Menstrual cycle occurs every month and it takes around 28 days, we start a new cycle from day one of bleeding then ovulation occurs at day 14. If no pregnancy occurs, imbalance then drop of hormones causes some symptoms that vary in severity which is known as premenstrual syndrome, then symptoms would disappear when bleeding starts. In the majority of cases symptoms are mild and don’t impair the daily normal activities. But in the other 30% of cases symptoms are severe and clearly affect the activities. Most common symptoms of premenstrual syndrome are: ● Breast tenderness. ● Headache. ● Mood swings, irritability, anxiety and sleep disorder. ● Depression, emotional lability and feeling sad. ● Easy fatigue and decreased activity. ● Abdominal cramps and bloating. ● Diarrhea or constipation. ● Acen. ● Increase desire for eating, especially sweets. ● Want to cry and feel emotional instability. ● Become more nervous.

More than 70% of women having premenstrual syndrome can deal with it without medical help. However if your symptoms worsen overtime and prevent you from doing your daily activities you may need help. First, doctor need to exclude other physical causes of such symptoms as: ● Endometriosis. ● Different types of Anemia. ● Spastic colon or irritable bowel syndrome. ● Thyroid disorders. ● Pelvic inflammatory diseases. Doctors would ask for some labs and investigations to rule out those disorders first before diagnosing premenstrual syndrome.

For mild to moderate symptoms of premenstrual syndrome there are some tips that would help in dealing with it such as: ● Eat a soft balanced diet and depend on fruits, salads and vegetables. ● Avoid meals rich with saturated fats and carbs as they worsen the bloating and may cause diarrhea or constipation. ● Avoid caffeine, salt, sugary food and drinks and smoking. ● Drink plenty of water and fresh juice. ● Multivitamin supplements containing folic acid, magnesium, vitamin D and calcium, all have a good effect on mood and enhance physical activity. ● Doing exercises help in relieving stress and put you in a better mood. ● Have enough sleep hours at night for at least 8 hours. ● Some analgesics may help as aspirin and ibuprofen reduce pain, cramps and headache.

It is a severe form of premenstrual syndrome affecting 8% of women, symptoms are much more severe and disturbing. It’s associated with low levels of serotonin so doctors would prescribe some SSRI antidepressants to control the symptoms. Other more powerful analgesics would help also.

Rubella is a viral infection that is very mild and less severe than the red measles, in some countries Rubella is rare due to the spread of MMR vaccine. Usually rubella is a contagious infection that is transmitted through close contact with the infected person and through cough, sneeze and use of personal objects the infection spreads. In most adult cases with good immunity Rubella causes very mild disease and passes unnoticed but if a pregnant woman becomes infected there would be very serious complications on the baby.

Symptoms and signs of rubella begin after 2 to 3 weeks of infection and range from mild to severe according to the general health condition of the infected person, however rubella with pregnancy shows obvious manifestations such as: 1. Mild or low grade fever (about 38.8 C). 2. Severe headache. 3. Runny or obstructed nose. 4. Eyes become red, itchy and inflamed. 5. Pain all over the body, especially joints. 6. Small pink itchy rash starts within the face then spreads to the back and limbs and disappears after 3 days. 7. Tenderness and enlargement of lymph nodes. Any pregnant woman especially during the first months shows any symptoms or signs like this, should seek medical advice immediately.

Rubella with pregnancy is considered one of the most serious infections during pregnancy especially if infection occurs at the first 3 months of pregnancy. Medical statistics revealed that 90% of pregnant women that become infected with rubella during the first 3 months of pregnancy bath the infection to the baby resulting in severe developmental complications. MMR vaccine is a weak live attenuated virus and can’t be taken if you are already pregnant, So it’s very important before getting pregnant to revise the vaccines you took with your doctor.

