Gynecology and Obstetrics Online Doctors Consultation — page 11

Patient Name: Shrutika Lakadkar Age: 22 years Date: [13/04/25] Chief Complaints: No significant increase in breast size despite weight gain (from 35kg to 48kg) Low self-confidence due to breast size not increasing with weight gain Previous treatments not showing results Diagnosis Considerations: Hormonal imbalance or lack of response to weight gain in breast tissue Insufficient muscle tone in the chest area Emotional and psychological impact of breast size on self-esteem Blood Tests: Hormonal profile (Estrogen, Progesterone, Testosterone, FSH, LH) to check for any imbalances Thyroid function test (TSH, T3, T4) to rule out thyroid-related issues that may affect metabolism and fat distribution **Follow up the reports as soon as possible so that I can plan a treatment ** Dr Shayeque Reza MD 9800280276

Hello Bazila, OPD PRESCRIPTION Name: Bazila Age/Sex: 18 years / Female Date: 12/04/25 Weight: Thank you for sharing that — it sounds like you're dealing with a really frustrating and painful situation. You’ve been doing everything right by getting tests done and watching your lifestyle, yet you're still experiencing symptoms that deeply affect your daily life and confidence. Chief Complaints: Irregular menstruation (last period: early February) Progressive weight gain despite healthy diet Hirsutism (excessive facial and body hair) Androgenic alopecia (scalp hair loss, balding) Inability to lose weight despite efforts Provisional Diagnosis: Oligomenorrhea with Clinical Hyperandrogenism — likely Subclinical or Phenotypic PCOS / Insulin Resistance (with normal labs) Let’s break it down clearly: Your Symptoms: Irregular periods (no period since early February) Belly bloating or "hanging" sensation Rapid or persistent weight gain despite clean eating Hirsutism – excessive facial and body hair Hair thinning/balding (likely androgenic alopecia) Difficulty losing weight despite efforts All blood tests (PCOD profile, CBC, TFT, USG) are reported as normal What Could Be Going On? You could still have a hormonal disorder that isn’t fully showing up in basic blood tests yet. Some forms of PCOS, especially lean or subclinical PCOS, don’t always reflect clearly in: Ultrasound (ovaries may appear normal) Testosterone (may still be in “normal” range but on higher side) Basic insulin/glucose levels You may have Insulin Resistance without diabetes — very common in women with your symptoms. Metabolic dysfunction can lead to: Fat accumulation around belly Weight loss resistance Increased androgens (causing hair issues) Non-classic Congenital Adrenal Hyperplasia (NCAH) or androgen-secreting issues (very rare but worth ruling out) These don’t always show up in general PCOD profiles They require specific tests like 17-OH Progesterone, DHEAS, and Free Testosterone Hypothalamic dysfunction or chronic stress can also disturb hormonal signals without showing in initial tests. What Can You Do? Even if reports are normal, your symptoms are clinically significant and deserve treatment. Dr Shayeque Reza MD 9800280276.

