CARING FOR WOMEN

EVERY STEP OF THEIR LIVES

CARING FOR WOMEN

EVERY STEP OF THEIR LIVES

CARING FOR WOMEN

EVERY STEP OF THEIR LIVES

CARING FOR WOMEN

EVERY STEP OF THEIR LIVES

CARING FOR WOMEN

EVERY STEP OF THEIR LIVES

CARING FOR WOMEN

EVERY STEP OF THEIR LIVES

WELCOME TO DR PAMELA TAN MEDICAL CLINIC

LEADING FEMALE OBSTETRICS AND GYNAECOLOGY SPECIALIST IN SINGAPORE

Obstetrics

View our list of obstetric services available during your pregnancy, birth and beyond. Find out more.

Gynaecology

Learn about our comprehensive gynecologic care including infertility, bleeding issues and abnormal pap smears, & more.

LIKE YOU, WE CARE

Dr Pamela Tan is an obstetrics and gynaecology specialist practising at Thomson Medical Center in Singapore. Prior to leaving for private practice, Dr Tan was a female Consultant in the Department of Obstetrics and Gynecology, KK Women’s & Children’s Hospital.

She obtained her undergraduate medical degree at the National University of Singapore and her post-graduate MRCOG in London at the Royal College of O&G. She is a specialist accredited with the Specialist Accreditation Board (Ministry of Health) and is a Fellow of the Academy of Medicine, Singapore (FAMS). She is an accredited member of the Society for Colposcopy and Cervical Pathology of Singapore (SCCPS) with a subspecialty interest in colposcopy (for pre-cancer of the cervix and vagina) and vulval disease.

In further pursuing this interest, she was a fellow for pre-invasive disease at the colposcopy and vulval unit at the Whittington Hospital in the United Kingdom. She is a visiting consultant at KK Hospital for colposcopy and is still involved in research on computer imaging analytics for screening cervical cancer in low resource settings in a joint collaboration with the National University of Singapore.

While in the United Kingdom, she was also a fellow at the Assisted Conception Unit in Guys Hospital to learn the latest in reproductive techniques and approaches to infertility. She is accredited to perform advanced Level 3 minimally invasive keyhole surgery such as laparoscopic hysterectomy, myomectomy and cystectomy (womb, fibroids and cysts removal).

Her philosophy to doctoring is one that is focused on building relationships with her patients. She strives to deliver patient care that is warm, caring, professional and well advised. She is a believer of pro natural birthing and providing an optimal birthing experience as desired by her patients.

Dr Pamela Tan is an obstetrics and gynaecology specialist practising at Thomson Medical Center in Singapore. Prior to leaving for private practice, Dr Tan was a female Consultant in the Department of Obstetrics and Gynecology, KK Women’s & Children’s Hospital.

She obtained her undergraduate medical degree at the National University of Singapore and her post-graduate MRCOG in London at the Royal College of O&G. She is a specialist accredited with the Specialist Accreditation Board (Ministry of Health) and is a Fellow of the Academy of Medicine, Singapore (FAMS). She is an accredited member of the Society for Colposcopy and Cervical Pathology of Singapore (SCCPS) with a subspecialty interest in colposcopy (for pre-cancer of the cervix and vagina) and vulval disease.

In further pursuing this interest, she was a fellow for pre-invasive disease at the colposcopy and vulval unit at the Whittington Hospital in the United Kingdom. She is a visiting consultant at KK Hospital for colposcopy and is still involved in research on computer imaging analytics for screening cervical cancer in low resource settings in a joint collaboration with the National University of Singapore.

While in the United Kingdom, she was also a fellow at the Assisted Conception Unit in Guys Hospital to learn the latest in reproductive techniques and approaches to infertility. She is accredited to perform advanced Level 3 minimally invasive keyhole surgery such as laparoscopic hysterectomy, myomectomy and cystectomy (womb, fibroids and cysts removal).

Her philosophy to doctoring is one that is focused on building relationships with her patients. She strives to deliver patient care that is warm, caring, professional and well advised. She is a believer of pro natural birthing and providing an optimal birthing experience as desired by her patients.

Latest Blogs

Decoding The First Signs of Pregnancy

Pregnancy is one of the interesting processes that could happen to a woman’s body. While there are expected milestones for the next nine months, the experience may vary for each expectant mom. In fact, each pregnancy may bring a different set of experiences for a woman.

If this is your first time, these changes can be uncomfortable, while some ladies might even miss the very first signs of pregnancy entirely. However, there is something to be said about knowing if you are pregnant the earliest time possible. It allows you and your baby to receive the right diet, the right care, and proper monitoring.

So, if you are trying to get pregnant or if you are reeling from certain changes happening to your body, these are the initial signs of pregnancy to watch out for even before you get to a pregnancy test.

Light Spotting

 

Also referred to as implantation bleeding, light spotting occurs when a 6-12 day-old fertilized egg attaches itself to the interior lining of the uterus.This may be mistaken as menstrual bleeding since some occurs a few days before the next menstruation cycle, but it is not as heavy.

Spotting can be determined as something that is present only when wiping, while bleeding refers to the kind of flow you experience during menstruation.To determine if it is indeed implantation bleeding, you should take into consideration other accompanying signs such as, light or faint cramping, headaches, breast tenderness, mood swings, nausea, or  lower backaches.

Key differences between implantation bleeding and menstrual bleeding include the following

  • Color: Women are familiar with the color of their period as it ranges from bright to dark red. Implantation bleeding, on the other hand, is typically light pink to dark brown in color.
  • Clotting: Some amount of clotting is present during with menstrual bleeding, but implantation bleeding doesn’t come with any at all.
  • Amount: It is normal for women to soak pads and tampons during their period, but it is different with implantation bleeding. The word “bleeding” is actually misleading because implantation bleeding is actually very light, almost like a stain rather than a full flow.
  • Length of Time: Typically, a woman’s period can range from 3-7 days, while those on birth control tend to bleed for a shorter time. Implantation bleeding can last for a few hours to less than three days, and it doesn’t require any treatment.

Light spotting isn’t as cumbersome as other early signs of pregnancy. It does not require any medical intervention, however, it is important that you closely observe it.

