Women’s Health

Dear bluecotton, 
It sounds like your mum has recurrent episodes of angioedema which could be an allergic reaction to various triggers (e.g. food, medications, insect bites or stings) especially if associated with an itchy rash like hives. One particular type of medication that can cause this is an ACE inhibitor (e.g. lisinopril,  enalapril) which is a drug used for high blood pressure and also heart conditions. It is important to make sure the episodes of lip swelling are not associated with difficulty breathing or wheezing that may suggest a serious reaction that needs immediate medical attention. It doesn't seem like the leg cramp is related though. You can consult your family physician or an allergist. 
Take care

Vaccinations during pregnancy should only be considered when the need for it exceeds the risk to the pregnancy. The usual vaccines that are recommended for all pregnancies (unless special circumstances dictates otherwise) include vaccines against Influenza and Pertussis (Whooping Cough). In addition, as we battle the COVID pandemic, the COVID vaccine is also recommended for pregnant women, albeit with limited long-term safety data.

Currently there is no evidence to suggest that vaccines (COVID or others) can impair fertility, although certain live vaccines should be avoided during pregnancy or you should avoid conceiving within 4-6 weeks of exposure to certain live vaccines (e.g. MMR).

Factors contributing to infertility may lie in either or both partners; the most common conditions encountered in infertile couples include advanced age, low egg count, low sperm count, failure to ovulate and endometriosis. Hence, it is likely that there are more medical factors in the female that can result in infertility, although not exclusively. "Enhancement" of fertility has to be individualised accordingly to the profile of each couple, depending on the unique fertility problems they face.

A thorough interview of both partners, a detailed pelvic assessment of the female and a basic semen analysis will enable a fertility specialist to establish the diagnosis of the causes for infertility in most cases. Sometimes, additional blood tests or scans may be required to aid in the diagnostic process, for the more challenging cases. In Singapore, the reference ranges used for semen analysis are that of WHO.

The Combine Oral Contraceptive (COC) pills are  supposed to be effective in preventing pregnancy when used properly and fertility should return quickly after cessation of use. However, we do see some women experiencing a delay in return of fertility after using COCs. It is likely that the COCs might have been masking the symptoms of underlying conditions that impair fertility, rather than the COCs causing the impairment of fertility directly. Conditions such as endometriosis and PCOS are easily concealed by COCs as menstrual cycles tend to be regular and less painful, therefore the unsuspecting women do not notice their presence, until they stop using COCs. 

Yes, the age of a woman will have significant impact on her fertility. This starts to be more evident after the age of 37-38 years, in general.

As the age of our first-time mothers increase, we see an increase in prevalence of infertility in our population. Biologically speaking, the reproductive window of a female is a lot smaller than that of a male, often dipping into the worrying (sub-fertile) range after the age of 37-38 years old in general. Of course, this can vary very widely between different women. There are many reasons for infertility itself and hence the treatment, each targeting different conditions, will be varied. It is important to accurately diagnose the medical conditions present and tackle each one accordingly. For that, you will need the help of a fertility specialist.

The "blind" screening for fertility for mass population usually will include basic hormonal assessment, semen analysis, tubal patency test, egg reserve and ovulation status, ultrasound of the pelvic organs, etc. However, I prefer to tailor the tests to suit the individual woman / couple based on the findings of the pelvic examination; this will avoid unnecessary tests and target the most likely problematic area(s) of that particular couple. Every woman / couple is different. Of course, the eventual treatment will depend on what conditions get picked up on this screening exercise and the expertise of the specialist to deal with them.

There should be no problem with getting the Covid vaccine after an abortion but if you feel too weak you may want to wait until you feel better, and it is probably appropriate to consult the gynaecologist that performed your procedure as there may be circumstances that are unique to you.

Dear Serene, 
Yes you can. There is no drug interaction between Fluimucil (or acetylcysteine) and prednisolone.
Take care
mh 

Hi Ann! Yes, vaginal rugae (or otherwise known as rugosity) is normal for young women. This physical state of the vagina coincides with the reproductive years of the woman (hence not present before puberty and is lost / reduced after menopause). There is nothing to worry about if you feel these "ridges" along the inside of the vagina. However, if you do encounter any form of discomfort, discharge, bad odour or any significant changes after exposure to new lubricants, you might wish to get it looked at by a gynaecologist. 

Hi. I am afraid you have to get a pregnancy test done at some point, the earlier the better. The morning-after pill (Plan B) is known to cause irregular bleeding after taking it; failure of the pill to work is possible, especially if not taken in a timely manner. If your pregnancy test is negative, you can safely do nothing and wait for your proper period to start. If you are indeed pregnancy, then help is easily available to get your though this rough patch. Many clinics in Singapore, including mine, are able to provide the necessary counselling and support for unplanned pregnancies. Your first step is to determine if you are indeed pregnant. So please do get a simple urine test done, either at home, or in the clinic. Everything else will fall into place thereafter.