Is it just a period cramp or Endometriosis?

Menstrual cycle or periods defines a woman’s womanhood. But there are also several complications associated with it and cramps or pain in abdomen is one of the major discomforts. While in most cases the endurance of the cramp is no more than a week, some might find the discomfort lasting longer than period days. This abnormality could be endometriosis, a sign of danger and should not be ignored. This prevalent, painful condition affects 1 out of every 10 women during their menstruation years and is affecting 190 million women globally (as per WHO).

Endometriosis is a medical condition that affects women of reproductive age. It occurs when endometrium, the tissue lining inside of the uterus, grows outside the uterus, attaching to other organs such as the ovaries, fallopian tubes, and pelvic area. Endometrial tissue in the uterus normally thickens every month and is shed during the menstrual period, leaving the body through menstrual blood. But with endometriosis, the tissue that grows outside of the uterus can’t exit the body like tissue in the uterus does. It also may cause scar tissue to develop in the pelvis or a cyst (a fluid-filled sac) to form in an ovary, which can lead to severe pelvic pain.

Unlike a typical period, women with endometriosis have periods accompanied by excruciating cramps. People with endometriosis are seen describing their pain as stabbing, sharp, throbbing, gnawing or even intense cramping. The symptoms of endometriosis can vary in severity, and many women may not even realize they have the condition. It starts off with the complaint of having really bad cramping to the point of not being able to accomplish basic daily tasks, going to work or school.

Other symptoms of endometriosis include heavy or irregular period, low energy, pain with intercourse, pain with bowel movements or urination, excessive bleeding, infertility and diarrheal or constipation during a menstrual period. The condition can decrease quality of life due to severe pain, fatigue, depression, anxiety, infertility and also rarely causing cancer. Most women with endometriosis are diagnosed late, more than 7 years on an average. Endometriosis-associated infertility is affecting a large number of women and is only realised during family planning. The condition occurs in 6% to 22% women of reproductive age, making it one of the most common gynaecological disorders.

Although the exact cause of endometriosis is yet not certain, possible reasons include problem with menstrual period flow, immune system disorder, hormones disorder, surgical scar implantation and genetic factor. There are also several risk factors associated with endometriosis such as early puberty, prolonged or frequent periods, not being able to bear child and obstruction in menstruation flow

Also there is no known way to prevent endometriosis completely but the symptoms can be treated with medicines or, in some cases, surgery. Better lifestyle choices can also help fight the symptoms like lowering your estrogen levels with birth control pills, avoid alcohol consumption and smoking, cut down on caffeine, ensuring 30 minutes workout daily, eat a healthy diet, avoid refined sugar, flour and processed foods, drink plenty of water, dress lightly, take supplements like vitamin E, evening primrose oil, Vit B complex, calcium & magnesium and also back therapy can do wonders to alleviate symptoms.

The disease can be diagnosed through a physical exam, ultrasound, or laparoscopy. The treatment options include pain medication, hormonal therapy, and surgery. Providing education on the early symptoms of endometriosis is crucial for detecting the condition early, promoting menstrual health, and reducing stigma of the condition.

Most importantly, counselling to the endometriosis sufferer plays a vital role. The life of a woman with endometriosis affects not only her – but everyone around including her partner, parents, siblings, family, friends, colleagues and even her children. Therefore, one should take utmost care of the sufferer. Try to communicate more with her, understand her pain and difficulties, give her utmost comfort and care.


Lifestyle choices and chemicals in environment are major reasons for decline in Men Sperm Count Globally

As a reproductive health expert, it is very disheartening to say to a couple that they are infertile or cannot have a baby. Infertility in today’s context has become a global health issue as millions of couples are found to be infertile or not able to conceive. Not only women, but also men in millions have been found to be the reason of infertility of a couple.

A recent study, published in the journal Human Reproduction Update shows 50% decline in men sperm count globally, including India leading to infertility in med largely. Fall in sperm count is not new. We have been witnessing the declination for decades and the recent alarming report indicates the focus to be equal on male reproductive issues.