Mild Cramping

 

What is tricky about interpreting this symptom is that it can be confused with ovulation cramps and menstrual cramping. The mild cramping sensation you feel when ovulating occurs when the follicle – a sac in your ovary that carries the eggs – ruptures and releases an egg. This is called “mittleschmerz,” which is a German word that means “middle” and “pain.” It often occurs mid cycle, or two weeks prior to your period, although most women don’t feel it at all. Meanwhile, menstrual cramps strike 24-48 hours before your period and goes away once menstruation starts. The pain can be range from mild to severe depending on the level of prostaglandins – a hormone-like substance that causes uterine muscle contractions.

Implantation cramps, on the other hand, are more mild and intermittent, occuring on and off for one to three days. This happens as the embryo implants itself into the lining of the uterus. It takes about a week for the fertilized egg to burrow its way into the thick, rich lining which causes the mild pain. This typically occurs about a week before you would expect your period (for those with a normal 28-30 day cycle), which is why some women confuse it with ovulation or menstrual cramps.

To relieve the discomfort you can do the the following:

  • Try sitting, lying down, or changing positions.
  • Try to do relaxation exercises.
  • Soak in a warm bath.
  • Place a warm water bottle wrapped in a towel on the area.

Tiredness

 

Feeling tired or exhausted is a common early sign of pregnancy. Some women may feel fatigued for the first 12 weeks or throughout the pregnancy, while others may hardly feel tired at all. You can get 10-12 hours of sleep but still wake up feeling lethargic. This can be frustrating especially when you can’t seem to get things done.

Hormonal changes are the likely cause of fatigue. Increased progesterone levels are responsible for making you feel sleepy. In addition, your blood sugar levels and blood pressure also lowers to provide blood flow to the baby.

As the second trimester rolls around, there is a good chance that your energy level will increase making you feel like your old self. Most call this stage “the happy trimester” and would take advantage of it to finish important tasks before energy levels are likely to decrease again during the third trimester. However, don’t be alarmed if you still feel fatigued during the second trimester.

So, if you notice your afternoon energy drop to be out of the ordinary, this could be your body’s way of telling you that a baby could be on board.

To cope with the constant feeling of tiredness, you just need to make sure that you adjust your schedule to allow yourself to get ample rest. Avoid drinking fluids several hours before bedtime to minimise on the number of times you have to get up at night to use the bathroom. It also helps that you choose a healthy, balanced diet because your level of nutrition can go a long way in supporting your energy levels. Make sure that you get enough calories, protein, and iron.

Nausea (with or without vomiting)

 

Along with constantly feeling tired, you may also experience light-headedness or dizziness. Commonly known as “morning sickness,” this occurs during the first week after conception as blood vessels dilate and your blood pressure drops. Not every women will experience nausea the entire duration of the first trimester. However, in some cases it can start earlier and can last longer too.

Another reason behind this is the presence of human chorionic gonadotropin (hCG) which is produced soon after the fertilized eggs attaches to the uterine lining. Women with more hCG in their system experience severe nausea and vomiting (hyperemesis gravidarum), which would require medical intervention.

Estrogen is also another hormone that increases during early pregnancy which could cause nausea. Stress and fatigue brought by the string of changes pregnancy does to the body can also contribute to queasiness.

To prevent or manage nausea during pregnancy you can try the following home or natural remedies:

  • Eat smaller meals more frequently throughout the day instead of three big meals.
  • Avoid foods or smells that can trigger your nausea.
  • Stash soda crackers by your bed and eat a couple before getting up. Allow some time for it to be digested before slowly getting up.
  • Suck on hard candy.

Shortness of Breath

 

Feeling like you are short of breath is a common symptom of pregnancy. It can begin before any upward displacement of the diaphragm due to a growing uterus. During the first trimester, increased levels of progesterone causes the lungs to increase its demand for oxygen. There is an increase in lung capacity which increases oxygen-carrying capacity to provide nourishment for the growing fetus but your respiratory rate (breathing cycles per minute) only changes slightly. This will make you feel like you are short of breath.

To relieve shortness of breath, give your lungs as much breathing room as possible. You can do this by standing up straight, sitting up tall, and sleeping propped up on pillows to expand the space in your abdominal cavity. It also helps to slow down when you feel that your heart and lungs are working harder.

Tender or Swollen Breasts

 

Changes to the breasts can start as early as one to two weeks after conception. In fact, this is one of the top three things women complain about in early pregnancy. The formidable duo – estrogen and progesterone – are the main culprits behind breast tenderness. In addition to that, the fat layers in your breasts thicken, you grow more milk glands, and blood flow increases. These changes may give your cup size a favorable boost, however it does not always leave you with a pleasant experience. But, more importantly, it also serves a purpose of preparing your breasts for breastfeeding in a few months.

To take care of tender or swollen breasts, it helps that you wear a supportive bra. A full-coverage bra can offer adequate support in lifting the breasts and relieving the pressure. You must also avoid underwire bras because it has the potential of digging into the skin. Furthermore, a cold compress or a warm shower can help relieve some tenderness. Warm water, in particular, can help ease the tension and relax the muscles around your chest.

Frequent Urination

 

A lot of women complain of having to spend a seemingly endless loop to the loo. This heightens during the first two to three weeks of your pregnancy. The reason behind this is because the blood flow to a pregnant woman’s kidneys increase by up to 30-60%. This makes the kidneys produce up to 25% more urine soon after she conceives.

Frequent urination can also be attributed to hormonal changes. Once the embryo is implanted into the uterus, your body produces the pregnancy hormone hCG. This triggers a woman to urinate frequently. Furthermore, the spike in progesterone levels can also result in this sensation.

Unfortunately, your urge to pee often will not only be an early sign of pregnancy. As the uterus expands to accommodate the growing baby, it presses down on your bladder, urethra and pelvic floor muscles. This means that your bladder can no longer expand to the same level of fullness as before, therefore it has to be emptied more often.

To reduce the hassle of having to go to the bathroom several times, especially during sleeping hours, avoid drinking too much water a few hours before bedtime.

Besides the usual missed period to signal that something is up, these signs should compel you to take that pregnancy test. Once you have confirmed it, your pregnancy calendar should now be lined with regular prenatal visits. The earlier you know, the earlier you can get professional help and regular monitoring. We hope that this knowledge will help you prepare for what is to come if you are still planning for a baby or if you are already experiencing some of these signs now.

