Menstrual health comprises the physical, social and mental aspects related to menstruation or periods. In India, women's health has been given secondary importance due to a male dominant society, illiteracy, low socio-economic conditions and ignorance.
The most common causes of menstrual problems are PCOS (Polycystic Ovarian Syndrome), and abnormal or heavy menstrual bleeding. Menstruation or monthly periods have been associated with a lot of social and cultural taboos in India.
Many young girls and women do not have facilities to manage their menses hygienically, maintaining their privacy, dignity and gender equality at home, schools and workplaces.
So, what are normal periods? A normal menstrual period lasts from 2-7 days and comes at an interval of 21-35 days. It is difficult to quantify the actual menstrual flow. In general, use of three to four XL or regular size sanitary pads per day (since they need to be changed every six to eight hours) can be considered normal on an average, but it may vary depending on the individual.
Common Menstrual Problems
1. Menstrual hygiene
2. Menstrual flow
3. Menstrual cycle
4. Menstrual hormones
Menstrual Hygiene Related Problems: Use of unclean sanitary pads or clothes can give rise to genital tract infections, anaemia and urinary tract Infection. This can be prevented by social awareness and easy availability of affordable sanitary products. It is also important to have the right knowledge about menstrual hygiene to avoid such issues from taking place.
Menstrual Flow Related Problems: One can experience excess or scanty flow during periods. Usually heavy menstrual flow can be for 1-2 days but if it continues for more than 5-7 days, it can lead to low haemoglobin and anaemia. This definitely needs to be investigated and treated along with oral iron replacement therapy. The less flow or change in flow over years can be due to hormonal imbalance. This can occur mostly after completion of family in perimenopausal age.
Menstrual Cycle Related Problems: Irregular periods, skipping or not getting periods for more than six months (also known as secondary amenorrhoea) and bleeding in between periods (called inter menstrual bleeding) are a few problems under this type of problem. The most common cause for this is Polycystic Ovarian Syndrome (PCOS), stress, anxiety and depression. Investigations in the form of pelvic sonography and hormonal investigations are necessary to make a diagnosis. Regular exercise, a balanced diet and healthy lifestyle changes are important.
Menstrual Hormone Related Problems: This usually gives rise to psychomotor issues. They can be symptoms of Premenstrual Syndrome (PMS) at any age group or peri/postmenopausal vasomotor symptoms after the age of 45. Bloating, breast tenderness, irritability and depression which occur premenstrually and disappear with onset of periods are classical symptoms of PMS. If they are affecting day to day family life, then it needs to be treated.
Every woman experiences menopausal symptoms in varying severity, starting usually 4-5 years before menopause. The night sweats, hot flushes, low moods, anxiety, irritability, joint and muscle pain, loss of interest in having sex, and weight gain are typical menopausal symptoms due to deficiency of oestorgen hormones.
No matter which type of menstrual problem you're facing, it is always advisable to visit a gynaecologist who will be able to identify all your queries after making the right diagnosis.
Nua, a new-age brand transforming the women's wellness space in India with holistic and personalised solutions that addresses real problems faced by women in managing their menstrual health and personal hygiene, provides an innovative range of products and services, including India's first customizable pack of sanitary pads and self-heating menstrual cramp patches, also available on a subscription basis. (Vaishali Joshi, #NuaExpert on Gynaecology, is an Obstetrician and Gynaecologist at Kokilaben Dhirubhai Ambani Hospital, Mumbai)
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With a whopping 77 million people in India living with diabetes, a simultaneous and sharp rise has been observed in the prevalence of diabetes-related preventable vision loss, particularly among the young people, say experts.
Diabetic retinopathy is a chronic, progressive retinal disease that is a leading cause of vision impairment in today's young adults, working population. It's of major concern among children suffering from juvenile diabetes (Type-1 diabetes) and especially if they have had diabetes for over 10 years.
It is estimated that approximately 1.1-crore people are suffering from retinal disorders in India and more alarmingly, about one in every three people living with diabetes have some degree of diabetic retinopathy, a diabetes complication that affects eyes.
"With the growing incidence of diabetes, it has been estimated that diabetic retinopathy affects one in three people with diabetes and remains the leading cause of blindness in young working-aged adults," Dr Mahipal Sachdev, Medical Director and Chairman, Centre for Sight Group of Eye Hospital, told IANS.
