Womb Healthcare for Women

18/11/2021

Severe Smog Episode in Mumbai & Delhi NCR - How to safeguard the pregnant ladies ! - Dr. Piyush Goyal MD

10/11/2017

Learn work-life balance the Swarna way

The Swarna Way !

As a working mom, Swarna Goyal balances sport and family life in her own interesting way

10/11/2017

Learn work-life balance the Swarna way

http://www.zevenworld.com/more-sports/news/learn-work-life-balance-the-swarna-way

As a working mom, Swarna Goyal balances sport and family life in her own interesting way

05/11/2015

Womb Healthcare for Women's cover photo

30/10/2015

Hysteroscopy can save you from IVF – A Necessary & Important Gold Standard Fertility Enhancing Procedure

Medical Author
Dr. Piyush S. Goyal MD
Consultant Obstetrician & Gynaecologist.
Laparoscopic Surgeon & Infertility Specialist, Urogynaecologist
Mobile - +919820045689 Email – drpiyushgoyal@gmail.com

Agarwal Nursing Home
74, Anne Villa, Junction of 14th & 30th Road, Near Saint Theresa High School.
Bandra West, Mumbai – 400050, Call - 02226455124, 02226455125

Date – 30th October 2015

INTRODUCTION
Hysteroscopy is a valuable diagnostic and therapeutic modality in the management of infertility which can save a patient from an IVF cycle.

Hysteroscopy is performed approximately half the time for the diagnosis of infertility. It is generally best performed in the postmenstrual proliferative phase.

Various aspects at different levels need a thorough evaluation to better success rates for patients.

1. Uterocervical Length with the help of a uterine sound.

2. Mapping the Direction of the Vagino-Cervico Uterine Axis after assessing the position of the uterus.

3. Vaginoscopy – Visualization with evaluation of the va**na, to detect the va**nal environment, infection, presence of any growth or lesion.

4. Cervicoscopy – The cervix also need to be studied in detail.

• Evaluation of the External Os – To detect any infection on the external os, cervicitis, erosion or growth

• Evaluation of the Cervical Canal – Presence of any Endocervical pathology like endocervical polyps, myomas or cysts which obliterate the canal and create obstruction for an easy access to the uterine cavity at the time of embryo transfer.

• Evaluation of the Internal Os – To detect Stenosis at the level of the internal os, which could be because of fibrosis or the presence of a growth like a polyp or myoma.

In my experience I have noted that identifying and correcting the cervical factors can increase the success rate tremendously.

5. Hysteroscopy Visualization and Evaluation of the uterine cavity.
• Isthmus – Lower one third of the uterine cavity just above the internal os
• Uterine Cavity - Evaluation of the cavity is of great importance
• Size – A small uterine cavity needs to be identified and treated with a metroplasty.
• Shape & Contour – A cylindrical uterine cavity can be corrected with a Lateral Metroplasty.
• Fundus – Presence of a septum and alteration in the fundal anatomy warrants a septal resection. Correction of Arcuate and Septate uteri is important to increase the success rates in fertility treatment.
• Ostia – Fibrosis of Block of the Ostia can be tackled by cornual cannulation and the fallopian tubes can be opened up.
• Endometrium – Evaluation of the vascularity and appearance of the endometrium is very important. Sub Mucous Polyps and Myomas need to be hysteroscopically resected and a normal uterine cavity has to be restored.

6. A gentle curettage / scratching of the endometrium should be performed and sent for Histopathological examination to detect the presence of infection. In addition endometrium should also be subjected to a TB PCR Investigation and if detected then should be treated for better results.
One recent review of endometrial scratching described endometrial receptivity as one of the key factors regulating embryo implantation and proposed "that mechanical trauma to the endometrium alters gene expression, enhances secretion of growth factors and makes it more receptive for implantation." Results of the review suggested that endometrial scratching is 70% more likely to result in pregnancy than no treatment. A more recent review -- but examining the same studies -- concluded that "hysteroscopy and/or endometrial scratching in the cycle preceding ovarian stimulation should become a standard for patients with [recurrent implantation failure].