Proper pregnancy planning and having the needed resources along with emotional support is essential during early pregnancy. For all your concerns, from pre-conception health screening to pre-natal visits, and everything in between, book a consultation with Dr. Pamela Tan today.

Dr. Pamela Tan, gynecologist and obstetrician based in Singpore, consults at Thompson Medical Center, Crawfurd Medical Centre, and Sengkang Island Family Clinic.

10 Tips-Choosing Obstetrician Gynaecologist Singapore Infographic

Having a good obstetrician-gynaecologist (OB-GYN) is very important.  Knowing that you are in the hands of a specialized physician gives you that feeling of security.Whether you come in for a gynaecological concern, planning to start a family, or reaching milestones in pregnancy, it’s worth having someone who can care for you according to your needs.

If this is your first time to visit an OB-GYN in Singapore and you’re still not sure who to approach, here are some important factors to consider in choosing one.

10 Tips-Choosing Obstetrician Gynecologist|Singapore(Infographic)

Please include attribution to Dr Pamela Tan with this graphic.

 

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What You are Missing Out On When You Skip Regular Visits to Your Female Gynaecologist

What are the things that you could not go a day without? Could it be your daily Facebook scroll, your morning coffee, or perhaps that 30-minute run?

We have set certain routines whether they may be good for us or not. But above all the humdrum of our daily habits, there are certain things that we must impose on ourselves. We can say that this is part of “adulting” or to a certain stretch, surviving.

So, let’s be honest.  On top of all those important routines, have you ever penciled in a visit to your gynaecologist? It’s understandable why this can easily be missed or tossed to the backburner when you generally feel nothing wrong, especially when it comes to your lady parts. So why waste time and money, right? Wrong.

We are not even going to sugarcoat it, but failing to put importance on female reproductive health can have serious consequences.This is not to scare you ladies, but to shed light on health promotion and disease prevention.

If you simply dust this off, then here’s what you are missing when you don’t go on regular gynae visits:

A better understanding about your body

A gynae visit may seem like a daunting experience, especially for those who are doing it for the first time. To allay your anxiety about the whole thing, think of these visits as a way for you to know more about your body. When you have a professional looking into your situation, you have someone who knows what to give your body and when.

Changes in your body, especially for those facing puberty or menopause, may come with varying symptoms. You may find these changes rather difficult to understand or cope with, therefore it helps to have someone who specializes on the matter with whom you can consult.

A common gynaecological problem that a lot of women today are suffering from is PCOS (Polycystic Ovarian Syndrome). It is a benign condition that is caused by elevated androgen (male hormone) levels. This causes women to skip menstrual periods, gain weight, and even make it harder for them to get pregnant.

A lot of women are not aware that they have this problem, and a consultation with an ultrasound can detect it. Once it is confirmed, a gynaecologist can also advise you on the right treatment, lifestyle changes, and dietary changes to correct the problem and improve the symptoms.  

It’s one thing to ask your mom or a friend about certain matters, but you get deeper into things, and you also get the right help,  when you ask someone who is in authority.

An in-depth discussion on birth control options

With most couples in Singapore pushing their plans to start a family much later, it helps that professional help is sought. A gynaecologist is the right person to help you find the appropriate birth control method. No two women are alike, so what worked for someone you know may not necessarily be effective, or safe, for you. A doctor who is familiar with your sexual health history, medical history, family history and lifestyle can guide you with the method that would be appropriate.

Like other medications, birth control also comes with potential risks and side effects. For instance, you will not be advised to use certain hormonal methods of birth control if you have a history of breast cancer. Health and lifestyle factors are also important considerations because these can influence how a woman’s body reacts to birth control (e.g. smoking increases a woman’s risk for developing blood clots while on birth control). In addition to this, birth control pills may also interact with certains medications that you are taking.

Therefore, it is not advisable to simply rely on advertisements or word-of-mouth in making these decisions. Rather, it is important that you are properly examined by a gynaecologist before using any birth control methods. Otherwise, you would be missing out on sound advise and proper monitoring.

Regular screening

Regular visits to the gynaecologist is one of a woman’s important yearly checkups. This allows you to be evaluated by undergoing the appropriate screening tests. Breast examinations and pelvic examinations are just some of the health assessments done in a well-woman checkup

What many may see to be a waste of time having found no need to see their gynaecologist is actually a good investment for your health. There are several health conditions, such as cervical or ovarian cancer, that doesn’t show symptoms early on. This makes regular screening very helpful in detecting anything that are out of the ordinary. Early detection gives you a good chance of managing the problem, better yet, preventing it.

A regular pap smear, blood workup, or mammogram are just some of the screening exams available for women today. Not making the time may cause you to miss out on your chances of avoiding preventable diseases that could even cost you your life.  

Vaccinations

Vaccinations are now widely available for women to prevent the common diseases they are at risk of. HPV (human papillomavirus) for instance, is the type of virus that causes no symptoms and may simply go away on its own. However some may cause most cervical cancers, as well as other neoplasms that develop in the vulva, vagina, oropharynx (back of the throat), and the anus. The HPV vaccine can help shield yourself from these potential problems.

The importance of vaccines is also emphasized for pregnant women. A consultation will help you to be aware of the kinds of vaccines that you must have and when to get them. Making sure that your vaccines are up-to-date will help protect you and your baby from serious diseases.

It is time for women to be proactive with their health since there are several solutions available today that can help prevent or even protect you from several diseases. Gynaecological problems are some of those insidious conditions that slowly gets worse over time if you allow them to linger. It is up to you to act on it now. As the the old adage says, “prevention is better than cure.”

Share your concerns with someone who understands your struggle. Book your appointment with a female gynaecologist in Singapore today at the Dr. Pamela Tan Clinic.

Your Honest Guide on How to Get Pregnant Fast

Are you facing a challenge when it comes to conceiving? If this is a problem that has been plaguing you, know that you are not alone in this struggle. Singapore’s total fertility rate (TFR) dipped by 1.16 in 2017, which is the second-lowest figure ever recorded. With all other contributing factors aside, one of the reasons is difficulty in getting pregnant. However, this should not rob you off of any hope, as there are several ways that can help you get pregnant fast.

