womens disorders.ppt

Dr. Shamanthakamani Narendran

M.D. (Pead), Ph.D. (Yoga Science)

Internal Genital Organs Female

• A pair of Ovaries - the primary reproductive organs

• A pair of Fallopian Tubes - uterine tubes

• The Uterus - body & cervix

• The Vagina - receives male sperm

1. Adolescent girls.

2. Pregnant women.

3. Middle-aged women.

4. Elderly Women.

HEALTH DISORDERS IN WOMEN

PMT

Dysmenorrhea

Amenorrhea

Obesity

Recurrent abortions

PML

After caesarean

Infertility

Uterine prolapse

Hysterectomy

Urinary incontinence

Menopause

Arthritis

Back pain

Knee pain

Hypertension

Diabetes

Rehab. HIV/AIDS

Stress may be physical, psychological, or some combination of the two.

Changes occur in

A. Autonomic nervous system

B. Endocrinal system

TYPES OF STRESS

Machines have replaced manual labour

Calculators and computers in modern age

Reduced the necessity for thinking

Has led to mental lethargy in most workers of the developed countries also

A menstrual cycle consists of two phases:

1. Pre-ovulatory phase lasting 2 weeks, during which the maturation of an egg follicle occurs.

2. Post-ovulatory phase which follows the release of ovum and lasts 14 days.

Ovulation - This is the process by which the mature oocyte is released from the primordial follicle.

FERTILIZATION

MENSTRUAL DISORDERS

Dysmenorrhea

1. Painful menstruation.

2. Release of prostaglandin

3. Primary dysmenorrhea or spasmodic or functional

4. Secondary dysmenorrhea.Treatment: 1. Analgestics, antiprostaglandins 2. Anovulatory cycles are known to have painless menstruation 3. Hormonal therapy is unsafe to use for long term therapy.

Amenorrhea

1. Absence of menstruation

2. Pathological causes are diseases of hypothalamus, pituitary, thyroid, adrenal glands, ovarian disorders, congenital disorders of genital organs and chromosomal abnormalities.

3. “Anorexia Nervosa” – Typically seen in young, emotionally unstable girls and also in over weight teenagers who go on “crash diet.”

Premenstrual tension (PMT)

1. Tremendous effects on mood and mental state of each person

2. Commonly precipitated a week to 10 days prior to menstruation

3. Depression, irritability, anxiety, fear of varying degrees are complained in this condition of PMT

4. Marital disharmony to suicidal tendencies

Menopause

The end of female menstruation and fertility.

These changes can begin as early as age 35 or as late as 59.

Symptoms of Menopause

      Hot flushes - sudden warmth and then sweating; affecting about 75% of women.

o       Sudden facial warmth

o       Facial flushing

o       Facial tingling

o       Flush spreads to neck and/or body

o       Cold sweat - usually after the flush subsides

Dysfunctional uterine bleeding (DUB)

1. Abnormal uterine bleeding not due to any organic gynecological disease.

2. Imbalance in cyclical sex hormone production.

3. Irregular menstrual cycles, excessive or prolonged bleeding.

Treatment:1. Both amenorrhea and DUB are treated with cyclical sex hormones

i.e., combination of estrogen and progesterone.2. In most cases it necessitates the removal of the organ itself i.e.,

hysterectomy, as a symptomatic relief.

Uterovaginal prolapse Is the downward displacement of the vagina and uterus, which is common and disabling condition. There are three stages of prolapse depending on the degree of descent of the uterus. Grade III is otehrwsie called procidentia where in the whole uterus lies outside the vaginal introitus.

The vaginal prolapse alone can occur without the descent of uterus. The terms cystocoele or urethrocoele are applied when the upper or lower portion of the anterior vaginal wall descends along with the underlying structure i.e., the bladder or urethra respectively. Similarly, the posterior vaginal wall prolapse in termed rectocoele or enterocoele where in rectum or a loop of intestine can herniate into the prolapse. Uterine prolapse is usually combined with vaginal prolapse where as the latter can occur independently.

Normal supports of uterus and vagina

The uterus and vagina are kept in position in the pelvis by several supporting ligaments and muscles which acts as opes on either side of the uterus to keep it in position. The transverse cervical ligaments on either side and utero sacral ligaments at the back, form the chief supports of uterus. The round ligaments are less important supports. All these ligaments act like spokes of a bicycle wheel. Each is weak by itself but together forms a strong mechanism.

