Gynecology and Obstetrics Online Doctors Consultation — page 10

Patient Name: Harman Age: 25 years Gravida: G2 (Second Pregnancy) Gestational Age: 26 Weeks Date: 12-April-2025 Chronic Illnesses: None reported Chief Concern: Mild nosebleeds during the 26th week of pregnancy. Concerned if this is normal and whether any other changes should be expected in this stage. Clinical Impression: At 26 weeks of pregnancy, several physiological changes occur in the body due to increased blood volume and hormonal influence. Mild nosebleeds (epistaxis) are common and usually harmless in pregnancy, especially in the second and third trimesters. This happens due to: Increased blood flow and vessel sensitivity – Pregnancy hormones like estrogen and progesterone increase blood flow to mucous membranes, making nasal blood vessels more fragile. Dry nasal passages – Often caused by weather changes, air conditioning, or dehydration, which can worsen nosebleeds. Minor trauma – Like nose picking or blowing the nose too hard. Advice and Reassurance: Stay hydrated – Drink plenty of water to keep mucous membranes moist. Use a saline nasal spray – Keeps nasal passages moist and reduces dryness-related bleeding. Humidifier at night – Helps prevent dryness from indoor air. Avoid blowing nose forcefully or picking nose. Cold compress on the nose bridge during bleeding episodes helps constrict vessels. Sleep in a slightly elevated position to reduce nasal pressure. Warning Signs (When to Seek Medical Attention): Frequent or heavy nosebleeds Bleeding that doesn’t stop after 10–15 minutes of applying pressure Bleeding with high blood pressure, dizziness, or vision changes Any signs of anemia (excessive tiredness, pale skin, breathlessness) Other Common Changes at 26 Weeks: Baby's movements become more regular and stronger Backache or pelvic discomfort Leg cramps or mild swelling in feet Increased heartburn or constipation Emotional mood swings or vivid dreams Next Steps: Continue prenatal vitamins (Iron, Calcium, Folic Acid) Maintain left-side sleeping position Monitor fetal movements daily Attend regular antenatal check-ups Optional: Blood pressure check and hemoglobin level (to rule out anemia if bleeding is frequent) You are doing great. Don’t worry mild bleeding is normal. Please rate and review. For consultation do reach me. Dr Shayeque Reza MD 9800280276

Thank you for sharing this, Harman. Based on your description, what you're experiencing is commonly seen in the second to third trimester of pregnancy especially around 26 weeks. Antenatal Follow-Up Note Patient Name:Harman Age:25 years Gravida :G1 (assumed, please confirm if not first pregnancy) Gestational Age:26 weeks Chronic Illnesses:None Date:12-04-2025 Chief Concerns: 1. Occasional right-sided abdominal/stomach pain 2. Pressure sensation while sleeping, especially at night 3. Pain in the right leg 4. Anxiety about whether this is normal in pregnancy Clinical Impression: Your symptoms are likely part of normal physiological changes in the second and third trimesters due to: 1. Round ligament pain– sharp or pulling sensation on one or both sides of the lower abdomen, more common on the right side. Caused by stretching of the ligaments that support the growing uterus. 2. Sciatic nerve pressure or pelvic girdle pain– the growing uterus can compress the sciatic nerve, causing leg or lower back pain (often one-sided). 3. Uterine pressure– normal as the uterus expands and shifts position. This may worsen at night due to sleeping posture. 4. Baby's position– can cause pressure in different areas at different times. Reassurance & Advice: - These symptoms are common and usually not dangerous if there are no red-flag signs. - Try left lateral sleeping position to reduce pressure on the inferior vena cava (a large vein). It improves circulation to baby and reduces pressure. - Use pillows between knees and under the belly while lying down for support. - Warm compress (not hot) can help relax muscles on the painful side. - Gentle stretching or prenatal yoga can relieve ligament and back discomfort. - Avoid standing or sitting for long period– shift positions frequently. When to Seek Immediate Medical Attention: If you have any of the following: - Severe or sharp constant pain (not relieved by rest) - Vaginal bleeding or fluid discharge - Fever or chills - Decreased fetal movement - Sudden swelling of feet, face, or hands - Headaches or visual changes Follow-Up Plan: - Routine antenatal visit as scheduled - Obstetric ultrasound (as per schedule or if advised for pain) - Monitor baby’s movements daily - Keep hydration adequate - Maintain iron and calcium supplements * PLEASE GIVE YOUR REVIEW . Thank you Dr Shayeque Reza MD 9800280276