 

Factors making it difficult for you to conceive

Age

More women today are waiting until their 30s or 40s to have children. With the drive to build a career and other goals in the pipeline, it is common for couples to put off starting a family for a couple of years down the road. However, the concern here is that ageing decreases a woman’s chances of having a baby.

With age, a woman has a smaller number of eggs left. It is also likely that she is no longer as healthy as she starts to experience health conditions that may cause fertility problems, also increasing the likelihood of a miscarriage.

Women above 35 are advised to undergo a fertility health check with their partners because not only does a woman’s number of eggs drop, the quality also begins to decline drastically.

Premature ovarian failure

This refers to the ovary’s loss of normal function before you even hit 40. If your ovaries fail, they will no longer produce eggs or normal amounts of estrogen which can lead to infertility and other problems.

The signs and symptoms to watch out for include:

– Vaginal dryness
– Decreased sexual desire
– Hot flashes or night sweats
– Irritability or difficulty concentrating
– Irregular or skipped periods (amenorrhea)

Fibroids and polyps

Among the most common uterine issues affecting a woman’s fertility are growths, such as uterine fibroids (noncancerous muscle growths) or endometrial polyps (an overgrowth of glandular tissue attached to the lining or inner wall of the uterus).

The uterus, or what we call the womb, is where the embryo is embedded and develops into a fetus. Physical issues with the uterus such as growths or any irregularities in its structure can contribute to female infertility, recurrent miscarriages, or complications during delivery. Fibroids and polyps are always benign but they may need to be removed to facilitate implantation.

Read: Your Easy Guide on Fibroid Treatment in Singapore

Damaged or blocked tubes

Every month, when ovulation occurs, one of the ovaries releases an egg. It travels through the fallopian tubes and into the uterus. The sperm also needs to swim their way up to the cervix, through the uterus, and through the fallopian tubes to get to the egg. Fertilization takes place while the egg is travelling through the tube. If one or both tubes are blocked, both the egg and sperm will not have the chance to fertilize.

Endometriosis

This is a condition where endometrial-like tissues are present outside the uterus, which causes a chronic inflammatory reaction, scar tissue and adhesions that may distort a woman’s pelvic anatomy. Typically, endometriosis causes pain and infertility, although 20-25% of patients show no symptoms. In moderate to severe cases, the chances of natural conception are reduced.

6 ways on how to get pregnant fast

If you are having problems getting pregnant, here are some ways that can significantly improve the odds:

Diet

A healthy, balanced diet is a basic requirement for couples who are looking to conceive. What you eat affects everything in your body, including your hormones. Nutritional experts suggest that you follow the “fertility diet.” This is not one of those fad diets; instead, it stems from the first comprehensive 8-year study on diet and fertility which revealed ten evidence-based suggestions for improving fertility.

Based on the recommendations of the study, fertility-boosting strategies for ovulatory infertility include:

  • Avoiding trans fats
  • Eating more plant protein and less animal protein
  • Going for slow carbs (minimally processed foods), not no carbs
  • Drinking whole milk
  • Using more unsaturated vegetable oils
  • Getting plenty of iron from plants
  • Taking a multivitamin

Exercise

If you are living a sedentary lifestyle and are above the “fertility zone” for weight, daily exercise can help improve fertility. However, it is also advised to not overdo it. Too much exercise, especially when you are quite lean already, can interfere with ovulation.

It is wise that women stay within the “fertility zone” for weight. It has been long established that body fat affects reproduction. Women with very little can have some difficulty in maintaining a pregnancy. Meanwhile, women with too much fat will find it difficult to conceive for other reasons, many of which may affect ovulation. A BMI (Body Mass Index) from 20 to 24 the fertility zone.

However, getting your weight within that range will not work like magic. This will put you at an advantage for getting pregnant. Things may look bleak for women who are overweight, but take heart because there are studies which show that losing a modest amount of weight (5-10% of their starting weight) can jump-start ovulation and improve fertility outcomes.

Avoid Alcohol

Many are asking if there is any harm in enjoying an occasional drink. As with most things, there is happiness in moderation. And if you are trying to get pregnant, it is important to know that alcohol may have a threshold effect on fertility.

Heavy drinking can adversely impact fertility. Harmful drinking patterns may consist of either heavy routine drinking (two or more drinks per day) or binge drinking (five or more drinks at one time). Heavy consumption within these two categories has been linked to increased rates of menstrual abnormality and miscarriage.

Women can enjoy an occasional drink during the holidays, but it is encouraged that they limit themselves to fewer than five glasses of wine or champagne in a week. It is also better if you avoid hard liquors with higher alcohol content.

Stop Smoking

Smoking can affect female smokers who are trying to conceive because it increases the risk of developing the following fertility problems:

  • Damaged eggs
  • Increased chances of a miscarriage
  • Problems with the fallopian tube

There are studies which show that smoking lowers a woman’s biological clock. It decreases the total number of eggs in her ovaries causing them to age prematurely. This may lead to earlier menopause, as much as 4 years earlier than normal.

The numerous toxins in tobacco smoke can interfere with the production of hormones that are related to fertility cycles. It can also damage egg cell production and damage the embryo even before it gets implanted in the uterine wall. Furthermore, it can also impede the processes that prepare the womb for pregnancy.

Right Timing

The best way to improve your odds of getting pregnant quickly is to have sex at the right time in your cycle. You increase your chances when you have sex within a day or so of ovulation (that period when your ovaries are releasing an egg). This happens about 14 days after the first day of your last period.

Once an egg is released it lives for about 12-24 hours. A sperm must fertilize the egg within that span of time in order for you to get pregnant. To get the best chances of success, it is best that you have sex every two to three days throughout the month.

Get Help

If you are planning on starting your family any time soon, go for a fertility health check to screen for some of the common health issues that may affect fertility. Since we can’t really detect fertility problems just by looking at someone, going for a fertility check can help couples be aware of any issues that should be addressed right away.

The fertility check will include a pre-conception health screening, and should there be any problems detected, it will be followed by infertility management.

