FAQ

The pregnant woman can surely take some actions to prevent getting the disease during pregnancy like:

  • Wash your hands frequently. Hand hygiene can really protect you from exposure to COVID-19. Practice social distancing. Always maintain a distance of at least 2 meters or 6 feet from others when you are in a public place. Avoid contact with others as much as possible.
  • Get your flu vaccination on time. Though the flu vaccine does not protect you from exposure to COVID-19, it does make you less susceptible to influenza, which can cause complications during pregnancy.
  • Use a tissue when you cough or sneeze, throw the tissue in the dustbin. Wash your hands right after.
  • Do not ignore any respiratory symptoms. If you develop a cough or any respiratory distress, do not hesitate to call your doctor.
  • As much as possible, consider virtual consultations instead of prenatal visits to your gynaecologist. Try to minimize or altogether avoid spending time in the doctor’s waiting room or in the hospital. However, some tests will require you to be there in people such as the ultrasound, blood tests, and fetal testing.
  • Work from home whenever possible.
  • Symptoms such as high fever with or without continuous cough may indicate a possible coronavirus infection. Avoid coming in close contact with anyone showing these symptoms.
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Due to the evolving nature of the disease it is still not clear about the high risk categories. The knowledge from past epidemics due to similar respiratory illnesses helps understand and manage viral infections during pregnancy. It is not yet known if pregnant women are more susceptible to be infected by COVID-19 when compared to the normal population. Despite this, pregnant women are advised to reduce social contact with social distancing. It is an established fact that in some women, pregnancy alters how the body fights some viral infections. Though evidence for coronavirus is still insufficient, it is for this reason that pregnant women are advised to be extra cautious during this pandemic. Pregnant women suffer from mild to moderate symptoms of cold / flu, such as cough, fever, shortness of breath, headache and loss of smell or taste .It is possible to transmit the virus to the child from a pregnant mother who is positive for COVID 19. However, the proportion of pregnancy in the studies is lower and there is no conclusive evidence of it and there is also no evidence of a virus found in amniotic fluid, cord blood or breast milk.

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There is definitely increased anxiety and stress levels among pregnant women during these pandemic times; it is very natural to feel extremely anxious about the situation. It is also important that the mothers –to-be visits doctor during pregnancy to ensure the wellbeing of herself and the baby. For routine checkups, the pregnant women can obviously opt for telemedicine. Many maternity hospitals are providing that facility so that expectant mothers are not exposed to unnecessary interaction with others. There are several plus points of opting for a virtual consultation. It saves a lot of time, energy and most importantly ensures they get treatment from the safety of their homes. But scans are also an important part of maternity care and thus routine scans helps in monitoring/ tracking baby and mother’s wellbeing. It is understandable to worry about being exposed to the virus while visiting the hospital, but it is important to know that many hospitals and birthing centers are taking the necessary steps to ensure that your visits are safe. Every member of the staff uses protective gear, there is enough spacing between couples in the waiting area to ensure social distancing, the surfaces (especially beds) are disinfected frequently and having temperature checks for both staff and the visitors. All hospitals have the necessary infrastructure for the testing and triage of COVID positive patients and they also have isolation rooms for suspected cases.

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The benefits of breastfeeding your infant far outweigh the risk of transmission of coronavirus through breast milk. In infants, the risk of COVID-19 infection is low; the infection is typically mild or asymptomatic, while the consequences of not breastfeeding and separation between mother and child can be significant. At this point it appears that COVID-19 in infants and children represents a much lower threat to survival and health than other infections that breastfeeding is protective against. The main risk of breastfeeding is due to the close contact between mother and the baby which can pose a risk of droplet infection that can spread to the baby while breathing. Some steps to follow to minimize the risk of transmission include washing hands before feeding or touching the baby, breast pump or bottles, avoid coughing or sneezing while nursing, wear a face mask while feeding, if available, if using a breast pump, follow instructions for cleaning and sterilizing properly. Consider asking one of the healthy family members to feed the baby if the mother is expressing milk.