"Approximately 7-10 per cent of young diabetics will go on to develop diabetic retinopathy, of which 2-4 per cent will have vision threatening sequelae if not taken proper treatment." added Dr. Aditya Sudhalkar, M.S. Ophthalmology, Consultant Vitreoretinal Surgeon.
The most common form of diabetic retinopathy is Diabetic Macular Edema (DME) which arises when the damaged blood vessels swell and flow into the macula of the retina causing visibility issues in the normal vision.
According to Dr. Chaitra Jayadev, senior vitreo-retinal consultant, Narayana Nethralaya Eye Institute Karnataka, studies have shown that the prevalence of DME and diabetic retinopathy is higher and more severe in young diabetics with a longer duration of diabetes.
"Diabetes in the younger is a distinct pathological entity characterised by a more aggressive presentation and manifestation. An earlier onset of diabetes leads to a longer exposure to insulin resistance and hyperglycemia. This gives rise to a greater propensity for developing long-term microvascular and macrovascular complications," Dr. Jayadev said.
Thus, screening for diabetes is of utmost importance, even if one is "young" and has no symptoms. It becomes more crucial if one has risk factors such as family history, obesity, sedentary lifestyle, or on long term steroid medications.
Dr. Sudhalkar said that in India, there is a general reluctance towards attending clinics and nearly 25 per cent of young patients with DME come late for diagnosis.
"It's important to know, only 11 per cent of diabetic retinopathy patients can actually reverse vision threatening sequelae once they set in. The rest continue to progress even with strict glycemic control," he noted.
"Retinopathy, unfortunately, is the most neglected complication of diabetes. We see so many patients come to OPD where eyes have not been checked for. So the screening, also known as Funduscopy, should be done at the time of diagnosis of Type-2 diabetes, in adults, and in children, five years after the onset of diabetes, and thereafter annually," Dr Dheeraj Kapoor, HOD, Endocrinology at Artemis, Gurugram, told IANS.
If diabetes occurs near puberty, then funduscopy should be checked for potential retinopathy.
"It is important because the condition poses no symptoms in the initial days. And once symptoms set in, such as bleeding in the eye, red vision, sudden loss of vision, it's too late," Kapoor said.
The doctors advised to adhere to the treatment and maintain a healthy lifestyle to effectively manage diabetes and to prevent the onset or progression of eye diseases.
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While Covid-19 spared none, people with diabetes were among the hardest hit. The infectious disease not only raised the risk of severe disease progression and death among diabetics, affecting even the recovery, it also contributed towards the burden of diabetes in the country.
World Diabetes Day is observed annually on November 14 to raise awareness on the high blood sugar condition and related consequences.
India, known as the diabetes capital of the world, is home to one in six diabetics in the world. The country has also suffered significantly from Covid-19.
While on an average, diabetes reduces life expectancy by 4-10 years increasing the risk of death due to other comorbidities, which include heart attacks, kidney failures and infections, Covid infection fast forwarded that among people with diabetes.
Diabetes increased inflammatory response among Covid patients, spiking their blood sugar levels. It then complicated the course of Covid, resulting in excess morbidity and mortality, as well as posing severe challenges in the recovery of patients.
"During Covid patients were succumbing to it, not because of the original disease, but because despite all other efforts their glucose levels remained high. Thus recognising glucose as a vital sign very similar to blood pressure and pulse rate, respiratory rate, became more necessary during the pandemic," Jothydev Kesavadev from Jothydev's Diabetes Research Centres, Kerala, told IANS.
"Studies from all over the world show that the majority of the deaths from Covid were linked to high glucose values, and this includes both patients with no diabetes and with the new onset of high glucose," he added.
Further, the use of steroids, to control the serious manifestations of Covid-19, worsened the glucose levels in the patients.
High blood sugar levels, coupled with increased use of steroids, also led to other complications such as an unprecedented surge in cases of mucormycosis, commonly known as black fungus. It is a fungal infection, which occurs by inhalation of spores and can disseminate to various organs rapidly.
According to a recent study, published in Diabetes and Metabolic Syndrome: Clinical Research and Reviews, more than 86 per cent of mucormycosis or black fungus cases related to Covid in India, had uncontrolled glucose values.
