Colposcopy

Colposcopy is used for close examination of cervix, vagina and vulva. A lighted magnifying instrument called colposcope magnifies the view of cervix, thereby ensuring its better examination.

At the beginning of colposcopy, you are asked to lie on your back on the obstetric table. The instrument used for examination is placed into your vagina to ensure better viewing of your cervix. After cleaning flows in cervix and vagina using salty water, your cervix will be moistened by a special fluid. If there is any problematic tissue or cell, it turns into white color under the effects of this fluid. Thus, your doctor will examine the white zones more closely and in details, and if needed, will take biopsies therefrom. Then, the biopsies are examined by pathologist.

This process generally takes 20 – 30 minutes.

Why is Colposcopy used?

Colposcopy is conducted to understand the cause of abnormal cellular changes, if any.

Why is Colposcopy important?

Thanks to this process, cervical cancers may be detected at a very early stage.

Is this process painful?

If your doctor takes a biopsy sample, you may feel a slight cramp and pain during removal of tissues. During this process, it may be helpful if you do not flex and stretch yourself, and you inhale and exhale slowly and deeply. In some patients, a slight analgesia termed and called as sedoanalgesia may be needed.

How must I get prepared for Colposcopy?

You may be more relaxed if you empty your urinary bladder and bowels before the process. Do not take a vaginal shower, and do not apply vaginal drugs or buffers, and do not have sexual intercourse, 24 hours before your appointment.

Does this process affect my having a baby?

No. Even if your doctor takes a tissue sample, it will be very small and will not preclude you from having a baby. However, if you are pregnant or are probably pregnant, advise this to your doctor. This information will change the treatment projected by your doctor for you.

Is bleeding expected after Colposcopy?

After colposcopy, you may have a dark colored vaginal flow and a stained bleeding for at least two days.

May I use a buffer after the process?

No. Do not use buffer or put anything in vagina for at least one week after the process or until your doctor allows you to do so. Do not have sexual intercourse for at least one week.

When should I call my doctor?

If you encounter any one of the following problems after colposcopy, immediately call your doctor:

• Excessive vaginal bleeding,
• Hypogastria pain and
• Fever, tremor or bad smelling vaginal flow.

Ovulation Signs

How can I recognize the ovulation day (period)?

What are the signs of ovulation in women? How can I understand that ovulation day is getting close? How can we understand the ovulation? How does one know she is ovulating or not ovulating? How is ovulation understood? And similar other questions are the most common questions asked by pairs planning a pregnancy.

For detailed information about tracking and calculation of date of ovulation, and when and in which days ovulation is realized, you may click here. Now, we are going to deal with signs and symptoms of ovulation, and complaints and signs felt in ovulation period.

Signs before and after ovulation:

Increase in vaginal (cervical) flow, and fluidization of flow. Women generally say “My wetness increased.” This sign starts a few days before ovulation.

Increase in body temperature. Patients do not generally feel this slight increase, but it is easily detected when measured by a thermometer. In general, it increases by around half a degree.

Inguinal pain: Unilateral (only at the left or at the right) inguinal pain is felt generally in the day of ovulation. Pain may sometimes be bilateral. The cause of this pain is the leakage of fluid in follicle towards pelvis (around the uterus) during ovulation. This fluid automatically disappears in a few days. Pain generally ceases in one day. Sometimes, the pain caused by growing egg starts 4-5 days before ovulation, and increases in the day of ovulation, and then disappears suddenly. (Mittelschmerz, middle pain)

Sensitivity, fullness and tension in breasts

Abdominal dyspepsy

Pain and cramps in abdomen

Increase in sexual drive: Generally starts a few days before ovulation.

Some women become excessively sensitive to and are disturbed by such stimulants as odor, taste and light.

Why do women menstruate?

Purpose of the cycle between first days of two consecutive menstruations is to prepare the uterus for pregnancy. Both physiological and spiritual processes contribute to regular functioning of this cycle: In the first day of each menstruation, under the effects of a hormone secreted from a secretory gland named pituitary gland in brain, an egg cell starts to mature and to produce estrogen hormone in one of the ovaries. This hormone is in charge of thickening of intrauterine layer and completion of preliminary preparations for pregnancy. During this thickening period of 14 days, fluid accumulates around egg call, and a sac of approximately 18 – 20 cm, filled with fluid, named follicle, develops on the surface of ovary. During these events, when the blood level of another hormone secreted from pituitary gland reaches a certain level, this developing follicle is cracked, and the matured egg cell therein is released. This cell enters into Fallopian tube and moves forward. If egg cell meets a sperm cell and is fertilized in Fallopian tube, pregnancy starts.