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Currently there is no evidence to suggest that either mode of birth vaginal or caesarean birth protects or puts the infant at risk. The choice of vaginal or caesarean birth should be individualized based on the condition of the mother and the baby. The timing and method of the delivery should be by obstetric indications rather than the maternal diagnosis of COVID-19. In the case of pregnant women suspected or confirmed COVID-19 early in pregnancy and who recovered, there is no alteration to the usual timing of delivery. Whereas for pregnant women with suspected or confirmed COVID-19 in the third trimester- It is reasonable to attempt to postpone delivery (if no other medical indications arise) until a negative test result is obtained or quarantine restrictions are lifted in an attempt to avoid virus transmission to the neonate. Vaginal birth usually takes longer than caesarean delivery, which might increase the risks of infection of COVID-19 during the second stage. Until now there is no evidence whether Caesarean delivery would reduce the infection risks of COVID-19 for newborns.

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Home births are generally not advised in this COVID-19 situation owing to a lot of factors. The safest place for you to give birth is always a hospital or hospital-based birth center. Even the healthiest pregnancies can have problems arise with little or no warning during labor and delivery. If problems happen, a hospital setting can give you and your baby the best care in a hurry. It is important to not take any risks that might put you or your newborn’s health in danger, especially while there is a high risk of getting COVID-19. If a mother or child is not low risk, then no matter what the world pandemic status is, the best place for the mother and baby is to be in the hospital. If a medical emergency does arise during birth at home, you should also be aware of the very real risk that emergency transport services could be unavailable due to the coronavirus response and hence a hospital birth is much safer.

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Pregnant women are more worried because of lack of information on how COVID-19 might impact their baby's health.You can take these measures to help you reduce your anxiety and stress- Stay away from news and fake content on social media, Do not panic, Keep in virtual touch with family or friends, remain physically and mentally active at home, follow simple procedures to protect yourself from COVID 19 and seek medical care if you need more help. Relax your body by practicing breathing exercises such as stretching, meditating, or engaging in mindful movements. Mindful movements include slow, intentional activity such as walking, yoga, or exercise. Mindfulness has been found to help relieve anxiety, depression, and stress during pregnancy. Remember to stick to a healthy diet, including fruits, vegetables, and lots of water to drink. Pregnant women need seven to nine hours of sleep a night. Establish a good sleep routine to help achieve this goal. Human connection will help reduce symptoms of anxiety, depression, boredom, and loneliness. Though we can't physically be with loved ones right now, we can connect in other virtual ways.

You can now ask questions and do video consultation with doctors from Divakar’s Hospital app which can be downloaded from Google Play Store or IOS

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Take all the precautions that are recommended against COVID-19 ,be extra careful and do not go out of the house unless it is absolutely necessary. Eat more of protein, take vitamin C, vitamin D, garlic, Cinnamon and citrus fruits as they will help in boosting your immunity and protect you against coronavirus. The top immune boosting vitamins and minerals include Zinc which is important for wound healing and found in foods like seeds, nuts, whole grains, seafood, and milk. Vit A helps regulate the immune response and found in foods like spinach, carrot, sweet potato. Vit E found in green leafy vegetables or Avocado helps protect cells from oxidative stress which happens as a result of inflammation or infection. Intake of Iron aids in non-specific immunity which is the body’s first line of defense. Vit B6 taken during this time is useful to support more efficient reactions between different parts of our immune system.

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As of now there is no evidence to suggest that COVID-19 during leads to increase risk of miscarriage or birth abnormalities to the baby or mother having premature labour and also there is no evidence that suggest the virus can pass through mother to the baby during pregnancy. The risk that pregnant women are at a higher risk of developing blood clots due to COVID-19 than non-pregnant women. Now, experts suggest that pregnant women are already 5 times more likely than non-pregnant women to develop a blood clot. This happens due to various changes that occur in the bodies of women during pregnancy; the blood clots more easily to prevent excessive bleeding during labour and not being active during pregnancy may reduce blood flow to legs, further increasing the risk of clotting. SARS-CoV-2, the COVID-19 causing virus, has also shown to cause blood clotting in patients. A study has also found that blood clots were formed in the placenta leading to restriction of blood flow to the baby. Even though all the babies in the study were born in good health, it was suggested that pregnant women should be watched more carefully during the pandemic.