"While the Covid cases are closely related to diabetes, mucormycosis is also very closely related to diabetes in Covid. Whenever the glucose is high, there is a deranged immune mechanism and in the presence of an infection it is persuaded rapidly," Kesavadev said.
Another study, published in the same journal showed that people with Type-2 diabetes who also suffered Covid-19 were more likely to experience severe fatigue than those who did not have the infectious disease, emerging as a major roadblock in the recovery of patients infected with SARS-CoV-2.
Moreover, among diabetes patients, those with increased fatigue level post Covid-19 also had increased postprandial blood glucose levels.
Covid also contributed to new onset of diabetes in many people, particularly the young. On one hand, Covid-induced lockdowns increased diabetes cases as people spent more time indoors, while eating more and exercising less.
On the other hand, Covid also contributed to nearly 25 per cent rise in diabetic patients in the country, according to an analysis of OPD data from a private hospital in Delhi.
Doctors found that among patients with confirmed Covid-19 infections, there was nearly 25 per cent of new onset of diabetic patients. Stress induced hyperglycemia -- high blood sugar -- was seen in 10 per cent of patients who had Covid-19 infection.
"The younger population is increasingly affected. We have seen that happening during Covid-19 epidemic. Increasing number of young people with more severe diabetes are now being seen," Dr Anoop Misra, Fortis-C-DOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, told IANS.
As per a recent study, among the younger generation in India, below the age of 30 years, there is a rapid increase in the occurrence of diabetes over the last 10 years.
"For these, diabetes as a disease will result in complications after 10 to 15 years. Imagine a situation where more and more people are developing diabetes at the age of 25 years or 30 years, which means even during the productive age group, by the time they are 35 years or 40 years, they will start developing complications. if the disease is not treated properly," Kesavadev said.
"There is an urgent need to decrease the screening age of diabetes to 25 years, from the current 30 years, in India," Dr Misra said, adding that "there is increasing urgency to ensure that young people follow correct lifestyle practices including more exercise, correct food choices, and maintenance of weight to normal, or even leaner category".
While diabetes cannot be treated it can be controlled and reversed by adopting a healthy lifestyle, diet and having proper sleep, as well as exercising for at least half an hour every day, suggested the experts. (Rachel V Thomas)
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An immediate challenge today is the prevention of Diabetes among the youth and pregnant women, Union Minister of State Dr. Jitendra Singh said on Sunday.
The minister, also a renowned Diabetologist, called for a mandatory diabetes test in all maternity hospitals and for every pregnant women, adding that more than 70 per cent of India's population is below 40 years of age.
Calling for an integrated and holistic approach to fight Diabetes, Singh said: Covid has prompted us to discover new norms in adversity and underlined the importance of combining traditional Indian management modalities with the Allopathic System."
"Diabetes is a growing epidemic globally and more so in India. A total of 88 million adult populations in India has diabetes in 2019 as per the latest International Diabetes Federation (IDF) estimates and this is projected to rise by almost 74 per cent to 153 million by 2045, giving India the dubious distinction of becoming the diabetes capital of the world," Singh said.
Sharing the concerns about of Diabetes that is making fast inroads in rural India with huge economic bearing on poor families, Singh said that there is a need to popularise Telemedicine to provide easy and affordable access to the ailing population.
Talking about the National Digital Health Mission, Singh said it can revolutionise healthcare in India as citizens will be issued a health card that will have all their medical information.
He said, the details of medical tests, illnesses, doctors' prescriptions and medical reports will be on a single identity card and will be the first of its kind in the world.
The Union Minister was speaking at a webinar on diabetes on the occasion of World Diabetes Day, jointly organized by Swami Vivekananda Yoga Anusandhana Samasthana, S-VYASA, Bengaluru and Central Council for Research in Yoga and Naturopathy, CCRYN, New Delhi.
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One in 12 adults or more than 74 million people living in India are diabetes patients, according to a new report from the International Diabetes Federation (IDF), ahead of the World Diabetes Day on Saturday.
The figure is the second highest in the world after China, which has 141 million people living with diabetes.
The findings are from the 10th edition of the IDF Diabetes Atlas to be published on December 6.
The report added that another 40 million adults in India have impaired glucose tolerance (IGT), placing them at high risk of developing Type-2 diabetes, while more than half (53.1 per cent) of people living with diabetes in India are also undiagnosed.
