#CrediTalk: Discussing Common Gynaecological Problems With Dr Malvika Sabharwal

The fight for women's rights is incomplete without mentioning women's health. The particulars of female reproductive health are diverse. And education remains a key component. Learning about common gynaecological problems is lagging in our society.

To understand the features of women's health issues, we began our journey with important questions, towards a top specialist in the field. We spoke with Dr Malvika Sabharwal, Gynaecologist and Obstetrician, at Apollo Spectra Hospitals. Read our interaction below.

Most Common Gynaecological Problems With Dr Malvika Sabharwal

Ques 1: PCOD is one of the most common gynaecological problems among women. How does someone identify the symptoms of PCOD? What are the health risks of this ailment?

Ans. PCOD (Polycystic Ovarian Disease) is a very common problem and one of the most important women's health issues. In fact, 2 out of 10 women have this disease. Young girls come with varied symptoms like irregular periods, a gain of weight, excessive facial hair growth or acne. All these are also clinical features of PCOD. Besides these, there can be lean PCODs as well, where the patient doesn't put on weight but other features are there.

For diagnosis purposes, we do the ultrasound and blood tests which are extremely important, to get a good analysis of the situation. There are specific blood tests that are hormonal tests. It is because, in this ailment, there is a hormonal pattern that is disarranged. So we try to pick up the disarranged hormonal pattern by checking certain blood parameters. There are also parameters for weight gain that are done in every patient irrespective of the weight gain.

Further, the patients have to be explained for the short term and long-term problems of this ailment. The short term problems being the right age for their fertility. We see that most girls today do not get married very early. If PCOD is there in a patient, she needs to watch out for her fertility. We suggest her to have a timely wedding and then timely babies. It is because the disarranged hormonal phase should not remain in the body for a long time.

We guide patients for regular health checkups with the gynaecologist. My advice is that women and girls should see that they don't put on weight. The weight has to be controlled, otherwise, they would be prone to diabetes and even cancer in the long term.

Lifestyle management is something that needs to be told to them in very clear terms. They should be made aware of exercises, dietary patterns, among other things.

Read about the PCOD Symptoms and Treatment Options

Ques 2: What is the importance of breast exams as one of the top women's health issues? How does the breast screening test work? And how can a woman check herself at home?

Ans. Breast exams are of great importance to every woman. Even young school girls should be counselled about this exam. There has been a rapid increase in the incidence of breast cancer. Here at Apollo Spectra, we arrange special classes for these young patients to know about their breasts. Breast examination means that you are familiar with your breasts.

You should stand in front of the mirror and look at your breasts. You should notice the size and shape of both your breasts including the size of the nipples. Then the examination is done with the palm of your hand. You have to use the palm and rotate it in a clockwise manner on the breast. Followed by this, you should then rotate the palm in an anti-clockwise manner. And without forgetting to go into the axilla (armpit) as well. After that, you should squeeze the nipples to see if there is a discharge. If you experience any suspicion, you should report to the gynaecologist. If you see any breast secretion or feel a lump, you should tell your doctor about it. You should also notice that your bra size may have suddenly increased. If you haven't gained weight, yet the breast size changes, visit a gynaecologist. It may not necessarily be cancer. Sometimes, it is a simple thing like a fibrocystic disease of the breast, which is among some common gynaecological problems. But at least, you should know as to what is happening.

Another thing to take into regard is the family history of breast cancer. Most girls carry it from the maternal side. So you should know any case of breast cancer in your family. In such cases, it is more important that you work up on that.

My suggestion to a young girl is that she should do a breast examination every month. After the age of 35-40, the exam should be done every week.

Ques: 3 Women are very doubtful while talking about their vaginal health, while the incidence of vaginal infections is rising. How can someone recognize the presence of such infections? What is your approach to treating these?

Ans. Vaginal health is very important and so is knowledge about common gynaecological problems. Two things are extremely important to consider -

One is awareness about the availability of vaccines for cervical cancer. The second is about vaginal discharge.

Women should be informed about what a healthy vaginal discharge is. There is a mid-cycle time when you can have some mucus discharge from the vagina, which is normal and healthy. The egg white kind of discharge that occurs in the mid-cycle is known as the ovulatory discharge, which is not unhealthy.

If ever there is a foul smell or discharge which is itchy, you must be concerned and report it to the gynaecologist for a checkup. We also need awareness of sexually transmitted diseases. Like STDs, there are other infections, etc. which can be transmitted from partners. If that is the cause, we always advise for the treatment of both the partners.

Women should get regular pap smears. If you have been involved sexually with multiple partners, then you must always use barrier contraception. The use of condoms protects you from transmitting a lot of problems. These awarenesses are very important when it comes to vaginal infections or susceptible vaginal discharge.

