी बी और गर्भावस्था ( (Tuberculosis And Pregnancy )

टी बी -यानि Tuberculosis की बीमारी एक जीवाणु Mycobacterium Tuberculosis की वजह से होती है।
टी बी आज भी विश्व की सबसे जानलेवा बीमारियों में से एक है।
40 लाख से भी ज़्यादा स्त्रियाँ हर साल इस बीमारी का शिकार बनती हैं और कई लाख मौतें भी होती हैं।
गर्भवती महिलाओं में सबसे ज़्यादा पायी जाने वाली टी बी फेफड़ों ( lungs ) की है।
इसके अलावा हड्डी (bones ), गुर्दा (kidney ), पेट ( abdominal ), lymph nodes , meninges ( part of brain ), यहां भी टी बी हो सकता है।

TB 1


टी बी का प्रेगनेंसी पर असर

अगर सही समय पर निदान (diagnosis ) हो जाए और संपूर्ण उपचार किया जाये तो टी बी से गर्भवती महिला और शिशु दोनों को ही कुछ भी हानि नहीं होती।
यदि ऐसा ना हो पाए या इलाज को बीच में ही छोड़ दिया जाये तो कई तरह की समस्याओं का सामना करना पड़ सकता है।
-गर्भपात ( abortion )
-पेट में ही बच्चे की मृत्यु ( intra uterine fetal death )
-गर्भ का ठीक से ना बढ़ना ( fetal growth restriction )
-नवजात शिशु की मृत्यु ( perinatal mortality )

अगर महिला का खान पान समय पर और पौष्टिक ना हो या उसमें खून की कमी हो तो उसे कई तरह की परेशानियाँ हो सकती हैं।

प्रेगनेंसी का टी बी पर असर

अगर किसी महिला को टी बी है और वह गर्भवती हो जाती है तो यह देखा गया है कि टी बी की बीमारी उससे अप्रभावित रहती है।

प्रेगनेंसी में टी बी के symptoms

प्रेगनेंसी और टी बी के लक्षण बहुत कुछ मिलते जुलते हो सकते हैं और यह जानना मुश्किल हो सकता है कि महिला को क्या हो रहा है। जैसे कि
-उबकाई या उल्टी ( nausea / vomiting )
-वज़न का कम होना
-बुखार जैसा लगना
-हृदय की धड़कन का तेज़ होना ( tachycardia )

टी बी की जाँचें
-मांटू टेस्ट ( Mantoux test )

TB 1

-छाती का एक्सरे ( Chest X- Ray )

TB 1

-बलगम की जाँच ( sputum examination )
-Biopsy , FNAC
-फेफड़ों ,पेट और हृदय के आस पास के पानी की जाँच ( Fluid from pleural, ascitic or pericardial effusion )
-रीढ़ की हड्डी के पानी की जाँच ( lumbar puncture for TB meningitis )
-दूरबीन द्वारा फेफड़ों या अमाशय को देखना
-ELISA & PCR test


टी बी का ट्रीटमेंट

टी बी की चार मुख्य दवाएं इस प्रकार हैं
– Isoniazid
-Rifampicin
-Pyrazinamide
-Ethambutol

इन दवाओं को छः महीने तक दिया जाता है
WHO ( World Health Organisation ), DOTS ( Directly Observed Treatment, Short Course ) को मान्यता देता है
ये सभी दवाएँ गर्भावस्था में देना सुरक्षित है।
जैसे ही टी बी का निदान हो , डॉक्टर की सलाह से इन दवाओं को शुरू कर देना चाहिए।

Drug Resistant टी बी

कभी कभी टी बी के जीवाणु पर इन मुख्य दवाओं का असर नहीं होता। इस समय कुछ अलग दवाएं इस्तेमाल करनी होती हैं । पर यह second line treatment गर्भ में पल रहे शिशु के लिए सुरक्षित नहीं है। ऐसे समय अगर गर्भवती स्त्री चाहे तो अपने डॉक्टर की सलाह से समय रहते , गर्भपात ( Abortion ) के उपाय को चुन सकती है। दवाओं के नाम इस प्रकार से हैं।
-Kanamycin
-Ofloxacin
-Ethionmide
-Cycloserine
-Capreomycin