"The increasing number of people living with diabetes and at risk of developing the condition in India confirms diabetes as a significant challenge to the health and well-being of individuals and families in the country," said Professor Shashank Joshi, Chair, IDF South-East Asia Region, in a statement.
Moreover, the report showed that worldwide, 537 million adults are now living with diabetes, a rise of 16 per cent (74 million) since the previous IDF estimates in 2019. Globally, 90 per cent of people with diabetes have Type-2 diabetes.
The total number of diabetics is predicted to rise to 643 million (11.3 per cent) by 2030 and to 783 million (12.2 per cent) by 2045. Currently, one in ten (10.5 per cent) adults around the world are living with diabetes.
Diabetes was also responsible for an estimated $966 billion in global health expenditure in 2021. This represents a 316 per cent increase over 15 years.
Excluding the mortality risks associated with the Covid-19 pandemic, approximately 6.7 million adults are estimated to have died as a result of diabetes, or its complications, in 2021.
This is more than one in ten (12.2 per cent) of global deaths from all causes. The South-East Asia Region accounts for 11 per cent (747,000) of total diabetes-related deaths, according to the report.
The rise in the number of people with Type-2 diabetes is driven by a complex interplay of socio-economic, demographic, environmental and genetic factors. Key contributors include urbanisation, an ageing population, decreasing levels of physical activity and increasing levels of people being overweight and developing obesity.
"We must do more to provide affordable and uninterrupted access to diabetes care for all in India, and around the world. Policy makers and health decision-makers must turn words into action to improve the lives of people with diabetes and prevent the condition in those at high risk of developing it," Joshi said.
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The Associated Chambers of Commerce and Industry of India (ASSOCHAM), the apex trade association of the country, as part of its 'Illness to Wellness' campaign and in the light of the forthcoming 'World Diabetes Day' on Saturday unveiled a report on the findings of a National Level Survey conducted on the state of Diabetes in India.
The release was followed by a webinar on "Diabetes Free India" organized with the objective of cascading awareness and disseminating wisdom on diabetes management and its prevention, which was attended by a panel of eminent experts and doctors from across the country.
The survey report entitled "Diabetes in India" was produced by ASSOCHAM and the Delhi-based think tank, Thought Arbitrage Research Institute (TARI). The survey was designed and conducted by IMRB-Kantar and covered 2,33,672 people and 673 public health offices in 21 state clusters covering appropriate regions and age segments.
The key findings of the survey relate to the burden of diabetes and its primary causes or risk factors which lead to its rise and increasing spread in the country. According to the report, the prevalence of diabetes cases in India almost doubled from 42.6 million cases in 2005 to 85.4 cases in 2019.
Globally, on the other hand, the prevalence of diabetes increased from 273.4 cases in 2005 to 460 million cases in 2019. Small wonder then that India has the dubious distinction of becoming the global hub for diabetes cases with prevalence of cases increasing from 15.6 per cent to 18.6 per cent cases in the same interval.
Globally, diabetes accounts for 70.9 million DALYs (Disability-Adjusted Life Years) and 36.7 YLDs (Years Lived with Disability) in 2019. In India, diabetes accounts for 12.8 million DALYs, 6.7 million YLDs and 0.3 million deaths during the same time-period.
In terms of risk factors for diabetes, dietary habits related to high intake of junk / fried foods, most common in younger people today, has highest relative risk of 47 per cent. The next highest risk factors as elicited by the survey report relate to low physical activity (38 per cent), low intake of fruits and vegetables (28 per cent), and other causes such as stress, pollution, and high consumption of alcohol and carbonated/ sugary drinks.
Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Over the time, uncontrolled diabetes leads to serious body's systems damage, especially the nerves and blood vessels. There are ample studies conducted by RSSDI (Research Society for the Study of Diabetes in India) which emphatically depict and highlights that diabetes is a major cause of blindness, kidney failure, heart attacks, stroke, and lower limb amputation.
The survey outlines the prevalence landscape of diabetes in that it accounts for 25 per cent of all NCDs in India at a rate of 2.9 percent. The disease incidence increases significantly in individuals above 35 years of age and affects men more than women.
