Q.) Hi I am a 27 year old girl and have been married for the past two years. I learnt about the new I-pill in the market. Can it be used as a regular contraceptive? I am aware of the recent unfavorable media reports about the pill. Please advise.

Ana. The I-pill is meant for emergency contraception only. It contains a hormone- progesterone, in a certain dose, which, if taken as a regular contraception, will certainly cause disturbances of your menstrual cycle. It would be wise to use ommonly available hormonal contraceptives – those containing the combination of hormones: Estrogen and Progesterone (Oral Contraceptive Pill – OCP) or Progesterone-only- pill (POP) for routine use. These are highly effective in preventing pregnancy with inimum to tolerable side-effects. Condom, alone, or in combination with oral pills, can also be used as a reasonably effective contraceptive method and for prevention of sexually transmitted diseases.

I-pill should be used in emergency only, when there has been unprotected or inadequately protected intercourse. E.g. condom tears, leaks or slippage during intercourse, forgotten pills or in cases of sexual assault. Don’t replace your current contraceptive method with I-pill irrespective of whatever media reports you may have read about OCPs. Remember that more women have illness or death related to unwanted pregnancy than the adverse effects you may have read about oral pills.

Q.) I am a 31 years of age and have two children. The stretch marks from the regnancies are still there. Can you suggest some method to remove these marks?

Ana. Probably the best way to deal with stretch marks of pregnancy is to prevent them. Most of my patients keep the abdominal skin supple, well hydrated and oiled during pregnancy. I said probably because there is no sure shot guarantee that these methods will work. The oiling seems to work for some but not for others.

Many proprietary creams, especially those containing Aloe Vera and Vitamin E, are available in the market advertised for this very purpose. But, honestly, their claims are not backed by good scientific research. This does not mean that they don’t or won’t work. This simply means that, maybe this subject was not important enough for serious researchers to work on.

Personally, I never discourage my patients in this oil and oil again regime but I do recommend yoga before, during and after pregnancy to increase the flexibility of their muscles and elasticity of the skin which is likely to lead to lesser stretch marks. This, too, is not backed by any research.

Dealing with stretch marks much after pregnancy, as in your case, is not easy but not impossible. If you are an actor or in any vocation where you are in public glare and need to expose your tummy, you could try foundation cream and makeup on the tummy. Jokes apart, don’t bother about your stretch marks. Your tummy needed to expand to accommodate the baby – the collagen fibres are bound to get overstretched and break. It’s a natural part of the joy of having a baby.

Q.) Hi! I am a 20 year old college going girl and am currently experiencing problem with the pimples on my face. While the others of my age have long ago gotten over the phase of pimples, in my case they seem to reappear frequently. Please suggest some way to avoid them completely.

Ans. Hi! Your age and collegiate status give you away. You are probably living on junk food and not ‘ma ke hath ka ghar ka khana’. That yucky, oily mess in the college canteen is full of maida and yesterday’s left over potatoes fried in oil used over and over again. All your bouncy energy is coming from colas and the sugar in your innumerable chai-coffee.

You know all this, don’t you. One doesn’t need to be told, really. Since you asked……… Do you wash your hands several times a day since your hands are touching objects touched by so many other people who do not wash their hands like you. And all these germs get transferred to your face whenever you touch it, however lightly – even if just to flick hair off your face.

Follow the simple rules as outlined above. Wash your face at least twice a day with a face wash followed by a cleansing toner chosen according to your skin type and tie your hair well away from your face

If, however, this does not clear off the pimples or if they are very severe, do consult your dermatologist.

If, on the other hand, you have noticed an increase in weight, excessive hair growth or an irregularity of your menstrual cycle, check out with a gynaecologist for hormonal problems. Excellent medicines are available that can be applied on the skin or taken by mouth. These need to be decided by your skin/Gynae doctor. But you must contribute to your own care by being wiser in your diet, habits and cleansing routine.

