Why regular routine check-ups are vital
ROHINI RAJESH, a 37-year-old Cochin housewife and mother of two, read about a Kerala government cancer detection programme last October and went to see a gynaecologist.
“Actually, I feel perfectly okay,” Rohini* told Dr Jaya Lalmohan, medical superintendent of the Tripunithura Government Hospital. However, examination revealed a small growth, known as a polyp, in Rohini’s cervix. “Such growths sometimes lead to life-threatening cervical cancer,” explains Dr Lalmohan, “so I had Rohini’s polyp surgically removed the following week. Rohini was indeed wise to come for that check-up.”
Unfortunately, what Rohini did was unusual. “Most Indian women are not aware of gynaecological matters and come for consultation only when they have problems,” says Dr Nutan Agarwal, a gynaecologist at New Delhi’s all India Institute of Medical Sciences (AIIMS). “In fact many are reluctant to come for routine check-ups for fear of discovering they may have cancer.”
A woman should visit a gynaecologist, especially for screening for cervical and breast cancer, ideally every one to three years, asserts Dr Agarwal. This can go a long way in preventing these cancers as well as other problems affecting the female reproductive system. Not taking tests at a gynaecologist’s clinic at least once in five years after age 40 can be extremely risky.
* Patients’ name changed to protect privacy.
Senior Bangalore GP, Dr K. Soorya, also stresses the importance of routine gynaecological consultation. “Cost is often a problem that keeps women from seeing a specialist,” says Dr.Soorya, “but a gynaecologist is best trained to detect women’s diseases early and greatly improve the chances of a cure.”
Another problem is that many women find it difficult to talk about intimate matters or to be examined. If so, a woman should ask her GP or a friend to recommend a gynaecologist with whom She could feel at ease and have confidence in.
Here’s why regular gynaecological consultations are important:
1 Cervical and uterine cancers
Taking a Pap smear test at lest once in three years permits the detection of abnormal cells and polyps which can degenerate into cancer of the uterus and cervix. It’s a simple surgical procedure which does not require anaesthesia” it involves scraping off some mucus and cells from a precise area in the sponge-like cervix-the neck of the womb. This test is recommended for all women from the time they start sexual relations or from age 35, even if they do not have an active sex life.
“Early pointers to cervical cancer are hard to detect,” says Dr Amish Dalal, who treats gynaecological cancers at the Jaslok and Bhatia hospitals are the best way to discover cervical cancer or pre-cancerous growths before it’s too late,” says Dr Dalal. “Indeed this common cancer is easy to avoid or treat if caught early, but it can cost a woman her life if discovered late.”
“A perfectly healthy lady used to come to me every year for a smear test,” recalls Mumbai gynaecologist Dr Ashok Bhat who runs his Excel Nursing Home. “She was fine the first five years but, suddenly, in the sixth year, we detected severe dysplasia, a condition of cells which often leads to malignancy.” A timely hysterectomy saved the 42-year-old woman from cancer of the uterus.
2 Breast pathologies.
Although a woman can learn to examine her own breasts, it is important that a gynaecologist does so too. Breast cancer is the most common cancer among women in urban India.
“The earlier breast cancer is diagnosed, the better the chances of a cure,” says Dr Amish Dalal, “and the best way to detect it is an X ray of the breast, known as a mammogram.” If you’re approaching 35 and there have been cases of breast cancer in your family, Dr Dalal recommends annual clinical examination. And, after the age of 50, he suggests that mammograms be taken along with a breast sonography, a technique that uses sound to create images of the interior of the breasts.
3 Menstrual Problems.
Tell a gynaecologist about menstruation cramps, or an increase or decrease in menstrual frequency, since they may be caused by an inflammation of the uterine walls or a vaginal infection. In addition, many patients suffer haemorrhages – bleeding – between menstruation. This may be a symptom of cervical cancer. And too much bleeding during menstruation is a leading cause of anaemia.
In 1996, when she was 33, Calcutta housewife and mother Rejeshwari Sinha experienced excessive menstrual bleeding that caused severe anaemia. Her haemoglobin count hovered around 8, well below the normal of 12. She also experienced swollen feet, palpitations, breathlessness even on slight exertion, and was constantly tired. Suspecting a hormonal imbalance, Rejeshwari’s GP put her on medication. That reduced the bleeding – and her anaemia – for a while.
Then in late 1999, when her menstrual bleeding got very heavy again with haemorrhages between cycles, an ultra-sonography showed the presence of several tumours and she was advised surgery. Yet Rajeshwari decided to wait.
She went to a gynaecologist, Dr Basudeb Mukherjee of the Calcutta Medical Research Institute, only in June 2000 with her haemoglobin count now at just 7. “A hysterectomy was done,” recalls Dr Mukherjee, “and since then Rajeshwari has been enjoying better health and is no longer anaemic.”
