Most recent international health newscast in addition to examination from our health explore band.

Anything done to block both fallopian tubes will result in female sterilisation because sperm cannot get through to fertilise the egg. The procedure is usually called tubal ligation, though in most modem methods the tube is not blocked by cutting and tying. These days tubal ligation is a simple procedure that (depending on the method used) may be done in a day surgery with a short stay in hospital. In Australia general anaesthetic is still preferred, though in many countries local anaesthetic is used most often.

Laparoscopic sterilisation is the most popular method in Australia at present. The laparoscope is put into the abdominal cavity through a small incision near the navel and positioned so that the uterus and tubes are clearly seen. Instruments may then be passed through the laparoscope to block each tube by putting on clips or rings or by burning it with diathermy or laser. Some surgeons insert the laparoscope through the vaginal vault.

Mini-lap (short for mini-laparotomy) is another, newer method of tubal sterilisation. A small (2-4 cm long) incision is made just below the pubic hairline. Each tube is brought to the outside and blocked by cutting and tying or putting on clips or rings. Tubal ligation may be appropriate when the abdomen has been opened tor other reasons, as long as there’s been adequate counselling.

What happens to the ova after sterilisation?

The same as happens in an unsterilised woman if her ovum isn’t fertilised within 12 hours of release: it dies, disintegrates and disappears.

Does tubal sterilisation ever fail?

These days the failure rate is around two per thousand. Rarely, a woman will be in the earliest stage of pregnancy at the time of the procedure.

Side-effects and complications

There are no side-effects. The ovaries are not touched by the procedure and continue to produce hormones, so that the ovarian and menstrual cycles continue as before and libido should be unchanged. Tubal sterilisation is not castration, as some women have believed in the past.

It has been claimed that sterilised women are more likely to have menstrual problems (heavier bleeding, irregular periods, dysmenorrhoea) but studies have shown that this is uncommon. However, two years after tubal ligation, women have a slightly higher risk of heavier bleeding and other menstrual problems than those whose husbands have had a vasectomy. Some circumstances may make it seem that periods are heavier after sterilisation. For example, if you come off the Pill when you’re sterilised, your menstrual flow will return to the amount you had prior to taking the Pill. Also, as women get older various hormonal and other changes may increase menstrual problems.

Procedural complications include those of any abdominal surgery such as wound infection, pelvic infection and bleeding. With modem techniques the risk is low. Very rarely there may be accidental damage to other internal organs and tissues during the procedure. If sterilisation fails, subsequent pregnancy is more likely to be ectopic.

There may be emotional complications associated with regrets about loss of fertility, leading to decreased libido. Let’s hope that proper counselling and consideration make these rare. Some women mention increased enjoyment of sex after sterilisation, which they say is because they’re no longer worried about pregnancy.

Hysterectomy for sterilisation

Women requesting sterilisation who have menstrual or other problems that suggest that hysterectomy might later be needed may be advised to have this operation instead of tubal ligation. It would be unwise and wasteful to have a tubal procedure if the need for hysterectomy seems certain.

In the past many women had hysterectomies on doubtful medical grounds. It seems that many of these were really for sterilisation in cases where the woman and/or her doctor couldn’t accept sterilisation. This seems to me to be dishonest, as well as putting the woman through a more costly operation with a much longer convalescence, as well as a higher complication rate. Fortunately this practice seems less common now.

Sterilisation after delivery or abortion

Though there are obvious exceptions, in general it is better to avoid tubal sterilisation immediately after childbirth or abortion. Women are more likely to request reversal if sterilisation is done at this time. Of course many women will make a well-considered decision during pregnancy, but it seems that the stress of delivery or deciding about abortion can influence a decision that is later regretted.

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Comments (0) Mar 11 2009

Advantages of injectable contraception

• It is highly reliable.

• It is very convenient for some, and is not related to intercourse.

• It is a reversible form of contraception (though usually with some delay).

• It reduces menstrual problems after an initial period where there may be irregular bleeding.

• To have no periods could be an advantage to women who have difficulty coping with menstrual hygiene (for example some physically and intellectually disabled women).

• It can be used by women who can’t tolerate or shouldn’t take oestrogens.

• It can be used during lactation. Some new progestogens that can’t be absorbed through the bowel are being developed for injection. Using these during breast-feeding would eliminate any possibility of long-term risks from tiny amounts of hormone being absorbed by the baby from breast milk. This type of progestogen can pass from the mother’s blood into the milk but can’t be absorbed by the infant.

Comments (0) Mar 11 2009

Menstruation is a visible sign of the ebb and flow of the hormones produced by the ovary. The first day of bleeding is a convenient marker to count as day one of the menstrual cycle, and it also coincides with the beginning of a new ovarian cycle.

During each cycle ovarian hormones prepare the reproductive tract for the possibility of fertilisation and pregnancy. Menstruation is evidence of these changes on the lining of the uterus – the endometrium.

The endometrium is a layer up to 6 mm thick. It is a very complex tissue, specialised for the implantation of the fertilised ovum and nurturing of the developing embryo and foetus. It consists of endometrial stromal cells and is richly supplied with small blood vessels. Its surface is covered by a single layer of columnar epithelial cells that dip into the stroma to form tiny glands.

At the end of a cycle without conception the surface two-thirds of the endometrium has died and is shed over the next several days as the menstrual flow. In the first two weeks of the next cycle, oestrogen produced by the next batch of ovarian follicles causes the endometrium to regrow from the remaining third. The stromal cells multiply, new blood vessels form, and the surface layer and its glands are restored. This is called the proliferative (growth) phase of the endometrium.

After ovulation, progesterone from the corpus luteum causes the glands to secrete substances that will nourish the embryo, especially glycogen. Progesterone also stimulates changes in the stromal cells in preparation for implantation of the embryo, and makes the endometrial blood vessels lengthen and coil and the muscle in their walls thicken. When the endometrium has been influenced by progesterone, it is described as being in the secretory phase. The hormonal changes in the endometrium are co-ordinated so that it will be in just the right state to receive and implant the fertilised egg when (and if) it arrives in the uterus six to seven days after ovulation.

Unless conception has occurred, the production of both oestrogen and progesterone in the ovary falls rapidly during the fourth week of the cycle. The fall in blood hormone levels signals to the endometrium that it is not needed for pregnancy, and triggers the changes that lead to menstruation. The muscle in the walls of the coiled blood vessels constricts so that the j blood supply to the surface two-thirds of the endometrium is pinched off. Without blood the tissue dies and is sloughed off. The dead tissue liquefies and drains from the uterus through the cervix and vagina.

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Comments (0) Mar 11 2009

It seems unnecessary to say that we all need regular exercise for good health. As well as keeping the muscles (including the heart) and other body tissues in good shape, exercise refreshes your spirits by relieving tension caused by stress.

Many teenagers are so busy with their studies that they give up sport to spend more time with their books. It becomes a bit of a vicious cycle: the less exercise you do, the less fit you are and the less you want to do.

If you don’t play sport regularly, try to have about 20 minutes exercise at least every second day. It doesn’t matter what you do – walking, swimming, cycling, skipping – anything that gets you moving is good for your health and you’ll feel more alert when you go back to your desk. Dancing makes a great break from studies. ‘Letting your hair down’ to half a dozen of your favorite rock songs is equal to a good 20-minute workout at the gym.

Comments (0) Mar 11 2009