There have been two major factors contributing largely to the declension of the total sperm count in male such as lifestyle choices and environmental chemicals. While lifestyle choices include improper diet, sleeping habits, smoking and alcohol consumption or drug abuse, environmental chemicals include exposure to pollutants, toxins in the air, radiation hazards from mobiles, laptops, plasticizers in plastics or pesticides in our food.

Plasticizers, found in most plastics like water bottles and food containers has negative impacts on testosterone and semen health. Herbicides and pesticides abound in the food supply specifically those with synthetic organic compounds that include phosphorus negatively affect fertility of men. Air pollution is subject to particulate matter, sulfur dioxide, nitrogen oxide and other compounds that likely contribute to abnormal sperm quality. Radiation exposure from laptops, cellphones and modems has also been associated with declining sperm counts, impaired sperm motility and abnormal sperm shape. Heavy metals such as cadmium, lead and arsenic are also present in food, water and cosmetics also harm sperm health.

While environmental factors may not be in one’s control, lifestyle choices that will help in sperm health can be adopted. A little modification in lifestyle such as avoiding junk food, smoking and alcohol, proper sleep, minimizing stress and exercising regularly could improve one’s sperm count as well as quality. Also checking with one’s environment like limiting use of plastics, eating organic, limiting usage of phones and laptops, wearing mask while outside can also help in male fertility.

Symptoms of lower sperm count should not be avoided. One should immediately see a doctor if any of these symptoms is witnesses. Symptoms include problems with sexual function like low sex drive erectile dysfunction, pain/ swelling or a lump in the testicle area, decreased facial or body hair or other signs of a chromosome or hormone abnormality.


Negligence of PCOS May Cost High

Infertility is becoming a common complication among couple globally now-a-days. Whether it’s men or women, Infertility is not a curse, rather the result of ignorance. In case of women, negligence of symptoms like irregular menstrual cycle, moderate weight, blood sugar levels and healthy diet etc. leads to Polycystic Ovary Syndrome (PCOS) which is one of the most common causes of female infertility. 1-in-10 women of childbearing age get affected with PCOS.

Polycystic ovary syndrome (PCOS) is a complex hormonal disorder common among women, caused due to factors like Insulin resistance, Obesity, Genetic and Environmental. Insulin resistance means cells in muscles, fat, and liver don’t respond well to insulin which results the body can’t use insulin well. As a result Insulin levels build up in the body and cause higher androgen (male hormones) levels, which stops eggs from being released (ovulation) and cause irregular periods, acne, thinning scalp hair and excess hair growth on face and body. In case of Women with obesity (overweight) PCOS complications become worse. On the other hand, under genetic factor women whose mother or sister has PCOS or type2 diabetes are more likely to develop PCOS. Likewise, the toxic chemicals presented in the environment are also the reason of PCOS.

The World Health Organization (WHO) data suggests that approximately 116 million women (3.4%) are affected by PCOS globally. The PCOS statistics in India 2021 shows that one in five Indian women suffers from PCOS. So the ignorance of PCOS may cause some serious health issues in many cases like Infertility, Type 2 diabetes, Miscarriage or premature birth and Cancer of the uterine lining (endometrial cancer).

Adopting lifestyle modification can help in PCOS reduction. Changes in diet, exercise and other aspects of life can also help to reduce the burden of symptoms. Switching to a nutritious and balanced diet is advisable. Among overweight women, the symptoms and overall risk of developing long-term health problems from PCOS can be greatly improved by losing excess weight. Weight loss of just 5% can lead to a significant improvement in PCOS. Low-fat, high-carbohydrate diets might increase insulin levels.

So if you’re getting irregular periods, having trouble getting pregnant or have signs of excess androgen, which might include new hair growth on face and body, acne and male-pattern baldness. Then you should consult with your doctor.


First-line ovulation induction for polycystic ovary syndrome: an individual participant data meta-analysis.

Hum Reprod Update. 2019 Nov 5;25(6) : 717-732. Doi: 10.1093/humupd/dmz029.