The levator ani is a large sheet of thick strong muscle which spreads to form the floor of the pelvis. In the middle of which three important structures pass through. They are rectum, urethra, and uterine cervix. The firm attachments of levator ani to pelvis bones and its muscular tone support the three canals. The other muscles of importance are the perennial muscles and the muscles of utogenital diaphragm. All three groups of muscles are important in controlling the mechanism of urinary continence and defecation.

Etiology of utero-vaginal prolapse

The recognised causes of weaknesses of supporting tissues are

1. Congenital weakness occurs in small proportion of cases.

2. Effects of pregnancy and parturition.

3. Menopause

4. Obesity and chronic bronchitis and abdominal tumors

Hysteroscopy Diagnosing and treating problems in the uterus.

Examination of the inside of the uterus.

Two types of hysteroscopy

– Diagnostic hysteroscopy

– Operative hysteroscopy.

What the doctor looks for

• Fibroids.• Polyps.• Adhesions or septum.• Cancer.

Hysterectomy

1. Female reproductive organs.

2. Menstrual cycle – estrogen and progesterone.

3. Menopause – between age 45-55.

Problems that hysterectomy can treat

1. Endometriosis.

2. Fibroids.

3. Pelvic relaxation.

4. Cancer.

Total hysterectomy with salpingo-oophorectomy

Sub-total or partial hysterectomy

HEAVY BLEEDING / HEAVY PERIODS

What causes heavy periods?

Hormonal imbalance.

In other cases, heavy bleeding may be due to,

1. Fibroids

2. Polyps

3. Endometriosis

4. Neoplasia

5. Blood clotting disorders

ProScan women’s imaging

1. Screening Mammography.

2. Diagnostic mammography

3. Breast ultrasound

4. Breast biopsy

5. Bone densitometry

INCONTINENCE (URINARY LEAKAGE)

People with stress incontinence may, 1. Leak urine when they cough,

sneeze or laugh.

2. Go to the bathroom more frequently in order to avoid accidents.

3. Avoid exercise because they are afraid this will cause leaks.

4. Sleep through the night, but leak upon getting up from bed in the morning.

5. Sometimes be incontinent when they get up from a chair.

People with overflow incontinence may,

1. Get up frequently during the night to urinate.

2. Take a long time to urinate and have a weak, dribbling stream with no force.

3. Urinate small amounts and not feel completely empty afterward.

4. Dribble urine throughout the day.

5. Fell the urge to urinate, but sometimes cannot.

People with urge incontinence may,

1.Wet themselves if they do not get to the bathroom immediately.

2.Get up frequently during the night to urinate.

3.Go the bathroom at least every two hours.

4.Feel they have a week bladder and that each drink of coffee, cola, or alcohol seems to cause urination our of proportion to the amount they actually drink.

5.Wet the bed at night.

People who have urge incontinence in addition to stress incontinence or overflow incontinence have a combination of these signs and symptoms.

Diagnostic tests

1.Urine culture.

2.Urine flow.

3.Cystoscopy.

4.Cystometrogram.

5.Cystogram.

Treatment

1.Pelvic floor muscle exercises.

2.Medication.

3.Surgery.

INCONTINENCE (URINARY LEAKAGE)

Infertility

The goals of infertility evaluation are twofold: to The goals of infertility evaluation are twofold: to discover the aetiology and to provide a discover the aetiology and to provide a prognosis for future treatment.prognosis for future treatment.

Failure to conceive during two years of Failure to conceive during two years of adequate opportunity is enough justification for adequate opportunity is enough justification for a full investigation of the couple as a unit. a full investigation of the couple as a unit. Indeed, a clinical examination of both partners Indeed, a clinical examination of both partners is indicated as soon as any couple becomes is indicated as soon as any couple becomes worried.worried.

Causes of infertility The clinician should be familiar with the causes

of infertility in his own population as the aetiology varies considerably even in the same region among different peoples.

A tentative list of the factors and common conditions leading to infertility is given below as a guideline.

1. Male factor – singly or in combination with others: a) Disorders of spermatogenesis, b) ductal obstruction, c) ejaculatory failure, d) abnormalities in the semen.

2. Vaginal and cervical factors: a) vaginitis, vaginismus, b) cervicitis or anatomical abnormalities, c) cervical hostility.

3. Uterine factors: a) Myomata or polyps, b) congenital malformations, c) synechiae

4. Ovulation disorders: a) Anovulation, b) Iuteal phasse defects, c) amenorrhoea, d) Luteinisation of unruptured follicles (LUF)

5. Tubo-peritoneal factors: a) Pelvic inflammatory disease (post-abortal, puerperal, iatrogenic, STD), b) pelvic tuberculosis, c) endometriosis, d) pelvic peritonitis.