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Though there is no evidence that a COVID 19 infection can directly impact the growing fetus, the stress of being pregnant during the pandemic might. Fetal infections later in pregnancy appear to be rare, and there are studies to support that the coronavirus won’t warp early fetal development .Stressors during pregnancy can have a deleterious effect on fetal brain development. During times of extreme distress, the body releases a cascade of hormones into the bloodstream. Those stress hormones, which include cortisol, have the ability to cross the placental barrier between mother and baby. Some areas of the fetal brain are quite receptive to stress hormones. One of those areas is the hippocampus, which plays a major role in learning and memory. Stress though is a modifiable risk factor and there are numerous methods to bring down anxiety levels in to- be mothers. If they can manage stress without letting it overwhelm them, they will be able to avoid the negative consequences of stress in pregnancy with benefits right through their children’s lives.

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Mental disorders can affect women and men differently. Some disorders are more common in women such as depression and anxiety. Treating women requires a different approach than is used to treat men with the same illnesses. There are also certain types of disorders that are unique to women. For example, some women may experience symptoms of mental disorders at times of hormone change, such as perinatal depression, premenstrual dysphoric disorder, and perimenopause-related depression. When it comes to other mental disorders such as schizophrenia and bipolar disorder, research has not found differences in the rates at which men and women experience these illnesses. But women may experience these illnesses differently – certain symptoms may be more common in women than in men, and the course of the illness can be affected by the sex of the individual. Researchers are only now beginning to tease apart the various biological and psychosocial factors that may impact the mental health of both women and men.

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Women and men can develop most of the same mental disorders and conditions, but may experience different symptoms. Some symptoms include; Persistent sadness or feelings of hopelessness, misuse of alcohol and/or drugs, dramatic changes in eating or sleeping habits, appetite or weight changes, decreased energy or fatigue, excessive fear or worry, seeing or hearing things that are not there, extremely high and low moods, aches, headaches, or digestive problems without a clear cause, irritability, social withdrawal, suicidal thoughts. Perinatal depression affects some women within one year of giving birth. It is characterized by feelings of extreme sadness, anxiety, and tiredness that impact the woman’s ability to care for herself and her baby. Diagnosing postpartum depression is challenging because the symptoms vary from woman to woman, and many of the symptoms are easy to attribute to some other cause. Serious conditions such as schizophrenia, bipolar disorder, depression, and anxiety are often difficult to diagnose.

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Postpartum psychosis is rare. It happens in up to 4 new mothers out of every 1,000 births. It usually begins in the first 2 weeks after childbirth. Many women will experience mild mood changes after having a baby, known as the "baby blues". This is normal and usually only lasts for a few days. But postpartum psychosis is a serious medical condition. Women who have bipolar disorder or another mental health condition called schizoaffective disorder have a higher risk of postpartum psychosis. Symptoms may include; Seeing or hearing things that aren’t there, feeling confused most of the time, having rapid mood swings within several minutes , trying to hurt yourself or your baby, paranoia, restlessness or agitation, behaving recklessly or in a way that is not normal. The most significant risk factors for postpartum psychosis are a personal or family history of bipolar disorder, or a previous psychotic episode. Of the women who develop a postpartum psychosis, research has suggested that there is approximately a 5% suicide rate and a 4% infanticide rate associated with the illness.

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There are many young women and girls who deal with a range of mental health conditions, including depression, anxiety, adjustment disorders, eating disorders and addictive behaviors. Parents of young girls should start to tune in to their child's mental well-being from the day their child is born. They should be taught about emotions, and what they can do when they have big feelings and model positive behavior. Mental health can affect a person's decision-making skills. So the girls should be talked to about how it is necessary to have a plan for how to work through emotions when they happen. This could be talking with a friend or a trusted adult, listening to music, or performing physical activity like going for a run or a walk. Hold back from asking a lot of questions, but make it clear that you’re ready and willing to provide whatever support they need. Teen depression goes beyond moodiness. It’s a serious health problem that impacts every aspect of a teen’s life. Fortunately, it’s treatable and parents can help. The parent’s love, guidance, and support can go a long way toward helping the teen overcome depression and get their life back on track.

Divakar’s Hospital has a speciality clinic for Adoloscents – YUVA Care Clinique.

