Motherhood Health Podcast

In this enlightening episode of BettHER Health Podcast, we have the privilege of welcoming Dr. Teji Dawane, a distinguished Senior Consultant Obstetrician & Gynecologist of Motherhood Hospitals Bengaluru, as she shares her expertise and insights on women's health. Join us as we dive into a thought-provoking conversation that explores various aspects of reproductive health, gynecological concerns, and empowering women to take control of their well-being.

As an esteemed practitioner in the field, Dr. Dawane has dedicated her career to supporting women throughout their life stages, from adolescence to pregnancy, menopause, and beyond. With a compassionate and holistic approach, she has become a beacon of knowledge and guidance for countless women seeking optimal health and wellness.

During this episode, Dr. Dawane discusses a wide range of topics pertinent to women's health. From menstrual health and common gynecological conditions to contraception options, fertility concerns, and pregnancy care, she provides valuable insights into understanding and managing various aspects of reproductive well-being. With a focus on evidence-based medicine and patient-centered care, Dr. Dawane sheds light on the latest advancements and treatments available in the field.

Moreover, Dr. Dawane addresses the importance of empowering women to actively participate in their healthcare decisions. She emphasizes the significance of open communication between patients and healthcare providers, and how this partnership can lead to better outcomes and enhanced overall well-being. Listeners will gain practical tips on how to advocate for their health, ask important questions, and make informed choices when it comes to their reproductive and gynecological needs.

Join us for this empowering episode as we tap into Dr. Teji Dawane's vast experience and compassionate approach to women's health. Whether you're a young woman navigating the complexities of puberty, a mother-to-be seeking prenatal care, or someone approaching menopause, this episode offers valuable insights to support and guide you on your unique health journey.

Episode Transcript:

Snehaa :

Welcome to Better Health podcast by Motherhood Hospitals. I'm Sneha, your host for today's episode. Better Health is a safe space for every woman to learn about their intimate health. We will have conversations about issues real women face and issues they are not comfortable speaking about openly. In today's episode, we are going to talk about a woman's a gynae health journey from puberty to menopause, how her body is changing, her hormonal health, emotions, and some know-how for gynae checks. We have Dr.Teji Dawanae, Obstetrician and Gynaecologist, Motherhood Hospitals, Bangalore. Thank you for making time and being here with us, Dr. Dawanae. How do you feel?

Dr Teji:

Namaste, Sneha. This is what we greet with at motherhood. So a very warm thank you for such a warm welcome. I'm really thrilled to be here. And I really feel that we should have more of these, you know, awareness programs such that people are more aware about how, what changes their bodies are going to undergo and how the things are, what are the things that are gonna happen in different phases of woman's life. So thank you so much for having me here today.

Snehaa :

And that's what we are here for, doctor. So without much ado, let's move on to the first question, doctor. So I and most of my friends have attend puberty at the age of 13. And we hear today that today's girls are attending puberty at a very early age, around seven years or eight years, doctor. So I would like to know a little bit about early puberty and what kind of advice would you like to give to these mothers of these daughters?

Dr Teji:

So, yes rightly said Sneha. So if you look at the whole timeframe, when we used to first get our periods or when we had menarche as we say, medically. So that used to the average age used to be around, you know, 12 years, 13 years. And then slowly as time passed, we started noticing that age had then fallen down to say 11 and then 10. And now we have girls as young as, you know, eight, nine year olds were having puberty and who are going through that phase. So if you see the entire reproductive age group now if you also notice that you know women like our parents had menopause at 50ish-52 that was the average age and then fell down to over period of time fell down to you know 47-48 and nowadays it's coming down to even 43-44 is the age where women are also you know going through these changes and attaining menopause. So the entire reproductive age group has been shifting prematurely and that whole age group reproductive cycle is been shifting. So there are lot of factors that we are noticing nowadays. So the biggest factor is one is genetics. So genetics is the age at which your mother, your sister has attained. But that is really not in our hands. So that is not something we can change, the very major fact that there are so many environmental changes that are happening, the lifestyle changes that are happening. So these are something that is having a very major impact on all of this premature or precocious puberty we say. So by definition when we say early menarche is anything less than 10 years of age when the girl has attained her first period and what are the factors that are there. So biggest is the dietary changes that the girls are going through. So nowadays there is so much of sugar. So we say there is a category of food called as SSB, sweetened sugar beverages that have increased for every birthday party you go to, you are having soft drinks and cool drinks and those tetra packs and all of this. So that the intake of these sugar filled beverages has increased their risk of obesity, risk of these hormonal changes. Not only that but even the increased intake of you know, junk food the deep fried stuff that is happening that they have, so they are increased weight during this time so all of this has had a major factor on you know, how the Timelines are changing. Apart from this, you know, the phones and the exposure to screen time that has increased so that is also in impacting their this puberty time, so they are feeling, I mean, nowadays lack of sleep due to excessive screen time, the sleep cycles getting disturbed, all of this has a major role to play when your menarche has started. And then apart from that, there are also other things like, you know, you have so much of peer pressure, you have so much stress from school, you know, probably parents also are then pushing parents. Now, each parent wants their children to be perfect at everything. You want the child to do very good at sports. You want the child to do well in music. You're, you know, you're trying to fulfil your wishes through the child, you know, putting the child through so many classes and so much of pressure. So sometimes the children are also, you know, they find themselves not being able to manage that much of stress. So, and balance it out. So all of this has been contributing. So these are the major environmental factors, the dietary, the sleep, and the pressure that is coming in from school, from parents, you know, the peer pressure that's there. All of this actually really contributes to this, Snehaa

Snehaa :

Understood, doctor. And doctor, it has also become a very common scenario that parents don't have the time to run around with their children. So what they do is they just give them the money, and then children have all the liberty to just go buy some bakery items and then eating it. And then the major issue we are also seeing in today's parents, I'm seeing my cousins who have children right now, and so that they can concentrate on their own work, So doctor, going forward coming to the pressure, the peer pressure in order to stand out or the stress they are getting from these schools and colleges. We also heard that these adolescent children basically the girls are coming up with a lot of gynae issues. So what are those common gynae issues these adolescent girls are coming up with?

Dr Teji:

So you know, I would definitely say that as soon as you get your periods for the first time, for the first few months, it is going to be a little irregular because body is taking time to get adjusted to that sync that is happening and that monthly release of hormones but then that period is prolonging so much so you know it's going on for eight months, one year, you know two years, the cycles have not stabilized the amount of bleeding is so much high and you know it's so it's distressing that the girl can't you know do her normal activities, she is limiting herself, she's you know, she's not able to do her sports or whatever playing and all of that, so that is usually not what we expect because once the cycle stabilizes, it takes about couple of months, maybe five, six months and after that it should happen on a regular fashion. But then the cycles being irregular and then that leads to problems with the bleeding. So we also get two extremes. Sometimes there is absolutely no bleeding at all where the girl lands up, doesn't have hardly a little bit of spotting or maybe one day of low. and then no periods for another two, three months. Or the other extreme wherein she's bleeding for seven days, 10 days, and she's not able to carry out her regular activities. So then that again puts in a lot of mental stress and she's like, she's not able to go out with her friends, she's not able to plan any parties and things like that. So these two, so irregularity of the cycle, the flow of the cycle. The second, third problem that we are really seeing nowadays is severe dysmenorrhea or severe pain during periods that girls are facing. So this also increases drastically with intake of sugar basically. So the more of sugar that you know they take in their day to day food, so that increases the inflammation in the body. So when the period cycle has to happen or just before your periods when, so there is as it is a lot of inflammation when increased intake of you know coffee. aerated drinks and sugar that increases the inflammation. So that increases, there is so much congestion around your uterus and around the ovaries and you have severe pain when you're having periods. You're not able to carry out your normal activities. So all these are something that is that we are noticing nowadays. Young girls coming saying you have severe pain, they're not able to go to school, they have to sit back at home. So all this you know catapults into so many things you know they start missing school, they start missing out. They start getting more depressed and they start sitting at home. You want to eat more because you want to overcome that kind of mood swing that has happened because of this. So coming slowly to that, so these are the physical things that we see, practically physical changes and the changes in the periods, but also the mood and the emotional aspect of it is also quite alarmingly high, wherein girls are getting so depressed. So when we tell young girls, it is your transition phase. Your mother has gone through it, your sisters, your grandmothers, and you are also going through it. But then for ours, our parents, for us, it was quite smooth. But then this transition phase is becoming so hard for them. So then they get into that kind of distress, and they don't want to face that time of the month when they get another period cycle and they have to go through so much pain and so much practical issues. So that then also leads to a lot of anxiety and a lot of sleep issues and not able to sleep well, even thinking about getting a period and all of that. So it's becoming like a very difficult thing for them to just face their normal periods. So. we have to put an end to this and this begins from you know, probably from our, it's our responsibility as parents not to, you know, give off screens and just because the child is not eating, you know, you show something on the screen and you know, stuff the child. So the child has no idea what the child is eating, you know, how much to chew, you know, to take the, you know, to get the actual taste of food. So when you're tasting, so it's recommended that you use your hands to, you know, eat food and not with spoons and all of that. So that's when you're activating the senses of your hands and that's when the food actually, you get to taste better, chew better, gets digested better, but all of that, the focus is so much on the screen and the distraction, the child forgets to chew. And so then all of that is undigested and all of that gets accumulated as fat. So it begins from there. So it is very important that as parents we try to give our children some time, at least during these crucial times of the day where you know Meal time is should be at the dinner table and for everybody I mean, it's all people so you can't have father sitting and doing some work at the laptop and having dinner But then you can't expect that the children would sit at the dinner table. The children are going to follow parents and they observe  basically children are reflection of what we do at home so if we are going to pay attention to the food that you are eating, they are going to do it. Because they see you do it so it's very important that you set a good example.

Snehaa :

Sure, Doctor. Since, Doctor, we are talking about first periods, early puberty and other things what adolescent girls go through, our listeners would like to also know about HPV vaccines, Doctor. Are vaccines enough? What is the right age a girl has to take HPV vaccine? What are the amount of doses she should go for? If you can throw some light on that.

Dr Teji:

Yes, so the cervical cancer is a dark horse topic because people are not really aware what is happening, what is uterus, where is the cervix, your cervix is the basically opening of the uterus. And this is exposed to a lot of sexual activity. So when you're having intercourse, when your periods are flowing out through this part, and when you're having discharge, the white discharges, the abnormal discharges, So there's a lot of activity going on there. there is a lot of wear and tear that is going on. It is exposed to so many discharges during various phases of the cycle. Sometimes there is bleeding, sometimes there's brown discharge, the white discharges. And also, you know, when you're changing pads, you're keeping it little, around the cervix. So, so many things are happening. So, and then there is a higher chance of infections and all of this. So, in short, HPV is nothing but a kind of an infection. So, it is a human papilloma virus. It's a viral infection. which can impact the cervix. So this is the only, actually if I can say this is the only cancer in the entire body which starts off with a simple infection. So it is just a viral infection which transforms the DNA of the cells of the cervix and makes them cancerous. So because there is an infection, there is a vaccine for it, and it can be totally preventable. So this is one cancer in the body which you can totally prevent it and it just starts off with a simple infection and if you're away from the infection and you can protect yourself from the infection, your chances of getting the cancer in the later on life is much, much less. So basically there are about multiple varieties of the viruses that can cause the cancer, but the most common ones, there are about nine varieties of viruses for which we have a vaccine. So there is the vaccine called as Gardasil 9. So there are three doses of the vaccine. One, if you take it today, you say zero dose, or the first this thing. And the second dose is taken after a month's time. And the next dose, the booster dose is taken about six months following the second dose. So there are three doses taken one month apart, second dose and the six months apart is the booster dose. Now in the West, it is taken even as, I mean, by girls as young as six years and seven years because they have a very early exposure to sexual life and all of that. And boys as young as even nine, ten years of age also. So the virus impacts both, both the girls and the boys. So it can also cause cancer of the cervix in women and cancer of the penis in boys and men. So we need to be protected against both because your partner could be carrying the virus and it could also get transmitted to you. So it is essential that you protect yourself and you take these vaccines, so the efficacy of the vaccine is very good when you have taken it before the contact of the first sexual contact because the virus has everything to do with sexual activity, so when there is so that's how you get infected, so when you are having intercourse or any bodily fluids that have come in contact, so there is a chance that the virus can get transmitted from one person to the other, so ideal time of the vaccine is for young girls who have not had sexual intercourse. And that the efficacy of the virus is also about 67, sorry, 96-97% of the times it is protected. Even after intercourse you could have the vaccine, but however the efficacy of the vaccine comes down to about 20-25 percent, but it is still better than not having any protection at all. One thing I would like to mention here is this is not something that you can be completely so your usual whatever precautions you have to take after the vaccine you have to continue. What I mean to say is lot of people, you know, they feel that once that they are vaccinated, they are completely protected against the virus and completely protected against the cancer. So that doesn't give you the, you know, the, the, this thing to, you know, the license to, you know, still have erratic sexual behaviour. It is response. I mean, you have to be responsible. You have to use, you know, protection and you have to use condoms when you're having intercourse, even after you have taken the vaccine because the vaccine covers only about nine varieties of the viruses. There are still about 50 varieties of viruses which are not still covered by the vaccine. So it's just like the COVID vaccine, people think that just because I've taken the COVID vaccine, I'm not going to get COVID and you don't use masks and your sanitizers and all of that but there is still a chance of getting the COVID. It's just that the symptoms and the severity is going to be less but there is still a chance of you getting. So it is not a 100% protection. Your routine, your barrier, contraception, your contraception, your condoms have to be in place and you have to have a responsible sexual attitude.

Snehaa :

And doctor should one go for pap smear test after having HPE vaccine?

Dr Teji:

yes, definitely recommended. So even after you get the vaccine, that's what so those that routine protocol should be in place. Your routine pap smears have to be continued even after the vaccine. And that the protocol remains the same. So you can have once in three years, the pap smear provided your previous pap smear has been normal.

Snehaa :

Understood, So doctor, moving on to the next question and little higher up to the elder generation, what we say as reproductive age between 20 to 30. So what are the common gynaecological issues that you see in today's women?

Dr Teji:

So this reproductive, so actually now if you ask us, I mean nowadays women are planning pregnancies also quite late. So earlier the age would be about 24, 28, 20, you know, about 22 to 28 times. Now because women are, you know, they are career oriented and they want to be focused on those aspects before they want to plan a family. So they are looking at little later on during life, which is nothing wrong. It is the personal choice and all of that. But that also means that you should be a little more responsible towards your health, your body, make sure that, you know, you kind of avoid, you know, lot of smoking and lot of, you know, alcohol, the intake of a lot of the soda and the same, the beverages that are there. Alcohol is something and smoking is something that you should. avoid and restrict not completely avoid make sure you have limited quantities of all of that. So because of all of this we have we have we have been seeing patients who are now struggling to have babies who are having problems in conceiving because that begins from your periods so because periods itself are getting irregular so then planning becomes difficult so the infertility problems have increased. And it's not only the female infertility, it's even the male, the sperm quality, the sperm counts are drastically reducing. And that is then again impacted by the lifestyles that men have against smoking and the alcohol impacts the sperm quality. And also stress, I mean, we are seeing young couples who are having hypertension at such a young age. You know, 30, 35 is the average age where men or women are having blood pressures, having diabetes So all of this also lands up contributing to the fact that they're having difficulty in conceiving. So that is the first step. And even if they do conceive, then we are seeing an increased chances of miscarriages and increased risk of abnormal pregnancies and then leading to miscarriages within the first three months itself. So that also is increasing because of your diet because your folic acid supplements are not in place. So it's always recommended that you plan well in ahead. You visit your doctor, you visit us, we give you a lifestyle change, we give you a diet change that you can do to improve your egg quality, your sperm quality and lifestyle does have a major impact. And coming to women, they are having other problems like polycystic ovarian disease or PCOD. Or they are having increased fibroids in the uterus. So fibroids are small lumps in the uterus and that is just because of hormone changes. And those hormone changes are again subject to stress and the lifestyle factors that we have been talking about. So all these problems, ovarian cyst is another thing that we see very commonly. So the ovary is developing cysts and those cysts, they don't sit quietly. The problem is they release their own hormones. So these are some very common problems that we are seeing. During the course of pregnancy, we are seeing increased risk of diabetes, extreme weight gain. Because, you know, that concept of eating for two people during pregnancy has been there around for such a long time. And so women just land up eating, but they're in a bubble, you know, they don't want to move. because they feel that when they move around, when they're active, there can be a chance of miscarriage. So that is then leading to increased weight gain and then increased chances of C-sections, instrumental deliveries. So all of this is what we are noticing nowadays.

