The hospital provides treatment to women of all ages.
--BY NEWBIZ TEAM
One morning, Susmita, a 24-year-old MBA student, woke up to find her bed sheet soaked in blood. Usually, her bleeding would stop once her menstruation cycle was over, but this time it continued. She experienced severe menstrual cramps in the days that followed and the bleeding persisted, prompting her to seek medical attention from Dr Chanda Karki at the Valley Hospital which was conveniently located close to her home. After a brief check-up, Dr. Karki and a team of gynaecologists at the hospital diagnosed Susmita with Abnormal Uterine Bleeding (AUB), a common gynaecological issue that affects Nepali women. She is currently undergoing medication and is gradually recovering.
According to Valley Hospital, women who experience monthly periods may anticipate some bleeding outside of their menstrual cycle and may be suffering from AUB.
AUB refers to any bleeding from the uterus that is not during a typical menstrual period. As many as 33% of women worldwide experience some form of abnormal uterine bleeding, which often signals an underlying condition, according to Dr Karki.
Common symptoms of AUB include heavy or prolonged menstrual bleeding, irregular menstrual cycles, bleeding between periods, bleeding after sex, bleeding after menopause, severe menstrual cramps, and anaemia.
According to Dr Karki, AUB-related disorders are on the rise among women globally, including in Nepal.
Dr Karki explains that the growing cases of AUB in Nepal is mainly due to an increased incidence of fibroids, adenomyosis, and obesity. She also notes that poor eating habits, a high-carbohydrate diet, decreased physical activity, and lack of exercise are the leading causes of AUB.
In addition to AUB, Nepali women commonly face gynaecological issues such as Polycystic Ovarian Syndrome, Endometrial Polyps, Adenomyosis, Fibroid Uterus, Ovulatory Dysfunction, and Malignancy. Dr. Chanda attributes genetic predisposition, obesity, low physical activity, and high consumption of junk food to these problems.
In Nepal, AUB is prevalent among perimenopausal women aged between 40-50 years, whereas Polycystic Ovarian Syndrome, another common gynaecological issue, is more common among young girls and women.
Dr Karki emphasises that gynaecological problems significantly impact the quality of life of women. AUB, for example, can result in anaemia requiring blood transfusion and even hysterectomy. Meanwhile, Polycystic Ovarian Syndrome is linked to menstrual irregularities, acne, hirsutism, subfertility, diabetes, and heart disease, according to Dr Karki.
Gynaecological diseases pose a significant health challenge in Nepal. According to the World Health Organization, cervical cancer is the fourth most common cancer in women worldwide and the leading cause of cancer-related deaths among women in Nepal. In 2018, there were approximately 570,000 new cases of cervical cancer worldwide, resulting in 311,000 deaths. In Nepal, there were an estimated 3,800 new cases of cervical cancer and 2,200 deaths from the disease.
Similarly, a 2018 study found that the prevalence of sexually transmitted infections (STIs) among female sex workers in Kathmandu was high, with over 60% of participants testing positive for at least one STI. This is also a common gynaecological issue among women.
Dr Karki explains that women in different age groups may be vulnerable to different gynaecological issues. Young women may be more susceptible to sexually transmitted infections (STIs) and cervical cancer, while older women may be more likely to develop uterine fibroids, ovarian cysts, and endometrial cancer. Women in their 20s and 30s are also at risk of developing uterine fibroids, polycystic ovary syndrome (PCOS), and endometriosis.
Despite the importance of reproductive health education, many girls and women in Nepal have limited access to information about reproductive health and hygiene. A 2017 study revealed that only 32% of adolescent girls in Nepal had received information about menstruation before their first period.
Gynaecological diseases can significantly impact the health and well-being of Nepali women, causing pain, discomfort, infertility, and complications during pregnancy and childbirth.
Unfortunately, stigma and discrimination still surround gynaecological diseases and women's reproductive health in Nepal. This can make it challenging for women to seek treatment and support, according to Dr. Karki.
Gynaecological diseases can also be expensive to diagnose and treat, creating a significant economic burden on women and their families.
Solving these issues requires a multi-faceted approach, including increasing access to healthcare, promoting awareness of gynaecological diseases and women's reproductive health, and reducing stigma and discrimination.
The Government of Nepal has implemented various health policies to address gynaecological problems and improve women's reproductive health. The National Women's Health Policy, developed in 2014, aims to address the health needs of women in Nepal, including gynaecological health. It aims to improve access to quality healthcare services, promote health education and awareness, and reduce maternal and neonatal mortality rates.
The Reproductive Health Rights and Services Policy, introduced in 2015, ensures that women have access to comprehensive reproductive healthcare services, including family planning, maternal and neonatal healthcare, and prevention and management of sexually transmitted infections.
In addition, the Safe Motherhood Programme was launched in 1997 to improve maternal and neonatal health in Nepal. In 2009, the government implemented a policy to provide free maternity services to all women to reduce maternal mortality and improve access to healthcare services.
To prevent cervical cancer in women, the government of Nepal launched a nationwide Human Papillomavirus (HPV) vaccination program in 2016. The program targets girls aged 9-13 years and aims to vaccinate 90% of the target population by 2020.
While these policies have made significant strides in improving women's reproductive health in Nepal, challenges remain, particularly in ensuring equitable access to healthcare services in remote and rural areas, and reducing the stigma and discrimination surrounding women's reproductive health.
Regular gynaecological check-ups and screening for common gynaecological issues are essential for women of all ages. Early detection and treatment of gynaecological problems can improve outcomes and reduce the risk of complications, according to Dr Karki.
For the treatment of Abnormal Uterine Bleeding, Dr Karki suggests medical management, hysteroscopic guided procedures, uterine artery embolization, dilatation and curettage, and hysterectomy as potential options.
Regarding Polycystic Ovarian Syndrome, she recommends diet modification (such as a low-carb diet and avoidance of junk food), physical activity, insulin sensitizers, and oral contraceptive pills (for hirsutism and menstrual irregularities).
Doctors report that health institutions in Nepal are generally well-equipped to treat women with gynaecological issues. However, Dr Karki notes that women in rural areas may still face barriers to accessing proper medical care.
It is essential for women of all ages to have access to quality reproductive healthcare services, including regular gynaecological check-ups and screening for common issues.
Valley Hospital, located in Putalisadak, Kathmandu, is a specialised gynaecological care facility with a team of medical experts, according to Prativa Malla, the hospital's marketing officer.
The hospital has a successful track record of curing patients with Endometrial Carcinoma and serous cystadenocarcinoma of the ovary.
“We offer a range of medical management services, including Dilatation and Curettage, Endometrial biopsy, Myomectomy, Hysterectomy, Ovarian Cystectomy/Oophorectomy, Laparoscopic & Chromotubation, and Hysterosalpingography, based on the nature of the patient's condition. Additionally, the hospital provides Intrauterine Insemination (IUI) treatment for infertility,” Malla added.
