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I am a first time mum. My breasts sagged after pregnancy. Could the sagging be due to breast feeding? Can I use natural cream or supplements to help restore the shape of my breasts? The breasts are attached to the chest wall by supporting ligaments. During pregnancy, increasing levels of hormones cause the breast tissues to grow. As a result, the breasts become enlarged, swollen and heavy. They then drag and stretch these ligaments resulting in sagging breasts after pregnancy. Other factors that contribute to sagging breasts include aging and smoking, — both of which reduce skin elasticity. Being overweight and having large breasts have a similar effect. Studies have shown that breast feeding does not result in sagging breasts. Many nutritional supplements in the form of creams and pills are marketed as a natural method of breast enhancement. They usually contain a variety of herbs with weak stimulatory effect on breast tissues. These plant-derived substances known as phytoestrogens are often marketed as having the potential benefits on breast health. Though some of them may firm up the breasts temporarily, scientific studies have proved their ineffectiveness. Besides, there are no long-term safety profile on these products. The safe and healthy ways to enhance breast appearance include; · Maintaining a correct posture · Eating a healthy diet · Doing exercises to develop your chest muscles.

My first pregnancy ended in caesarean section because my baby was in a breech position. I am now in the last trimester of my second pregnancy. The baby is in a head- down position. I am very keen to experience a normal vaginal birth. Can I try? What are the risks? In general, vaginal delivery has physical and emotional benefits for mother and baby. They include: · reduced blood loss, · less post-delivery complications such as wound infection and pain, · shorter recuperative period, · decreased risks in future pregnancies of placental problems, · positive emotional experience of achieving a vaginal delivery. But for a vaginal delivery after caesarean section (CS), one has to consider the risk of uterine scar rupture. A CS scar in the uterus is the weakest part of the womb. The stretching that occurs during pregnancy and the strong contractions of labour can cause the scar to become thin and split open, a condition called uterine rupture. It may be life threatening as it can cause massive bleeding and injuries to neighbouring organs like bladder and intestines. An immediate CS has to be done and blood transfusion and possible hysterectomy (removal of the uterus or womb) may be required to save the mother’s life. Sometimes, the baby may not be delivered in time and foetal death or brain injuries may occur. Luckily, the incidence of uterine rupture is low, occurring in 0.5% in spontaneous labour and increasing to 2% in induced labour using medications like prostaglandins or oxytocin. Research has shown that women who try to deliver vaginally after a CS can achieve a success rate of 60-80 % The choice of vaginal delivery after a CS has to be individualised. Your obstetrician may allow you to have vaginal birth if: · You have an uncomplicated pregnancy, · You have a lower segment CS, · You do not have the same reason as for the previous CS. To maximise your chances of having a vaginal birth, your obstetrician may · Allow labour to start naturally without induction, · Let your water bag break spontaneously, · Avoid using medications to induce or ‘speed up’ labour, · Monitor the foetal heart rate continuously and closely during labour. Since you have expressed a desire to experience a vaginal birth after a previous caesarean section, you should consult your obstetrician and follow his/her advice.

Normal menstrual period occurs every 21 to 35 days and lasts about 5 days. Vaginal bleeding in between periods or intermenstrual bleedingis abnormal. Vigorous exercise, unless resulting in undue stress, is perhaps not the reason for the bleeding. Most cases of intermenstrual bleeding are due to non-cancerous and treatable causes. Occasionally, it may be due to cancer or pre-cancer. Thus it has to be assessed and treated promptly. Common causes of intermenstrual bleeding include: Pregnancy complications: Miscarriage and ectopic pregnancy. Hormonal imbalance from emotional or work-related stress. Cervical or endometrial polyps: These are benign or non-cancerous growths in the cervix (neck of womb) or lining of the womb. Hormonal contraception: Irregular bleeding can happen during the first three months of taking hormonal contraception in the form of pills, vaginal rings, skin patches, implants or injections. Infection of the cervix from sexually transmitted diseases. Uterine fibroid: This is a muscle growth of the womb. It it protrudes into the uterine cavity, it can cause heavy and irregular bleeding. Polycystic ovary syndrome (PCOS): The irregular or absent ovulation in this condition may result in irregular bleeding. Cervical cancer or pre-cancer may cause irregular bleeding, especially bleeding after sex. Uterine cancer: this is more common in older women, who may present with abnormal bleeding during menopause.