Q. I) am 23 years old and planning a family. When my husband and I contacted the doctor, she advised that I get tested for TORCH test. What is a TORCH test and is it necessary for conception?

Ana. TORCH refers to Toxoplasmosis, Rubella, Cytomegalovirus (CMV) and Herpes. These infections can cause immense harm to the unborn baby if the mother gets infected during pregnancy, not before pregnancy. Therefore, screening for TORCH infections, in toto, is not recommended before pregnancy, except for Rubella. Rubella screening is done by getting a blood test for ‘Rubella IgG’. If test result is positive, please don’t be alarmed as it indicates that you are immune or protected against Rubella. If your report says negative, you must get the vaccination done and wait 1-3 months before conceiving. Since routine screening before or during pregnancy is not recommended for the other three unless there is infection, you should be alert and take precautions wherever possible.

Pain in the genital area with blisters leading to ulcerations, and painful urination, both in men and women, are the commonest symptoms of Herpes. Avoid sexual contact during such times not only to prevent pregnancy but also to protect your partner from getting infected too.

CMV infection results in a severe flu like picture Blood tests are available for diagnosis if your doctor suspects this. There is no real problem to the mother, but CMV is the commonest cause of deafness, learning disabilities and mental retardation in the baby. Avoid contact with young children who are suspected to be suffering from CMV to decrease risk of transmission to yourself, in case you are planning pregnancy or are pregnant. Vaccination against CMV is still in experimental stage.

To prevent Toxoplasmosis avoid uncooked meats, even uncooked food which may have come in contact with raw meat and contact with cat faeces since you are planning your pregnancy.

Q.1) I'm Shalini, 32, from Jammu . My mother underwent menopause at 40. Should I be worried?

Ans. The chances of your having menopause earlier are higher but there is really no need to be ‘worried’, Shalini. Be alert to this possibility, however, and take remedial measures to decrease your chances of having problems if you were to follow your mother’s footsteps. Avoid getting overweight because women are more prone to the bad effects of obesity like abnormal lipids in the blood, high blood pressure, blocked arteries, heart attacks, and diabetes. Eat right – high fibre, low fat, low carbohydrates, seasonal bright coloured foods, 5-6 helpings of fresh fruits and vegetables, 1 glass of milk, some fish or dietary omega 3 fatty acids and a few nuts every day. Avoid junk food and colas. Exercise to keep your weight in check, to improve the performance of your heart and to deposit calcium in your bones. Share this information with your mother and see that she takes at least 1000mg of calcium and 200 iu of vitamin D supplement daily since she is already menopausal. Your mother must also have her annual check up done which includes blood tests, Pap Smear for cancer cervix screening, Bone Mineral Density test and a mammography. If your mother has any stress factors, help her solve them and identify some ways – gardening, music, reading or even cooking which could serve as stress busters for you.

Q.2) Hi, I am Manish, my mother who is 52 is undergoing menopause. She has been behaving in an irritating manner for quite some time and she is moody and temperamental whenever we try to talk to her. Please tell us how can we help her cope with the stress of menopause?

Ans. Manish, how sweet of you, as a son, to be concerned about your mother. Do you know, however, that menopause per se is not stressful. Women do not go ‘mad’ at menopause. It can be a gentle transition from reproductive phase to a period free phase. Mood changes, irritability and depression are common in these years, more often due to social causes like death or illness in family, retirement blues, financial insecurity, need to take care of old parents and children going away from home –the ‘Empty Nest Syndrome’ coupled with the thoughts that you are needed no more. Help and support her in whatever way you can. Understand her fears and tensions but I would discourage you to ‘cookie-poochie’ her in an excessive way because she should not get emotionally dependent on anyone. Show that you love her even when she is older, greyer and you don’t need her help to ‘go to school’ as it was. Encourage her to go back to the joys of days when she did not have responsibility of rearing a family like painting, singing or anything creative. Don’t force her in religious pursuits like temple going or mantra chanting, as some youngsters are wont to say, unless she desires.

