Dear Doctor: I am 26 years old, but I have failed to conceive again yet I have never used any contraceptives. In 2008, I conceived and carried the pregnancy up to eight months and two weeks, when I got an abruptio placenta. I was operated but lost the baby. From that time, I only managed to conceive again in 2010 but miscarried at three months. I consulted a gynaecologist who carried out various tests and said everything was fine. Last year, I conceived again but got another miscarriage. What could be causing these many miscarriages?
Dear Irene: Medically, an abortion is when a woman loses her pregnancy before it is 28 weeks old. This may be induced or spontaneous. At eight months and two weeks, what you experienced is called premature delivery.
A woman’s pregnancy may be going well, only for the placenta to prematurely separate from the womb, denying the unborn baby oxygen and food and protection, thus, putting its life in danger.
That is most likely why your baby died. The mother’s life is also in danger from mainly the likelihood of bleeding.
The cause of abruptio placentae is unknown, although mothers with high blood pressure during pregnancy, alcoholics and smokers may be at great risk of developing the condition.
It is unlikely that your first pregnancy loses were an accident.
A person having three or more consecutive early pregnancy losses is said to have had habitual abortions and the time of loss may provide a clue about the cause though such losses may still be varied.
Unfortunately, in many cases, the cause may never be found, even with the best tests, making early pregnancy loss a frustrating experience for both patient and doctor. Also, this is a common occurrence in as many as 75 per cent of all women trying to conceive. Most of these losses are unrecognised, only being considered delayed periods.
Lifestyle practices of alcohol, drugs or drug abuse, smoking, worrying too much, sedentary lifestyle and eating fatty foods among others have to be avoided to improve pregnancy outcomes.
The good news is that you are seeing a gynaecologist and for the best follow up, you need not change him or her but rather consult often even when not pregnant.
Also, at 26, you could be at the peak of fertility and it is likely you will get pregnant and carry your pregnancies to good outcomes sooner than later.
Male factors may also be responsible for recurrent spontaneous miscarriages and for this and better psychological support, you require visiting your gynaecologist with your partner, so that if required, tests may also be carried out on him.
Dear Doctor: I had two safe abortions last year but after the last one, I have failed to get my menstrual periods for over six months now. I am scared, please help.
Dear Peruth: Blood flow during periods depends on the normal growth of the internal uterine lining. If too much was removed during an abortion, cobweb-like fibres called adhesions may form destroying the womb cavity, leading to failure to have periods.
Anxiety and stress can affect the brain that stimulates the ovaries to produce sex hormones that lead to growth and shedding the membrane for menstruation, resulting in scanty or no menses.
One issue usually not addressed before an abortion is the psychological factor leading to stress and anxiety that comes with the act. When one aborts a pregnancy that is less than three months, she can get pregnant again within two weeks even before she gets her period. There are many other causes of missing periods that require a doctor to investigate and address before they return.
Dear Doctor: I am married woman, however, I also have a boyfriend I trust. The problem is that this boyfriend wants to engage in sexual intercourse even when I am in my periods. I also have high libido when I am in my periods. Is it safe for me to engage in sex during this period?
Dear Brenda: Many men and women worry that having sexual intercourse during a woman’s period is unhealthy. Though demonised by many cultures and faiths, sex during menstruation is entirely normal and completely healthy. Worries about this act generally stem from societal misconceptions about menstrual blood.
Most girls are taught from a young age that their menstrual blood is unclean and dirty, and therefore should be hidden and contained at all times. However, menstrual blood is an entirely natural bodily fluid, and does not in any way affect manhood or a woman’s reproductive tract.
Sex during periods actually may reduce cramps and bleeding through contraction of the womb.
Cramping is due to prostaglandins produced by the inner womb membrane and contractions due to sex used up by the prostaglandins, reducing cramping further.
A woman is also least likely to get pregnant then because the implantation membrane is being shed and usually the ovulation has not occurred yet. However, it is always better to have protected sex since blood can be messy and still contains germs like HIV carried in blood in case one is infected.
Libido is dependent on the male sexual hormone and reduced by female ones. A woman, just like a man, has male and female hormones but with considerably more female hormones.
During periods, the female sex hormones are at their lowest making the male hormones relatively higher and many women horny.
The horny women, however, may not engage in sex because of society beliefs about periods they consider dirty.