INTERVIEW: Dr. Irena Andonova – gynecologist

 

Develop good hygiene habits and take impeccable care of your intimate area

 

What problems do you usually encounter in your gynecological practice?

– Annually about 300 million women in the world are diagnosed with some kind of urogenital infection. Usually it is a matter of an inflammation of the vagina with symptoms that are rapidly manifested after the infection and every woman recognizes them (as a change of the normal vaginal secretion). Most common infections include bacterial vaginosis, vaginal candidiasis or trichomoniasis. However, in addition to these, there are also infections of the genital organs that are often not accompanied by symptoms, such as chlamydia infection, which is sometimes diagnosed for the first time once the problems are already present. If the infection is not treated, it can lead to complications such as: infertility, inflammation of the pelvic organs, pregnancy problems (such as premature birth, spontaneous abortion), etc.

Is there a natural barrier that increases the resistance to genital infections?

– The development of medicine and new techniques for mapping the genes of the human organism have come to the realization that out of 100 trillion cells present in and on the human body, only about 1/10 of them are actually human The remaining 90% of them belong to microorganisms – bacteria, viruses and other microbes. To maintain our overall health, we need a delicate balance of microbes that live in and on our bodies. This also applies to the balance between microorganisms and the maintenance of good health of the genital organs. The main cause for the emergence of some vaginal infections is the disbalance of microorganisms in the vagina. The balance is disturbed due to a reduction in the number of good bacterial species or due to excessive growth and proliferation of “bad” bacteria or fungi. These are two processes that occur simultaneously.

What is a normal vaginal flora and how does it work?

– A healthy vagina is populated by a large amount of “good”, useful bacteria, lactobacilli. These bacteria are considered a sort of guardians of vaginal health – they can inhibit the growth of potentially harmful bacteria/fungi through the production of lactic acid and hydrogen peroxide, preventing colonization of the vagina with “bad bacteria”. Lactic acid helps to maintain the acidic environment, the pH of the vagina, which in turn allows the growth and development of good bacteria for the vaginal health, while hydrogen peroxide helps to eliminate “bad” Lactobacilli also form a protective biofilm of the vaginal mucosa, which does not allow harmful microorganisms to stick to it.

When is the normal vaginal flora disturbed?

– Between “good and bad” bacteria there is a constant competition in maintaining a delicate balance. There are many factors that can disrupt it, some of which include: poor hygienic habits, wearing synthetic and tight underwear, swimming in a swimming-pool, antibiotic therapy, heavy menstrual bleeding, diabetes, reduced immunity, stress, inappropriate hygiene, irritants present in cosmetic products, hormonal changes, pregnancy, etc. If the vaginal flora is compromised, the protective role of lactobacilli is reduced. Due to the reduced number of lactobacilli, less lactic acid is produced and the protective vaginal pH is changed, which allows the “bad bacteria” to multiply and lead to bacterial imbalance. When harmful microorganisms multiply above a certain concentration, symptoms that are characteristic of vaginal infections begin to occur. In case the following symptoms emerge, typical of vaginal infections, such as: increased vaginal secretion, changed color or unpleasant odor, burning sensation, redness and itching of the external genitalia, frequent urination, painful and unpleasant sexual intercourse, it is necessary to consult a gynecologist.

What are the most common vaginal infections that you usually encounter in your practice?

– Every woman at least once in her life has experienced a vaginal infection of a different type. The most common infection is bacterial vaginosis, 50% of women in the world have had this type of infection, and it is a disorder of the vaginal flora with the predominance of anaerobic bacteria, primarily Gardnerella vaginalis. The presence of this infection increases the risk of pelvic inflammatory disease, especially after curettage, hysteroscopy, and during pregnancy it increases the risk of premature birth. One of the symptoms may be a grayish secretion with a specific smell of rotten fish, while usually there are no other symptoms such as itching and a burning sensation. An exception to this are cases of mixed infection, where fungi proliferate along with Gardnerella, mainly Candida albicans, which easily proliferate in conditions of reduced acidity and pH of the vagina, higher than 4.5. The second most common infection is a fungal infection, which occurs in cases of reduced immunity, after the use of antibiotics or oral contraceptives, due to increased intake of sugars, diabetes, pregnancy. The first symptoms are observable with the increase in the number of fungi: curd-like secretion whose smell is similar to the smell of yeast, as well as itching and redness.