Women who regularly experience heavy or abnormal menstrual bleeding, menstrual cramps, and pelvic pain should consult their gynaecologist. A fertility screening can help determine if these symptoms are caused by a severe underlying fertility issue.

If you are having trouble conceiving, it is wise that both you and your partner get checked. This is to ensure that the right person receives treatment as soon as possible. Make the right lifestyle changes today and the professional help you need.

Book your consultation with Dr. Pamela Tan today and get the appropriate tests and infertility management going.

Make an Appointment Today

Please help us to place your appointment by telling us as many details as possible about your condition, or why you would like a consultation. Rest assured that any details you choose to share with us will be held in strictest confidence.

Are you facing a challenge when it comes to conceiving? If this is a problem that has been plaguing you, know that you are not alone in this struggle. Singapore’s total fertility rate (TFR) dipped by 1.16 in 2017, which is the second-lowest figure ever recorded. With all other contributing factors aside, one of the reasons is difficulty in getting pregnant. However, this should not rob you off of any hope, as there are several ways that can help you get pregnant fast.

Make-An-Appointment-Button-Dr-Pamela-Tan

Factors making it difficult for you to conceive

Age

More women today are waiting until their 30s or 40s to have children. With the drive to build a career and other goals in the pipeline, it is common for couples to put off starting a family for a couple of years down the road. However, the concern here is that ageing decreases a woman’s chances of having a baby.

With age, a woman has a smaller number of eggs left. It is also likely that she is no longer as healthy as she starts to experience health conditions that may cause fertility problems, also increasing the likelihood of a miscarriage.

Women above 35 are advised to undergo a fertility health check with their partners because not only does a woman’s number of eggs drop, the quality also begins to decline drastically.

Premature ovarian failure

This refers to the ovary’s loss of normal function before you even hit 40. If your ovaries fail, they will no longer produce eggs or normal amounts of estrogen which can lead to infertility and other problems.

The signs and symptoms to watch out for include:

– Vaginal dryness
– Decreased sexual desire
– Hot flashes or night sweats
– Irritability or difficulty concentrating
– Irregular or skipped periods (amenorrhea)

Fibroids and polyps

Among the most common uterine issues affecting a woman’s fertility are growths, such as uterine fibroids (noncancerous muscle growths) or endometrial polyps (an overgrowth of glandular tissue attached to the lining or inner wall of the uterus).

The uterus, or what we call the womb, is where the embryo is embedded and develops into a fetus. Physical issues with the uterus such as growths or any irregularities in its structure can contribute to female infertility, recurrent miscarriages, or complications during delivery. Fibroids and polyps are always benign but they may need to be removed to facilitate implantation.

Read: Your Easy Guide on Fibroid Treatment in Singapore

Damaged or blocked tubes

Every month, when ovulation occurs, one of the ovaries releases an egg. It travels through the fallopian tubes and into the uterus. The sperm also needs to swim their way up to the cervix, through the uterus, and through the fallopian tubes to get to the egg. Fertilization takes place while the egg is travelling through the tube. If one or both tubes are blocked, both the egg and sperm will not have the chance to fertilize.

Endometriosis

This is a condition where endometrial-like tissues are present outside the uterus, which causes a chronic inflammatory reaction, scar tissue and adhesions that may distort a woman’s pelvic anatomy. Typically, endometriosis causes pain and infertility, although 20-25% of patients show no symptoms. In moderate to severe cases, the chances of natural conception are reduced.

6 ways on how to get pregnant fast

If you are having problems getting pregnant, here are some ways that can significantly improve the odds:

Diet

A healthy, balanced diet is a basic requirement for couples who are looking to conceive. What you eat affects everything in your body, including your hormones. Nutritional experts suggest that you follow the “fertility diet.” This is not one of those fad diets; instead, it stems from the first comprehensive 8-year study on diet and fertility which revealed ten evidence-based suggestions for improving fertility.

Based on the recommendations of the study, fertility-boosting strategies for ovulatory infertility include:

  • Avoiding trans fats
  • Eating more plant protein and less animal protein
  • Going for slow carbs (minimally processed foods), not no carbs
  • Drinking whole milk
  • Using more unsaturated vegetable oils
  • Getting plenty of iron from plants
  • Taking a multivitamin

Exercise

If you are living a sedentary lifestyle and are above the “fertility zone” for weight, daily exercise can help improve fertility. However, it is also advised to not overdo it. Too much exercise, especially when you are quite lean already, can interfere with ovulation.

It is wise that women stay within the “fertility zone” for weight. It has been long established that body fat affects reproduction. Women with very little can have some difficulty in maintaining a pregnancy. Meanwhile, women with too much fat will find it difficult to conceive for other reasons, many of which may affect ovulation. A BMI (Body Mass Index) from 20 to 24 the fertility zone.

However, getting your weight within that range will not work like magic. This will put you at an advantage for getting pregnant. Things may look bleak for women who are overweight, but take heart because there are studies which show that losing a modest amount of weight (5-10% of their starting weight) can jump-start ovulation and improve fertility outcomes.

Avoid Alcohol

Many are asking if there is any harm in enjoying an occasional drink. As with most things, there is happiness in moderation. And if you are trying to get pregnant, it is important to know that alcohol may have a threshold effect on fertility.

Heavy drinking can adversely impact fertility. Harmful drinking patterns may consist of either heavy routine drinking (two or more drinks per day) or binge drinking (five or more drinks at one time). Heavy consumption within these two categories has been linked to increased rates of menstrual abnormality and miscarriage.

Women can enjoy an occasional drink during the holidays, but it is encouraged that they limit themselves to fewer than five glasses of wine or champagne in a week. It is also better if you avoid hard liquors with higher alcohol content.

Stop Smoking

Smoking can affect female smokers who are trying to conceive because it increases the risk of developing the following fertility problems:

  • Damaged eggs
  • Increased chances of a miscarriage
  • Problems with the fallopian tube

There are studies which show that smoking lowers a woman’s biological clock. It decreases the total number of eggs in her ovaries causing them to age prematurely. This may lead to earlier menopause, as much as 4 years earlier than normal.

The numerous toxins in tobacco smoke can interfere with the production of hormones that are related to fertility cycles. It can also damage egg cell production and damage the embryo even before it gets implanted in the uterine wall. Furthermore, it can also impede the processes that prepare the womb for pregnancy.

