Menopausal Hormone Therapy (MHT)

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Menopause is the permanent cessation of menstruation. It can occur as early as age 40 or as late as nearly age 60s. The average age of menopause is usually about 49 to 51. It is normally diagnosed in females after 1 year of absent menstrual flow. Menopause does not occur suddenly. It is a slow transition and peri-menopause usually begins a few years before the last menstrual period. Menopause is only one event in the transition period involving changes in the female body between the mid or late 40’s, when the production of female hormones (estrogen and progesterone) begins to decline. Most of the signs and symptoms of menopause arise from this decrease in estrogen production. Therefore, MHT (referring to both the EPT and ET) is often given to women who have significant symptoms that have an impact on their daily activities.

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Menopause – symptoms and treatment options

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Menopause is the permanent cessation of menstruation. It can occur as early as age 40 or as late as nearly age 60s. The average age of menopause is usually about 49 to 51. It is normally diagnosed in females after 1 year of absent menstrual flow. Menopause does not occur suddenly. It is a slow transition and peri-menopause usually begins a few years before the last menstrual period. Menopause is only one event in the transition period involving changes in the female body between the mid or late 40’s, when the production of female hormones (estrogen and progesterone) begins to decline. Most of the signs and symptoms of menopause arise from this decrease in estrogen production even before periods stop altogether. Menopause occurring before age 40 is termed premature and may need medical evaluation for the cause. However, if menopause is delayed beyond the age of 55 (meaning a woman is still experiencing menstrual bleeding), there is an increased risk of breast, ovarian, and uterine cancer. This is due to the increased amount of time a woman’s body has been exposed to the estrogen. Therefore, regular mammograms and gynaecological review by specialist is important for women experiencing late-onset menopause.

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Loop Electrosurgical Excision Procedure (LEEP/LLETZ) for CIN

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Loop electrosurgical excision procedure (LEEP), also known as large loop excision of the transformation zone (LLETZ), is a procedure for further diagnosis and treatment of cervical intraepithelial neoplasia (CIN). CIN lesion is an abnormal growth in the cervix. The CIN lesion is usually diagnosed during a routine Pap smear (or called Thin Prep) test. LEEP is a very safe way to remove abnormal tissue from the cervix that might otherwise progress to cancer. It minimizes the amount of tissue removed in order to preserve childbearing ability.

Reason for the procedure

• Presence of CIN lesions from the colposcopy evaluation and confirmed via cervical biopsy. Some types of CIN can progress to cervical cancer if not treated. This can be used as a treatment for CIN lesions.
• Unsatisfactory colposcopic evaluation whereby the whole transformation zone cannot be visualized or the cervix appeared abnormal and requires a bigger tissue specimen for a more accurate diagnosis to exclude cancer changes.

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Endometrial biopsy (Endometrial sampling or curettage)

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Endometrial biopsy is a procedure that involves the removal of tissues from the endometrium, which is the inner lining of the uterus.

Reason for the procedure

It is done to diagnose endometrial cancer or hyperplasia (with or without atypia). Endometrial hyperplasia is a potentially precancerous condition. This procedure is indicated in a woman with abnormal uterine bleeding. This includes bleeding between menstrual periods, excessive bleeding during a menstrual period, or bleeding after menopause. It is also done to exclude endometrial cancer in post-menopausal  women with abnormal endometrial finding on ultrasound scan of the uterus.

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Pre-Pregnancy Care for Woman with Type 2 Diabetes Mellitus

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Article contributed by Ms Yong Lai Mee

The prevalence of Type 2 Diabetes Mellitus (T2DM) among women in childbearing age is increasing. Pre-existing T2DM in pregnancy increased the risk of maternal and neonatal complications such as macrosomia big baby), miscarriage, stillbirth, eclampsia (high blood pressure and its complications), and preterm labour. The American College of Obstetricians and Gynaecologists and the American Diabetes Association emphasized the importance of achieving optimum diabetes control for promoting the well-being of maternal and reduced prenatal fetus and baby adverse outcomes. Below are some tips to achieve optimum pre pregnancy diabetes care.

Blood Glucose Control

  • Keep pre pregnancy HbA1C < 6.5% to avoid complications during pregnancy.
  • Fetal mortality rate increased 4 folds in those with HbA1C >6.6%.
  • Poorly controlled pre pregnancy diabetes increases congenital heart diseases by 3 folds, neural tube defects increase by 4 folds and spontaneous miscarriages in 30-60% of all pregnancies.
  • Plan 4-6 months before pregnancy to ensure diabetes control is within target range.

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Uterine Prolapse (pelvic organ prolapse)

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This refers to the descend of the uterus into the lower half of the vagina and beyond. In its most severe form, the whole uterus may be outside the vagina. Besides the uterus, other pelvic organ may descend as well such as bladder (cystocoele), rectum (rectocoele) and the small intestines (enterocoele).

Symptoms and signs

  • A lump is seen or felt at the opening of the vagina. It may be seen protruding outside of the vagina.
  • Vague discomfort or pressure in the pelvic region.
  • Backache that worsens with lifting.
  • Urination problems such as frequent and painful urination, difficulty in urination. occasional stress incontinence (urine leakage when laughing, sneezing or coughing), inability to control urination (uncontrollable urine leakage).
  • Difficulty in defecation.
  • Pain during or difficulty with sexual intercourse.
  • Abnormal per vaginal bleeding, usually arising from the exposed vagina wall and cervix.

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Vasectomy – Male contraception

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Article contributed by Dr Peter Ng and Dr Beatrice Chua Yoong Ni

The aim of a vasectomy is to prevent sperm from reaching the semen by disconnecting the sperm duct. The resulting ejaculate is therefore sperm-free, eliminating the risk of pregnancy. Sort of like a cheap shark fin soup without the shark fins (sperms).

Vasectomy is the contraception of choice for 6%–8% of married couples worldwide. Vasectomy is a minor procedure that provides effective and permanent contraception. In fact, it is far more effective than many other methods of contraception, including female sterilization.

Prior to a vasectomy, it is important and both husband and wife be present together to be counseled by a specialist on the implications of the procedure. It is important that the completeness of family is ascertained and that both husband and wife had discussed beforehand and agreed that it is the husband who should undergo a vasectomy to attain permanent contraception.

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Lower Urinary Tract Infection (Lower UTI, cystitis)

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Infection of the lower urinary tract occurs when the inner lining of the bladder becomes infected and the urine is full of bacteria. In pregnancy, 5 – 10% of women have bacteria in their bladder and some will have no symptoms at all.

How common?

Up to 40 – 50% of women will have at least one attack in their lifetime and 25% will have recurrences.

Causes

  • Bacteria can reach the bladder from the genital and anal area, or through the bloodstream.
  • Injury to the urethra or the bladder.
  • Prolonged use of a urinary catheter to empty the bladder, such as during childbirth or surgery.

Risk factors

  • Sexual activity.
  • Infection in other parts of the genitourinary system.
  • Pregnancy.
  • Poor hygiene.
  • Menopause.
  • Diabetes mellitus.
  • Underlying abnormalities of the urinary tract, such as tumours, calculi (stones), and strictures.
  • Incomplete bladder emptying.
  • During or after major surgery

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