How do infections affect pregnancy?

– During pregnancy, the amount and variety of vaginal lactobacilli often decreases, under the action of hormones, by putting pregnant women at greater risk of infection.

Infections in pregnancy can go unnoticed, while damaging both the fetus and the health of the mother. If some of the infections in pregnancy are not detected, they may lead to miscarriage, premature rupture of the membranes, discharge of the amniotic fluid and premature delivery, infections and sepsis of the fetus. Some of them can harm the organogenesis, acting on the development of the fetal organs, leading to congenital anomalies. The number of infections during pregnancy that can harm both the fetus and the mother is really high, and therefore regular gynecological examinations before and during pregnancy are necessary to reduce their occurrence and to timely prevent problems that may affect the health of the mother and the fetus.

How are these infections being treated?

– The treatment of these conditions involves the administration of antibiotics and/or antifungals, which are very efficient. However, specifically due to the disturbed vaginal microflora, the disease very often returns. In the first three months after the treatment, bacterial vaginosis is repeated in 15-30% of cases, and after a longer period, almost 50% of women will have the same symptoms as before the treatment. While in case of vaginal candidiasis, the inflammation in 20% of the patients repeats, four to six weeks upon completion of the therapy. For this reason, after the treatment of the acute infection, it is important to normalize the vaginal flora. Today, for this purpose we have products that contain lactic acid or probiotics (bacteria useful for our organism). The balance of the vaginal flora can be restored by using the product Vagisan, vaginal tablets with lactic acid, necessary for maintaining the normal vaginal flora and rapid establishing of the vaginal acidity. Vaginal tablets with lactic acid can be administered after antibiotic therapy, or preventively in order to prevent the occurrence of a vaginal infection.

What is your advice on maintaining good vaginal health?

– A balanced vaginal flora helps to prevent bacterial and fungal infections and is crucial for good vaginal health. In order to reduce the risk of imbalance in the vaginal flora, develop good hygiene habits and follow the general recommendations on how to take care of your intimate area. You can also use a product that contains ingredients that support the growth of good bacteria to prevent possible infections and promote recovery if the symptoms are already developed.

A DIFFERENT MONTH FOR THOSE IN LOVE – A MONTH DEDICATED TO THE HEALTH OF THE HEART

Traditionally every year in the past decade, the hospital’s team has been making sure to mark the month of February as a month dedicated to the health of the heart. This year’s celebration included numerous activities. A group of parents of children with cerebral palsy had the opportunity to participate in an experiential workshop led by Frosina Ristovska – psychologist and psychotherapist, titled “Take care of your heart, don’t let it fall apart” by means of which the parents had the opportunity to dedicate some time to themselves and to self-reflection. For the youngest patients who have undergone an intervention or a heart surgery, a creative workshop and a tour through the Museum of Illusions were organized, titled “We are all the same in the game #for good health’s sake, run, jump, and shake”. It was impressive to see the laughter and joy of all present and see how friendships that are created in different conditions last for a long time. This month we were also active on Facebook live and we were guests in TV shows, and through these activities we tried to convey the message about the importance of active and healthy lifestyles that help us preserve our health. Until the next activity which we believe will happen soon, don’t forget to be active, choose healthy food, control the level of blood fat, control blood pressure, reduce sugar intake, stop smoking, and most importantly do not forget to laugh and enjoy the nature of the people who care about you.

Folic acid

Folic acid or vitamin B9 is a necessary supplement in the diet of pregnant women, however not only for pregnant women, this vitamin is indispensable to every individual, for normal health and life.