Right Timing

The best way to improve your odds of getting pregnant quickly is to have sex at the right time in your cycle. You increase your chances when you have sex within a day or so of ovulation (that period when your ovaries are releasing an egg). This happens about 14 days after the first day of your last period.

Once an egg is released it lives for about 12-24 hours. A sperm must fertilize the egg within that span of time in order for you to get pregnant. To get the best chances of success, it is best that you have sex every two to three days throughout the month.

Get Help

If you are planning on starting your family any time soon, go for a fertility health check to screen for some of the common health issues that may affect fertility. Since we can’t really detect fertility problems just by looking at someone, going for a fertility check can help couples be aware of any issues that should be addressed right away.

The fertility check will include a pre-conception health screening, and should there be any problems detected, it will be followed by infertility management.

Women who regularly experience heavy or abnormal menstrual bleeding, menstrual cramps, and pelvic pain should consult their gynaecologist. A fertility screening can help determine if these symptoms are caused by a severe underlying fertility issue.

If you are having trouble conceiving, it is wise that both you and your partner get checked. This is to ensure that the right person receives treatment as soon as possible. Make the right lifestyle changes today and the professional help you need.

Book your consultation with Dr. Pamela Tan today and get the appropriate tests and infertility management going.

Make an Appointment Today

Please help us to place your appointment by telling us as many details as possible about your condition, or why you would like a consultation. Rest assured that any details you choose to share with us will be held in strictest confidence.

Make an Appointment Today

Please help us to place your appointment by telling us as many details as possible about your condition, or why you would like a consultation. Rest assured that any details you choose to share with us will be held in strictest confidence.

Please help us to place your appointment by telling us as many details as possible about your condition, or why you would like a consultation. Rest assured that any details you choose to share with us will be held in strictest confidence.

Our Locations

THOMSON MEDICAL CENTRE

Phone: 6254 2878
Fax: 6254 6233

SUNTEC CITY MALL

Phone: 6804 9508
Fax: 6341 9757

SENGKANG ISLAND FAMILY CLINIC

Phone: 6384 2759

Emergency hotline: 6333 5550

Induction of Labour: What You Need to Know and How To Be Safe

While most women expect to welcome their little bundle of joy 38-40 weeks into their pregnancy, some may be thrown a curve ball and experience things a different way. If your labour doesn’t start on its own, your ob-gyn may use medications and other techniques for the induction of labour. If you are an expectant mom who wants to prepare for this potential scenario, here’s what you need to know.

Induction of Labour

The induction of labour is a procedure that is used to jump-start the labour process with the aim of delivering the baby vaginally. Letting nature take its course may be best, but some patients may need some help to start things along.

What are the Reasons for an Induction of Labour?

During the course of your pregnancy, a variety of medical conditions may arise. These may put you or your baby at risk. These instances necessitate your ob-gyn to advise you to undergo an induction of labour, but only if there is no immediate danger to both mother and child. The maternal and fetal reasons behind this are the following:

Maternal:

  • You are still pregnant a week or two past your due date.
  • Your water breaks (ruptured amniotic membranes) but your labour doesn’t start on its own. Inducing your labour decreases the risks of infection to your uterus and your baby.
  • You develop pre-eclampsia(a serious medical disorder caused by pregnancy and may manifest as high blood pressure)
  • Your placenta is insufficiently nourishing the baby and growth is less than expected or the amniotic fluid is low.
  • You previously had a full-term stillbirth.
  • Diabetic mothers are commonly induced before their estimated date of delivery. Babies who are born to diabetic mothers are often larger (fetal macrosomia), and more prone to birth trauma hence an early delivery makes it less challenging. These babies also have a higher risk of stillbirth if they are not delivered by their due date, especially if there is poor sugar control by the mother.
  • Women with a personal history of precipitous labour (i. e a very quick delivery) may be offered an induction of labour after 37 weeks of gestation.

Fetal:

  • Intrauterine Growth Restriction (UGR). This means the baby is not growing to his/her full potential. Under the circumstance, it would be preferable to deliver the baby and provide nutrition externally.
  • Premature rupture of membranes
  • An infection inside the uterus known as chorioamnionitis
  • Reduced fetal movements at term or a suspicious fetal heart trace pattern on monitoring

What are The Different Methods for Inducing Labour?

1. Medications

  • Prostaglandin

Prostaglandin is applied vaginally in a pessary form. The most commonly used medication is Prostin or Cervidil.

This medication causes the softening of the cervix (or the neck of the womb) and it stimulates uterine muscle activity leading to labour. Once it is inserted, you will usually be required to stay in the hospital for monitoring. You will continue to rest in a lying position while the labour ward team monitor your uterine activity and your baby’s heart rate pattern.

After the insertion of the prostaglandin most women should feel comfortable and should be able to rest. However, if there is any fluid or blood leaking from your vagina, if you need any pain relief, or if you have other concerns, immediately let your midwife or doctor know.

Women respond differently to the medications. So, if your cervix does not respond to the first dose of prostaglandin application, you may require further doses to allow your cervix to be ready for labour. However, the lowest dose regime is commonly used to prevent over-stimulation.

  • Oxytocin

Oxytocin can stimulate uterine activity that is enough to produce cervical dilatation and fetal descent without compromising fetal health or risking the woman to uterine hyperstimulation when used with monitoring.

Oxytocin is first diluted before it is administered intravenously either continuously or titrated using an infusion device. The oxytocin levels needed to produce effective contraction vary among pregnant women, hence titration must be individualized. Since oxytocin has a short half-life in a mother’s blood, the drug concentration reduces rapidly averting potential over-stimulation.

2. Artificial Rupture of Membranes (AROM)

A mechanical way to induce labour involves the use of an amniohook or an amniotic membrane perforator, a specially designed instrument used to break a waterbag. The artificial rupture of membranes alone may induce or augment contractions in some women. The frequency of these contractions will then be monitored in the delivery suite, and if these are inadequate, an oxytocin infusion may have to be given.