Hello Babli You’re carrying so much right now—physically, emotionally, hormonally. What you’re describing isn’t just random symptoms; it sounds like your body is waving red flags, asking for attention and support. Let’s gently break this down together and look at what might be going on, because there’s a strong possibility that it’s hormonal imbalance, maybe something like PCOS, thyroid issues, or even perimenopause, depending on your age. But regardless of labels, your experience is valid, and you deserve to feel better. Here’s what your body might be trying to say: 1. Weight gain (especially belly/thigh/waist) + bloating + joint pain These can point to hormonal imbalances (like insulin resistance, PCOS, or low thyroid). Feeling heavy even when not eating is often tied to inflammation, sluggish digestion, or hormonal water retention. 2. Low, brown/yellow period flow + irregular cycles This might suggest: Estrogen dominance (too much estrogen compared to progesterone) Perimenopause if you’re late 30s or 40s Thyroid dysfunction—hypothyroidism often causes light, irregular periods. 3. Headaches, nausea, fatigue, not able to eat These often come from gut issues, chronic stress, or again—hormones. Could also be linked to IBS or poor nutrient absorption (like low iron, B12, or magnesium). Things you can do now (gently, no pressure): 1. Get lab tests done if possible: If you’re up for it, ask your doctor to check: Thyroid panel (TSH, T3, T4, antibodies) Hormones (estrogen, progesterone, testosterone, LH, FSH) Vitamin D, B12, iron, CRP (inflammation) Insulin & fasting glucose Supportive things to do at home: Gentle movement daily (even stretching or walking)—helps joint pain, hormones, and digestion Warm, easy-to-digest meals (soups, stews, veggies + healthy fats + protein) Magnesium supplement (great for hormones, IBS, sleep, and joint pain) Stay hydrated, but avoid cold drinks—they can worsen bloating for some Got it! Based on everything you’ve shared—and since your periods are coming but the **flow is very low**, and you’re dealing with **hormonal imbalance, IBS, fatigue, joint pain, and vaginal boils**—here’s a **gentle daily routine with suggested medicines, supplements, and self-care practices** to help support your healing. --- ### **Daily Wellness Plan (Natural + Medical Support)** **(Feel free to screenshot or copy this)** --- ### **Morning (Empty stomach – after waking)** - **1 glass warm water** with a few drops of lemon (optional: pinch of turmeric) - **1 capsule: Myoinositol + D-Chiro Inositol** (e.g., Ovacare Myo / Normoz / OvaBoost) *Supports hormonal balance, weight, ovulation* --- ### **After Breakfast** - **Vitamin D3 + B12 + Iron supplement** *(e.g., Neurobion Forte + Shelcal-D or similar)* - **1 capsule Omega-3** (anti-inflammatory, supports joints and hormones) - **Probiotic capsule** (e.g., Darolac / VSL#3) *Supports gut, reduces IBS, improves immunity* **Breakfast Idea:** Warm khichdi, oats, poha with veggies, or eggs + toast *(Avoid cold/raw or heavy fried foods in the morning)* --- ### **Mid-morning (Optional)** - **Ashwagandha capsule or tea** (stress + hormone support) *(Skip if it worsens IBS)* --- ### **Lunch** - Warm, cooked meals—dal, rice, veggies, ghee, or roti + sabzi - Add **cumin + ajwain + ginger** in cooking to help digestion - Sit calmly during meals—no phone/stress eating --- ### **Post-Lunch** - **Liv52 tablet or syrup (Himalaya)** – supports liver, reduces bloating --- ### **Evening (Pre-dinner)** - **Peppermint tea or chamomile tea** – soothes digestion, helps calm mind - **Gentle walk or light stretching** – improves digestion, relieves joint tension --- # **Dinner** - Light meal – soup, khichdi, steamed veggies + moong dal *(Avoid cold drinks, heavy spices, sugar)* ### **Night (Before Bed)** - **Magnesium glycinate or citrate** supplement (relaxes muscles, eases sleep, supports digestion + headaches) - **Warm compress** on belly or joints if pain or bloating - **1–2 Himalaya Evecare capsules** *(regulates hormones, supports menstrual flow)* **Optional:** - Body scan meditation or deep breathing to quiet thoughts - Keep lights dim and phone off 30 mins before bed ### **Bonus Tips:** - Track your cycle, mood, and symptoms daily (can help your doctor too) - Drink warm water through the day, not cold - Try not to skip meals—it can worsen hormones and IBS This plan is **a supportive base**, not a cure—but many women see improvement in energy, flow, digestion, and mood over 2–3 cycles with this kind of care. If you're okay with it, I can also help write a message you can take to a gynecologist or general physician to ask for blood tests or confirm these meds. Want that? And if there’s one symptom that’s bothering you the most *right now* (like nausea or pain), I can suggest more targeted relief too.

In PCOS there is delayed periods. You can wait for 45 days from your last period.

Please explain in detail .when did you have your last period? when did you had your last intercourse?