Snehaa :

In fact, doctor, adding on to your insight about lifestyle issues, and also I'm adding the family history as well. So there is a rise in high risk pregnancies, and a lot of IVF pregnancies have also gone up, doctor. Again, a lot of factors are involved there, lifestyle issues, stress, a lot of other things. So, doctor, how do these precious pregnancies have an impact on women's health post-delivery? What can be done to make more awareness about these IVF pregnancies or precious pregnancies, preconception planning, lifestyle management, and access to care and management of these pregnancies. Like how will you help these women have a smooth pregnancy and delivery?

Dr Teji:

So yes, I mean, if you ask me, Sneha, actually all pregnancies are precious. I mean, just because you know, you had an IVF conception, that doesn't mean that you're even more precious than a lady who's conceived naturally. So if you ask me today, every single pregnancy is precious. But at the same time, that doesn't mean, precious doesn't mean that you should not move around at all and then you should be at complete bed rest because it's a natural process. And once you conceive, it really doesn't matter whether it is an IVF conception or whether that process of conception may have been assisted. Maybe you have taken some extra medications, but once you conceive, more or less the journey is the same, whether you have conceived with a major procedure or whether it is a natural conception. So that journey should remain the same and that motivation starts from the time that you are even planning your pregnancy. So you should be motivated and that's our job. So that's our job to motivate you. We will guide you the right way. We will give you what are the lifestyle changes and how active you need to be. So otherwise you see our parents, when you look around you, 90% of people have been very active and medically there is no problem and they go about your usual lives, like before COVID, Sneha. Pregnancy is not a disease, that where you take 24 hours bed rest and you need to live in a bubble. It's a natural process and it comes with the flow. It is something that is an add-on to your life. It's not something that stops your life completely and puts you on bed rest and focusing only on pregnancy and stressing only about it. So I have a lot of couples even asking me that you give me work from home because I don't want to travel because there is an option of work from home but I would say you shouldn't you know you should go about your normal life at least weekly 3-4 days, 3 days a week you could go because that's when you meet 4 people, you meet your friends, you know you get a little move around a little bit, you have a little bit more of you know independence you just not you know in those that 4 walls and you stuck to your laptop and that's not going to really help know anyone or even the baby.

Snehaa :

So Doctor, let's move on to a little higher up generation, which is the perimenopause and menopause stage. With you being here, I'm very much intrigued to ask this question to you. So I have a sister who is 47 years old. And she is going through this perimenopause phase. She is not having periods consecutively, obviously. It's one of the symptoms. And she is having a lot of mood swings, brain fog, and she has a adolescent daughter who is very finicky. So nobody is actually supporting her. So because she's going through a lot of issues, what advice would you tell women, you know, in this particular age group, and women post menopause, how to take care of their health, and how family should support them.