7. Serial Cervical Dilatation with Hegar dilators will ensure that the cervical stenosis is cleared to ease further treatments.

A large multicentric trial finally has resolved one of IVF's long-running controversies - whether the outlook for women with a poor IVF record can be improved by routine hysteroscopy performed before further IVF treatment.
For the TROPHY study, whose results are reported has now found no significant difference in IVF success rates between those who had outpatient hysteroscopy performed before their IVF and those who didn't. "Based on these findings, outpatient hysteroscopy before IVF doesn't significantly improve IVF results and cannot be considered essential for women with recurrent IVF failure," Only around one-third of IVF cycles achieve a pregnancy, and unsuccessful attempts (implantation failure) can usually be explained by embryonic or uterine factors.
As a result, outpatient hysteroscopy is performed routinely in many fertility clinics before further attempts, first diagnostically to visualise the surface of the uterus and check for any abnormal growths, and then operatively during the same procedure to remove these growths. This has proved to improve success rates.

CONCLUSIONS
In order for a fertility treatment cycle to succeed, the embryos need a healthy uterus in which they can implant. There are many tests to evaluate the uterine cavity and the endometrial lining. These include non-invasive tests such as ultrasound scans and a HSG, and invasive tests such as hysteroscopy. The most accurate method for evaluating the uterine cavity is a hysteroscopy, because it allows the doctor to actually look inside the uterus.
Routinely performing a hysteroscopy for every patient prior to doing an IVF cycle is considered to be a part of basic pre-IVF evaluation, along with the semen analysis and the testing for ovarian function.

Routinely performing a hysteroscopy allows experts to pick up & correct intra uterine pathologies which would otherwise be missed by other techniques such as ultrasound scanning, because these non-invasive tests are not as reliable or sensitive as a hysteroscopy.
Consultants feel that if a patient is going to spend money on an IVF cycle, then it makes sense to evaluate and optimize the cycle so it will improve the success rate of having a baby.

Dr. Piyush Goyal MD

26/08/2015

FibroidsTreatment and Surgery Options

Fibroids - Treatment & Surgery Options

Fibroids -- Symptoms, Treatments & Surgery This Video is a presentation by Dr. Piyush Goyal MD for Patient Education. For Second Opinion Call +919820045689 U...

26/08/2015

Fibroid Surgery - Laparoscopic Hysterectomy

Fibroid Surgery - Laparoscopic Hysterectomy

A TLH is defined by the laparoscopic ligation of the ovarian arteries and veins with the removal of the uterus va**nally or abdominally, along with laparosco...

26/08/2015

Uterus Removal Surgery - Laparoscopic Hysterectomy

Uterus Removal Surgery - Laparoscopic Hysterectomy

A hysterectomy is the surgical removal of the uterus. Hysterectomies are performed for a wide variety of reasons. A hysterectomy is major surgery, but with n...

27/01/2013

Polycystic Ovarian Syndrome Signs Symptoms, Diagnosis & Treatment
(PCOS, POS, POD, Stein-Leventhal Syndrome)

Polycystic Ovarian Syndrome (PCOS) At A Glance
• Polycystic ovarian syndrome (PCOS) is an illness characterized by irregular or no periods, acne, obesity, and excess hair growth.
• Women with PCOS are at a higher risk for obesity, diabetes, high blood pressure, and heart disease.
• With proper treatment, risks can be minimized. Ideal treatment is directed to each of the manifestations of PCOS.