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By the teenage years, girls are much more at risk than boys. Before puberty, the prevalence of mood disorders is about the same in boys and girls—3 to 5 percent. But by mid-adolescence girls are more than twice as likely to be diagnosed with a mood disorder as boys. Teens with depression don’t necessarily appear sad. Instead, irritability, anger, and agitation may be the most prominent symptoms. While there is no one way to prevent mental illness, pay attention to emotions, thoughts and behaviors, and be open to seeing a health professional. Sometimes symptoms, such as depression and anxiety, may manifest themselves in physical symptoms, such as headaches, muscle tension, or the inability to sleep or eat. Other symptoms can be withdrawal from friends and activities, significant tiredness or low energy, irritability, extreme mood changes of highs and lows, or excessive fears or worries. Depression is very damaging when left untreated, so don’t wait and hope that worrisome symptoms will go away.

Divakar’s Hospital has a speciality clinic for Adoloscents – YUVA Care Clinique.

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When a child is depressed or anxious, her suffering isn’t the only reason it’s important to get help. In addition to the disorders themselves, there are add-on effects that may cause lifelong issues. With depression comes low energy and poor concentration, two factors that are likely to have a significant impact on social and academic functioning. Anxiety, and the withdrawal that may accompany it, is likewise a detriment to social and academic progress. It’s easy to see the effects of poor academic functioning: falling behind in school undermines a child’s confidence and self-image, and can impact her future if it’s prolonged. But social learning is just as critical as academic learning in childhood and adolescence. This is a time when a girl would normally be learning such things as how to be a daughter, a sister, a friend; with either depression or anxiety, she may miss or fall behind on these critical kinds of learning. These deficits not only put her behind her peers, but in themselves they can compound her depression or anxiety. Fortunately, early involvement of health care professionals can shorten the period of illness and increase the likelihood of her not missing important life lessons. The most common treatment a mental health professional is apt to use is some form of cognitive behavioral therapy, and depending on how young the child is, it may involve teaching the parents as well.

Divakar’s Hospital has a speciality clinic for Adoloscents – YUVA Care Clinique. Youngsters can also discuss their health issues with specialists through Divakar’s Hospital app, which can be downloaded from Google play store or ios

Social stigma, care giving responsibilities, and gender-specific risk factors all contribute to increased rates of mental health disorders and disability among women worldwide, Women suffer more stress than men because their response to stress is different. Women have a completely different hormonal system, which as a result causes them to react more emotionally and become more exhausted on an emotional level. Women are more often the primary caregivers in families and can experience stress balancing their multiple roles: mother, employee, friend, etc. Consequently, while women may share many health concerns with men, they have unique health-care needs. This long-term stress can contribute to both physical and mental illness through effects on the heart, immune and metabolic functions, and hormones acting on the brain. Some of the emotional and behavioral symptoms of stress overlap with those of mental health conditions like anxiety or depression. Women who are depressed report more physical symptoms than men.

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Women with good mental health can experience happiness and sadness, anger, and excitement, all in healthy ways. When you have good habits to improve mental health, it means your mind can perform all its functions appropriately. A variety of factors can affect women’s mental function and health. These factors can be as simple as being sleep-deprived or hungry or as complex as eating disorders and major depression. Depending on your state of mental health, you can increase your wellbeing with healthy habits. Good habits to improve mental health will look different for every woman. To help maintain good mental health, you can, exercise regularly, practice mindfulness, get eight hours of sleep each night, express gratitude for things and people in your life, say positive things about yourself and others, make new friends and connections, participate in activities you enjoy. However, if you face a condition such as depression or an anxiety disorder, these healthy habits alone may not be enough to improve your mental health.

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Mental health disorders can happen to anyone, and there is no single, known cause for why some people develop a mental health disorder, and others do not. Several aggravating factors can trigger underlying mental health disorders in susceptible people. When compared to men, women are more likely to opt for treatment or assistance. Doctors are more likely to prescribe psychotropic medications to women than men. Taking Medication for mental health issues is not a taboo. The fact that the affected ones come forward after realizing they have issues in itself is commendable. Physiological changes often accompany mental illnesses, which may demand medication, depending on the stage of diagnosis for each individual. Unfortunately, the stigma around mental health makes it hard for anyone going through it to accept this. It is hard to accept that such a problem can affect one’s own, but putting aside the stigma and seeking help is the only way forward. The bodily changes that happen as a result of mental health issues can get better with medication just like for any other illness. And it is important so that the disease will not escalate and will be harder to recover from.