Please share your problem properly I am here to help you. Dr Shayeque Reza Md 9800280276

Hello Vandana, **Patient Information:** Name: [Your Name] Age: 20 years Sex: Female **Presenting Complaint:** The patient reports experiencing irregular periods that are often delayed, along with constant weight gain despite following a regular exercise routine and diet. She also experiences frequent bloating. The patient is concerned about her inability to manage weight effectively, despite healthy lifestyle habits. **Clinical History:** - Periods are delayed at times. - Significant weight gain over time, despite consistent efforts with diet and exercise. - Occasional bloating, which exacerbates discomfort. - No specific history of other chronic illnesses or major health concerns. **Possible Causes:** The patient’s symptoms suggest potential underlying conditions that could be contributing to her issues: 1. **Polycystic Ovary Syndrome (PCOS):** A common cause of irregular periods, weight gain, and bloating in young women. PCOS is characterized by hormonal imbalances, where higher levels of androgens (male hormones) can disrupt the menstrual cycle and lead to weight gain, particularly around the abdomen. Bloating is also a common symptom. 2. **Hypothyroidism (Thyroid Imbalance):** An underactive thyroid can lead to slowed metabolism, which causes difficulty in losing weight, weight gain, fatigue, delayed periods, and bloating. Hypothyroidism is a common cause of unexplained weight gain and menstrual irregularities. 3. **Insulin Resistance:** This often occurs with PCOS and can lead to difficulty losing weight, fatigue after meals, and bloating. Insulin resistance also affects how your body processes sugar and can cause cravings, making weight management more difficult. 4. **Stress and Sleep Disorders:** Chronic stress or poor sleep can disrupt the hormonal balance in the body, contributing to weight gain, delayed periods, and bloating. Stress impacts cortisol levels, which can lead to weight retention, particularly around the abdominal area. **Recommended Investigations:** To understand the root cause of the symptoms, the following tests should be considered: 1. **Thyroid Function Tests:** TSH, T3, T4 levels to rule out hypothyroidism. 2. **PCOS Testing:** LH, FSH, serum testosterone, and an ultrasound of the ovaries to check for cysts or other abnormalities indicative of PCOS. 3. **Fasting Insulin and Glucose Levels:** To assess insulin resistance. 4. **Complete Blood Count (CBC) and other routine investigations** to rule out any other potential causes. **Management Plan:** Based on the results of the above investigations, a treatment plan will be formulated, which may include hormonal treatments, dietary adjustments, insulin-sensitizing medications (if insulin resistance is present), and targeted exercise plans to manage weight and bloating. Stress management techniques, including mindfulness, relaxation exercises, or counseling, may also be beneficial. **Follow-Up:** A follow-up appointment will be necessary to review lab results and progress with any prescribed treatment. If any of the tests indicate a specific condition like PCOS or thyroid dysfunction, further referrals to a specialist may be recommended. Dr Shayeque Reza MD 9800280276

Hello Muneba, Thanks for sharing that—since you're just 20, the sudden change in your periods is definitely something worth getting to the bottom of, especially since they were regular before. Given your age and the symptoms (irregular cycles, shortened periods, past Nabothian cyst), here are some focused possibilities: Top Likely Causes at Your Age: 1. **PCOS (Polycystic Ovary Syndrome)** - Very common in young women. - May cause: - Irregular periods - Short, light bleeding - Acne, weight gain, or facial/body hair (but not always!) - Can be diagnosed with: - Pelvic ultrasound (to check for multiple small cysts in ovaries) - Blood tests: LH/FSH ratio, testosterone, insulin, etc. 2. **Thyroid Dysfunction** - Hypothyroidism (underactive thyroid) or hyperthyroidism can affect your cycle. - Simple blood test (TSH, T3, T4) will clarify this. 3. **Stress / Weight Changes / Diet** - Mental or physical stress, under-eating, or rapid weight changes can shut down ovulation. - This leads to shorter or missed periods. 4. **Hormonal Imbalance or Early Ovarian Dysfunction** - Although rare at your age, low estrogen or hormonal issues can cause thin endometrial lining—leading to only 1–2 days of bleeding. 5. **Post-Cyst Hormonal Disruption** - Sometimes after Nabothian cysts or minor gynecological procedures, your hormones take time to settle, especially if you were given any hormonal medication. What You Should Consider Doing: **1. Hormonal Blood Work** (done on Day 2–5 of your cycle if possible): - **FSH & LH** - **TSH (thyroid) - **Prolactin - **Estradiol (E2) - **AMH** (to assess ovarian reserve) - **Testosterone & DHEA-S** (if acne or hair issues) 2. Pelvic Ultrasound** - To check ovaries (for PCOS signs) - Endometrial lining thickness - Any structural changes after cyst healing Dr Shayeque Reza MD 9800280276