Complications of rubella with pregnancy varies in severity according to the stage of pregnancy at which the infection occurs as follows: ● Infection after the 6th month of pregnancy usually doesn’t cause any harm to the fetus. ● If infection occurs from the 3rd to the 5th month of pregnancy the complications would be very mild. ● Infection during the first 3 months of pregnancy, usually the virus is transmitted to the baby causing serious complications which is known as Congenital Rubella Syndrome. Features of Congenital Rubella Syndrome: Many pregnant women that are infected with rubella may lose their pregnancy. Every year there are more than 100000 babies born with congenital rubella syndrome around the world. Rubella virus is transmitted through the placenta from the maternal blood to the baby and causes a group of developmental disorders called congenital rubella syndrome. The main features of congenital rubella syndrome are: ● Sensorineural hearing loss. ● Eye problems, usually Cataract and retinal damage (Retinopathy). ● Congenital heart diseases. ● General developmental delay. ● Baby is born with a smaller head than normal. ● Low set eyes and lower jaw. Unfortunately, all these complications are irreversible and can’t be treated. Researches also noticed other disorders that would happen to the infected baby later on his life such as: ● Type 1 diabetes mellitus. ● Schizophrenia. ● Autism and ADHD.

The exact cause of getting uterine fibroids is uncertain but there are many risk factors associated with high incidence such as: ● Never get pregnant before. ● Overweight and obesity. ● Early puberty and starting menstrual periods at a young age. ● Genetic factors as uterine fibroids run in families. ● Start of Menopause at an older age.

Fibroids are benign growing masses that can grow inside or outside the uterus and in different sizes. There are main 4 types of uterine fibroids according to the site of the mass as follows: 1. Intramural Fibroids In this type, the fibroid originates from the muscle layer of the uterus and grows within the wall of the uterus itself. 2. Submucosal Fibroid Submucosal fibroid is a common type where the mass grows into the lumen of the uterus and hanges from the upper side of it. 3. Subserosal Fibroid In this type of fibroid the mass grows outside the lumen of the uterus and attaches tightly to it. 4. Pedunculated Fibroid It resembles the subserosal type in growing outside the lumen of the uterus but it differs as it connects to the uterus by a thin stalk.

Many cases with fibroids don’t suffer from any symptoms or signs which are called asymptomatic and just need regular follow up. However the more the size of the fibroid the more severe symptoms and complications, some of most common symptoms are: ● Severe bleeding during menstrual period more than the usual blood amount. ● Bleeding from vagina in between periods. ● Pain in the lower back. ● Discomfort or pain during intercourse. ● Bloating and feeling fullness in the pelvic region. ● In cases with fibroid causes pressure over the urinary bladder you may experience frequent urge to urinate. ● Chronic constipation. ● Huge fibroid may cause partial or complete urinary obstruction which would lead to many serious complications. Many types of fibroids stop growing and get smaller sizes after menopause due to decreased hormonal blood levels, so such symptoms may disappear.

Having a uterine fibroid may contribute to infertility in many cases, however other cases pregnancy could happen in presence of a fibroid. During pregnancy many hormones elevated in the blood which could cause more enlargement of the existing fibroid, and this may have some risks as: ● Prevent the normal positioning of the baby inside the uterus that would lead to cesarean section. ● Increase risk of premature labour. So if you already have a fibroid, proper examination before getting pregnant and close follow up during pregnancy is very important to avoid such hazards. However in rare cases fibroid causes infertility and either medical or surgical intervention is mandatory to get pregnant.

Most of cases of fibroids are discovered accidentally during the regular gynecological examination and there many investigations used to detect the size and the nature of those masses such as: ● Pelvis ultrasound. ● CT and MRI. ● Hysteroscopy passed through the vagina for close visualization and biopsy. ● Hysterosalpingography. ● Laparoscopy.