Menopause does, however, cause sleep disturbances and night hot flashes/sweats which impair good sleep. This would manifest as irritability during the day. If troublesome, hot flushes can be managed by simple measures: decrease the room temperature without increasing covers, avoid food, alcohol, and stimulants like caffeine, exercise at least 3 hours before bedtime. Avoid spicy and non-vegetarian food, decrease fat and sugar intake. Counseling helps as well as exercise especially aerobics, but only during the day. The hours before bedtime should be spent in quietitude and meditation. Increase intake of dietary phytoestrogens like soy, Bengal gram, lentils, pulses and if further help is required, hormones or other medicines can be prescribed by the doctor.

Q.3) I am a 23 year old from Ludhiana . I read somewhere that menopause causes a lot of bleeding. Do I have to go through the pain? Are there any medicines available to lessen the pain?

Ans. Menopause does not cause heavy bleeding. Any such bleeding is abnormal and needs immediate attention by doctor. A ‘normal’ menopause should have periods which become lesser in flow and/or the gap between periods increases. Any change from the above two criteria – either heavy bleeding or bleeding occurring more frequently than usual is not normal. Further, any bleeding occurring 1 year after the last period is termed as ‘postmenopausal bleeding’. All these abnormal bleeding patterns need thorough investigation.

Menopause is not a pain. It is a natural life event, not a disease. Just as growing from a schoolgirl to a young adult is not painful, neither is menopause. If you can learn how to live totally, each moment lived to its fullest dimension, then one neither regrets the moment passed nor fears the moment yet to come. Your fear of menopause could be an underlying fear of ageing. All fears, even a fear of lizards, say, are a fear of dying. You are young. Why not find that which is deathless within you. Then no old age, menopause, wrinkles, some degree of inevitable bodily illness will terrify you.

While you ponder over this, may I suggest that you don’t miss your daily glass of milk and your calcium supplements. All girls should follow this advice up to the age of 25 years, during their pregnancy and when breast feeding their babies. One glass of milk and moderate exercise will help to build up your bone bank. By the time you reach menopause, your bone bank balance will be sufficient to overcome the excessive loss of bone that begins soon after menopause. By the time a woman is 20 years past her menopause she has already lost almost 50% of her bone mass. 50% of the patients with hip fracture die and the rest are almost bedridden. The longevity of life is important, no doubt, but the quality of life is far more important. And the time to ensure menopausal years free from fracture risk begins as soon as the girl child is born, by ensuring an adequate calcium intake.

Q.4 ) Hi I'm a 30 year old working woman, I have heard that menopause is a very tough phase. Since I'm a working professional, can you suggest some ways to make menopause easy for me, can we prepare our mind & body for it?

Ans. All working people retire some day. Suddenly you will not be as important as you are now and someone younger will be better than you at your best. Even though working women never retire from household work, have you discovered the joys of doing nothing? You are running in two directions at the same time, continuously multi-tasking. Take time out to the watch the bees in your garden as they merrily chase each other, flavour the fragrances in the air, feel the raindrops as they tingle your skin, taste each morsel of food slowly, with joy. Try and catch what the wind is whispering to the trees. In silence. Once you go back to heightened awareness of your senses, both your mind and body will disappear. Then, any effects, as your body and mind age, will not touch you.

Most important, for working women, however, is to see how they create guilt for themselves in all situations as they juggle career and family together. If nothing else, it is this guilt and regret which will destroy you in your ‘mature’ years. The solution: live every moment totally absorbed in what you are doing at that time.

Care for your family, certainly, but spare some time for caring for your body too. It has to last you a long time. Eat only so much and what the body needs. Avoid putting on weight. Exercise – walking, aerobics, weights as well as some yog stretches and asanas 3-5 times each spread over a week. Do something totally different from your work as a hobby. Don’t do meditation. Be meditative. Enjoy being alive. Then there is no need to prepare in any other special way for the natural events of life.

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