wWHO Class III anovulation.

Tip 3: Never confuse between bioactivity of diff PRL molecules (monomer):-This rise may be due to innocuous immune reactive   so called big-prolactin -prolactin that are detected by the standard prolactin assays and give an incorrect impression of a problem. It is the very small molecules which are bioactive but what about PCO cases with excess PRL?? When Hyperprolactinaemia is associated with PCOS, the syndrome is characterized by adequate oestrogenisation, polycystic ovaries  on ultrasound scan and a withdrawal bleed after a Preogestogens challenge; the 'mineral density is usually normal.

Galactorrhoea may be found in up to one- third of hyperprolactinemic patients, although its appearance is not correlated with prolactin levels or with the presence of a tumour, approximately 5% present with visual field defects.

A prolactin-secreting microadenoma is usually associated with a moderately elevated prolactin (1500-4000 mud/L) and is unlikely to result in abnormalities on a lateral skull X-ray. Conversely, a microadenoma in concentrations of 4000 mud/L or more, and the figures may rise to 50,000 mud/L. Other causes of mild Hyperprolactinaemia include hypothyroidism, PCOS (occurs in 15% of cases up to 2500 mud/L) and

No ovulation as a result no pregnancy:-What is WHO Class II anovulation?? Anovulatory Infertility: Not all causes of an ovulation can be ascertained even in the best lab of world:-Anovulatory Infertility: Of many causes of anovulatory subfertility, in most cases a cause can be ascertained and reproducible by Lab tests., But a fair no of cases of anovulatory the cause of anovulation remains  uncertain and . but others can’t be documented, In such cases  where no cause  can be ascertained we quite often empirically prescribe ovulation inducting agents likes or Letrozole with the expectations these may be induce ovulation irrespective of the cause, But today my topic is the issue of Hyperprolactinaemia may be a cause of Anovulation(WHO Class III)  Ovulation Induction.WHO III anovulation:-Diag & management Causes of Hyperprolactinaemia: Pharmacological Hyperprolactinaemia:--The commonest cause is now a days is:-several drugs (e.g. the dopaminergic antagonists phenol-
Thiazines, selective serotonin reuptake inhibitors (SSRIs), domperidone and metoclopramide). In fact, the SSRIs are now the most common cause of drug-induced Hyperprolactinaemia 
Tips 1:--Not to prescribe Bromocriptine or say Cabergolin if a) PRL is < 50 b) No LPD c) no an ovulation d) no early preg loss and e) no demonstrable Galactorrhoea in absence of pharmacological Hyperprolactinaemia, Ladies and gentleman Hyperprolactinaemia may cause 1) LPD 2) poor Ovum quality too poor to get fertilize or failure to grow after fertilization &cleavage. Failure to fertilize or early preg loss 3) Anembryonic preg or Blighted ovum 6) anovulation; 
Tips 2:-: If the prolactin concentration is slightly raised and she is having regular cycle then no need to prescribe Bromocriptine or cabergolin so long as ovulation is there or there no Lab evidence of LPD (low P value in serum on day 23 of regular cycle) of regular menstruation, there is no evidence that treatment is warranted so long as value is below< 50 IU of PRL,

Teenage marriage in India-A ray of hope

Teenage pregnancy in India:

Nutrition in adolescent girls in South Asia

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1309 (Published 11 April 2017)Cite this as: BMJ 2017;357:j1309

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Teenage pregnancy in India:

Over past decade, India has successfully reduced the proportion of pregnancy between 15-19 years to half (16% during NFHS 3 in 2005-06 and 7.9% during NFHS 4 in 2015-16).

1 Still, the estimation by UNFPA runs to 11.8 million teenage pregnancy for the country.

2 An early marriage inevitably put the adolescent girls at the risk of being pregnant with low contraceptive awareness. High fertility and discontinued education after marriage remain the other facets of concern but the greatest threat of teenage pregnancy is higher rate of pregnancy-related complications, leading to high mortality.
Through mass awareness and legislation, India tries to mitigate the burden of early marriage. In addition, adolescent girls are being introduced to basic knowledge of menstrual health as a sincere effort to come out of social taboos. Even then, their families are not in favour of practicing what the girls were taught, suggesting that mere training/ knowledge cannot bring about changes in social perception in the country

.3 With the introduction of peer educators, India is expecting to bridge this gap and addressing a sensitive social and medical issue like teenage pregnancy.