Vaginal infection is also called vaginitis and it can be caused by many factors. Symptoms and signs differ according to the type of infection as well as the treatment protocol would depend on it. Here are the most 5 common factors causing vaginal infections: 1. Fungal Infection Fungal infection is caused mostly by Candida albicans, normally the vaginal discharge contains flora to act against fungal infections. However, there are many risk factors that lead to fungal infections such as: Excessive vaginal douches, prolonged Antibiotic use and uncontrolled diabetes. 2. Bacterial Infections There are some bacterial flora in the vagina and it doesn’t show any symptoms or signs. Abnormally overgrowth of some types of bacteria can cause inflammation of the vagina. 3. Atrophy of the Vagina Vaginal atrophy is caused by many factors mainly associated with low estrogen levels such as: Menopause, during breastfeeding and other hormonal disorders. All those factors cause vaginal dryness that increases the risk of irritation and inflammation. 4. Trichomoniasis Trichomoniasis is a type of protozoa that can be transferred during intercourse and causes vaginal inflammation. 5. Chemical Irritants Overuse of many chemical agents such as: perfumes, vaginal douches, soaps and body washes can cause irritation of the vaginal epithelium increasing the risk of infections. In many cases with vaginitis doctors can’t reach the definite cause for the infection and it’s called “Nonspecific vaginitis”.

Many women with vaginal infections may have no symptoms and signs, however there are certain symptoms that need medical advice. If you develop such general symptoms and signs you should see a doctor for proper treatment to prevent further complications, these symptoms as: ● Changes in the Vaginal discharge: The normal vaginal discharge has a certain amount, colour and odour, if you notice changes in any of these features you may have a vaginal infection. Changes may be in the form of: excessive amounts, bad odour and abnormal colors such as greasy white, bloody, brown or greenish discharge. ● Itching and burning sensation deep in the vagina. ● Pain during or after intercourse. ● Burning sensation during urination. ● Blood spots or bleeding from vagina in days away from the menstrual period. There are specific signs according to the organism causing the vaginal infection and they really help in accurate diagnosis: ● In Fungal Infections the main symptoms are itching and the discharge is thick and whitish like cottage cheese. ● In trichomoniasis the bad odour is a characteristic feature with greenish discharge. ● In bacterial infections the fish like odour and grayish-white discharge.

Vaginal infections are usually benign medical disorders and in some cases may be self limiting. On the other hand, some cases should see a doctor as: ● Married women trying to get pregnant. ● Pregnant women especially near the time of labour. ● Persistent symptoms and signs after previous medical treatment. ● Diabetic women with recurrent infections. ● Fever with other symptoms of vaginitis.

lThe good news is that the vaginal infections can be prevented by following these advices: ● Wear cotton comfortable underwears and avoid tight ones. ● Keep vagina clean by using a vaginal douche free of irritant chemicals and odours. ● Treat any medical condition associated with low estrogen levels. ● Use proper lubricants during intercouse if you suffer from dryness. ● Condom use during intercourse.

Till now doctors can’t find the exact cause of preeclampsia and it’s one of the unpredictable health hazards connected to pregnancy. However there are many factors increase the risk of getting preeclampsia during pregnancy such as: ● Autoimmune systemic diseases. ● Genetic factors. ● Disorders related to blood vessels. ● Obesity and overweight. ● Getting pregnant for the 1st time. ● Pregnancy with twins. ● Having hypertension or Diabetes or kidney disease. ● Pregnancy at age above 35 years. The bad news is that doctors can’t predict or prevent preeclampsia, so close and regular follow up during the first 3 months of pregnancy is very important.

If you are pregnant and experience such warning symptoms or signs you should seek medical advice at once: 1. Continuous headache. 2. Sudden increase in body weight. 3. Blurring in vision. 4. Edema or swelling in feet or face or hands especially in the morning. 5. Discomfort or pain in the epigastric region (upper abdomen area). Your doctor would ask for some labs and do physical examination and ultrasound to decide if you are at risk of developing preeclampsia or if you already have it. Other severe symptoms and signs that require hospitalization: ● Convulsions. ● Kidney or liver failure. ● Severe abdominal pain. ● Fetal distress (Baby shows irregular heart rates).