Medical Author:
Dr. Piyush Goyal, MD
Consultant Obstetrician & Gynaecologist

Date – 27th January 2013

What is polycystic ovarian syndrome (PCOS)?
Polycystic ovarian syndrome (PCOS), also known by the name Stein-Leventhal syndrome, is a hormonal problem that causes women to have a variety of symptoms. It should be noted that most women with the condition have a number of small cysts in the ovaries. PCOS occurs in 5% to 10% of women and is the most common cause of infertility in women.
What are the symptoms of polycystic ovarian syndrome (PCOS)?
The principal signs and symptoms of PCOS are related to menstrual disturbances and elevated levels of male hormones (androgens). Menstrual disturbances can include delay of normal menstruation(primary amenorrhea), the presence of fewer than normal menstrual periods (oligomenorrhea), or the absence of menstruation for more than three months (secondary amenorrhea). Menstrual cycles may not be associated with ovulation (anovulatory cycles) and may result in heavy bleeding.
Symptoms related to elevated androgen levels include acne, excess hair growth on the body (hirsutism), and male-pattern hair loss.
Other signs and symptoms of PCOS include:
• Obesity and weight gain,
• Elevated insulin levels and insulin resistance
• Oily skin,
• Dandruff,
• Infertility,
• Skin discolorations,
• High cholesterol levels,
• Elevated blood pressure, and
• Multiple, small cysts in the ovaries.
How is PCOS diagnosed?
The diagnosis of PCOS is generally made on the basis of clinical signs and symptoms as discussed above.
Laboratory tests can be helpful in making the diagnosis of PCOS. Serum levels of male hormones (DHEA and testosterone) may be elevated.. Additionally, levels of a hormone released by the pituitary gland in the brain (LH) that is involved in ovarian hormone production are elevated.
What conditions or complications can be associated with PCOS?
Women with PCOS are at a higher risk for a number of illnesses, including high blood pressure, diabetes, heart disease, and cancer of the uterus (endometrial cancer).
Infertility
Because of the menstrual and hormonal irregularities, infertility is common in women with PCOS.
Menstrual Irregularity
Because of the lack of ovulation, progesterone secretion in women with PCOS is diminished, leading to long-term unopposed estrogen stimulation of the uterine lining. This situation can lead to abnormal periods, breakthrough bleeding, or prolonged uterine bleeding in some women.
Obesity
Obesity is associated with PCOS. Obesity not only compounds the problem of insulin resistance and type 2 diabetes (see below), but it also imparts cardiovascular risks. PCOS and obesity are associated with a higher risk of developing metabolic syndrome, a group of symptoms, including high blood pressure, that increase the chances of developing cardiovascular disease.
Acanthosis Nigricans
Changes in skin pigmentation can also occur with PCOS. Acanthosis Nigricans refers to the presence of velvety, brown to black pigmentation often seen on the neck, under the arms, or in the groin.

What treatments are available for PCOS?
Treatment of PCOS depends partially on the woman's stage of life. For younger women who desire birth control, the birth control pill, especially those with low androgenic (male hormone-like) side effects can cause regular periods and prevent the risk of uterine cancer. Another option is intermittent therapy with the hormone progesterone. Progesterone therapy will induce menstrual periods and reduce the risk of uterine cancer, but will not provide contraceptive protection.
For acne or excess hair growth, a water pill (diuretic) called spironolactone (Aldactone) may be prescribed to help reverse these problems.
Eflornithine (Vaniqa) is a cream medication that can be used to slow facial hair growth in women. Electrolysis and over-the-counter depilatory creams are other options for controlling excess hair growth.
For women who desire pregnancy, a medication called clomiphene (Clomid) can be used to induce ovulation (cause egg production).
Weight Loss can normalize menstrual cycles and often increases the possibility of pregnancy in women with PCOS.
Metformin (Glucophage) is a medication used to treat type 2 diabetes.
PCO Drilling, a surgical procedure known as ovarian drilling can help induce ovulation in women who have not responded to other treatments for PCOS. In this procedure a small portion of ovarian tissue is drilled by an electric current delivered through a needle inserted into the o***y.
Polycystic Ovarian Syndrome (PCOS) At A Glance
• Polycystic ovarian syndrome (PCOS) is an illness characterized by irregular or no periods, acne, obesity, and excess hair growth.
• Women with PCOS are at a higher risk for obesity, diabetes, high blood pressure, and heart disease.
• With proper treatment, risks can be minimized. Ideal treatment is directed to each of the manifestations of PCOS.
Contributed by
Dr. Piyush S. Goyal MD
Consultant Obstetrician & Gynaecologist.
Laparoscopic Surgeon & Infertility Specialist, Urogynaecologist