3. Membrane sweep

Stripping the membranes involves sweeping a gloved finger over the thin membrane that connects the amniotic sac to the wall of the uterus. This action may cause your body to release prostaglandins which soften the cervix and may cause contractions. This is quite a natural way of encouraging more contractions to occur in the next few days.

4. Nipple Stimulation

This rather simple measure can actually help kick start labour. Rubbing or rolling your nipples can help release oxytocin. As mentioned earlier, oxytocin can help bring on full labour by making contractions longer and stronger. Generally, doctors use the drug Pitocin, which is a synthetic form of oxytocin to start things along.

It is important to note that this method of labour stimulation is only recommended for normal pregnancies. Always speak with your doctor before using nipple stimulation to induce labour to avoid problems like over-stimulation.

When using this method, always remember the following:

  • Focus on one breast at a time.
  • Limit the stimulation to only five minutes, and wait another 15 minutes before trying again.
  • Pause nipple stimulation during contractions.
  • Stop the stimulation when contractions become three minutes apart or less, one minute in length or longer.

Requirements for the Induction of Labour

  • Labour can only be induced once the patient has been duly informed. They should receive an explanation regarding the indication of the procedure, the possible need for a Caesarean delivery, and other risks associated with induction.
  • Fetal gestation is ascertained.
  • It should only be performed in an environment where there are trained personnel and facilities are available to immediately deal with any potential complication.

Should a VBAC be induced?

In a 2010 VBAC Practice Bulletin No. 115 produced by the American Congress of Obstetrician & Gynecologists (ACOG):

Induction of labour for maternal or fetal indications remains an option for women undergoing TOLAC (trial of labor after caesarean). However, the potential increased risk of uterine rupture associated with any induction, and the potential decreased possibility of achieving VBAC, should be discussed.

In general, inductions for patients with a previous Caesarean section is not recommended as the risk of rupture increases by 2-3 fold compared to the naturally occurring spontaneous onset of labour.

Unsuitable Candidates for an Induction of Labour

  • Induction of labour is not performed if you are unsuitable for a vaginal delivery.
  • Women with a low-lying placenta
  • Women whose baby is not lying head down.
  • If you have had previous cesarean sections as the risk of uterine rupture increases

It is important for expectant women to talk with their doctors about their personal risks, concerns, and preferences. At the Dr. Pamela Tan clinic, we aim to offer women the proper guidance as you prepare for labour and delivery, with your needs in mind.

Book your consultation with us today.

Your Easy Guide on Fibroid Treatment in Singapore

Uterine Fibroids Infographic by Dr Pamela Tan

Fibroids are known by many names such as leiomyomas, myomas, myofibromas, fibromas, or fibromyomas. It is a type of growth that develops from the uterine muscle tissue and it is attached to the muscular walls during a woman’s reproductive years.

This guide is intended to walk you through the different fibroid treatments, but we also included the basics about this condition to give you a good grasp of what to expect.

Classifications

There are four types of fibroids and they are classified based on their location in the womb. These are:

  • Intramural

These are the most common type, growing within the uterine walls or uterine muscles. Technically, all fibroids start out as intramural fibroids but they may evolve into other types. These do not cause symptoms until they reach a critical size.

  • Subserosal fibroids

These type of fibroids grow on the outside of the uterus. These have a tendency to progress into pedunculated fibroids where they develop a stalk and can become quite large.

  • Submucosal fibroids

These grow just underneath the uterine lining and into the endometrial cavity. This type of fibroid, even the ones that are no more than an inch in diameter can produce severe heavy bleeding and prolonged menses.

  • Cervical fibroids

These are located in the wall of the cervix or the neck of the uterus.

Uterine Fibroids Symptoms

There are women who have fibroids but don’t have any symptoms. Some may show mild symptoms, while others have it worse, and the severity can be influenced by size, location, and the number of fibroids. Each individual may experience it differently, but the following are the most common:

  • Prolonged or heavy menstrual periods
  • Abnormal bleeding between periods
  • Pelvic pressure or pain due to the tumour pressing on the pelvic organs
  • Frequent urination due to pressure on the bladder
  • Difficulty emptying the bladder
  • Low back pain or leg pain
  • Pain during intercourse
  • Constipation due to pressure on the rectum
  • A firm mass usually located near the middle of the pelvis which can be felt by the physician upon palpation
  • Change in abdominal contour and an increase in size around the waist area
  • Multiple miscarriages or early labour

If you have any of the following signs or symptoms, it is advised that you immediately contact a healthcare practitioner:

  • Severe or prolonged pelvic or abdominal pain
  • Menstrual bleeding that would have you soaking more than 3 pads per hour
  • Lightheadedness, dizziness, shortness of breath, or chest pain associated with vaginal bleeding
  • Sharp pelvic pain that comes on suddenly

Diagnosis

  • Transvaginal ultrasound (ultrasonography)

Helps identify the size, number and shape of most fibroids. Using a handheld device called a transducer inserted into the vaginal canal, this procedure allows the doctor to see if there is any abnormality in the uterus, cervix, endometrium, fallopian tubes, ovaries and pelvic cavity.  What makes this different from an abdominal ultrasound is that the latter uses warm water-based clear gel that is applied to the skin of the abdomen. The transvaginal route usually offers better visualization and is performed for patients with prior sexual exposure but both may be performed to give the most accurate characterization.

  • Magnetic Resonance Imaging (MRI)

This is the preferred method for accurately characterizing pelvic masses. It is known to be more sensitive in identifying uterine fibroids. Submucosal, intramural and subserosal fibroids are often differentiated using an MRI scan. Even fibroids in relatively unusual locations can be identified. In the majority of cases, however, it is not required if the ultrasound assessment already gives enough information. It is often indicated if there is uncertainty about the diagnosis or nature of the pelvic mass.

  • Hysterosalpingography (HSG)

This involves the injection of a dye into the uterus and Fallopian tubes which are then X-rayed to identify the anatomical structures. This may be recommended if infertility is a concern and there is a suspicion that the fibroids are affecting the cavity for implantation or blocking the tubes.

  • Hysteroscopy

This procedure is done by passing a lighted telescope called a hysteroscope through the opening of the cervix. The doctor injects saline into your uterus to expand the uterine cavity, allowing the doctor to assess the walls of the uterus and the openings of the the fallopian tubes. If the fibroids are submucosal (projecting into the cavity), removal can be performed at the same sitting (transcervical resection of myoma).