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It does not matter how much your dear and near ones want to help you get through a mental illness. Only a professional can guide you on how to do it. One may often worry about how they are being judged when speaking to a friend or a family member about feeling mentally ill. The best thing about talking to a professional therapist is that they are giving you advice or guiding you in recovery without any prejudice, judgment, or personal equation getting in the way. There is nothing wrong with going to a therapist once in a while even if you are not particularly ill. It’s about learning to cope with the tough times that we live in. Some people may not be comfortable with therapy. They’re afraid they’ll have to go back into their childhoods. But modern therapy is designed to be short term. It focuses on problems and solutions. Research has shown that it is very effective in treating mental illness. It’s usually most effective when used in combination with medicine.

Most pregnancy symptoms begin to go away within 24 hours after the abortion, with nausea usually gone by the third day. Abortion recovery times vary from woman to woman. Women who have first trimester abortions and those who do not have any complications will usually feel normal within a few days. The Recovery times for every woman is different post uncomplicated pregnancy termination, and it will depend on how long pregnant (gestation) at which the untimely birth happens. Mostly it will take few weeks’ time to recover for women. After a medical abortion the process may happen within four to five hours and is normally finished within one to two days. Bleeding, cramping and passing clots is common after this. Once the pregnancy has been passed, the bleeding will decrease and this will continue till the uterus contracts and returns to its normal size. After the second tablet the bleeding and cramping will most likely be there for up to 2 weeks. The bleeding should stop within 6 weeks. However, the recovery may take longer for late-term abortions.

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Medical Abortions and Surgical Abortions are the two procedures performed to end an unintended pregnancy or women who have maternal or foetal indications to end their wanted pregnancies. A medical abortion procedure, also known as a medication abortion is a non-surgical procedure that is used to terminate an unplanned pregnancy. The procedure is performed by taking two types of medications. A medical abortion works by terminating pregnancies in the first, second and third trimesters of pregnancy. A woman can usually access medical abortion until about 10 weeks after her last period. Surgical abortions are also called in-clinic abortions. The two types of surgical abortions are aspiration abortions & dilation and evacuation (D&E) abortions. If a woman is 10 or more weeks into her pregnancy, she cannot opt for a medical abortion. Women up to 15 weeks pregnant can have an aspiration abortion, while D&E abortions are typically performed at 15 weeks or after.

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A medical abortion can be done at home provided a doctor is consulted in the event of any complications. The prescription should also be obtained from a doctor for this. There are an increasing number of fake doctors or quacks writing out abortion prescriptions and this can be extremely detrimental. Medical abortion can be done using the medications: Oral mifepristone (Mifeprex) and oral misoprostol (Cytotec). Keep in mind that medical abortions are only recommended if you’re 10 weeks pregnant or less. For safety, what is important is that women have access to the medicines and get accurate information on how to use the medicines, what to expect after taking the medicines, and how to identify signs of a possible complication. The process of medical abortion is similar to a miscarriage. A medical abortion doesn't require surgery or anaesthesia and can be started either in a medical office or at home with follow-up visits to your doctor. It's safer and most effective during the first trimester of pregnancy.

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The experience of an abortion varies between individuals. Abortions may cause some pain or cramping, but it is quite manageable for women. The level of pain that a woman may experience largely depend on the type of abortion she has. Medical abortions may cause some pain and cramping because they cause the uterus to contract to expel the pregnancy tissue. Every woman who has a medical abortion will respond differently. Some women describe the experience as being similar to having a heavy period and cramps. Others may experience more intense cramping.The short answer is that it’s different for everyone.Whether it hurts depends on several unique factors, such asoverall health, including underlying medical conditions, how far along the pregnancy is, the general pain tolerance, the type of abortion chosen and the patient’s emotions and stress level. A majority of the women have abdominal pain after taking the tablets but if the pain is severe and not helped be analgesics then medical attention will be required.