प्रसव ( Delivery ) के दौरान क्या करें

टी बी ग्रस्त महिला की प्रसव के दौरान देखभाल वैसे ही की जाती है जैसे की किसी भी दूसरी महिला की करेंगे।

नवजात शिशु की देखभाल

यह इस बात पर निर्भर करता है कि माँ की टी बी कितने ज़ोर पर है। बलगम में टी बी के जीवाणु उपस्थित हैं या नहीं। क्या माँ को drug resistant टी बी है।
नवजात शिशु की कुछ जाँचे भी करनी पड़ सकती हैं जैसे कि –
-Tuberculin test
– छाती का x -ray
इन सब जाँचों के आधार पर शिशु रोग तज्ञ ( Pediatrician ) यह निर्णय लेते हैं कि शिशु को दवा दी जानी चाहिये या नहीं।
BCG Vaccine ( टीकाकरण ) करने का निर्णय भी जाँचों की रिपोर्ट के आधार पर लिया जाता है।

टी बी और स्तनपान ( Breast Feeding )

अगर माँ की टी बी Drug Resistant है , तब स्तनपान करना वर्जित Contraindicated ) है।
बाकी सब तरह की टी बी में माँ को स्तनपान करना अनिवार्य ( Compulsory ) है।
यह हो सकता है कि शिशु को भी कुछ दवायें देने की ज़रुरत पड़े जैसे कि Isoniazid या Pyridoxine , यह दवाएँ शिशु को सुरक्षित रखती हैं।

टी बी और गर्भ निरोध

अगर महिला टी बी की दवाइयाँ ले रही होती है तब गर्भ -निरोधक गोलियाँ उसे सुरक्षित नहीं रख सकतीं। ऐसे में गर्भ निरोध के अन्य साधनों जैसे कंडोम का इस्तेमाल करने की सलाह दी जाती है।

HIV बाधित गर्भवती महिला और टी बी

TB 1

अगर महिला HIV बाधित है तो उसे टी बी होने की संभावना एक आम महिला के मुकाबले दस गुना ज़्यादा है। यहाँ महिला को जान का खतरा भी ज़्यादा है।
बुरे परिणाम बच्चे पर भी हो सकते हैं। जैसे –
-उसका समय से पहले जन्म लेना ( Prematurity )
-कमज़ोर पैदा होना ( IUGR – Intra Uterine Growth Retardation )
-शिशु का HIV बाधित हो जाना

जन्मजात ( Congenital ) टी बी

नवजात शिशु भी टी बी ग्रस्त हो सकता है।
यह बीमारी उसे अवल नाल ( Umbilical Cord ) के ज़रिये माँ के खून से मिल सकती है।
गर्भ में शिशु जिस तरल पदार्थ में तैरता है ( Amniotic Fluid ), वह भी जीवाणु युक्त हो सकता है और शिशु को संक्रमित कर सकता है।
जन्म के बाद आने वाली अंवल नाल ( Placenta and Cord ) को जाँच के लिए भेजना चाहिए ताकि संक्रमण का पता कर सकें।
अगर माँ को टी बी है तो जन्म के बाद शिशु की कुछ जाँचे की जाती हैं ताकि पता चल सके की वह संक्रमित है या नहीं।
जन्म के दूसरे या तीसरे हफ्ते से टी बी के लक्षण सामने आने लगते हैं। जैसे कि –
-बच्चे का ठीक से दूध न पीना
-बुखार
-कमज़ोरी
-चिड़चिड़ापन
-कान का बहना
-त्वचा पर चकत्ते
-साँस लेने में तकलीफ़

अगर शिशु में यह लक्षण दिखाई दें और टी बी का निदान करना आवश्यक समझा जाये तो निम्नलिखित जाँचो को किया जा सकता है –
– Mantoux test
-छाती का एक्स रे ( Chest X -Ray )
– फेफड़ों और अमाशय के पानी की जाँच ( Broncho-alveolar and Gastric Lavage )

