What is preconceptional counselling?
As soon as you start thinking about having a baby, a visit to your doctor at least 3 to 6 months prior to planning a pregnancy is known as preconceptional counselling.
Details of counselling:
When a couple visits for preconceptional counselling a detailed history and examination is done. The goal is to identify factors which can adversely affect you or your baby during the course of pregnancy. A treatment plan can be worked upon subsequently.
The one major obstacle is that most of the pregnancies are unplanned and most women take it for granted. So, ideally it should be actually offered to all women of child-bearing age regardless of intent to become pregnant.
It is a golden opportunity to ask your doctor all the queries you have about pregnancy. All doubts regarding any pregnancy mishap in the family should be discussed. You should also discuss about reasons / complications associated with preterm birth, repeated pregnancy losses, intra uterine death and ectopic pregnancy because many of these are preventable. Many unfortunate events can be prevented by treating them before conception. If the mother is over 35 years of age, there is a risk of Down's syndrome in the baby which can be diagnosed by some advanced tests. Also ultrasounds history of birth defect, mental retardation, blood clotting disorders, congenital blindness in the family and consanguineous marriages warrant genetic counselling.
Some important things you can do for preconceptional health are:
Take 400 to 800 micrograms of folic acid every day. It lowers your risk of birth defects of the brain and spine.
Stop smoking and drinking alcohol. Avoid contact with toxic substances. Stay away from cat or rodent faeces.
If you have a medical condition, like anaemia, asthma, diabetes, oral health, obesity, epilepsy, thyroid disease, hypertension, epilepsy, tuberculosis or kidney diseases, be sure it is under control.
PCOS (Polycystic Ovarian Syndrome) and YOU
A typical case scenario commonly seen in our clinic is a young obese girl with intractable acne, irregular cycles, and increased facial hair. On ultrasound polycystic ovaries are seen, creating a lot of anxiety in her mind. But it is the most common endocrine disorder affecting 25 to 30% of young women. Approximately 75% of anovulatory women have polycystic ovaries.
About the disease
PCOS, as called as Stein-Leventhal syndrome is a syndrome of ovarian dysfunction along with features of increased male hormones and ovaries showing polycystic morphology in the absence of other explanatory endocrinopathy.
The etiology is complex with recent studies suggesting role of insulin resistance. Obesity exacerbates the signs and symptoms of PCOS by worsening insulin resistance symptoms. The symptoms may be as varied as irregular or missed periods, excessive hair growth on the face, around the nipples, and/or around the lower abdomen, obesity, thinning of the hair on the head, intractable acne, infertility, miscarriage, and type 2 diabetes or pre-diabetes.
Management
A good history, clinical examination, followed by pelvic ultrasound, and hormonal profile completes the diagnosis of PCOS. Ultrasound shows enlarged ovaries, with multiple small cysts generally oriented in the periphery, like "String of pearls". Hormonal profile reveals high levels of DHEA, LH, AMH, and a normal FSH level. High LH Levels with a normal FSH level is typical of PCOD
Goal of Treatment
Weight loss by diet and exercise is the most effective treatment. It lowers insulin resistance which restores regular cycles and ovulation. Anti-diabetic drugs like metformin, glitazone, newer drugs like D-chiro-inositol, Myo-inositol, Vitamin D3, and acupressure are other supportive therapies.
Restoration of fertility - Not all women have difficulty in conceiving. For those that do, ovulation is induced with drugs like clomiphene or HMG/FSH injections. Some might require laparoscopic ovarian drilling (A laser or cautery is used to drill 4-10 multiple holes through the thickened ovarian capsule). Those not responsive to these and diet and lifestyle modification, IVF (In-vitro fertilisation) is the option. Treatment results with PCOS are good
Treatment of hirsutism or acne
Restoration of regular menstruation, to prevent endometrial hyperplasia and endometrial cancer by using progesterone or combined contraceptive pill. If periods are occurring atleast every three months no treatment is needed.
Early diagnosis and treatment may reduce the longterm risk of type 2 diabetes and heart disease.
Is there a cure?