Ques 4: Could you expand on the common discomforts of pregnancy that women experience?

Ans. I would say pregnancy is a psychological state. Most women experience pregnancy at some time in their life. Only if they are made aware of the problems that they may face, they would be able to deal with common gynaecological problems better.

In the first three months, you will have a little bit of nausea and vomiting. These are good signs but up to a certain level. Nausea and vomiting just show that the hormones are going up. And that you have enough hormones to protect your pregnancy. You may feel more sleepy, tired or have a lot of mood swings.

In the middle trimester (4-6months of gestation) you are safer with your pregnancy. You may have little back cramps and pain, because as the pregnancy grows your centre of gravity is going to change. So to balance that we always tell you to learn antenatal exercises. Almost all the physiotherapy centres can guide and help you with these exercises. You may also get constipated at this time. So we tell you to increase the fibre in your diet. You may also have urinary tract infections, which are very common in pregnancy. Such things should be tested regularly.

And in the third trimester, you may experience more acidity. This acidity is going to be pushed up into the oesophagus, that may make you throw up a little. My advice is that you have more frequent meals. You can even make it 6 meals a day, but have a fewer amount and more frequently so that you can digest it easily. This way you can get all the nutrients in your body for the baby. Your doctor may give you supplements of iron, calcium and multivitamins to lay these problems, which will help you in eating properly for a healthy pregnancy.

Ques 5: What are uterine fibroids? Is there a way to prevent them?

Ans. Uterine fibroids are basically growths in the body of the uterus. The uterus is like a room where the baby will be. It has two tubes and two ovaries. Any growth in the body of the uterus is called a fibroid. This fibroid can grow inside the uterus, outside the uterus, or can be found inside the wall of the uterus.

It is one of the most common gynaecological problems. Patients experience various symptoms, one of which is excessive bleeding. In some cases, even a 2cm large fibroid, a small one coming towards the inside of the uterus, will cause lots of bleeding problems. And at other times, a very large fibroid, much as a 3kg one may grow towards the outside, but cause no problems like bleeding. In this case, there may be urine control symptoms. The patent may not be able to pass urine and when you examine them, you find almost like a 6-month baby's size uterus which is a fibroid.

Even during pregnancies, there may be an issue of fibroids. Sometimes there can be a history of repeated abortions or premature baby deliveries because of the presence of fibroid in the wall of the uterus. It obstructs the placental flow as the placenta of the baby is gone and embedded on the fibroid. So, the flow to the uterus may not be fine. But all these cases can be managed. We have had so many deliveries with large fibroids and with a full-term baby. It is important to be in touch with your gynaecologist if this happens.

Another aspect of treatment is a laparoscopy. I have been doing laparoscopy since 1992. It is a procedure where we use a telescope with a camera. The insides are visible on a television monitor and that is how this surgery is done and fibroids are removed.

Ques 6: What could be the chief reasons for abnormal vaginal bleeding?

Ans. There are various reasons. Sometimes, the patient comes and says she has just got a spotting. And if you ask the history she will tell you the incident of taking an i-pill. I feel i-pill has been so over advertised and people have started to use it over-the-counter. It is available to all of them and it's extremely wrong. They are spoiling the hormonal status of the body. On top of that, women do not know as to what is happening.

Sometimes vaginal bleeding could also be because of pregnancy. Otherwise, there can be growths in the uterus or the mouth of the uterus like polyps or fibroids. There could be fibroid which could be growing like a polyp. All this may cause intermenstrual bleeding which means bleeding other than periods.

There can be other issues like some infections which also have to be kept in mind. So if a patient has come to you with abnormal vaginal bleeding, it is important to work up the patient. You have to look at the uterus, the inner wall of the uterus, how much is the thickness, if there is any polyp or fibroid which has to be picked up and accordingly, then you manage the patient. There are simple antibiotics that can be given but reporting to the gynaecologist is a must. Check out all the article in #CrediTalk series here.

About The Doctor

Dr Malvika Sabharwal is a senior consultant- Gynaecology, female Laparoscopic Surgery at Apollo Spectra Hospital, Karol Bagh, New Delhi. She has a rich experience of 36 years in her field.

Dr Malvika was honored with one of the highest civilian awards, Padma Shri by former President Smt Pratibha Patil for her contributions to the field. She has completed her graduation and post-graduation in Gynae & obs from Lady Hardinge Medical College, New Delhi. She has received training in Hysteroscopy by Dr. Wamsteker in Netherlands and laparoscopy with Dr. Adam Magos in the UK.