Wang R1,2,Li W2, Bordewijk EM3, LegroRS4, Zhang H5, Wu x6, Gao J6, Morin-Papunen L7, Homburg R8, Konig TE9, Moll E 10, Kar S11, Huang W12, Johnson NP1,13, Amer SA 14, Vegetti W15, Palomba S16, Falbo A17, Ozmen U18,Nazik H19, Williams CD20, Federica G21, Lord J22, Sahin Y23, Bhattacharya S24, Norman RJ1,25, Van Wely


Racial and ethnic differences in the prevalence of metabolic syndrome and its components of metabolic syndrome in women with polycystic ovary syndrome: a regional cross-sectional study.

Am J Obstet Gynecol. 2017 Aug; 217(2):189.e1-189.e8.doi:10.1016/j.ajog.2017.04.007.Epub 2017 Apr 8.Am J Obstet Gynecol.

Chan JL 1, Kar S2, VenkyE3, Morin-Papunen L4, Piltonen T4, Puurunen J5, Tapanainen JS6, Maciel GAR7, Hayashida SAY7, Soares JM Jr7,Baracat EC7, Mellembakken JR8, Dokras A9.


TRPV4 is endogenously expressed in vertebrate spermatozoa and regulates intracellular calcium in human sperm

Transient Receptor Potential Vanilloid sub-type 4 (TRPV4) is a non-selective cationic channel involved in regulation of temperature, osmolality and different ligand-dependent Ca(2+)-influx. Recently, we have demonstrated that TRPV4 is conserved in all vertebrates. Now we demonstrate that TRPV4 is endogenously expressed in all vertebrate sperm cells ranging from fish to mammals. In human sperm, TRPV4 is present as N-glycosylated protein and its activation induces Ca(2+)-influx. Its expression and localization differs in swim-up and swim-down cells suggesting that TRPV4 is an important determining factor for sperm motility. We demonstrate that pharmacological activation or inhibition of TRPV4 regulates Ca(2+)-wave propagation from head to tail. Such findings may have wide application in male fertility-infertility, contraception and conservation of endangered species as well.

Ashutosh Kumara, Rakesh Kumar Majhia,1, Nirlipta Swaina,b,1, S.C.Giric, Sujata Kard, Luna Samantab, Chandan Goswamia,*

Keywords: Calcium-wave; Evolution; Sperm; TRP channels; TRPV4; Vertebrates.

Comprehensive treatment of high risk maternal diseases like diabetes, hypertension, heart, kidney, liver disease , blood thrombophilias, sickle cell disease, RH isoimmunization and cancer survivors And Fetal congenital abnormalities, genetic diseases, twins, triplets with sophisticated testing such as Prenatal biochemical screens, amniocentesis, chorionic villus sampling, NIFTY (non invasive fetal trisomy), targeted fetal anomaly screening, high risk level three sonographies, fetal echocardiography.Lady Gynecologist Doctors in Bhubaneswar Odisha DR SUJATA KAR.



Histone retention, protein carbonylation, and lipid peroxidation in spermatozoa: Possible role in recurrent pregnancy loss

Contribution from a defective paternal genome has been attributed to be an important cause for spontaneous recurrent pregnancy loss (RPL). Increased oxidative stress results in decreased detoxification and is a cause for damage to chromatin, proteins, and membrane lipids. The present study aimed to explore if there is a significant relationship between retained histones due to defective packaging of DNA in spermatozoa and oxidative stress. RPL patients (n=16) with a history of ≥2 embryo losses before the 20th week of gestation and no female factor abnormality, and fertile healthy volunteers (n=20) as controls were included in the study. A significant difference in the levels of protein carbonylation and lipid peroxidation together with an increased retention of histones in the experimental groups was noticed. Histone carrying sites for oxidative modification such as arginine and lysine might be responsible for disturbing the paternal epigenomic control during early stages of embryonic differentiation leading to abortion.