निदान होने के पश्चात उचित उपचार तुरंत शुरू कर देना चाहिए।

अगर समय रहते टी बी का निदान और सम्पूर्ण उपचार किया जाए तो Tuberculosis यानि कि टी बी भी अन्य दूसरी बीमारियों की तरह पूरी तरह से ठीक हो जाती है।

सतर्क रहें सुरक्षित रहें।

6 Things To Remember If You Are Planning To Become Pregnant

6 Things To Remember If You Are Planning To Become Pregnant

A couple looking for pregnancy visits a gynaecologist. Here are the pointers to prepare them about what they may expect during this visit.
pregnant woman
1)History
Medical history– couple will be asked about the any existing or past illnesses . If they are on any regular medication. Specific questions will be asked about presence of diabetes and epilepsy.
Similar questions will be asked about the family and if there are any genetic disorders running in the family
Social history –With growing urbanisation, nuclear families are becoming a norm. There is loss of support in terms of someone taking care of you, whether it is cooking or doing house chores. Inquiry is also done about substance abuse, alcohol consumption and smoking.
Obstetrics ( previous pregnancies ) history of woman is asked

2)Examination
-A general medical examination is done.
-A note of nutritional deficiencies is made

3)Diet
Obesity as well as extreme underweight- both these clinical conditions are commonly encountered and may come in way of achieving pregnancy normally

4)Exercise
Exercising regularly is important to keep fit. At the same time you should not exhaust yourself. Augment heat dissipation by wearing light clothes and fluid replacement.

5)Investigations
A few routine and at times special tests are done
-HIV-to rule out infection
-HbsAg-to rule out infection
-VDRL-to rule out infection
-HCV- to rule out infection
-Hb Electrophoresis-to know about abnormal haemoglobin and Thalassemia
-Chromosomal microarray analysis-in cases of previous pregnancy loss
-Thyroid tests- T3, T4, TSH
-Pap’s Smear

6)Vaccines
A few vaccines are recommended
-Influenza vaccine
-Rubella- a blood investigation will tell if the woman is susceptible.Those who are yet unimmunized, vaccination is done
-Tetanus
-Varicella- Chicken pox- if not contracted previously, vaccine is given

5 Tips to Solve the Problem of Irregular Periods

5 TIPS TO SOLVE THE PROBLEM OF IRREGULAR PERIODS

1) Exercise and diet
-Regular physical exercise in the form of walking, jogging, yoga, dancing, cycling Is a must
-Regularisation of eating habits,  avoiding junk food and too much eating of outside food should be done
-Don’t skip breakfast
-Three square meals with dinner by 8 pm
-Two small in between healthy snacks on salads sprouts or nuts should be done
-Drink plenty of oral liquids
-Exercise & diet have a value as they will keep your body fit and weight under control

2)Healthy lifestyle
-Early to bed and early to rise was the ‘Mantram’ given by our elders.It still holds true
-Your body is the only place where you live. Take utmost care of it.
-Meditating for some time daily will calm your mind and will maintain positive outlook
-It is a scientific fact that stress causes hormonal imbalance
-Avoid unwanted factors in life, be it alcohol,smoke or excessive social media

3)Hormones check
-Most common cause of irreglar menses is hormonal imbalance
-Disorders of thyroid and prolactin hormones is commonly seen
-Diagnosis of these canditions can easily done in blood tests & subsequently medicines can be started
-PCOS(PCOD)- Poly Cystic Ovarian Syndrome- is another hormonal imbalnce disorder, which is now on a rise.Its diagnosis also depends on some specialized hormonal tests

4)Sonography
-Sonography tells us the structure of uterus and ovaries
-Abnormalities can be detected and appropriate treatment offered
-In cases of PCOS, at times hormonal tests in blood come normal, but when we do sonography of ovaries, we come to know that PCOS is a likely diagnosis

5)Treatment
-Taking prescribed medications on time is a must
-It may include hormonal or non-hormonal tablets
-Treatment may last uptoa period of 3-6 months
-Afterwards it is stopped
-Many a times normalization of menses occurs & no further treatment is required
-At times we also see cases where woman will experience recurrence of symptoms. These women will require repeat course of medicines