  • Endometrial biopsy

This is performed by taking a uterine tissue sample. A small instrument is passed through the cervical opening to obtain small samples of tissue inside the uterus. This may be performed in the case of heavy or frequent menstrual bleeding to rule out endometrial disorders like hyperplasia and cancer.

  • Blood test

Your doctor may order a series of blood tests to investigate the potential cause of any abnormal menstrual bleeding. This may include a haemoglobin level to check if you are already experiencing anemia due to chronic blood loss. Other blood tests are done to rule out thyroid problems and bleeding disorders.

Treatment

Medications

Medications are used for the short-term relief of fibroid-related symptoms. These include:

a. Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs such as ibuprofen and naproxen can help reduce menstrual cramps and decrease menstrual flow in some women.

b. Tranexamic acid

Tranexamic acid is an anti-fibrinolytic for use on heavy menstrual days that can help to reduce blood loss. It is well tolerated and often one of the first line treatments for patients who present with excessive menstrual blood loss.

c. Birth control pills

The use of contraceptive pills for the treatment of uterine fibroids must be done with careful consideration. Fibroids are very hormone-responsive, which means that it may cause the fibroids to grow larger. However under low doses, birth control pills will not induce fibroid growth. They can also be used to treat the menstrual cramps and bleeding symptoms caused by fibroids.

d. Levonorgestrel intrauterine system (LNG-IUS)

This is a T-shaped device with a vertical stem which contains a reservoir of levonorgestrel which is widely known for its contraceptive effect. Research has shown that LNG-IUS may be an effective and safe treatment for symptomatic uterine fibroids in premenopausal women.

e. Ulispristol acetate (Esmya)

Esmya has been shown in clinical trials to shrink the volume of up to 80 % of fibroids over time. It appeared to be a good modality of treatment in halting progression during duration of treatment particularly for women with symptomatic fibroids and who were keen for child-bearing. Surgical removal often involves a cut (incision) in the uterine wall. A scarred uterus may result in rupture through the scar during normal labour hence these patients may require an elective Caesarean section for delivery.

Using Esmya to shrink the fibroids buys time to try natural conception and reduce Caesarean sections. However, there has been some associated cases of liver failure reported recently and while investigations are pending on the outcomes no new patients are started on this medication until further notice.

Hysterectomy

This is the surgical removal of all or part of the uterus, and it is considered the only permanent and definitive cure for fibroids. The doctor may also remove the fallopian tubes, ovaries, and/or cervix during the same surgery. This can result in permanent infertility and is performed for a woman who is symptomatic and have failed or are not keen to continue with medical treatment and have no wishes to child bear.

The size and location of the fibroids and uterus will determine if it can be performed key-hole (small incisions) or open (bikini line cut) in the abdomen. A laparoscopic or keyhole surgery is an operation that is performed through a small abdominal incision (around 0.5 to 1 cm). It allows better dissection and precision during surgery with fewer chances of internal scarring and infection. Open or conventional surgery requires a longer cut of up to 10 cm which means a longer recovery.

Hysteroscopic resection of fibroid

Also known as a Transcervical Resection of myoma (TCRM), this surgery is done to remove submucosal fibroids in the cavity without taking the healthy tissue of the uterus. A long, thin scope with a light is passed through the vagina and cervix into the uterus. This means that no incision is needed. The device allows the doctor to assess the inside of the uterus for fibroids and other problems. Having this clear view of an internal pelvic structure allows the surgeon to perform a localized approach, hence lessening potential trauma.

Myomectomy

This is considered a conservative surgical therapy. It involves removing the fibroids while leaving the uterus intact giving the patient a chance at a future pregnancy. Traditionally, a myomectomy comes with a large abdominal incision, however, some specialists are trained to remove it key-hole, making it possible for the procedure to be less invasive with faster recovery.  The chance of recurrent growths after the surgical removal of fibroids is between 15% to 30%.

Patients are advised to avoid getting pregnant for at least three to six months after surgery to allow the myometrium (the muscle of the uterus) to heal. In the instance that a large part of the myometrium was removed during surgery, the patient will be advised to undergo a Caesarean section (C-section) to deliver her baby if every she becomes pregnant again.

Gonadotropin-releasing hormone agonists (GnRH agonists)

This hormone therapy halts the intrinsic production of hormones that cause the fibroids to grow. The smaller the fibroids, the easier it is to remove. This treatment is only considered a “stop-gap” measure before surgery because it can induce menopause, hence it should not be used on a long-term basis as it can predispose to osteoporosis.

Uterine artery embolization (UAE)

This is a procedure that is done to treat fibroids without surgery. During this treatment, a radiologist uses a slender and flexible tube (catheter) to inject embolic agents into the uterine arteries. The intent is to block the fibroid blood vessels which causes them to shrink and die. This is usually indicated for patients not suitable for surgery and is not suitable for patients keen to conceive after the procedure.

MRI-guided ultrasound waves

This treatment is also known as Focused ultrasound surgery and it is considered a new medical treatment to “kill” fibroids and is suitable for women who have only a few fibroids. It uses focused ultrasound ablation while you are inside an MRI scanner that is equipped with a high-energy ultrasound transducer.

The ultrasound transducer delivers focused sound waves into the fibroid which heats and destroys small areas of fibroid tissues until most or all of it are destroyed. The MRI images give the doctor the precise location of uterine fibroids and the locations of nearby structures. The body gradually absorbs the treated tissue over a few months or years. This is offered in very limited centres with the expertise and not suitable for patients keen for childbearing post procedure.

Fibroids treatment in Singapore will be determined by your healthcare provider(s) based on the following:

  • Your overall health
  • Medical history
  • Age (how close a woman is to menopause)
  • The extent of the disease
  • Your tolerance to certain medications, procedures or therapies
  • Your opinion or preference
  • Your expectations for the course of the disease
  • Your desire for pregnancy

Discuss your concerns with Dr. Pamela Tan and act on any gynaecological issues now. Fibroid treatment is not life-threatening but there is something you can do to address any discomfort and problem that fibroids may already be causing you. Book your consultation now and get the right answers.