Dr Lee Say Fatt

Contraception – Hormonal implant (Implanon)

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The main purpose of contraception (or birth control) is to prevent an unplanned pregnancy. You should know and understand the different types of methods available to you, the risks and benefits of each, and any possible side effects so that both you and your partner can able to make an informed choice. Contraception can be broadly divided into:

  1. Temporary or permanent methods – permanent birth control is accomplished through sterilization (tying or removal of the fallopian tubes) or hysterectomy (removal of womb/uterus). The rest of the methods are classified as temporary or reversible.
  2. Short term or long-term methods – short term methods are condoms and oral pills. Long term methods are injectables, intrauterine device and hormonal implants.

Hormone implant currently available is Implanon NXT®. It consists of a single plastic rod measuring 4 cm and contain a progestogen hormone called etonogestrel. Implanon is inserted surgically, just under the skin of the upper arm. The implant will release a minute amount of this hormone every day for 3 years. It works by preventing the monthly ovulation (the release of an egg from the ovary) during your menstrual cycle. It also thickens the vaginal mucus to prevent sperm from reaching the egg (fertilization). Continuous effect of the hormone will thin out the lining of the uterus (womb) to prevent attachment of a fertilized egg. Implanon does not contain any oestrogen.

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Trichomoniasis

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Trichomoniasis (or Trichomonas vaginalis, TV) is an infection of the vagina and is caused by a parasite (a flagellate protozoan) that lives in the lower genitourinary tract. The disorder can involve the vagina, urethra and bladder in women. In men, it can affect the prostate gland and urethra.

 

Symptoms and signs

The symptoms varies from women to women. Some may not have any symptoms at all and may not be aware of this infection. Infected men may have no symptoms as well. Typical symptoms are:

  • Vaginal discharge which is foul-smelling, frothy and it is most noticeable after sexual intercourse or after menses.  The discharge color may be greenish or yellowish.
  • Vaginal itching and discomfort.
  • Redness of the vaginal lips (the labia) and vagina.
  • Painful urination especially if the labia is inflamed and the urine touches the surrounding area.

Causes

This is due to a parasite called Trichomonas vaginalis. The transmission from person to person is almost exclusively via sexual intercourse. It may live in its host without producing symptoms. Since it is usually transmitted sexually, both the sexual partners must receive treatment to eliminate it completely.

Complications

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Endometrial Hyperplasia

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Endometrial hyperplasia is an overgrowth of endometrial tissue (which is the inner lining of the uterus which shed every month as menstrual blood flow). It is not cancerous. However, there is a form of severe hyperplasia which can be precancerous (especially when there is presence of abnormal cells called atypia). Classification of the hyperplasia includes:

  1. simple or complex (adenomatous) hyperplasia without atypia, or
  2. simple or complex (adenomatous) hyperplasia with atypia.

Patients who have endometrial hyperplasia without atypia usually respond well to progestogen therapy and are not at increased risk for uterine cancer. The progression of hyperplasia to endometrial cancer increases as the abnormal cells (atypia) of the hyperplasia develops.

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Bone mineral density testing (BMD)

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This test is done to measure the density of bones and this is able to predict the risk of fractures. Bone density decreases in both men and women with age, but in women, the decrease is more rapid and more severe following menopause when the ovaries stop producing the oestrogen hormone. BMD testing can show whether there is significant bone loss, resulting in low bone mass. This is a major cause of osteoporosis and of bone fractures (partic­ularly the hip, spine or forearm) in men and women over the age of 40.

Osteoporosis is a reduction in the amount of bone mass resulting in the loss of bone strength. This will predispose it to fracture. Osteopenia refers to a decrease in bone mineral density and is less severe form compared to osteoporosis. Eventually, it is likely to lead to osteoporosis if no treatment is given.

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Vulvovaginal candidiasis (Vaginal yeast infection)

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Vulvovaginal candidiasis is an infection of the vagina caused by a yeast-like fungus (usually Candida albicans). It is one of the commonest causes of vaginitis (inflammation of the vagina). An estimated 75 percent of all women will develop a yeast infection during their lifetime. Vaginal candidiasis infections are very common in pregnancy due to the increased levels of circulating oestrogen in the bloodstream.

CAUSES

The fungus Candida lives in small numbers in a healthy vagina, rectum and mouth without causing problems. When the vagina’s hormone and pH balance is disturbed, the organisms multiply and cause infections.

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Heartburn during pregnancy

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Heartburn is a term used to describe a burning pain or discomfort in the chest and upper abdomen. The actual medical term for it is gastro-esophageal reflux disease (GERD). It is quite common for pregnant women to experience the symptoms of heartburn, which usually come and go until delivery. It can start anytime during the pregnancy period and may worsen as the pregnancy progresses (second or third trimester). While it can be uncomfortable or painful, heartburn by itself will not harm the baby.

Symptoms and signs

  • Burning pain in the center of the chest and the upper abdomen, frequently accompanied by an unpleasant taste in the mouth.
  • Belching (burping).
  • Nausea with or without vomiting.
  • Persistent throat irritation, with or without irritating dry cough.

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Benign ovarian cysts

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The ovaries are the female reproductive organs that contain eggs and will release them on a regular basis (usually monthly in the majority of the women). It also produces female and male hormones. An ovarian cyst is abnor¬mal growth in the ovary and can be either solid or cystic. It can be divided into either a benign (non-cancerous) or malignant (cancerous) type. Benign or non-cancerous cysts do not invade neighboring tissue the way malignant cyst does. The exceptionally large ovarian cyst often turns out to be benign.

The term ovarian cyst refers to abnormal growth in the ovary that contains mainly fluid, although occasionally some solid component may be present as well.

Symptoms and signs

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Breast Cancer: The importance of Self Breast Examination

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Breast cancer is the most common type of cancer affecting women. In Malaysia, the overall lifetime risk of developing Breast cancer is 1 in 27, with 1 in 22 for Chinese, 1 in 23 for Indians and 1 in 30 for Malays.

Breast cancer is curable if detected early and treated appropriately. One must be mindful of how our breast feels. What is normal for one person, may not be normal for someone else. Only YOU know what is normal for You. Hence Self Breast Examination (SBE) is particularly important. It is quite easy to do and can be done by any woman independently. Self Breast Examination is best done 10 days after one’s period or if you are post-menopause, then pick any day of the month as a routine.

 

Steps to check your breast

Step 1 – Stand in front of the mirror and look at your breast (picture 1). Look for changes in shape and size, any dimpling in the skin, any hyper pigmentation. Look at your nipple and look for skin changes. Raised both your hands above your head and look to see if your breast moves symmetrically. Then bend forward to see the shape and size again

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