Womb Healthcare
Agarwal Nursing Home
74, Anne Villa, Junction of 14th & 30th Road, Near Saint Theresa High School.
Bandra West, Mumbai – 400050, Call - 02226455124, 02226455125
Email – drpiyushgoyal@gmail.com

22/01/2013

Safe S*x Calculator
Natural Contraception to Avoid Unwanted Pregnancy & Unsafe Abortions in Teenagers

Dr.Piyush S.Goyal MD
Consultant Obstetrician & Gynaecologist
Laparoscopic Surgeon & Infertility Specialist, Urogynaecologist

Mobile - +919820045689
Email – drpiyushgoyal@gmail.com

Date – 22nd January 2013

Safe Period Calculator Fact Sheet

Hello. My name is Dr. Piyush Goyal. I'm here to speak to you about natural contraception and safe s*x today

The following is the best & safe method to avoid pregnancy:-

First, one should know the duration of the cycle, i.e. first day of the last menstrual bleeding to the first day of the present menstrual bleeding.
This is the duration of the menstrual cycle.
This duration varies from person to person & is usually between 26 to 31 days.
It is very important to maintain a Menstrual Calendar.

Ovulation approximately occurs in the middle of the cycle, i.e. duration of the cycle - (minus) 14 days (this may also vary).

A week before and a week after the approximate day of ovulation is considered to be Fertile Period.

The days apart from these are called the Safe period, where the fertilization does not take place.

So, to calculate the safe period you must know the fertile period.

Calculation of fertile period:
The Shortest Cycle minus 18 days =1st day of fertile period.
The Longest Cycle minus 10 days = last day of fertile period.

Ex: If a woman's menstrual cycle varies from 26 days to 31 days cycle,
The Shortest cycle [26 days] minus 18 days = 8th day.
The Longest cycle [31 days] minus 10 days = 21st day.

Thus, 8th to 21st day of each cycle counting from first day of menstrual period is considered as the FERTILE PERIOD.

The Period other than this fertile period in a menstrual cycle is considered as SAFE PERIOD.

If one wants to Avoid Pregnancy one has to Avoid in*******se during fertile period.

However it is advisable to use a Barrier Contraceptive like Condoms to avoid S*xually Transmitted Diseases.

Safe period is SAFE for intimate activity.

The infertility period depends on the life span of s***m and on the life span of the egg. The average time of ovulation is the 14th day of an average length (28 day) menstrual cycle. Ovulation time vary for each individual, and can occur from 12th to 19th day of the cycle. S***m can live up to 3 to 5 days in a woman’s reproductive tract, so it is possible to become pregnant if unprotected s*x occurs 5 days before ovulation. The life span of the typical egg is relatively short, only around 24 hours. If fertilization does not occur within that time frame, the egg will die

Contributed by
Dr. Piyush S. Goyal MD
Consultant Obstetrician & Gynaecologist.
Laparoscopic Surgeon & Infertility Specialist, Urogynaecologist

Mobile - +919820045689
Email – drpiyushgoyal@gmail.com

Womb Healthcare
Agarwal Nursing Home
74, Anne Villa, Junction of 14th & 30th Road, Near Saint Theresa High School.
Bandra West, Mumbai – 400050, Call - 02226455124, 02226455125

16/01/2013

Emergency Contraception in TeenAgers
Dr.Piyush S.Goyal MD

Hello. My name is Dr. Piyush Goyal. I'm Teach at the Department of Gynaecology at Wadia Hospital. I'm here to speak to you about the recent paper that was published by the Academy of Pediatrics on emergency contraception. I was one of the coauthors of this paper.
The basic point about this particular policy statement is that we, as practitioners in family medicine, obstetrics and gynecology, and psychiatry are recommending that people be aware of emergency contraception and discuss emergency contraception with their teenage patients.

