Health Education

FAQ

Some common questions about your health answered by Top Gynaecologist Dr Manjit Singh Sidhu.

Q: My daughter is aged 15 years. She keeps having pain in her tummy. Which doctor should I take her to?

A: The first doctor to be contacted in case of a problem is usually a family doctor. However, if the problem is occurring again and again or is severe, it is better to get workup done by a gynaecologist so that important gynaecological conditions which present with pain in this age group are not missed.

Q: My daughter is aged 7 years. I noticed that she has developing big size nipples and is having spotting. Is it normal for her to have periods?

A: Age of 7 years is very early to have periods. If she is having a breast growth and or even periods, she may be suffering from a condition called Precocious Puberty.

In such cases the child gets into puberty and starts growing into an adult early. This results in early stoppage of bone growth and leads to short final height of the girl. It is also associated with stress and depression in the child.

This condition requires immediate treatment to delay the puberty and allow the child to reach her natural potential of height.

Q: My daughter is 16 years of age and has not yet started getting her periods. Is it normal?

A: Non getting of normal periods till 16 years of age is indicative of a delayed puberty especially in the absence of breast enlargement and lack of pubic hair. It requires evaluation by a gynaecologist to find out the cause. The cause may be a hormonal issue or a local cause in the genital tract. Treatment will depend on the cause.

Q My daughter studying in 10th class has to miss her school during her periods as she does not get up due to pain. Is it normal?

A. Some amount of pain during periods is normal. However debilitating pain especially if increasing over the months can be sign of endometriosis.

It needs to be evaluated by the gynaecologist clinically and with an ultrasound. This condition can be controlled and pain can be relieved with modern day medicines and she can comfortably attend to her studies.

Q I am 21 years of age. I am overweight and recently, I’m developing a lot of acne. What should I do?

A. You need to first consult a gynaecologist. She will evaluate you clinically and then with blood tests and an ultrasound. You may be having a condition called Polycystic ovaries. This is a modern day disease which is more common in girls with a sedentary lifestyle. The gynaecologist will give you medicines and advise you lifestyle changes such as change in food habits and regular physical activities. You will also have to work on it to get to a normal weight.

Q: I had an unprotected sex with my boyfriend. I don’t want to be pregnant. What should I do?

A. Medicines are available to take care of such an issue. You should consult your gynaecologist and take your pills within seventy two hours of the unprotected sex. However, this should not be done again and again as it is not to be considered as a contraception method and it may be detrimental to your health in the long run.

Q: I have got a tumour in my uterus and need to undergo a hysterectomy. Who would be the best surgeon for my surgery?

A: The best surgeon in case of an illness of the female genital tract, would be a gynaecologist just like in case of an eye problem, the surgery is done by the eye surgeon only.

A gynaecologist is a doctor who has an MD or MS or DNB degree in the subject of Gynaecology.

He or she has the best knowledge and understanding about your gynaecological problem and can provide you the best surgery to tackle it.

In many places you will find doctors without these particular degrees operating for gynaecological disease.

However, the Medical Council of India rules state that “a physician should not claim to be specialist unless he has special qualification in that branch”. It prohibits doctors to practice in any other specialty other than in which he or she has specialised.

In the western countries and in renowned institutions like PGI Chandigarh and AIIMS New Delhi all gynaecologic surgeries are done only by gynaecologic surgeons in the gynaecology department.

Therefore, you should choose a doctor who is qualified as a gynaecologist and has a wide experience of doing gynaecologic surgeries.

Q: What are the different types of hysterectomy surgeries? Which one would be best for me?

A: A hysterectomy surgery varies according to the type and extent of disease in the uterus and surrounding tissues, the age of the patient, the skills-set of the surgeon and the mindset of the patient.

The hysterectomy may involve removing the uterus alone or

removing the ovaries along with it or

additionally removing the some other surrounding structures along with it.

A hysterectomy can be done through

an abdominal incision which may be vertical or transverse (TAH) or

by minimal access through laparoscopy (TLH or LAVH) or

it can be stich-less with the entire surgery done through the vaginal route (NDVH).