Vitamins and minerals are nutrients that are essential for the healthy development of the foetus. During pregnancy, the daily intake requirements for certain nutrients, such as folic acid, calcium, and iron will increase. Although a healthy and balanced diet is the best way to get these key nutrients, sometimes it may still fall short and supplements can help fill the nutritional gaps. Supplements are also useful if you are: · unable to prepare healthy meals regularly yourself. · vegetarians or vegans · have an eating disorder · having twins or multiple pregnancy But supplements should not be taken as a substitute for a healthy diet. They should be taken under the guidance of your obstetrician as overdose of certain vitamins may be harmful to the foetus. It is best to take prenatal supplements throughout your entire pregnancy. Your obstetrician may recommend you to continue taking them if you are breast-feeding.

Adenomyosis is a condition where the inner lining of the womb (endometrium) is abnormally embedded in the muscle layer of the womb ( myometrium). During menstruation, this misplaced tissue also bleeds causing surrounding muscle layers to become reactive and thickened. As a result, the whole womb gets enlarged giving rise to symptoms of heavy and painful menses. Adenomyoma is a localised form of adenomyosis where only some parts of the womb are swollen. This condition can mimic uterine fibroid on ultrasound examination which is just a simple growth in the myometrium. The differentiation between adenomyosis and uterine fibroid is further complicated by the fact that both can coexist in the same patient .and present similar symptoms.

I am married for 2 years, trying actively to conceive for the past 6 months without success. I went for a check-up recently and was told that I had uterine polyps. What are they and what are the causes? Must I have them removed? Uterine polyps also known as endometrial polyps are overgrowth of the cells in the inner lining of the womb (endometrium). They are attached to the wall of the womb by a stalk, the base of which can be thin or broad. They can be single or in a cluster and vary in size from a few millimetres to several centimetres. They usually extend into the cavity of the womb, but may slip down occasionally through the neck of the womb (cervix). They are usually noncancerous (benign), but may be pre-cancerous occasionally. They rarely turn cancerous. Hormonal imbalance resulting in an over-dominance of circulating female hormone, oestrogen appears to play a role in the formation of uterine polyps, the cells of which grow in response to oestrogen. Obesity and infertility are also associated with uterine polyps. Uterine polyps can occur in any age group but more commonly in older women around or completed menopause. They do not give rise to symptom usually but may cause the following occasionally Bleeding in between menstrual periods Excessively heavy menstrual flow Irregular vaginal bleeding Vaginal bleeding after menopause Infertility Uterine polyps may be detected by ultrasound examination, hysterosalpingogram (an X-ray examination for the uterine cavity) or by hysteroscopy using a thin telescope inserting into the cavity of the womb. Small polyps without symptoms might resolve on their own. No treatment is required unless other risk factors for uterine cancer are present. Since you have fertility issues, surgical removal using hysteroscope may be necessary. After the polyps have been examined under microscope, you may require medications such as progestogens to balance the oestrogen or GnRH agonist injection.

I am now in my 4th month of pregnancy. My friends advise me to take a lot of fish so that my child can have a better I. Q. I do not like to eat fish. Besides, I am afraid that fish may contain toxic substances, like mercury, which are toxic for my baby. Can I take other types of food? Should I take supplements? I presume you are referring to the omega-3 fatty acids found in fish. They belong to a class of fatty acids called essential fatty acids which the body cannot produce and must be obtained from food. Omega-3 fatty acids are the "good" fat that come in more than one form. The types found in fish, called DHA and EPA have the best health benefits. Another form known as ALA is found in vegetable oils, flaxseed, walnuts, and dark leafy vegetables. Omega 3 fatty acids are important for building healthy cells and maintaining brain and nerve function. They are important for the intellectual and visual development of the fetus. They have been found to reduce the risks of pregnant mother getting high blood pressure and premature birth. Studies have also suggested that they reduce the chances of babies having intrauterine growth restriction (IUGR)-a condition where the baby stops growing in the womb and remains small for the period of pregnancy. They also lower the incidence of maternal depression after birth. Rich sources of omega-3 fatty acids are found in fish, such as salmon, Pollock, tilapia, catfish, cod, anchovies, mackerel, sardines, sea bass and trout. World Health Organization recommends 1-2 servings of fish per week. As you rightly pointed out, there are increasing levels of mercury in fish from pollution in the environment. Large “predator” type of fish such as swordfish and shark are unsafe for pregnant women. Since you do not like fish, there are other sources of omega-3 such as egg yolks and meats, flaxseed, walnuts, canola and soybean. Vitamin supplements containing omega-3 fatty acids may be another option. The supplements are absorbed more efficiently with meals. But you may have the side effects of a fishy breath, a fishy taste in your mouth, occasional nausea and stomach upset. If these side effects are too much to bear, you may try algae supplements. Algae that is commercially grown is generally safe, though blue-green algae in the wild may contain toxins.