Why is this? Because the India has more unintended pregnancies than any other developed country in the world. This is something that has been very devastating to many teenagers, and we would like to have this number drop. One of the most important ways we can effect this change is by providing emergency contraception. We know that in the 15- to 19-year-old age group, approximately 33% of children become s*xually active by the age of 15 years, and that percentage increases to 70% of 19-year-olds.

Are these kids using contraception? Not always. Many times we find that after s*x, they have not had protection, and that is a very big issue. Sadly, in 10% of kids who have s*x, it is nonconsensual. It is forced in*******se, and it is forced in*******se without any protection. These kids need to know about emergency contraception. What is emergency contraception? What it is not is an abortifacient. The emergency contraception that we discuss in this paper is levonorgestrel -- that's Plan B One-Step® or Next Choice®. These products can be taken up to 120 hours after unprotected in*******se. That's 5 days.

When you are under 17 years of age, you need a prescription to obtain the emergency contraceptive levonorgestrel. Those over 17 years of age, both men and women, can go into any pharmacy and obtain this medicine. It costs money so it is not something that's readily accessible to those with limited means.

It is important for pediatricians, OB/GYN doctors, family practitioners, nurse practitioners, and physician assistants to discuss emergency contraception with their patients. If they don't feel that they can ethically talk about this with their patients, then they should refer them to someone who can. It is their responsibility as a healthcare practitioner, and it is something that we stressed when we wrote this policy paper representing the AAP.

I would encourage all practitioners -- pediatricians, obstetricians, internists, family practitioners, nurse practitioners, physician assistants -- to read this policy paper. There are multiple different explanations as to mechanism of action of levonorgestrel. We discussed ulipristal and the Yaz B method, which are alternate methods of emergency contraception. We also discussed some of the legal and ethical issues that some practitioners might face when confronting patients who want this prescription when they do not feel comfortable prescribing it.

12/12/2012

To-be moms not keen on 12.12.12
Dec 12, 2012 | Age Correspondent | Mumbai


This Wednesday is expected to be a good date for new beginnings as the calendar would read 12.12.12. However, gynaecologists claim that expecting mothers and their families are not really taken in by the idea.
According to gynaecologists, for Indians, it is the time of birth, which is of greater importance than the date.
Consultant gynaecologist at Lilavati Hospital, Dr Rishma Pai said, “Normally people would assume that mothers and families, who have caesarean section planned would want to undergo the procedure on 12.12.12. But on the contrary, I have had two cases where they were least concerned about the catchy date. Their concern was an auspicious time according to the mahurat.”
A case in point being that of Trupti Mahesh Patil, who delivered twins on December 10. Despite having the choice of undergoing the caesarean section on December 12, Ms Patil chose otherwise.
“We were not so taken in by the idea of the date. What was more important for us was the timing. December 12 happens to be Amavasya and we were not comfortable with the timing, so we chose December 10, which was a better time.”
However, there are some surgeries planned for Wednesday, as some families do not want to miss the 12.12.12 bus. Chief gynaecologist at Agarwal Nursing Home in Bandra, Dr Piyush Goyal recounted the experience of conducting an interventional delivery last year on 11.11.11 and precisely at 11.11 am.
Dr Goyal said, “A family last year insisted that it should be at that precise time. Fortunately, it was a caesarean and we could do it at the specified time, so it went off well. But it’s always not easy to accommodate such a request. That said, it is the choice of the family and it is their discretion.”