The recovery is faster with NDVH and Laparoscopic surgery. The NDVH is totally scar-less while Laparoscopic surgery there are 3 to 5 small 5 to 10 mm scars.

The best surgery for a particular patient can be decided only after a thorough check up and a discussion with the gynaecologist.

Q: My mother had died due to cancer of cervix. I am also scared of it. What should I do?

A: It is possible to detect a cancer of the cervix at a very early stage and even before the condition becomes cancerous, what we sometimes call a zero stage. This is possible because the cervix is very accessible and can easily by examined in a gynaecologist’s clinic.

It is recommended that a lady should undergo a regular gynaecological examination. During this visit, which can be scheduled yearly to three yearly, the gynaecologist examines the cervix, does a simple Pap’s Test alone or with an additional HPV test. If the report is suspicious an additional Colposcopy examination and a biopsy may be required. Then the treatment can be given according to the findings of the tests.

This visit can be used for doing additional screening of the breast and a general body check-up also.

Q: Is it possible to prevent cancer of uterus?

A: Some type of cancer can be prevented if preventive measures are taken at the right time.

It has been found that the cervical cancer (Cancer at the lower end of uterus) is related to certain type of HPV, which is a type of virus infection.

A vaccine is now available which prevents this infection by certain strains of HPV.

Vaccination is best done and is most effective in prevention of cervical cancer if given at the age of 9 to 11 years of age. Usually three doses of the vaccine are to be given.

Q I am 30 years of age and trying to conceive for last 4 years. My periods have always been irregular coming after every 45 to 60 days. What should I do?

A. You need to consult a gynaecologist to find out the cause of this problem. In some cases it is due to polycystic ovaries (PCO) in which the egg formation in the ovary is not proper. This may also be the cause of your failure to conceive.

It can be confirmed with a pelvic ultrasound and treated with medicines.

Q: I am 25 years of age and have gained a lot of weight. Also I am getting a lot of hair growth on my upper lip and the chin. What should I do?

A: You should consult a gynaecologist who will take your history, examine you and get an ultrasound and some blood tests. If a problem such as polycystic ovaries is found, then treatment can be given accordingly. Apart from taking the medication it is advisable that you should take a healthy diet, avoid all junk food and have a regular physical exercise routine. With proper treatment and guidance, the growth of facial hair will be much reduced and you should be able to reduce your weight to near normal.

Q: I have missed my period by 7 days this time while my previous periods were normal. But I do not have any vomiting. Could I still be pregnant?

A: The amount of vomiting a lady gets during pregnancy is very variable from no nausea to sever vomiting.

To find out that you are pregnant or not you should undertake a urine test for pregnancy. This test should preferably be done in a gynaecologist’s clinic or a laboratory or can be done with a home kit by following instructions written on the kit.

Q: I have missed my periods by 10 days. I checked with a pregnancy kit at home and found it to be positive. But I do not want to have a baby right now as my file for Canada Visa is pending. What should I do?

A: In India an MTP (Medical Termination of Pregnancy) is legal under certain conditions and circumstances up to a certain period of pregnancy by a qualified gynaecologist at registered MTP clinics. An MTP clinic can be registered for MTP up to 12 weeks of pregnancy or up to 20 weeks of pregnancy.

If your pregnancy is a result of a failed contraceptive measure, you can legally request for an MTP.

For this should immediately consult your gynaecologist. He/she will do your check-up and confirm with urine test that you are pregnant. It is also important to confirm that the pregnancy is located only inside the uterus. This can be done by using an ultrasound. After that depending upon the duration of your pregnancy, a medical or surgical method will be advised after taking proper legal consent.

Though an MTP is a very safe procedure, complications can sometimes occur which may be bad for you in the long run. Therefore, it is advised that if you do not want a pregnancy, you should use proper contraception and not rely on an MTP again and again.

Q How many ultrasound examinations should I have during my pregnancy? Are they safe for me and my baby?

A. During pregnancy an ultrasound is an essential to tool to find out the status of the pregnancy at various stages. The following are the usual times during pregnancy when an ultrasound is to be done.