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Once you have met with a doctor and decided to opt for a medical abortion. The doctor will first evaluate your medical history and overall health, the pregnancy will be confirmed with a physical exam. Before the process an ultrasound exam will be performed to date the pregnancy and confirm it's not outside the uterus (ectopic pregnancy) and not a tumour that developed in the uterus (molar pregnancy). Routine blood and urine tests will also be done. The doctor will explain how the procedure works, the side effects, and possible risks and complications. Having a medical abortion is a serious decision. Talk with your doctor, a to get answers to your questions, help you weigh alternatives and consider the impact the procedure may have on your future.If an abortion procedure is done for a miscarriage, there are no special legal requirements or waiting periods required.Medical abortion doesn't require surgery or anaesthesia. The procedure can be started in a medical office or clinic. A medical abortion can also be done at home, though you'll still need to visit your doctor to be sure there are no complications.

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After the medical abortion, the patientwillexperience vaginal bleeding and abdominal cramping. This is to be expected, as it is a result of your uterus expelling the pregnancy and indicates that the procedure has been successful. After the insertion of the misoprostol medication the patient might also experience blood clots, nausea, vomiting, diarrhoea, constipation, headache, breast tenderness, low-grade fever, chills, dizziness, fatigue. These usually clear up in a day or two. Although misoprostol is usually taken orally, some take it vaginally, buccally (between teeth and cheek), or sublingually (under the tongue). Vaginal, buccal, or sublingual medications may have fewer side effects than oral medications. These drugs block pregnancy hormones and also cause uterine contractions to push the embryo out. It can take four or five hours for tissue to be expelled. Rather large clots are also usual during this time. This will slow down after a few days, but you may continue to bleed or spot for a couple of weeks.

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The doctor will most likely give medications to manage pain before the procedure.Strenuous exercise or sexual intercourse is best avoided for the first week. Rest from the normal work routine is the best way to manage cramping and bleeding. Breast tenderness and swelling may last up to 2 weeks. Ensure that whatever analgesics is taken for the pain is prescribed by the doctor as others drugs might counter-act the misoprostol.Drink plenty of fluids to prevent faintness or dizziness. You may eat lightly.If you get up from lying down, get up slowly and use support.It is best to have a caregiver help during the cramping and bleeding phase of the process. Sanitary pads can be used for the bleeding but tampons should be avoided. You may pass what appears to be a small glob of tissue in addition to blood clots. Eventually, the heavy bleeding and cramping will diminish.

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Medical abortion procedures are available for terminating a pregnancy during the early weeks of the first trimester.Abortions performed in the first trimester are the safest. Medical abortion should not be attempted if the pregnancy is more than 9 weeks old. Some types of medical abortion aren't done after seven weeks of pregnancy. The first trimester refers to the first 12 weeks of pregnancy. Third-trimester abortions are often done only if the mother’s or the baby’s life is in danger. The reasons for having a medical abortion are highly personal. You can choose medical abortion to complete an early miscarriage or end an unwanted pregnancy. You can also choose to have a medical abortion if you have a medical condition that makes continuing a pregnancy life-threatening. For women seeking a medical abortion procedure, a sonogram is done to determine if the pregnancy is viable (uterine, non-ectopic pregnancy) and for accurate pregnancy dating.

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Abortion starts a new menstrual cycle, so the period should go back to normal 4-8 weeks after your abortion.The first periods after a medical abortion may be heavier and longer than before. If a woman’s periods do not start 8 weeks after an abortion or return to normal after 3 months, she should see her doctor. How abortion can affect the menstrual cycledepends on many factors, including the type of abortion and what the period was like before. Postabortion bleeding is normal. This bleeding might look like the monthly period, but it isn’t the same.Some people don’t bleed at all after an abortion. They won’t start to bleed until their next period.How much time elapses before the first post-abortion period depends, in part, on how far a pregnancy it was. Pregnancy hormones may remain for a few weeks afterward, causing a delay in menstruation. The first period after a medical abortion is likely to be longer than before. This irregularity is due to hormones and menstrual cycle returning to normal.It’s ok for some people to have irregular cycles for the first few months after their abortion.