References
1. International Institute for Population Sciences (IIPS) and Macro International. National Family Health Survey 4, 2015-16: India Fact sheet. Mumbai; 2017.
2. Inter-Parliamentary Union and World Health Organization. Child, early and forced marriage legislation in 37 Asia-Pacific countries. World Health Organization. Geneva. 2016.
3. Visaria L, Mishra RN. Health Training Programme for Adolescent Girls: Some Lessons from India’s NGO Initiative. J Health Manag 2017;19(1):97-108.

Why India Has 16 Million Teenage Pregnancies

•  11 percent of the world’s teenage pregnancies happen in India.

This translates to 16 million women between the ages of 15-19 who become mothers each year.

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Shocked?

In fact, India has one of the highest rates of early marriage in the world. The recent National Family Health Survey (NFHS) estimates that 27 percent of girls in India are married before their 18th birthday, that’s a third of all our young women.

Therefore, it is not surprising that we have one of the world’s highest numbers of teenage mothers, given that in India, pregnancies occur in the context of marriage.

The Reason Why So Many Minors Get Pregnant in India

Dr Niranjan Saggurti, from the Population Council India, who pioneered research on young people’s health and development, including sexual and reproductive health, says that the need for contraception among adolescents is almost twice the need in case of adult women.

 (Photo: iStockphoto)

Law enforcement hesitates to get involved, even though it is illegal for under 18 girls to marry. Largely because early marriage is sanctioned by culture and social norm. The worst affected state is Bihar where 70 percent of women in their early twenties are reportedly married by the age of 18.

When girls start their periods, their potential to be married and bear children takes primacy. They are married off early as families worry that they could engage in romantic relationships, bringing “dishonour”.

Financial considerations also play a role in early marriage. Dowry demands and “suitability issues” increase with age. In addition, when a family has more than one daughter, they find it economical to get both the younger and the older one married at the same time to reduce cost of multiple weddings.

In Indian culture, adolescents have little access to correct and comprehensive information on family planning and access to contraceptives, whether married or not. Wives too have little say in the number, timing and spacing of children. All these factors, taken together increase the likelihood of teen pregnancies.

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The reality is that early marriage and consequently pregnancy is most often not the result of a deliberate choice, but the absence of choices, and of circumstances beyond a girl’s control. It is a consequence of little or no access to school, employment, reliable information about healthcare, and poor utilisation of health services and patriarchy.

Professor Sunil Khanna, Oregon State University, who has worked extensively on adolescent health in India, emphasises that childhood and youth – two of the most formative stage of life – must never be disrupted by parenthood.

The Impact of Early Pregnancies

Maternal malnutrition has a direct impact on the child, as it causes inter-generational malnutrition, especially irreversible stunting. That has a severe impact on the health and productivity of a nation.

Piyasree Mukherjee, from Foundation for Mother and Child Health, meets mothers as young as 18 already on their second pregnancy, weighing as low as 40 kilos, almost every other day.

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The greatest threat of teenage pregnancy is higher rate of pregnancy-related complications like anaemia , hypertension, hemorrhage and unsafe abortions. In addition, malnutrition, sexually transmitted infections (STI) , cervical cancers and the psychological issues are highly prevalent. This makes adolescent pregnancies one of the most serious health and psychological threats to young women in India.

Dr Hema Divakar, Former President of Federation of Obstetric and Gynaecological Societies of India (FOGSI), stresses that adolescents pregnancies are one of the leading causes of the high burden of mother and neonatal deaths in India.

Multi-pronged approaches like comprehensive sexual education, change in social norms by involving village and community and religious leaders, through life skills education of both girls and boys, access to contraception, setting up of confidential and adolescent friendly clinics are helpful.

There are many ongoing efforts to tackle this issue, especially through path-breaking research, leading to adolescent friendly programs by various stakeholders.

Dr Atul Mittal, part of the Maternal and Child Survival Program (MCSP), says that it is essential to ensure youth-friendly sexual and reproductive health services with confidentiality and privacy as non-negotiables.

Children as mothers, do not just have consequences for the mothers and the newborns, but have a huge ranging implication for our society and our economy.

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And though over past decade, India has successfully reduced the proportion of pregnancy between 15-19 years to half (16 percent during NFHS 3 in 2005-06 and 7.9 percent during NFHS 4 in 2015-16), we have miles to go before we sleep.

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Prevalence of adolescent Pregnacy in India and How best to prevent such unwanted pregnancy Which contractive is safe for teenages?.

