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Doctors in the House!

  • Hi, I have a question for Doctor in the House.

    I am 22 years old this year and had been having regular missing periods since last year. I've only had less than 5 period last year. Since the start of this year, I've only had two periods, and they were caused by the taking of pills given by my gynaecologist to intentionally cause them. However after one menstrual cycle, I've not had any period until now. I have consulted a gynaecologist and he said there's nothing wrong with my hormones after taking a blood test. He attributed it to stress from school work and weight loss from my trainings. Since last year, I've lost 5kg from two seasons of intensive trainings for competition, with each season lasting about 2 months.

    I am concerned about my missing period as it's been some time since I felt that my stress level is high, and I've been eating normally. I am also worried that my fertility would be affected in future. I would greatly appreciate your advice. Thank you.


What you are describing is "oligomenorrhea", which means not having menstruation for more than 3 months.

 

There are many reasons for oligomenorrhea. One common reason is hormonal imbalance. Hormones that affect the menstrual cycles are not limited only to the female hormones. Other hormones like the thyroid hormones, prolactin will affect the regularity of the menses as well. The doctor you consulted probably checked all of the above and found them to be normal.

 

The other main reason why some young girls do not have regular menses is due to being underweight or overweight. You did not provide your height and weight so we are not able to calculate your body mass index for you.  Body mass index (BMI) is calculated from weight (kg)/ height (m) x height (m). The normal BMI for Asian women is between 18-23. If your BMI is less than 18, that is probably the cause of your irregular menses. In addition, too much exercise can also lead to oligomenorrhea.

 

Perhaps you can try to reduce your exercise intensity and aim to achieve optimal body weight. Once you have attained your ideal BMI, your menses will most likely become regular and your fertility, in the long term, should not be affected.

There are other causes of oligomenorrhea like  polycystic ovarian syndrome, premature menopause, chromosomal abnormalities. If your menses do not resume normalcy after you have reduced your exercise regime and attain ideal weight, you are advised to see a doctor with a view to investigate for these other causes of oligomenorrhea.

 

  • I am a mother of 3, recently diagnosed with hyper- thyrodism. I am on regular medication but has since put on weight only around the waist. My waistline has increased significantly for me to suspect an issue is at hand. Please advise – Esther

When a patient is hyperthyroid, the high thyroid hormones increases her metabolic rate. Therefore, a hyperthyroid patient often loses weight. Even if she does not lose weight, she might have noticed an increase in appetite and food intake, while not gaining weight during the time when she was hyperthyroid. 

 

With the treatment of her condition with an anti-thyroid drug, the metabolic rate returns to normal. However, this is lower than the metabolic rate when she was hyperthyroid. Consequently, she will experience weight gain and an increase in her waist line. This weight gain may be ameliorated by increasing physical activity and reducing caloric intake, but it may not be completely avoidable. 

 

There are other ways also reduce this problem of weight gain with treatment but this should be discussed with her physician. Also, there is always a possibility that the weight gain may not be entirely explained by her thyroid condition. Continued unexplained weight requires a proper medical evaluation by her physician to exclude other conditions. 

 

  • Any ways to stop snoring? – Snorer

There are various causes for snoring. The common causes are a person's age and weight. If the patient is overweight, he should lose weight. 

The other causes of snoring are due to nasal, throat and tongue-based obstruction. Depending on the reasons (could be multi-factorial), each issue should be dealt with accordingly. If it is obstruction in the nose - we could offer the patient medication or surgery. If there is a sinus issue, further investigations need to be done. 

 

Patients need to be evaluated and seen by an ENT surgeon. 

 

Snoring in itself may not be considered an illness but when associated with other symptoms like daytime sleepiness and morning headaches, it could indicate obstructive sleep apnea. If the surgeon thinks it is necessary and that the snoring might lead to obstructive sleep apnea, a sleep study needs to be done before appropriate treatment can be advised. Each problem will then be treated accordingly.

 

  • As a parent, I am concerned about Meningitis. Since those at risks include young adults living closely, what are the preventions and would we need vaccination? – Khoo

A good example of young adults living closely would be university/college students living in residence halls. Meningococci (the bacteria that causes meningococcal disease) can be transmitted from person-to-person by close contact. Meningitis is part of the spectrum of meningococcal disease.

We would recommend meningococcal vaccination for such students prior to college entry. The most recent dose of meningococcal vaccination should preferably be on or after the 16th birthday. If the student was previously given meningococcal vaccination before the 16th birthday, he would need a booster dose before enrollment.

Haemophilus influenza type b (Hib) can cause meningitis in children, and Hib vaccination has recently been included in Singapore’s National Childhood Immunisation Schedule.

 

  • I have stiffness in my left knee joint and have seen a doctor who says that the x-ray doesn’t show any issues. I suffer the occasional pain which can get very bad. What is happening and what can I do? – Angel, 42

This is most likely due to some early cartilage wear and tear. Usually we prescribe medications like anti inflammatory for a short period of time....as well as physiotherapy to strengthen the muscles around the joint.  If this fails to alleviate your pain and stiffness then an MRI would be required to see the status of the cartilage in your knee.

Another reason for stiffness could be inflammatory joint problems. Most knee problems are due to wear and tear or injuries to the cartilage in about 90 percent of cases. In 10percent of cases the pain and stiffness could be due to inflammatory joint problems. Eg rheumatoid arthritis. This is more prevalent in females and are usually symmetrical in nature ie both knees are affected at the same time. The usual way to exclude such problems is to do a blood test to make the diagnosis .

 

  • My dad has terrible arthritis in his knees, and the tablets prescribed for the pain don't work. Is knee replacement surgery successful? – Justin

 

Knee replacements have been very successful. They have been around for a long time and this is the forth decade in which knee replacements have been performed. Such knee replacements  can help to take away the pain and the stiffness and allow you to return to your activities of daily living. The success rates of such procedures are in excess of 99 percent in the short term. With the advent of newer materials, techniques and technology, many knee replacements are expected to last more than 20years if proper surgical techniques and newer materials are used. 

 

The latest technology in knee replacement surgery is to replace only the worn out segment of the knee.more often than not,only one or two of the three compartments of the knee are worn out. A such, rather than replacing the whole knee,there is increasing tendency for surgeons to replace only the worn out segment. Usually the inside of the knee is the first to wear and this is the compartment that is replaced first. 

 

This is called a unicompartmental knee. As the name suggests only one of the three compartments is replaced. The reason for doing so is that we preserve a lot of the normal knee. As such most patient are more satisfied with the performance of their unicompartmental knees as they are still able to squat as well as the behavior feels more like a normal knee. We tend to replace the whole knee now only if all The compartments are destroyed. As mentioned the unicompartmental knee has normal kinematics and behaviour compared to the total knee.

 

The latest method to implant such joints is to use robotic technology.

 

One big reason for early failures in knee replacements is poor implant placement. This could be due to many factors eg soft tissue restrictions during surgery that impedes the surgeons ability to accurately assess the tissues tension etc. With the advent of robotic surgery there has been a big paradigm shift in the management of knee replacement. As the implants are more accurately placed and selected , and the cuts are made more precisely , this will certainly add to the performance as well as to the longevity of the knee.

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