Immediately after ovulation, not only estrogen hormone, but also progesterone hormone starts to rise in blood. This hormone makes intrauterine layer fit and ready for placement of fertilized egg and for continuation of pregnancy, or in other words, completes the preliminary preparations made by estrogen hormone therein. If pregnancy does not emerge, a certain time after fall of hormone levels in blood, intrauterine layer (endometrium) starts to fall down. It proceeds with menstruation. With this menstruation process, intrauterine layer (endometrium) starts to get prepared for a probable gestation in the new menstruation cycle, and the events described above restart.

Pelvic Inflammatory Disease (PID)

Pelvic Inflammatory Disease (PID) is an expression used broadly for infections of upper reproductive tract organs such as Fallopian tubes and ovaries. PID is a serious and common disease. PID can be successfully treated, but may at the same time lead to permanent and long-term problems. Women who know to protect themselves against this infection reduce the probability of this disease. In this part, we are going to deal with:

Causes of PID

Diagnosis and Treatment, and

Measures

Causes of PID:

PID may be caused by various different microorganisms. Mostly caused by sexually transmitted diseases. The most common reasons of sexually transmitted diseases (STD) are two bacteria named gonorrhea and chlamydia. If untreated, these bacteria lead to sexually transmitted diseases (STD) and thus to PID.

PID is seen when bacteria move upwards from vagina and cervix. Later, bacteria move towards uterus, Fallopian tubes and ovaries. Disease progresses in days or weeks.

Dangers

In the United States, one-fourth of women with PID is hospitalized, and some of them need surgery.

PID may cause serious problems in the long run. For example, infertility (inability to have a baby though desired), extrauterine pregnancy and long-term pelvic pain.

PID leads to infertility in one-fifth of women. The more frequently and severely a woman suffers from PID, the more her infertility risk is. PID causes damages in internal tissue of Fallopian tubes, which in turn blocks the tube, thereby leading to infertility. The damaged tube may preclude the egg from reaching inside the uterus, thereby causing extrauterine (ectopic) pregnancy.

In the United States, a great number of ectopic pregnancy associated with PID is reported every year. Ectopic pregnancy is frequently seen outside the uterus at the side of damaged tube. The fertilized egg may continue to grow inside the tube, and cause tearing of tube and its bleeding inside abdomen. This serious case may require a surgical intervention.

Who are under risk?

PID is seen most commonly in young women, but may normally be seen at any sexually active age. PID risk factors are:

Women suffering from sexually transmitted diseases caused by gonorrhea and chlamydia.

Women with more than one partner (The more the partners are, the more the disease risk is).

Women with a partner having other partners.

Women with PID history

Sexually active women making frequent vaginal washing

Symptoms:

PID may cause severe or slight symptoms, and may sometimes show no symptom at all, but in any case PID may lead to severe damages in female reproductive organs.

If you have any one of the following symptoms, absolutely consult your doctor:

• Abnormal vaginal flow
• Pain in lower parts of abdomen
• Pain in right top part of abdomen
• Abnormal menstruation
• Fever and fatigue
• Painful urination
• Nausea and vomiting
• Painful sexual intercourse

However, existence of any one of these symptoms does not mean you are suffering from PID. It may also indicate another disease.

Diagnosis

PID is not diagnosed easily, because it is not easy to examine the organs affected therefrom, and its symptoms are similar to those of many other diseases (such as appendicitis or ectopic pregnancy).

Your doctor will take note of your history also containing your sexual habits, and contraception method, and symptoms. Through pelvic examination, your doctor must check sensitivity in your reproductive organs.

Samples may be taken from cervix to check for gonorrhea and chlamydia infections. Blood tests may also be performed. If more information is needed, your doctor will conduct other tests as well. For instance:

Ultrasonography: By this tool, pictures may be drawn by using sound waves over abdomen or through vagina, like watching on a TV screen. Fluid or abscess may be checked inside tubes.

Intrauterine sampling: A small intrauterine sample may be taken, and examined under microscope.