• Contraceptive choice for teenagers
  Old generation POP is best in special situations as it does not cause break though bleeding i.e. bleeding at middle part of the cycle. This oral contraceptive is the best suited for teenagers as it does not cause nausea, vomiting, giddiness and what is most importantly no intermenstraul bleeding or spotting,. We call it BTB (break through bleeding). drug is to be taken daily. In India this is available as the brand name of Minikare (Lynesr...
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  ps to prevent such a tragedy:- You must , by profession spread the contraceptive knowledge to community at large where you reside at please do spend at least in village / Block Office/ Anchal Office/ College 12+# class male & female students,. t one ady per 3 months (total 4 days in a yr) to spread the knowledge pf Contraception. Pl do encourage our country men to to educate & counsel about use of effective contraceptives.. It is a patriotic .duty as a doctor &as a human.
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   Contraceptive choice for teenagers
  Old generation POP is best in special situations as it does not cause break though bleeding i.e. bleeding at middle part of the cycle. This oral contraceptive is the best suited for teenagers as it does not cause nausea, vomiting, giddiness and what is most importantly no intermenstraul bleeding or spotting,. We call it BTB (break through bleeding). drug is to be taken daily. In India this is available as the brand name of Minikare (Lynesrol-500 mg): cot about Rs. 210/- for 28 tabs to be taken daily without any gap. Following are the indications where we tithe contraceptive prescribers hesitate to advocate COC but may be prescribed POP in some special situations:
  A) Prevention & complications of teenage Pregancy-Prime indications in adolescents”:-Role of POP in Adolescent girls:
  Contraceptive choice for teenagers. It may be a lesser evil to provide the adolescents with the knowledge and technology of contraception along with teaching them the ethical, religious and moral values than leaving them to the risk of sexually transmitted diseases and unwanted pregnancies and running their life. Sociomedically this is a difficult issue as maters are seldom distressed in this age group particularly if she is unmarried but sexually achieve. HCP should remember that the ovulation rate is high in this age group and the frequency of intercourse is also frequent especially f she is married. As such fecundity (pregnancy rate) is also high amongst then. So thus a reliable i.e. a near 100% effective contraceptive has to be suggested.
  
  Teenage pregnancy is not rare:
  One night think that in India teenage pregnancy must be a rare event today because we know that Indian load prohibits teenage marriage. It permanents marriage only when the age of girl is 18 years or beyond. But author continuous to se thousands of teenage pregnancy even in 2009. The complication of pregnancy and puerperium are profound in this tender age. Septic abortion is by far too common in this age group particularly in rural setting. Young mothers lack in breast feeding smiles. What then is the exact scenario? What the statistician report on teenage marriage and pregnancy? Do they affirm author’s observations?
  
  Age at first marriage in India:
  Marriage occurs relatively early in India. More than one quarter (27 percent) of Indian women age 20-49 married before age 15; over half (58 percent) married before the legal minimum marriage age of 18, and three quarters (74 percent) married before reaching age 20. But there has been a steady rise in age at first marriage, which is reflected in the gradual decline in the proportion of women married by ages 15, 18 and 20 years. The median age at first marriage among women age 20-49 is 17.2 and the median age at the over 13 million women are married below the legal age of 18 years. BMRU (Bihar, MP, Rajasthan and UP) contribute 75 percent of total married women in the age group 15-19 who have begun childbearing is highest in Jharkhand (28 percent), West Bengal (25 percent), and Bihar (25 percent), all in the East Region. First cohabitation is 17.7 years. Wealth has a positive association with the median age at first mirage. Women age 25-49 in the highest wealth quintile marry over four years later than women in the lowest wealth quintile. There is a steady increase in age at marriage with increasing education, resulting in a seven year difference in the median age at marriage between women age 25-49 with no education and women with at least 12 years of education. Urban women marry more than two years later than rural women on average (Source: NFHS-3).
  
  Age at first pregnancy:
  World wide 15 million (1/5) of all births are in the teenage group. Teenage abortion number approximates 4.4 million in developing countries. Most of them are clandestine abortions. The marriage of girls at young ages in India leads to teenage pregnancy and motherhood. Overall, 12 percent of women age 15-19 have become mothers and 4 percent of women age 15-19 are currently pregnant with their rest child. This means that one in six women age 15-19 have begun childbearing. The percentage of women who have begun child bearing increases sharply with age, from 3 percent at age 15 to 36 percent at age 19. (Source: NFHS-3).
  
  Teenage Abortion:
  In India, the incidence of induced abortion in women less than 15 years in 1990-91 was 0.5 percent and between 15 and 19 it was 6.6 percent (Dept. of family welfare, Ministry of Health and Family Welfare). Ministry of Health figures from Maharashtra in 1997 show that girls younger than 15 accounted for 21.7 percent of all abortions.

Social, Community and Attitudinal factors in Malnutrition of people of any Country ...