Results and discussion

The semen was viscous and had a pH within the range of 7.0-8.0 in both the control and RPL groups. Routinely analyzed sperm attributes except sperm count and leukocyte concentration showed a distinct significant change in the RPL group (Table 1). The percentage of motile spermatozoa drastically dropped in the RPL group but it was still possible to achieve pregnancy as it is above the lower reference limit of 40% [WHO 2010]. However, the oxidative stress parameters of semen showed a significant increment in the RPL patient group

Gatatri Mohantya,*, Nirlipta Swaina,b,*, Chandan Goswamib, Sujata Karc , and Luna Samantaa

As an experienced Endo-ART specialist, to date has done more than 10000 cases of advanced Gynaecologic endoscopic surgery & Assisted Reproduction. She is the recipient of many prestigious awards for her achievements in the field of Gynaec Endoscopy.Dr Sujata Kar Best Laparoscopic Surgeons in Bhubaneswar Odisha


Clomiphene citrate or letrozole as first-line ovulation induction drug in infertile PCOS women: A prospective randomized trial.



To compare Letrozole (5 mg) and clomiphene citrate (100 mg) as first line ovulation induction drug in infertile PCOS women.


Prospective Randomised trial.


A Tertiary level infertility centre.


103 infertile PCOS women.


Treatment naïve infertile PCOS women were randomised to treatment with 5 mg letrozole (51 patients) or 100 mg clomiphene citrate (52 patients) daily starting day 2 to day 6 of menstrual cycle. Timed intercourse or Intra Uterine Insemination (IUI) was advised 24 to 36 hours after Human Chorionic Gonadotropin (HCG) injection.


Ovulation rate, mono or multi follicular rate, days to ovulation, endometrial thickness, serum progesterone, serum estrogen, pregnancy rate, miscarriage rate.


The mean age, Body Mass Index (BMI), duration of infertility in both Clomiphene Citrate (CC) and Letrozole groups were similar.Ovulation rate was 73.08% in letrozole group and 60.78% in CC, which was not statistically significant (P=0.398). There was no statistically significant difference between Endometrial thickness (CC 7.61 ±1.96, Let 7.65 ± 2.10), Sr E2 on day of HCG (CC 178.3 ± 94.15, Let 162.09 ± 73.24), Days to ovulation (CC 14.2 ± 3.41; Let 13.13 ± 2.99) and Sr P4 on D21 (CC 10.58 ± 6.65; Let 11.86 ± 6.51). Monofolliculo genesis (CC 54.84, Let 79.49 %, P=0.027) and Pregnancy rate (CC 7.84%, Let 21.56% P=0.0125) were statistically significantly higher in letrozole group.


Our study shows that letrozole has excellent pregnancy rates compared to clomiphene citrate. Letrozole should be considered at par with clomiphene citrate as first line drug for ovulation induction in infertile PCOS women.


Clomiphene citrate; PCOS; letrozole; ovulation induction


Assisted reproduction in polycystic ovarian disease: A multicentric trial in India.



The aim of this study is to compare ovarian response, oocyte, embryo quality, ovarian hyperstimulation syndrome incidence, and pregnancy rates in polycystic ovary syndrome (PCOS) and non-PCOS group.


This was a prospective observational study on PCOS carried out in seven assisted reproduction centers in India between August 2008 and July 2010, as part of trial under the Indian Society of Assisted Reproduction. A total of 192 women (77 in the PCOS group and 115 in the non- PCOS group) undergoing in vitro fertilization/intracytoplasmic sperm injection were included. All women had long protocol and recombinant follicle-stimulating hormone stimulation.


The mean number of follicles and oocytes was higher in PCOS group compared with non-PCOS, being 27.2 (±8.8) and 13.6 (±5.3); 15.9 (±6.3) and 10.9 (±6.2), respectively. The recovery rates of oocytes and mature oocytes per follicle were less in the PCOS group which was 64% and 61.1%, respectively as opposed to 80.3% and 74.5%, respectively in non-PCOS group. The total numbers of top-quality embryos were less in the PCOS group.


In PCOS women though the number of follicles was more, recovery of mature oocytes, top-quality embryos was less. Pregnancy rates were comparable in both groups.


Fertilization response to ovulation induction; polycystic ovary syndrome