Hi kalai, Of course, Kalai. Here's a detailed **doctor-format case summary** including your obstetric history, current condition, lab interpretation, and recommendations: ### **Patient Case Summary** **Name:** Kalai **Age:** 29 **Sex:** Female **Location:** Bangalore **Gravida 2, Para 1 (G2P1)** --- ### **Presenting Concern:** Patient is currently pregnant (second pregnancy) and concerned about the risk of **rubella affecting the fetus**, as in the first pregnancy the child was born with **congenital cataract** and has **developmental delay** attributed to **Congenital Rubella Syndrome (CRS)**. --- ### **Obstetric History:** **G1:** - **Full-term delivery**, 2.5 years ago. - Infant diagnosed with **congenital cataract**, delayed developmental milestones (not walking yet). - Mother was presumed to have **primary rubella infection** during the first trimester based on clinical history. - No documented vaccination history prior to first pregnancy. **G2 (Current Pregnancy):** - Routine antenatal screening shows **Rubella IgG positive**. - No clinical symptoms of recent viral infection (fever, rash, arthralgia, lymphadenopathy) during this pregnancy. - No documentation of **Rubella IgM** in the current pregnancy yet (pending or not performed). - No history of contact with any rubella-infected individuals. - Pregnancy age and trimester: [Insert gestational age or trimester if known]. --- **Lab Investigation Summary:** - **Rubella IgG:** Positive → Indicates **past infection or vaccination-induced immunity** - **Rubella IgM:** [Insert Result if Available] → **If Negative:** Confirms **no recent/active infection** → **If Positive:** May suggest recent infection — requires **IgG avidity testing** to determine timing of infection. **Clinical Assessment:** - Based on the **Rubella IgG positive** status and **absence of symptoms**, it is **most likely that the patient is immune** to rubella due to past exposure (either from first infection or natural immunity). - **Risk of fetal rubella infection in current pregnancy is extremely low**, provided **IgM is negative**. - No additional symptoms to suggest current rubella reinfection. - However, given history of Congenital Rubella Syndrome in the first child, **close fetal monitoring is advised**. --- ### **Recommendations:** 1. **Confirm Rubella IgM status:** - If not yet done, perform **Rubella IgM test**. - If **IgM negative**: Patient is immune; fetus **not at risk**. - If **IgM positive**: Recommend **Rubella IgG avidity test** to assess timing of infection (low avidity = recent, high avidity = old infection). 2. **Fetal Monitoring:** - Serial ultrasounds: Monitor fetal growth and look for signs of congenital anomalies. - Targeted anomaly scan (Level II) at 18–20 weeks. - If any abnormal findings: Consider **fetal echocardiography** and **neurosonography**. - TORCH screening may be done as part of the antenatal panel if not already done. 3. **Genetic Counseling / MFM Referral:** - Referral to **Maternal-Fetal Medicine (MFM) specialist** is recommended due to history of CRS in previous child. - Can provide additional guidance and high-risk pregnancy management. 4. **Psychosocial Support:** - Reassure patient regarding the low likelihood of rubella affecting this pregnancy if immune. - Encourage regular antenatal visits and complete pregnancy monitoring. --- **Summary:** Kalai is a G2P1 woman with a past pregnancy affected by Congenital Rubella Syndrome. She is currently Rubella IgG positive, suggesting immunity. If IgM is negative, there is **no risk of rubella-related congenital defects** in this pregnancy. Continued monitoring is advised due to past obstetric history. --- If you provide your **Rubella IgM result** and **gestational age**, I can complete this summary for you with exact details. You're doing an excellent job being careful with this pregnancy, Kalai—keep following up with your doctor regularly, and don't hesitate to ask for specialized care when needed. Dr Shayeque Reza MD 9800280276

Though we don’t regularly advise medications for helping lactation but I believe breastfeeding is the first thing which connects mother to her infant. Now for non medical management part 1. Correct position and breastfeeding techniques https://www.researchgate.net/figure/Breastfeeding-techniques-and-Burping-Positions_fig1_364305561 2. It is advised to take no stress which means you should be calm everytime. 3. Keep trying even if no milk is being poured out from any breast 4. Trying emptying breast manually As far medication is involved Take 1. Tablet Domstal 10mg three times a day until optimal breast milk comes out from each breast 2. Lactogranules- put it in milk PS- Tablet Domstal can have a side effect- causing your neck to turn at one side. It is quite common side effect. In case you experience such side effect stop the medication and don’t panic it will become normal after sometime. Hope it solves your query Thank you

Though we don’t regularly advise medications for helping lactation but I believe breastfeeding is the first thing which connects mother to her infant. Now for non medical management part 1. Correct position and breastfeeding techniques https://www.researchgate.net/figure/Breastfeeding-techniques-and-Burping-Positions_fig1_364305561 2. It is advised to take no stress which means you should be calm everytime. 3. Keep trying even if no milk is being poured out from any breast 4. Trying emptying breast manually As far medication is involved Take 1. Tablet Domstal 10mg three times a day until optimal breast milk comes out from each breast 2. Lactogranules- put it in milk PS- Tablet Domstal can have a side effect- causing your neck to turn at one side. It is quite common side effect. In case you experience such side effect stop the medication and don’t panic it will become normal after sometime. Hope it solves your query Thank you

Do you have discharge?

Patient Name: Varshini Age: 24 years Date: 13/04/25 Chief Complaints: Diagnosis of PCOS (ovarian enlargement, irregular periods) Subclinical hypothyroidism No medication prescribed by previous doctor for PCOS Diagnosis Considerations: Polycystic Ovary Syndrome (PCOS) Subclinical Hypothyroidism Irregular menstrual cycles due to hormonal imbalance Blood Tests: Repeat Thyroid Function Tests (TSH, T3, T4) to monitor thyroid status and ensure proper management. Hormonal Profile: LH, FSH, estrogen, progesterone levels to check hormonal imbalance. Glucose and Insulin Levels: To check for insulin resistance, which is common in PCOS. *Follow with the reports for your treatment plan* Thank you Dr Shayeque Reza MD 9800280276