07/11/2012

Treatment of Painful Periods

Dr. Piyush Goyal MD
Consultant Obstetrician & Gynaecologist

Date – 7th November 2012

Dysmenorrhoea Fact Sheet

Dysmenorrhea can be literally translated as "difficult monthly flow." Although it's normal for most women to have mild abdominal cramps on the first day or two of their period, about 10% of women experience severe pain.
There are two types of dysmenorrhea:
• Primary dysmenorrhea is menstrual pain that's not a symptom of an underlying gynecologic disorder but is related to the normal process of menstruation. Primary dysmenorrhea is the most common type of dysmenorrhea, affecting more than 50% of women, and quite severe in about 15%.
• Secondary dysmenorrhea is menstrual pain that is generally related to some kind of gynecologic disorder. Most of these disorders can be easily treated with medications or surgery. Secondary dysmenorrhea is more likely to affect women during adulthood.

Causes of Dysmenorrhea
Primary dysmenorrhea is thought to be caused by excessive level of prostaglandins, hormones that make your uterus contract during menstruation and childbirth. Its pain probably results from contractions of your uterus that occur when the blood supply to its lining (endometrium) is reduced. Other factors that may make the pain of primary dysmenorrhea even worse include a uterus that tilts backward (Retroverted uterus) instead of forward, lack of exercise, and psychological or social stress.
Secondary dysmenorrhea may be caused by a number of conditions, including:
• Fibroids - benign tumors that develop within the uterine wall or are attached to it
• Adenomyosis - the tissue that lines the uterus (called the endometrium) begins to grow within its muscular walls
• S*xually transmitted infection (STI)
• Endometriosis - fragments of the endometrial lining that are found on other pelvic organs
• Pelvic inflammatory disease (PID), which is primarily an infection of the fallopian tubes, but can also affect the ovaries, uterus, and cervix
• Ovarian cyst or tumor
• The use of an intrauterine device (IUD), a birth control method

Symptoms and Complications of Dysmenorrhea
The main symptom of dysmenorrhea is pain. It occurs in your lower abdomen during menstruation and may also be felt in your hips, lower back, or thighs. Other symptoms may include nausea, vomiting, diarrhea, lightheadedness, or general achiness.
For most women, the pain usually starts shortly before or during their menstrual period, peaks after 24 hours, and subsides after 2 to 3 days. Sometimes clots or pieces of bloody tissue from the lining of the uterus are expelled from the uterus, causing pain.
Dysmenorrhea pain may be spasmodic (sharp pelvic cramps at the start of menstrual flow) or congestive (deep, dull ache). The symptoms of secondary dysmenorrhea often start sooner in the menstrual cycle than those of primary dysmenorrhea, and usually last longer.
Diagnosing Dysmenorrhea
If you experience painful periods, check with your doctor to see whether you might have an underlying disorder that is causing secondary dysmenorrhea. You may be given a pelvic examination, and your blood and urine may be tested.
A doctor may also wish to use ultrasound to get a picture of your internal organs or even use the technique of laparoscopy for a direct look into your uterus.

Treating and Preventing Dysmenorrhea
Your doctor may prescribe medications or other remedies depending on the cause of the dysmenorrhea.
Primary dysmenorrhea is usually treated by medication such as an analgesic medication. Many women find relief with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen*, naproxen, and acetylsalicylic acid (ASA).
Some doctors may prescribe hormone medications. Oral contraceptives also may also help reduce the severity of the symptoms. Nausea and vomiting may be relieved with an antinausea (antiemetic) medication, but these symptoms usually disappear without treatment as cramps subside.
Treatment for secondary dysmenorrhea will vary with the underlying cause. Surgery can be done to remove fibroids or to widen the cervical canal if it is too narrow. If treatment isn't successful and the pain is extreme, you may consider surgery that severs the nerves to the uterus. While this can help, complications may arise due to injury to nearby organs.
In addition to the above, other non-medicinal treatments for the pain of dysmenorrhea include:
• lying on your back, supporting your knees with a pillow
• holding a heating pad or hot water bottle on your abdomen or lower back
• taking a warm bath
• gently massaging your abdomen
• doing mild exercises like stretching, walking, or biking - exercise may improve blood flow and reduce pelvic pain
• Getting plenty of rest and avoiding stressful situations as your period approaches.