6. Immunologic factors: a) Sperm antibodies in serum, b) sperm antibodies in cervical or vaginal secretions or seminal plasma.

7. Endocrine or metabolic disorders:

a) diabetes,

b) thyroid disorders,

c) severe malnutrition,

d) hyperprolactinaemia.

8. Psychogenic infertility

9. Unexplained infertility.

Factors in the FemaleVaginal and cervical factors Immunologic factorsUterine and endometrial factorsOvarian factorsAnovulationTubo-peritoneal factorsPsychogenic factorsPrognosis in infertilitySurgical treatment of infertility

Male factor in Infertility – Treatment

Artificial Insemination – Counselling

In vitro fertilisation & Embryo transfer (IVF & ET)

Prevention of infertility

EARLY PREGNANCY LOSS

1. Miscarriage.

2. Ectopic pregnancy

3. Molar pregnancy.

SURYA NAMASKARSURYA NAMASKAR

Three cardinal principles of yoga

A. Relax the body

B. Slow down the breath

C. Calm the mind

YOGA THERAPY

CYCLIC MEDITATION

A. Stimulation – Relaxation combination.

B. A holistic life style for effective stress management.

MANDUKYA UPANISHAD

LAYE SAMBODHAYET CITTAM

VIKSIPTAM SAMAYET PUNAH

SAKASAYAM VIJANEEYAT

SAMAPRAPTAM NA CALAYET

STABILISE

RELAX

STIMULATE

RECOGNISE

Series of successive stimulations and relaxations that can solve the complex problem of the mind.

Help to release stresses at deeper and deeper levels.

THE SEQUENCE OF PRACTICE

Instant Relaxation Technique [IRT] Standing up for Tadasana from left

side. Relaxation and centring in Tadasana. Ardhakati Cakrasana. Pada Hastasana. Ardha Cakrasana. Coming down to Savasana from right

side.

Quick Relaxation Technique [QRT] Raising up straight (with the support of

elbow and palms) Relaxing in leg stretch sitting pose. Vajrasana. Sasankasana and return to Vajrasana. Ustrasana or Ardha Ustrasana. Relaxing in leg stretch sitting pose. Going straight back (with support of

elbows and palms.

Deep Relaxation Technique [DRT] Coming up straight (without support) Any comfortable sitting position

(Vajrasana preferred).

INTEGRATED YOGA MODULE FOR MENSTRUAL DISORDER – I

Breathing practices Hands in and out breathing Hands stretch breathing Ankle stretch breathing Tiger breathing Sasankasana breathing Straight leg raise breathing Cycling Quick relaxation technique (QRT)

(Heavy Periods and Frequent Periods)

YogasanasStanding Ardhakati cakrasana Ardha cakrasana Padahastasana Viparita karani with wall support Quick relaxation technique (QRT) Setubandhasana Halasana Matsyasana Ardha Sirsasana/Sirsasana Bhujangasana Ustrasana Deep relaxation technique (DRT)

PranayamaKapalabhatiVibhaga pranayama (Sectional breathing)Nadi suddhi

Meditation (Dhyana Dharana)NadanusandhanaOM meditation

KriyasJala NetiVaman Dhouti

INTEGRATED YOGA MODULE FOR MENSTRUAL DISORDER – II

Sithilikarna Vyama (Loosening Exercises) Jogging Forward & Backward bending Side bending Twisting Butterfly loosening Baddhakonasana exercise Tiger stretch Pavanamuktasana kriya Situps from standing position Halasana Pascimottanasana exercise Suryanamaskar Quick relaxation technique (QRT)

(Decreased flow, pain during menses, less frequency periods)

Yogasanas Bhujangasana Salabhasana Dhanurasana Malasana Supta Vajrasana Janusirsasana Ardha Sirsasana/Sirsasana Viparitakarani Kriya and Banda Sarvangasana Matsyasana Halasana Sasankasana Marichyasana Deep relaxation technique (DRT)

Pranayama Kapalabhati Vibhaga pranayama (Sectional breathing) Surya Anuloma Chandra Anuloma Nadi suddhi Sitali/Sitkari/Sadanta pranayama Meditation (Dhyana Dharana) Nadanusandhana OM meditationKriyas Jala Neti Sutra Neti Vaman Dhouti Laghu – Sankha praksalana