Hello Shreya, Certainly! Below is the prescription in a format commonly used in medical colleges and by healthcare professionals: **PRESCRIPTION** *Patient's Name:* Shreya *Age:* *Gender:* [Female] *Date:* 12/0425 *Diagnosis:* Fibroadenoma Bilateral, Pain, Migraine --- **1. Pain Management** - **Ibuprofen 400 mg Tablets** *Sig:* Take 1 tablet orally every 8 hours as needed for pain relief. Do not exceed 1200 mg per day. *Quantity:* 30 tablets *Refills:* 1 - **Paracetamol 500 mg Tablets** *Sig:* Take 1-2 tablets every 4-6 hours as needed for pain. Do not exceed 4 grams per day. *Quantity:* 30 tablets *Refills:* 1 **2. Hormonal Regulation (For Fibroadenoma)** - **Primosa (Evening Primrose Oil) 1000 mg Softgel** *Sig:* Take 1 softgel daily after a meal. *Quantity:* 30 softgels *Refills:* 1 --- - **Vitamin E 400 IU Capsules** *Sig:* Take 1 capsule daily. *Quantity:* 30 capsules *Refills:* 1 **3. Migraine Management** - **Sumatriptan 50 mg Tablets** *Sig:* Take 1 tablet at the onset of a migraine. If no relief, may repeat dose after 2 hours. Do not exceed 200 mg in 24 hours. *Quantity:* 6 tablets *Refills:* 1 **4. Preventive Care and Support** - **Magnesium 400 mg Tablets** *Sig:* Take 1 tablet daily for migraine prevention. *Quantity:* 30 tablets *Refills:* 1 **Instructions:** - Follow the prescribed doses. - Contact the healthcare provider if pain persists or worsens. - Schedule a follow-up consultation in 4-6 weeks to assess progress. - If symptoms of migraines or fibroadenoma worsen, further diagnostic tests (ultrasound, mammogram) may be necessary. - Avoid high-caffeine and alcohol intake. Dr Shayeque Reza MD Date- 12/04/25 9800280276

Hello Ruhi, Nothing to worry about, as I can see you high TSH which means you have hypothyroidism. And because of this you having delayed in period. For now you can do USG of Pelvis to overcome your fear. Thank you . Do give your review.

Hi kaur Can totally understand your problem Here is it what we can do : Due to your on flow menstrual blood local application is difficult and per vagina insertable tabs cant be prescribed, For presently: 1.Tab AF kit ( contains anti bacterial & anti fungal tablets) All three tablets to be taken at once after breakfast ( advised to have good breakfast) 2. Tab Esomac Dsr daily once before food for 3days . After your periods have completed Use Candid V cream local application at your private parts Candid V pessary set of 7 tablets One tablet per vagina every night for 7days ( advised to wash it in morning) Maintanence of personal hygiene is very important ( shaving of pubic hairs ) Avoid using tight underwears And always use totally dry and properly washed undergarments Hope so I have resolved your problem

Hey Sahana I’m really sorry you’re dealing with that ,it sounds incredibly uncomfortable, especially on top of everything else. Vaginal boils can be painful and stressful, both physically and emotionally. Probably the diagnosis is Bartholin cyst. It's often caused by a blocked hair follicle, ingrown hair, or bacterial infection (like Staph). It starts as a red, tender bump and may grow larger, fill with pus, and become more painful over a few days. How to care for it at home (gently and safely): Warm compresses: Use a clean, warm, damp cloth and gently press it against the boil for 10–15 minutes, 3–4 times a day. This can help it drain naturally and ease pain. Keep the area clean & dry: Wash gently with warm water and mild soap. Avoid any harsh scrubbing or scented products. Wear loose, breathable underwear (cotton is best): Avoid tight clothing to prevent friction and help healing. Don’t pop it. As tempting as it might be, squeezing it can push bacteria deeper and worsen the infection. IF YOU HAVE FEVER, CHILLS YOU MIGHT NEED PROPER FOLLOW UP.

Ok I can understand your problem. Feel free to interact. This is Called Vaginitis which is very common with women. Please let me know if you have past history of any chronic illness like Diabetes Mellitus, TB and if your pregnant. As you told it is itchy and you have white discharge without any foul smelling, then probably it is Vaginal candidiasis. Both the partner needs anti fungal treatment.