Contributed by
Dr. Piyush S. Goyal MD
Consultant Obstetrician & Gynaecologist.
Laparoscopic Surgeon & Infertility Specialist, Urogynaecologist

Womb Healthcare
Agarwal Nursing Home
74, Anne Villa, Junction of 14th & 30th Road, Near Saint Theresa High School.
Bandra West, Mumbai – 400050, Call - 02226455124, 02226455125
Email – drpiyushgoyal@gmail.com

28/10/2012

Treatment of Pre Menstrual Syndrome

Dr. Piyush Goyal MD

PMS Fact Sheet

Premenstrual syndrome (PMS) refers to a wide range of symptoms that:
• Start- during the second half of the menstrual cycle (14 days or more after the first day of your last menstrual period)
• Go away 1 - 2 days after the menstrual period starts.
Causes, Incidence, and Risk factors
The exact cause of PMS has not been identified.
Changes in brain hormone levels may play a role, but this has not been proven. Women with premenstrual syndrome may also respond differently to these hormones.
PMS may be related to social, cultural, biological, and psychological factors.
Up to 3 out of every 4 women experience PMS symptoms during their childbearing years. It occurs more often in women:
• Between their late 20s and late 40s
• Who have at least one child
• With a personal or family history of Depression
• With a history of postpartum depression or an affective mood disorder

The symptoms often get worse in a woman's late 30s and 40s as she approaches the transition to menopause.
Symptoms of PMS
PMS refers to a set of symptoms that include:
• Bloating
• Breast Tenderness
• Clumsiness
• Constipation or Diarrhea
• Food cravings
• Headache
• Less tolerance for noises and lights
Other symptoms include:
• Confusion, difficulty concentrating, or forgetfulness
• Fatigue and feeling slow or sluggish
• Feelings of sadness or hopelessness
• Feelings of tension, anxiety, or edginess
• Irritable, hostile, or aggressive behavior, with outbursts of anger toward self or others
• Loss of s*x drive (may be increased in some women)
• Mood swings
• Poor judgment
• Poor self-image, feelings of guilt, or increased fears
• Sleep problems (sleeping too much or too little)

Treatment of PMS
Keep a daily diary or log for at least 3 months.
Record the type of symptoms you have, how severe they are, and how long they last. This symptom diary will help you and your health care provider find the best treatment.
A healthy lifestyle is the first step to managing PMS.
For many women, lifestyle approaches are often enough to control symptoms.
• Drink plenty of fluids (water or juice, not soft drinks, alcohol, or other beverages with caffeine) to help reduce bloating, fluid retention, and other symptoms.
• Eat frequent, small meals. Leave no more than 3 hours between snacks, and avoid overeating.
• Eat a balanced diet with extra whole grains, vegetables, and fruit, and less or no salt and sugar.
• Your health care provider may recommend that you take nutritional supplements Vitamin B6, calcium, and magnesium is commonly used.
• Get regular exercise throughout the month to help reduce the severity of PMS symptoms.
• Try changing your nighttime sleep habits before taking drugs for insomnia.
• Aspirin, Ibuprofen and other NSAIDs may be prescribed for headache, backache, menstrual cramping and breast tenderness.
Birth control pills may decrease or increase PMS symptoms.
In severe cases, medicines to treat depression may be helpful.
Medicines that may be used include:
• Anti-anxiety drugs for Severe anxiety
• Diuretics (may help with severe fluid retention, which causes bloating, breast tenderness, and weight gain)
• Bromocriptine, Danazol & Tamoxifen may be rarely used for relieving breast pain)
Most women who are treated for PMS symptoms get significant relief.
PMS symptoms may become severe enough to prevent you from functioning normally.
Calling your Gynaecologist
Call for an appointment with your OBGYN if:
• PMS does not go away with self-treatment
• Your symptoms are so severe that they limit your ability to function.