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Wednesday, 27 July 2011

Atrophic Vaginitis during menopause

This common problem arises during the peri and menopause period. It happens because of a decrease in the female hormone oestrogen. As a result changes in the lining of the vagina take place causing it to be thinner, more susceptible to infection and inflammation. If you are starting to feel itch, discomfort, dryness and pain with intercourse, more discharge then usual then you probably have this condition and should seek help from your gynaecologist. Of course not every peri or menopausal woman will have it, but there is no need to suffer the discomfort as treatment is available. In a sense treatment should be sought as the vagina will slowly contract in size and the lining of the vagina will eventually stick together and make it difficult to view the neck of the womb necessary for doing a PAP smear. An early cancer of the cervix can therefore go undetected. 

Treatment is with creams or pessaries inserted in the vagina. The oestrogen pessaries are inserted nightly for 2 weeks to obtain a therapeutic effect and then maintained with 2 weekly insertions. The effect of the oestrogens is local and only a small amount is absorbed into the blood stream, making it safe to use for prolonged periods. Oestrogens taken orally are mostly ineffective for this condition.

Sunday, 3 July 2011

Obesity associated with Polycystic Ovary Syndrome (PCOS) and diet

Diet is important in a patient with PCOS to help control the condition. Obsesity in PCOS is very common due to insulin resistance ie the levels of insulin in the body are high. This happens because there is a defect in getting the blood sugar into the cells so the pancreas secretes more and more insulin. It has been shown that just reducing weight by 5% can help improve the condition. Periods go back to being regular and insulin levels decrease, skin improves. The problem is that it is difficult to lose weight in PCOS. The normal diet of low fat high carbohydrate diets dont work because the refined carbohydrates are quickly turned to sugar in the blood, and this in turn raises the insulin level even higher. The ideal would be a low carbohydrate high protein diet, combined with aerobic excercises. Some carbohydrate should be consumed to prevent ketosis. Complex carbohydrates such as whole meal bread and brown rice should be taken in small amounts. Low glycaemic foods should be part of the diet so as not to allow spikes of blood sugar. So diet and excercise are the first line of treatment for PCOS especially when associated with obesity.