Folic acid is essential for the human body, having a role in many metabolic processes. The organism can not produce it itself, and it can not be stored in the organism for a long time, so it is necessary to take the required amount through the diet, and in case of an increased need of folic acid, it should be taken through supplements. Folate is the form of the B9 vitamin contained in food, and folic acid is a form of B9 vitamin in vitamin supplements.

Folic acid is significant for many important processes in our organism, especially in the division, differentiation and growth of the embryo and the fetus. It is important for the synthesis of DNA and the functioning of the cells in the body. It participates in the metabolism of nerve cells, and together with vitamin B12 it is necessary for the creation of red blood cells or the creation of DNA. It also has a significant role in the conversion of amino acids that our body needs, thereby reducing the level of homocysteine ​​in blood. An elevated level of homocysteine ​​leads to occlusion of blood vessels acting thrombogenically. The consumption of folic acid gives energy to the organism.

Folic acid is one of the essential vitamins that is recommended if a woman is pregnant or planning to get pregnant

Folic acid has the highest value in pregnant women, for normal growth and development of the fetus: in the period before pregnancy, during pregnancy and during breastfeeding. Folic acid acts on the development of the fetal system of the fetus, preventing 50 to 70% of the occurrence of neural tube defects in the fetus. Neural tube defects are serious congenital anomalies of the spinal cord (such as spina bifida) or anomalies of the head and the central nervous system, such as anencephaly in the fetus.

However, although these reasons are significant, they are not the only ones for folic acid intake before and during pregnancy. There are studies that show that it can reduce the risk of other congenital defects in newborns. In addition, a particular group of pregnant women who have an inborn deficiency of MTHFR (methylenetetrahydrofolate) reductase, an enzyme whose deficiency significantly impairs the conversion of folates to folic acid, in consultation with a gynecologist, should make sure that they receive a sufficient dose and an appropriate form of this vitamin through supplements.

Previous pregnancy with a neural tube defect, or a known history of such a defect in one of the partners, is of particular importance, where the supplementation should be initiated with appropriate doses of folic acid several months before the planned pregnancy.

In the human diet, folic acid is mostly contained in fruits and vegetables

It is present in all dark green leafy vegetables (spinach, beta, cabbage leaves …), asparagus, beans, beets, broccoli, kale, cauliflower, corn, peas, green beans … Fruits rich in folic acid include: avocado, orange, lemon, banana, melon, grapefruit … In addition to fruits and vegetables, folic acid is also found in brewer’s yeast, eggs and liver.

When is it necessary to add a folic acid supplement in your diet?

Folic acid supplements are usually recommended to women who intend to conceive (several months before pregnancy), to women during pregnancy and nursing. Of course, a doctor should be consulted before use.

A large number of associations of gynecologists and perinatologists recommend that women in the reproductive age receive 400 mcg of folic acid daily, because the neural tube closes by the 28th day of pregnancy, when maybe the pregnant woman does not know she is pregnant yet. It is therefore important that women who are planning to get pregnant start to take folic acid three months before and at least during the first 12 weeks of gestation.

However, folic acid intake is not necessary only for pregnant women. Its intake through supplements is beneficial for the body in case of other health problems as well such as: anemia, heart and blood vessel diseases, increased pressure, depression, prevention of colon cancer, infertility, neuroses, insomnia, immunodeficiency, metabolism problems, infections, poor memory, stress, and chronic fatigue.

Folic acid deficiency is usually experienced by people who have problems with the digestive system, kidneys, liver or who consume alcohol. Symptoms that may suggest folic acid deficiency include: anemia, depression, insomnia, irritability, loss of concentration, loss of appetite, muscular weakness.

In fact, the use of folic acid supplements is beneficial to many processes in the organism, keeping us healthy, protecting our offspring during pregnancy and helping us create healthy generations.

Dr. Irena Andonova

Specialist in Gynecology – Obstetrician

Zan Mitrev Clinic