The report also finds that about 16.8 per cent of the male adult population (15 years) and 14.6 per cent of the female adult population (15 years) on average are estimated to be diabetic. Prevalence of diabetes is highest in southern states including Puducherry, Kerala, Tamil Nadu, Andhra Pradesh and Telangana and lowest in Uttar Pradesh and Rajasthan.
In terms of sufferers seeking treatment for diabetes, the survey presented some important insights in this regard too. About 7 per cent of the respondents who were suffering from diabetes stated that they were not seeking any treatment at all. However, more than 56 per cent of the respondents stated that they are seeking treatment for more than one year, a fact testifying to the indisputable and inevitable morbidity of this disease.
Diabetes is proven through studies to be associated with a high risk of cardiac arrest and there have been substantial increases in new cases of diabetes during the Covid-19 pandemic due to various reasons. In the current situation, diabetes has become a serious health concern since large numbers of patients are already vulnerable to the coronavirus.
Thus, diabetic patients affected by Covid-19 can cause a major health crisis. Reports show that large occurrence of diabetes makes it a serious comorbidity in Covid-19 patients. Diabetes also imposes a substantial burden on society in the form of higher medical costs, lost productivity, premature mortality, and intangible costs in the form of reduced quality of life.
Setting the tone for the panel discussion at the webinar, Anil Rajput, Chairperson, ASSOCHAM CSR Council, said: "This year marks the 100th anniversary of the discovery of insulin. It is, however, unfortunate that diabetes has been underrated as a global public health issue. This needs to be addressed on priority and we as a nation need to take urgent important steps to address this challenge. It is a fact that diabetes is one of the top three NCDs in India and with each year the burden of this disease is rising."
Dr. Banshi Saboo, President, Research Society for Study of Diabetes in India (RSSDI), said: "Diabetes prevention must be part of a larger national mission. Students should be taught 'Health Science' as a subject in schools which can help in preventing this disease and creating awareness about healthy lifestyles among our future generations. We must also change the age limit for the cyclical three-year testing protocol for sugar from 30 years presently to 25 years of age."
Dr. (Col.) Sudhir Tripathi, Chairperson and HOD, Endocrinology and Metabolism, Sir Ganga Ram Hospital New Delhi, said: "Diabetes can be prevented even at the pregnancy stage. Healthy mothers give birth to healthy children. We must also educate and inform people that this disease is reversible with healthy lifestyle and timely interventions.
Babies who are healthier, not obese, have a far lesser risk of developing diabetes in adulthood. It is advised that we must now have a National Diabetes Month in November to spread awareness and access about diabetes amongst people."
Dr. Dinesh Agarwal, Senior Consultant Internist and Head of Department, Department of Medicine Marwari Hospitals, Vice Chairman, RSSDI Assam Chapter, said: "One of the key risk factors and causes of diabetes is stress and junk food. Even children undergo a huge amount of stress these days due to a highly competitive and strained environment.
It is a fact that stress leads to hormonal changes which in turn can trigger diabetes in individuals. Add to this the fact that lack of exercise among both children and adults lead to an onset of the disease which could have easily avoided by following simple steps."
Dr. Rajesh Kesari, Founder and Director, Total Care Control, Delhi-NCR, said: "Diabetes free India is a dream for all of us. Diabetes, a chronic disease, has so many affected all of us either as families or as individuals. It is important to control this disease because not only does it cause many other diseases or co-morbidities and complications to take place, but also leads to a huge economic burden. The interesting aspect here is that 95 per cent of diabetes can be prevented, and it is important that we all work towards this."
The webinar was addressed by Shri Anil Rajput, Chairperson, ASSOCHAM CSR Council; Dr. Kaushik Dutta, Founder and Co-Director, Thought Arbitrage Research Institute (TARI), New Delhi and eminent doctors which included - Dr. Banshi Saboo, President, Research Society for Study of Diabetes in India (RSSDI), Dr. (Col.) Sudhir Tripathi, Chairperson and HOD, Endocrinology and Metabolism, Sir Ganga Ram Hospital New Delhi, Dr. Dinesh Agarwal, Senior Consultant Internist and Head of Department, Department of Medicine Marwari Hospitals, Vice Chairman, RSSDI Assam Chapter, and Dr. Rajesh Kesari, Founder and Director, Total Care Control, Delhi-NCR.
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