• At 6 to 8 weeks to confirm a pregnancy in the uterus and check its viability.
• At 11 to 13 weeks to do a NT (Nuchal Translucency) Scan to look for any indicators of a genetic disease such as Down’s Syndrome.
• At 18 to 19 weeks to do an Anomaly Scan (Also called Level II Scan).
• At 28 to 30 weeks to check the growth of the baby.
• At 34 to 36 weeks to check for foetal growth and do a Colour Doppler to know about the adequacy of blood flow to the foetus.

Apart from this, an ultrasound may be done more often and anytime during pregnancy especially in high risk cases such as diabetes and in twin pregnancy.

Till date there is no real evidence that the ultrasound examination during pregnancy is harmful to the mother or the baby. But it is advisable to do it only when advised by the gynaecologist.

Q My first baby has a Down’s syndrome. How can I make sure that I have a healthy baby next time?

A. Down’s Syndrome is a congenital condition of an abnormal number of chromosomes. This is slightly more likely to occur in mothers with increased age.

These days it is possible to know very early as to whether the baby is suffering from Down’s Syndrome or any other such congenital problem.

For this your gynaecologist will recommend an ultrasound to be done at 11 to 13 weeks (called NT scan) to find out the indicators of such anomalies. Along with this a “Dual Marker” blood test is done to calculate the exact probability of such genetic disease.

If the results are in the high risk range then your gynaecologist will do a genetic testing by Amniocentesis or chorionic villous biopsy. These tests are available in government registered Genetic Clinics only. The material taken out is tested in the Genetic Lab to look for and rule out multiple genetic diseases.

Nowadays, a new blood test is also available with the gynaecologist to give a good provisional diagnosis of genetic disease. However, if this test report is positive, it has to be confirmed by the Amniocentesis.

If the foetus is found to have congenital anomaly, the pregnancy can be terminated at an MTP center registered for termination of pregnancy up to 20 weeks of pregnancy.

Q When would I get to feel the movements of my baby?

A. You may get to feel the movements of you baby (this is known as “Quickening”) as early as 16 weeks or as late as 25 weeks. It is felt later if it is your first pregnancy and earlier in subsequent pregnancies.

Q I am 3 months pregnant. I have not gained any weight so far. Is it okay?

A. If a lady is in the healthy weight range at the time of start of pregnancy, she usually gains between 11.5 kg to 16 kg during her pregnancy. The rate of weight gain is usually 1 to 1.5 kg every month in first three months and then 1.5 to 2 kg every month till delivery.

However in case someone has an excessive amount of vomiting during the first three months, the weight gain is less or minimal. However it is recommended that you should consult your gynaecologist to check out everything is alright with your pregnancy.

Q I want to have a normal delivery. What should I do?

A. A normal vaginal delivery is the physiological way of delivery of a baby.

However, a baby should be delivered by vaginal delivery or by a caesarean section depends on many factors. Some of the maternal and foetal conditions in which a caesarean delivery is the preferred choice are,

• An inadequate size of mother’s pelvis
• Abnormal presentation
• Low lying placenta (Placenta praevia)
• Decreased fluid (Oligohydramnios)
• Big baby
• Short stature of mother
• Co-morbidities such as severe hypertension
• Previous caesarean delivery
• Foetal distress which may occur at any time before or during labour.

In many cases these days the mothers and their families want to have a caesarean delivery as they do not want to go through a long process which involves pain and discomfort and may leave them with a relaxed perineum.

If you want to go for a normal delivery, you should remain active, do light physical exercise and prepare yourself mentally. Your gynaecologist will be happy to assist you with your normal delivery.

The pain of normal delivery can also be partially taken care of by the process of “Painless delivery” which involves placement of a thin catheter into your lower spine.

Q My first pregnancy had to be terminated as there was a problem with the head and spine of the baby. I do not want that to happen to my next baby. What should I do?

A. The condition of absence of proper formation of head or a defect in the spine is called a “Neural Tube Defect”. It is found that this condition can be prevented by simple inclusion of Folic Acid vitamin in the diet of the mother in the early pregnancy period. To be on the safe side, Folic acid supplements should be started before conception itself.