There is no straightforward cure. Medical treatments reduce the symptoms and consequences of PCOS. Majority of women respond excellently to lifestyle modifications only
As soon as you start thinking about having a baby, a visit to your doctor at least 3 to 6 months prior to planning a pregnancy is known as preconceptional counselling.
Details of counselling:
When a couple visits for preconceptional counselling a detailed history and examination is done. The goal is to identify factors which can adversely affect you or your baby during the course of pregnancy. A treatment plan can be worked upon subsequently.
The one major obstacle is that most of the pregnancies are unplanned and most women take it for granted. So, ideally it should be actually offered to all women of child-bearing age regardless of intent to become pregnant.
It is a golden opportunity to ask your doctor all the queries you have about pregnancy. All doubts regarding any pregnancy mishap in the family should be discussed. You should also discuss about reasons / complications associated with preterm birth, repeated pregnancy losses, intra uterine death and ectopic pregnancy because many of these are preventable. Many unfortunate events can be prevented by treating them before conception. If the mother is over 35 years of age, there is a risk of Down's syndrome in the baby which can be diagnosed by some advanced tests. Also ultrasounds history of birth defect, mental retardation, blood clotting disorders, congenital blindness in the family and consanguineous marriages warrant genetic counselling.
Some important things you can do for preconceptional health are:
Take 400 to 800 micrograms of folic acid every day. It lowers your risk of birth defects of the brain and spine.
Stop smoking and drinking alcohol. Avoid contact with toxic substances. Stay away from cat or rodent faeces.
If you have a medical condition, like anaemia, asthma, diabetes, oral health, obesity, epilepsy, thyroid disease, hypertension, epilepsy, tuberculosis or kidney diseases, be sure it is under control.
PCOS (Polycystic Ovarian Syndrome) and YOU
A typical case scenario commonly seen in our clinic is a young obese girl with intractable acne, irregular cycles, and increased facial hair. On ultrasound polycystic ovaries are seen, creating a lot of anxiety in her mind. But it is the most common endocrine disorder affecting 25 to 30% of young women. Approximately 75% of anovulatory women have polycystic ovaries.
About the disease
PCOS, as called as Stein-Leventhal syndrome is a syndrome of ovarian dysfunction along with features of increased male hormones and ovaries showing polycystic morphology in the absence of other explanatory endocrinopathy.
The etiology is complex with recent studies suggesting role of insulin resistance. Obesity exacerbates the signs and symptoms of PCOS by worsening insulin resistance symptoms. The symptoms may be as varied as irregular or missed periods, excessive hair growth on the face, around the nipples, and/or around the lower abdomen, obesity, thinning of the hair on the head, intractable acne, infertility, miscarriage, and type 2 diabetes or pre-diabetes.
Management
A good history, clinical examination, followed by pelvic ultrasound, and hormonal profile completes the diagnosis of PCOS. Ultrasound shows enlarged ovaries, with multiple small cysts generally oriented in the periphery, like "String of pearls". Hormonal profile reveals high levels of DHEA, LH, AMH, and a normal FSH level. High LH Levels with a normal FSH level is typical of PCOD
Goal of Treatment
Weight loss by diet and exercise is the most effective treatment. It lowers insulin resistance which restores regular cycles and ovulation. Anti-diabetic drugs like metformin, glitazone, newer drugs like D-chiro-inositol, Myo-inositol, Vitamin D3, and acupressure are other supportive therapies.
Restoration of fertility - Not all women have difficulty in conceiving. For those that do, ovulation is induced with drugs like clomiphene or HMG/FSH injections. Some might require laparoscopic ovarian drilling (A laser or cautery is used to drill 4-10 multiple holes through the thickened ovarian capsule). Those not responsive to these and diet and lifestyle modification, IVF (In-vitro fertilisation) is the option. Treatment results with PCOS are good
Treatment of hirsutism or acne
Restoration of regular menstruation, to prevent endometrial hyperplasia and endometrial cancer by using progesterone or combined contraceptive pill. If periods are occurring atleast every three months no treatment is needed.
Early diagnosis and treatment may reduce the longterm risk of type 2 diabetes and heart disease.
Is there a cure?
There is no straightforward cure. Medical treatments reduce the symptoms and consequences of PCOS. Majority of women respond excellently to lifestyle modifications only
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