4. Menopause & HRT
Due to a decline in the levels of the female hormone oestrogen, menopause is associated with various physical and psychological disturbances such as hot flushes, depression and osteoporosis – a debilitating disorder, seen mainly in older women, where the bones become porous and brittle.* Hormone replacement therapy (HRT) can help women overcome these problems. HRT not only prevents osteoporosis but can also treat the condition. “Many Indian women are reluctant to take HRT for fear of getting breast or uterine cancer,” says Dr Nutan Agarwal. “But, when it’s done under supervision of an experienced gynaecologist, HRT is perfectly safe.”
Oestrogen is given in the form of oral pills, skin patches or vaginal creams. If the woman hasn’t had her uterus removed, another hormone progesterone – is added with oestrogen to prevent uterine cancer. HRT can be started after menopause, if a woman shows symptoms like hot flushes or depression. Two to five years of HRT is usually sufficient to get over the symptoms, but a longer term may be required to reduce the risk of osteoporosis. Under expert supervision, HRT can certainly improve the quality of life for women after menopause,” says Dr Agarwal.
Noted Mumbai gynaecologist and obstetrician Dr Adi Dastur agrees. “Many natural foods also combat hormonal imbalances,” he adds, “for instance, soyabean and chick peas.”
5 Knowledge of the body
Regular consultations help a woman get to know her own body better and to clear up many doubts. A gynaecologist is the confidant who can help a women through the various stages of her life. Routine consultations help detect certain vaginal and uterine problems which sometimes go unnoticed, among them are fibromyomas – benign tumours – and ovarian cysts.
Alice George, 28, was about to be married when she suffered severe abdominal pains and went to see Dr Ashok Bhat – the first time Alice had ever consulted a gynaecologist. Examination revealed a large ovarian cyst that required to be surgically removed. “Had Alice come for a routine annual check-up after age 25, we’d have discovered the cyst and saved her all the pain,” says Dr Bhat. There are also unfounded fears that such an operation means you can’t have children. “ Alice’s finance had such a fear,” recalls Dr Bhat., “But they got married and now have two healthy children.”
6 Family planning
There are many methos of contraception, but each woman has her own sex-life patterns, physical characteristics and preferences. The gynaecologist is the best adviser in what concerns maternity control, adjusting contraceptive methods to individual needs and controlling their effects. “Though the pill, which is taken by lakhs of Indian women, can be bought without a doctor’s prescription, it’s best taken under the supervision of a gynaecologist,”says the Cochin gynaecologist and obstetrician Dr Jaya Lalmohan, who was until recently head of the Health and Family Welfare Training Centre in Trivandrum. “It is also important for a young woman to visit a gynaecologist before marriage, and before deciding to have a child. This can prevent many problems for the foetus as well.”
Many complications can be avoided by seeing a gynaecologist as soon as there is the slightest symptom of infection.
Dr Agarwal of AIIMS says : “Many patients come with complaints of pelvic pain and discharge due to gynaecological infections. These cases can be treated with antibiotics, although the chances of reinfection are high if a woman has an untreated partner. Sometimes symptoms may be mild, but if left untreaed, a young woman is likely to develop other problems including infertility on account of damage to the Fallopian tubes.”
Regular checkups can prevent a young woman from becoming infertile. It can even reverse her infertility. Medically assisted reproduction techniques, like in-vitro fertilization (IVF) remain very expensive in India. “Depending on the exprpertise and skill of the gynaecologist,” explains Dr Adi Dastur, “the success rate of assisted reproduction techniques in the best centers here and abroad is between 30 and 35 percent,” Yet there is no one better than a gynaecologit to determine the cause of the infertility and help the patient seek a solution.
Some times infertility itself may be due to a more serious condition that can be detected and treated. Dr Dastur relates the case of one of his infertile patients who, he discovered, had cancer of the uterus. “We quickly performed hysterectomy,” he says, “we removed her ovaries and Fallopian tubes and saved her life.”
9 Sexual dysfunction
Although this should be treated by a sexologist – a some what rare specialty in India – it’s a good idea to consult a gynaecologist first in order to determine any causes that might have a physical origin (men should consult a GP or urologist). “Innumerable cases of female and male sexual problems, referred to me by gynaecologists everywhere have been successfully solved,” says Dr Prakash Kothari, Professor and head, department of sexual medicine at Mumbai’s KEM Hospital and Seth GS Medical college.
10 Sexually transmitted diseases.
Unprotected sex with several partners facilitate the transmission of germs that cause infections, at times without symptoms at first, as in the case of AIDS, gonorrhoea and chlamydia. Gynaecological examinations, followed by lab tests, can tell if an STD is present. If not treated adequately, any STD can lead to sexual inadequacy and infertility.
AS THE saying goes, forewarned is forearmed. Going for a routine gynaec check can provide just that.