Delay Your Menstruation Period

Some female may wish to delay their menses cycle due to various reasons, such as wedding, holiday trip, taking exam etc. This can be easily achieved.

For female who are NOT taking oral contraceptive pills, you can take a pill called "norethisterone" which is a progesterone hormone. It is taken 3 days before the expected first day of the next menstrual cycle. The dose is 5mg three times a day. Just stop the hormone when you want the menses flow to start. Usually the menses will start 2-3 days after stop taking norethisterone. Side effects are not common, as it is only taken short term. Some known side effects include stomach upset and breast changes. If your menses cycle is irregular and you are not sure when will be the start of next cycle, then it's a problem. In this case you may want to start norethisterone many days earlier before the day of your trip. Don't take norethisterone continuously for more than 2 weeks.

          Example of Norethisterone. Not expensive.

For female who are taking oral contraceptive pills (OCP), you have to continue to take the pills with hormone in order to delay the menses. In a typical OCP, the first 21 pills are with hormone while the last 7 pills are "empty" without hormone. Normally when you take the pills without hormone, menses flow will start. If the period of time you don't want your menses to come falls between Day 1 to Day 21 of the pills, then just continue the OCP as usual. However, if it falls after Day 21, then after the Day 21 pill, you have to start a new strip of OCP from Day 1, without taking the "empty" Day 21-28 pills. When you want your menses flow back at anytime, just take the "empty" pills for 7 days.

     Example of OCP: Note the 7 empty pills in white

Vanishing Twin: Take it easy

Vanishing twin syndrome is when one of your twin baby just disappears in your womb during the course of pregnancy. It can also represent one or more babies lost in triplet, quadruplet or more.

This syndrome becomes more widely identified with the use of early pregnancy ultrasound scan. It occurs when an early ultrasound scan reveals 2 or more babies but a later scan shows less than that. The loss of fetus (baby in womb) can happen at any point of pregnancy. It can be in the first, second or third trimester. Generally, the earlier it happens, the better the outcome to the viable fetus and mother. Some research reveals that about 10-15% of single baby born are initially twins.

    Fetus papyraceus

 

No one knows exactly what causes vanishing twin syndrome. It is believed that the vanished fetus has some chromosomal or genetic defect and is aborted for good. The viable twin has normal chromosome and usually no other abnormality, but may have increased risk of cerebral palsy if it occurs after the second half of pregnancy. For mother side, there is some risk for complication if it happens later in pregnancy, such as preterm labour, infection of the retained material, post-delivery bleeding, obstruction of labour etc. However, if vanishing twin syndrome occurs in the first trimester (<12 weeks), these complication are very unlikely.

Vanishing twin syndrome may cause some per vagina bleeding and/or lower abdominal discomfort. The vanished fetus can “disappear” completely, form part of the placenta or become “mummified” depends on at what stage it starts to disappear. Mummified fetus need close observation during the pregnancy as it has higher risk to cause complication.

So, don't panic or feel too sad if your doctor tell you that one of your twin just disappears. It is actually good as if the disappeared baby is born, it will give you more problems as it has genetic defect. If the phenomenon occurs in the first half especially first trimester, there should not be too much worry.

Helicobacter pylori: are you infected?

If you have frequent stomach upset, you may want to check whether you are infected with Helicobacter pylori or not. Since the discovery of this bacteria in early 1980's, it has changed the belief that bacteria cannot survive in the acidic environment of the stomach.

    Helicobacter pylori

Why is H. pylori so important and why should you be treated if you are infected with it? The reasons are:

• Almost 70-90% of all peptic ulcer diseases are related to H.pylori
  • About 90% of duodenal ulcers are related to H.pylori
  • About 60% of gastric (stomach) ulcers are related to H.pylori
• If you are infected, you have 10-20% risk to get peptic ulcer disease
• If you are infected, you have a 1-2% risk of getting stomach cancer

Yes. H.pylori has been classified as class I carcinogen (cancer-causing agent) for gastric cancer, in the same class as smoking causes lung cancer.

    Gastric & duodenal ulcer

Since the bacteria stay in the digestive tract, we can get infected by taking in food/drink contaminated with the bacteria. H.pylori infection produces no symptoms in 30-35% of patients. When it does, it can cause:

• Dyspepsia (indigestion)
• Nausea/vomiting
• Abdominal pain/discomfort
• Anemia if bleeding from ulcer

It's easy to check whether you are infected or not. The screening test is usually a blood test that check your antibody level against H.pylori. If it is positive, it means that you have current or recent infection, and should be treated.

After treatment, you should check whether the bacteria are eradicated successfully by doing a urea breath test. This should be done at least 4 weeks after finishing treatment. Blood test is not recommended to be used to confirm eradication because the antibody level may remain high up to 2 years after all the bacteria died. Besides the breath test, another test that can be done to confirm eradication is stool antigen test.

If you have severe symptoms that make a doctor suspect ulcer in your stomach/duodenum, then you can straight away go for an endoscopy in which a tube with camera is inserted through your mouth into your stomach to look for the ulcer. At the same time, tissue samples (biopsy) can be taken to check for the presence of H.pylori.

Treatment for H.pylori is called triple therapy, as it is a combination of 3 types of medication (2 antibiotics and 1 anti-acid). It should be taken accordingly for at least 7 days (up to 14 days) or failure of treatment and bacteria resistance can occur easily. If treated rightly, the success rate is up to 90-95%. It is not easy to get the infection again after it has been successfully eradicated. The re-infection rate is only about 1-2%, but it is noted to be slightly higher in children and women.