The gold standard treatment option for preeclampsia is termination of pregnancy, however treatment may differ according to the stage of pregnancy. Doctors decide the treatment protocol for each case according to many factors such as the severity of symptoms and the stage of pregnancy. There are 3 main stages in the treatment: 1. Treatment during pregnancy Pregnant women have preeclampsia before 37 weeks of pregnancy, doctors would prescribe some medications such as steroids and drugs to control high blood pressure. The majority of cases would need hospital admission for intravenous drugs administration, accurate follow up and monitoring. 2. Termination of pregnancy If preeclampsia occurs after 37 weeks of pregnancy the doctor would decide to deliver the baby and it should end the condition. By that stage of pregnancy the baby is mature enough and well developed and delivery would be safe for him. 3. Treatment after labour American College of Obstetricians and Gynecologists revealed that the majority of cases with preeclampsia are completely normal after delivery and regain normal blood pressure levels within 48 hours. However some patients would have irregularities in blood pressure and regain normal kidney functions within a few months after labour. So continuous monitoring and follow up is recommended for a few months after labour.

Preeclampsia is a complicated and dangerous disorder that would be life threatening for the mother and the baby if left untreated. Preeclampsia can cause many risks and complications such as: ● Kidney and liver failure. ● Rupture and separation of placenta from the uterine wall. ● Bleeding tendency due to decreased platelet count. ● Pulmonary edema and respiratory distress. ● Intrauterine fetal death. Here comes the importance of prenatal care and continuous monitoring of blood pressure from the start of pregnancy for early diagnosis.

Female pelvis contains many organs such as ovaries, uterus, urinary bladder, parts of the small intestine and rectum. All those organs are supported and kept in place by a number of pelvic muscles, ligaments and tendons. When there’s weakness in pelvic muscles and/or ligaments, prolapse of any of the pelvic organs may occur and then it will cause pain, discomfort and impairment in its function. In Pelvic organ prolapse one organ or more slips down from its position and protrudes through vagina either from the anterior wall or from the posterior wall.

There are many reasons that increase the pressure inside the abdomen which in turn lead to pushing down any of the pelvic organs and prolapse occurs. Here is a list of 8 of the most common reasons that increase the risk of pelvic organs prolapse: 1. Recurrent pregnancy Recurrent pregnancy is the most common risk factor, especially pregnancy of more than one baby, difficult labour and multiple cesarean sections. 2. Obesity Obesity and accumulation of fats in the abdomen increase weakness of pelvic muscles, ligaments and tendons. 3. Chronic Constipation and Cough Chronic cough and constipation increase the pressure within the abdomen and if there is concomitant muscle weakness, risk for prolapse elevates. 4. Low levels of Estrogen There are many medical disorders causing low levels of estrogen such as menopause, which has a direct effect on muscle strenght in women. 5. Wrong Weight Lifting Doing exercises incorrectly, especially weight lifting, may harm the body in different ways and cause pelvic organ prolapse. 6. Pelvic tumors Large masses within any pelvic organ of any type; benign or malignant may cause prolapse of this organ. 7. Hysterectomy Hysterectomy is surgical removal of the uterus due to many medical reasons is an important risk factor for pelvic organ prolapse. 8. Genetic Factor Many theories assume that there are genetic factors causing genetic muscles, ligaments and tendons weakness in women and these factors run in families.

There are many types of female pelvic organ prolapse like: ● Cystocele Cystocele is the most prevalent type of pelvic organ prolapse, it occurs when the urinary bladder bulges through the anterior vaginal wall. ● Uterine Prolapse Uterus is a muscle mass when prolapsed causes severe pressure on other pelvic organs and may result in prolapse of any of them also. Uterine prolapse occurs in several stages ranging from mild vaginal prolapse till complete protrusion outside the vagina (Procidencia). ● Enterocele Enterocele happens when part of the small intestine protrudes through the vaginal wall. ● Rectocele Rectocele occurs only in women when rectum bulges through the weak posterior vaginal wall. Rectocele may develop to a serious stage while complete tear of the vaginal wall occurs and the rectal and the vaginal lumens become continuous (not separated). ● Vaginal Vault prolapse This type of prolapse occurs frequently in women after hysterectomy; When the vaginal vault is free and not tightly fixed to the pelvic wall. Pelvic organ prolapse in women is a common health problem and there are many risk factors that increase the incidence, so awareness of these factors is very crusial in preventing developing that disease.