Pregnancy involves the release of various hormones and substances in the body of a woman to help her body adjust to the new task. After an abortion, your body won’t just have to recover physically, since it is an invasive procedure, but hormonally as well, as a major process of pregnancy is stopped. Because of all these, there is always a risk connected to an abortion. This is why there is only a limited number of abortions a woman can endure during her lifetime. The optimum number though varies for each woman based on her medical history, health problems, and many variables.There are women who have faced two or three abortions and still enjoyed a good health afterward. But there are also women who suffered from complications after their first abortion. It is highly recommended to use the various contraception methods available if the woman has undergone two abortions. never good to push your luck and to subject yourself to further risks. Basically, there is no pre-set number of abortions that a lady should have in her lifetime.

Low body fat is one of the reasons that is attributed to delayed menarche. The body does require an optimum amount of fat to enter the puberty phase and make way for the first menstruation. Adolescents with eating disorders like with extreme dieting or binging and purging are most vulnerable because a lack of balanced and nutritious diet has found to be another cause of delayed menarche. Constitutional delayed puberty could also be inherited from parents because of its genetic predisposition. Delayed puberty may also be because of the ovaries being damaged or not developing properly called ovarian insufficiency. A lack of the pituitary hormones' LH and FSH, also called gonadotropins or pituitary deficiencies including the growth hormone can make girls start puberty late. Some other causes of delayed menarche can be health issues such as inflammatory bowel diseases (IBD), anaemia, diabetes mellitus, kidney disease, and cystic fibrosis, radiation or chemotherapy treatment, Autoimmune disorders like Addison's disease and Hashimoto's thyroiditis or even tumours of the pituitary gland or hypothalamus, which can affect hormone production.

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The Adolescent period is usually considered to begin with the onset of puberty and is characterized by cognitive, psychological, emotional, and sociocultural changes. The psychosocial effects of a delayed menarche or amenorrhea is of great concern among such girls. The peers in the same age category can cause some amount of psychological stress and thus teenage girls must be given counselling and guidance to cope with this. Psychosexual development is influenced by numerous biological, psychological, and social factors. There is a likelihood that a delayed puberty can affect psychosexual development. Adolescence is a critical period of growth for both girls and boys and this is the time when almost half of the bone density is achieved. A delayed menarche can mean delayed bone development and hence the increased risk of fractures or curved spinal bones and could also make way for osteoporosis at a later stage in life. A delayed menarche could have some effect on the normal development of reproductive functions but it is not a determinant of fertility though. Testosterone and oestradiol are the top contributors of developing secondary sexual characteristics and a delayed menarche may signify an imbalance of required hormones.

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One of the best predictors of menarche age is skeletal age and body mass index. Apart from genes or external factors, diet does play a role in menarche age. Faster-growing and taller girls with a higher BMI or better composition of body fat was found to reach menarche earlier. Body composition means the different body compartments which constitute the human body like the lean body mass, fat mass and water. An optimum amount of body fat is essential for sexual maturation and this is important for the onset of menarche. An altered ration of lean mass to body fat because of the effect of diet seems to delay menarche. The quality of food intake influences the onset of puberty because the intake of fat, vegetable and animal protein have shown to greatly influence age of onset of menarche.Nutritional factors that have been associated with a younger age at menarche have included both higher and lower energy intakes, higher animal relative to vegetable protein intakes, and lower intakes of phytoestrogens.

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The start of the woman’s reproductive capacity is marked by menarche. The age of menarche does have a genetic component associated with it. Other external or environmental factors also affect the age of menarche but genes are also a major contributor. The identification of the genes that contribute to puberty and the timing of menarche has helped us to understand the physiological mechanism of this trait and the fertility and health risks associated with this. Many studies have proven that genetics, and not diet, has the biggest influence on when a girl starts her periods. Family history has a greater effect than lifestyle and a girl’s environment on the menarche age. Certain genes have found to alter the estrogenic biological activity and this in turn could affect the maturation of the hypothalamic pituitary-gonadal axis which is responsible for the onset of puberty or menarche. Children with Leptin gene mutations were also found to have delayed puberty. A family history of delayed menstruation is one of the most common causes for the primary amenorrhea condition.