Further, it is possible to diagnose a condition like that very early in the second trimester or in some cases even earlier than that by a good quality ultrasound in the gynaecologist’s clinic.

Sometimes, this condition or some other anomaly is diagnosed at the time of an ultrasound done at about 18 weeks.

If an anomaly is present, a Medical Termination of Pregnancy can be done in a MTP Centre which is registered for MTP up to 20 weeks of pregnancy.

Q: I am 25 years of age. Recently, I have noted painless lump in my breast. I’m scared that it may be cancer. What should I do?

A: Although most of breast lumps are benign, some of these can turn out to be cancerous.

You are therefore advised to consult your gynaecologist. Your gynaecologist will examine you and probably ask for some investigations. The usual investigations that are ordered in such a case are a sono-mammography and an FNAC. The mammography is usually reserved for later age and an MRI-mammography is sometimes indicated.

Depending on the reports the doctor will advise you treatment which may be surgical removal of the lump with or without surrounding tissues of the breast. The removed lump is also sent for lab testing.

Q: I have been diagnosed to have multiple fibroids in my uterus. Now how will I become pregnant?

A: Though fibroids are known to lead to infertility in some cases, sometimes pregnancy does occur normally despite the fibroids. In such a case, there may be an increased risk of miscarriage or preterm delivery but it can usually be taken care of if one is under good care under an experienced obstetrician.

In case the fibroids are symptomatic or are contributing significantly to the infertility, the fibroids can be removed while conserving the uterus by a surgery called myomectomy.

Q: I have severe pain abdomen during periods and am unable to conceive. The ultrasound showed that my uterus is enlarged with adenomyosis. What are my options?

A: Adenomyosis can be the cause of your severe pain and infertility. If localized, it can be removed by excision. If it is extensive and global, still the symptoms can be relieved by surgery of partial removal. Many a times this surgery leads to correction of infertility also. However, if there is associated tubal block or endometriosis assisted reproduction may be required.

Testimonials

I had come to Dr Sidhu from U.K. for treatment of recurrent abortion as I had lost 4 pregnancies. Courtesy the highly professional treatment by him, I have had two successful pregnancies at Preet Hospital.

- Mrs Ritneet

I came from Moga as I had been having difficulty in conceiving for over five years and had been advised IVF. Dr Manjit Sidhu investigated and treated me very nicely and today I am a mother of two healthy children.

- Mrs Shaweta

I had adenomyosis because of which I had severe pain for last several years. Dr Manjit Sidhu did a laparoscopic hysterectomy for me. My recovery was so good that I went back to Patiala after 2 days.

- Mrs Parkash

I was unable to conceive after my first child due to an unknown cause. So I came to India from Toronto to take treatment from Dr Manjit Singh Sidhu. He investigated me and did a laparoscopy and a hysteroscopy. The cause was found to be some problem with the tubes which he treated by cannulation of the tubes in the same sitting. I went back to Canada and conceived naturally. Now I am a very happy mother of two. Thank you Dr Manjit.

- Mrs Kiranjit

I had a large tumour in my uterus which caused me a lot of pain and discomfort. It was diagnosed as multiple fibroids with my uterus size reaching up to 5 months of pregnant size. All the surgeons I met told me that my uterus would have to be removed. I was devastated as I’m only 23 years of age and unmarried. Dr Manjit Singh Sidhu studied my case in detail and assured me. I found him to be very experienced and kind. True to his promise, he removed a large fibroid while keeping my uterus intact and safe. Now I am without any symptoms and looking forward to a happy married life and can dream of becoming a mother naturally.

- Ms Prabhjot

I had been having severe pain in left side of my body for last several years. The ultrasounds and MRI tests gave conflicting results. I was scared as some doctors said that it was likely to be an ovarian cancer which might have spread. However when Dr Manjit examined me and himself did the ultrasound, he told me that it was bad case of endometriosis. After that he did a conservative surgery removing. This diagnosis was later confirmed by the test of the removed issue specimen. I have been totally free of pain and disease since then.

- Mrs Jasveer