Laparoscopy: By using a thin tube with a light called laparoscope, and through a small incision on belly or immediately beneath it, pelvic organs may be examined and if required, samples may be taken.

Treatment

PID is treatable. Early treatment is important and may prevent such problems as infertility. However, even if infection is treated, the long-term problems may continue.

PID is mainly treated by antibiotics. In many cases, antibiotics may alone eliminate the infection. However, PID is generally caused by several bacteria, and a single antibiotic is not sufficient to destroy all bacteria. Therefore, more than one antibiotic is prescribed. Antibiotics may be taken orally or administered intravenously.

Sometimes, symptoms may disappear before the infection is fully treated. Even if symptoms disappear, your must take all of the drugs prescribed to you. In some cases, drug treatment must be completed up to 14 days in order to make sure that infection is entirely eliminated.

2-3 days after start of treatment, your doctor will review your situation. If no improvement is seen, you may be required to be hospitalized. Inpatient treatment is required also in the following cases:

If a differential diagnosis cannot be made (appendicitis, extrauterine pregnancy, ovarian masses, etc.)

In case of pregnancy

If antibiotic is required to be administered intravenously

In presence of severe infection, and in case of nausea-vomiting or high fever

In case of abscess

If symptoms continue or abscess does not regress, surgical intervention may be required. In addition, partner treatment should also be made, because partners of PID patients may also have gonorrhea and chlamydial infections without any symptom. Thus, partner must also be examined and if required, treated in order to minimize PID risk.

Protection

In order to protect yourself from STD and PID:

You must have only one partner without any STD and having an affair only with you. Limit the number of your sexual partners, and avoid partners with an increased STD risk. Such persons are:

People who had or have more than one sexual partner

Sexual intercourse with a person suffering from STD

STD history

Use condom in each sexual intercourse. If used correctly, condom will protect you from sexually transmitted diseases. If you are using other contraception methods, separately use condom as well in order to protect yourself from these diseases.

If you suspect of having STD or PID, immediately consult your doctor.

As a conclusion

PID may threaten your health and cause infertility. However, you can be protected and treated. If you have PID symptoms, immediately consult your doctor. If you are on treatment, absolutely comply with the recommendations of your doctor. Fully complete the medication and go to your doctor for a follow-up visit. Furthermore, in order to protect yourself from reinfection, do not have sexual intercourse with a partner suffering from sexually transmitted diseases.

Osteoporosis (Bone Loss)

After menopause, bone loss resulting in osteoporosis may develop in many women. Healthy bones are intensive and strong and may resist a large pressure. However, in case of osteoporosis, bones are thinned down and embrittled, and this in turn increases the probability of fracture of bones. Osteoporosis develops upon removal from bone of substances making the bones resistant, and especially calcium.

In absence of estrogen hormone, bone loss is speeded up, and menopausal osteoporosis develops. In menopause period, bone loss is reported less in women taking hormone replacement therapy.

At its early stage, osteoporosis leads to very small recognizable physical changes. However, as the disease progresses, particularly backbone, wrists and hipbone may fracture due to simple traumas. Bone loss may cause pains, shortening, movement restrictions or even curvature of spine (also known as “old woman hunchback”).

Other Factors that may contribute to osteoporosis risk:

• Smoking
• Very much alcohol consumption
• Very small exercise, immobility
• Very small calcium intake (now or in childhood)
• Use of such drugs as steroids (frequently used in asthma and arthritis treatment) and thyroid hormone (in a very high dose).
• Early menopause (before 45 years of age)
• Genetic factors

According to bone mineral measurement methods:

Normal T-score = < -1 SD

Osteopenia T-score = -1, -2.5 SD

Osteoporosis T-score = > 2.5 SD and no fracture

Treatment

In drug therapy, various different drugs are used for reducing the fracture of bones (D Vitamin, bisphosphonates, raloxifen, calcitonin and hormone replacement) and for increasing the bone production (parathyroid hormone, strontium ranelate).

Nutrition, excessive, adequate sunlight and regulation of life style are also important in treatment.

What must we do for protection against osteoporosis?

Nutrition sufficient in calcium and D vitamin

Adequate sunlight

Abundant exercise and mobility

Getting rid of such bad habits as smoking, alcohol and excessive caffeine, and of factors increasing osteoporosis risk.