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Most doctors recommend a medical investigation in the absence of signs or onset of puberty in girls by 13 years of age but no later than 14.5 years. But if the child feels pressured or isolated among her peers because of this then counselling can help to counteract the associated anxiety. It is important that both the parents and the child understand that this deviation from the normal time course is treatable and not a serious developmental issue. In the case of delayed puberty and menarche, the preliminary diagnosis can be made based on factors like clinical signs, family history. Serum FSH levels. A medical diagnosis can also be done to check the other hormones like evaluating pituitary deficits by measuring IGF-I, T4, TSH and cortisol. A decreased composition of body fat could be the reasons for low levels of LH, FSH or oestradiol. Very high levels of LH and FSH will indicate that the ovaries are not working properly causing the pituitary to work even harder. A hand X-ray can help determine the bone age. When the bone age is lesser than 11 years with growth failure a delayed puberty is expected and when the bone age is much greater than 11 years also calls for further investigation of a condition called hypogonadism. A pelvic abdominal scan could also give an insight into the uterine or ovary health.

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A woman’s reproductive life is marked by milestones like menarche and menopause. The age of menarche and the age at which a woman enters menopause is not connected biologically. An early menarche will not necessarily mean that the woman will enter menopause early. To some extent the age of menarche and the age of menopause are controlled by genes. But the beginning age of both changes to the reproductive system is in no way connected. In the same way getting a period at an early age will not make your adult life window to conceive shorter. The duration of the reproductive period may be an indicator of the cumulative exposure to oestrogens and progestogens during the life course. Every woman’s body is different and hence the reproductive mechanisms too so no such connection has been established thus far. The studies show that the delayed age of menarche is in no way an indicator of menopause or the duration of the reproductive period or even fertility.

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The Thyroid hormone affects every cell in the body and it can be responsible for an array of problems like fatigue, elevated cholesterol, hair loss, and dry skin and menstruating problems. Hypothyroidism have found to cause delayed pubertal development in children. There are many ways in which the thyroid hormone could affect menstruation. Thyroid disease causes failure to ovulate with resulting progesterone deficiency. Both hypothyroidism and hyperthyroidism disturb pituitary hormones and hypothyroidism deprives the ovarian follicles of the thyroid hormone they need to develop. The thyroid also triggers release of prolactin by the pituitary gland. Prolactin interferes with the production of oestrogen from the ovaries, causing infrequent or absent periods. Hypothyroidism impairs insulin sensitivity, which is one reason thyroid disease is associated with polycystic ovarian syndrome.Hypothyroidism reduces sex hormone binding globulin which causes higher oestrogen exposure and therefore heavy periods. In contrast, hyperthyroidism can cause light periods because of the increase in coagulation factors. Abnormal menstruation is a potential clue to an underlying thyroid condition, but not a definite indicator of a problem.

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When compared to sedentary girls, those who participated in sports were found to experience delayed menarche at least by a year or two. There have also been speculations that sports activity may adversely affect sexual development and reproductive functions in girls. One explanation could be that 82% of the former athletes begin training for their events in high school or before that. All the exercising could mean that they turn leaner which consequently means low levels of oestrogen. Most of the oestrogen gets metabolized to non-potent catechol oestrogens. Succeeding in sports usually makes girls maintain pre-pubertal body habits longer like thin physique, narrow hips, long legs and low body fat composition. The female reproductive system is highly sensitive to physiological stress, and reproductive abnormalities so rigorous physical activity could be associated with some risks for female athletes. The menstrual problems in puberty may also be because of the energy drain as well when inadequate energy intake can cause hormonal imbalances.

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The age of menarche or first period is a determinant of many things in a woman’s life like the risks of developing breast cancer or even heart disease. But there are no studies so far that proves that a delayed menarche could be responsible for a woman’s fertility. Women who started menstruating late does not signify any reproductive problems. Delayed menarche has to do with various external factors and genetics perhaps but not fertility. The only issue will be if the late menstruation is because of some underlying issue like polycystic ovarian syndrome or an underactive thyroid condition called hypothyroidism. Women with PCOS could struggle with fertility. But with timely treatment and proper medications the thyroid’s production of hormones can be improved as well as the odds for getting pregnant. In both these cases the fertility is due to a health issue and not to do with the woman’s age of menarche.

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