Dr Teji:

Correct, So that's again a very important phase. I think our mothers really didn't get much support. They were like, I think our parents used to say that, my father used to say, he didn't even know what really happened to my mom during that phase and how. So, but now it is important that we do support the lady because you know, I think the lady really runs the house. I mean, the health of the family is in the lady's hands. So right from the kind of food children eat, right from the lifestyle they have, the timing of how they sleep and all of that. So it's important that the lady is fine and she is well taken care of so that the entire family is healthy and runs well. So it is, so see, I mean, see hormones, it's not like a switch, the menopause is not like a button that you switch off and then everything goes to zero in a day. So there are slowly these variations start. then that slowly then dies down and then it the period actually stops so when you have no periods for more than a year then is when we say that you have attained menopause so one year of no periods is when you attain menopause and before you reach that when there is this phase of this hormonal imbalance then this phase is called a peri or a pre-menopausal phase wherein the body is undergoing so many hormonal changes to get adjusted to that kind of menopausal state. So when that kind, there are so many hormonal changes. This is the last time that we want to give medications because naturally, the brain is trying to vary the hormones. And on top of it, you take medicines or you take hormonal tablets during that time. So that really confuses the body. So we would really suggest that the lady understands that this is the phase that she has to go through. And there are some certain tips that we give. that you can make dietary changes in your lifestyle that helps the lady to transition through this phase. So there are two kinds of hormones in our body Sneha, one is the estrogen and one is the progesterone. Estrogen is the main hormone or the dominant hormone in any lady. So three main systems that the estrogen controls, one is the estrogen protects the brain. So it has a protective effect on the brain, on the heart, it has a very good impact and protects the heart and the bone. So these are the three main systems. Now, when as the effect of estrogen starts reducing, then the protective effect on all these three systems starts reducing. So that is where you start getting, when you're more anxious, you get more anxiety, you have severe mood swings during this phase, you start having a little bit of bone issues, your knees are hurting, your back is hurting, you have weak bones, you start developing osteoporosis during this phase. And you do have odd flushes you have really, you know, when everyone else is sitting comfortably in the room, but you're really sweating or in the middle of the night, you get up with a lot of sweating and then you want fresh air and breath of fresh air, or you can hear your heartbeat, you know, palpitations really hard. So all of these changes that are happening during menopause, but this is very much natural. All ladies go through it. Some women have a little more exaggerated symptoms than some. women it's a little more smooth. So there are some natural dietary foods which have which are rich in estrogen which we recommend. So I have a diet plan I usually guide the women as to what dietary foods you can take which are natural estrogen. So that's absolutely no side effects and these are plant extracts of estrogen which helps us transition this phase better. Apart from that yoga and pranayama is also very very good you know. way to help you go through this phase. There are evidence nowadays to say and you know people and there are a lot of studies done in the US also to say how yoga and breathing simple breathing techniques helps us stabilize these hormones and the impact of the hormones on the body. So these things are something that you have to change in your lifestyle and have an active kind of a lifestyle have every day at least half in a 40 minutes of some kind of activity. whatever you like, this thing. And it could be a simple swimming or it could be a Zumba. Simple brisk walk is more than enough. Family plays a very, again, very important role because in this time, we should make sure that we give the lady her time. You have to give her at least one hour in the day to do what she wants to do and to help her transition through this. And from our side, what is it that you can help and contribute maybe? The children can help a little bit in the kitchen, you know, you can help a little bit in by cleaning and make her happy basically if there's medically something we can help, we can definitely do that.

Snehaa :

A big thanks to you, doctor. I mean, we are so honoured to have you on board today and talk a lot about puberty to menopause and share great insights, valuable insights today with us. That was Bet Her podcast powered by Motherhood Hospitals. If you have enjoyed this episode, please do follow us on our favourite podcast and player and leave us a rating and review as well. It helps other listeners to discover the show and I would just really appreciate it. Even better if you know someone who could learn and be empowered with the podcast, don't forget to share with them. Thank you so much, doctor.

Dr Teji:

Thank you, Sneha. Thank you so much. My pleasure.

Snehaa :

Thank you.

 

 

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