When people think of women’s health, the first topics that come to mind may be gynecological concerns, such as infertility, menopause, pregnancy and childbirth, as well as breast health. But there’s a lot more to women’s health than that: many health issues affect women differently from men, and in ways that have an impact on diagnosis and care. For instance, a heart attack may show up with different symptoms in a woman, putting her at risk for a misdiagnosis. Doctors are increasingly aware of how managing osteoporosis, urinary conditions, sports injuries, colorectal cancer and diabetes in female patients may call for different approaches that take into account women’s physiological differences. In all health matters, an informed patient or caregiver can advocate more effectively. Clear communication with health care providers can help ensure that women’s unique health needs are recognized and met.

1. Health problems in
female- including
abortion, infertility
and menopause
Presented by- Dr Asmita Poudel
MPH-2022
School of public health and
community medicine
BPKIHS
1

2. Contents
• Health problems- before, during and after pregnancy
• Women health issues
• Health problems in women (Abortion, Infertility, Menopause)
• Global scenario
• National scenario
• Types
• Causes
• Management
• Preventive measures
• References
2

3. Health problems of female
3
Before pregnancy During pregnancy During later age of life
Eating disorders (anorexia
nervosa, bulimia nervosa)
Hypertensive disorders(pre
eclampsia , eclampsia)
Osteoporosis
Cancer anemia Cancers
Road traffic injuries Gestational diabetes Mental health problems like
depression
Sexually transmitted infections hemorrhage Uterine prolapse
Anemia sepsis Cardiovascular diseases
Malnutrition abortion Road traffic injuries
Sexually transmitted infections

4. 4

5. Women
health
issues
5
Premenstrual Syndrome (PMS)
Reproductive Health
Heart Disease
Breast and Cervical Cancer
Osteoporosis and Arthritis
Prenatal Health
HIV and Sexually-Transmitted Disease
Mental Health Illnesses
Aging and Getting Older
Insomnia and Sleep Disorders
Violence against women

6. Premenstrual
Syndrome (PMS)
• Most common problem that women face
year after year
• PMS affects 40% of women and usually
occurs in the last two weeks of the
menstrual cycle.
• PMS is painful and mentally taxing, but you
can do things to fight its effects.
• Consumption of carb-rich diet consisting of
lots of grains and veggies, exercise for at
least 30 minutes per day, three days a
week, include a broad range of vitamins and
minerals in daily diets, such as calcium,
magnesium, and vitamin B6.
6

7. Reproductive Health
• RH means Physical, mental and social health condition related to reproductive system, process and
function.
• Components of reproductive health
1. Family planning
2. Safe motherhood
3. Newborn care
4. Safe abortion service
5. Adolescent sexual and reproductive health
6. STI, HIV/AIDS
7. Problem of elderly women
8. Prevention and management of infertility
9. Gender based violence 7

8. Heart Disease
• CVD develops 7-10 years later in women than in men.
• Study shows that young women with oestrogen deficiency have more than 7 fold
increase in coronary artery risk.
• Oestrogen have regulating effect on lipids, inflammatory markers and coagulant
system
• Post menopausal women are at high risk ( total cholesterol and LDL increases but
HDL remains unaffected)
• After menopause body weight may increase and body fat distribution changes from
gyneoid to more android pattern with central obesity- risk factor for CHD
• Also obese women are more prone to type 2 DM.
• Women have smaller coronary arteries than men which makes angiography,
angioplasty and coronary bypass surgery more difficult to do.
• Regular exercise, eating healthy, abstaining from smoking, and lowering your stress
levels will reduce the risk of heart problems. 8

9. Breast and Cervical Cancer
• women should receive screenings for once they reach adulthood.
• Breast cancer and cervical cancer common
• The earlier you diagnose cancer, the better your odds are of beating it.
Osteoporosis and Arthritis
• The older we get, the more likely women are to contract osteoporosis or arthritis.
• Osteoporosis is a disease that weakens the bones and increases your risk of fractures.
• Arthritis, on the other hand, attacks the joints and results in painful inflammation around the joints.
• The best way to prevent arthritis is through early screenings and catching the problem before it
progresses.
• Osteoarthritis can be prevented through regular exercise, a diet heavy in vitamin D and calcium, and taking
additional supplements where necessary.
9

10. Prenatal Health
• The health care of pregnant women
• Pre natal health care is an important entry point for pregnant women to receive health promotion and
preventive information and services including iron supplementation, deworming tablet, tetanus injection, and
malaria prophylaxis.
• The availability of routine prenatal care, including prenatal screening and diagnosis, has played a part in
reducing the frequency of maternal death, miscarriages, birth defects, low birth weight, neonatal
infections and other preventable health problems.
• Government of Nepal (GoN) recommends focused antenatal visits at fourth, sixth, eighth, and ninth months
of pregnancy
HIV and Sexually-Transmitted Disease
• HIV, gonorrhea, syphilis, and chlamydia are some of the top STDs
• Using proper protection and engaging in safe sex is the best way to protect from these illnesses.
• Syphilis that goes untreated is responsible for hundreds of thousands of stillbirths and tens of thousands of
newborn deaths.
10

11. Mental Health Illnesses
• Problem for women of all ages.
• The stresses of everyday life combined with the anxiety of uncertainty
can result in depression, high anxiety, and feelings of hopelessness.
• Women are more likely to experience a mental health problem than men,
and suicide has become a leading cause of death in women under 60.
• If you begin feeling any signs of anxiety or depression, it’s important to
seek the help you need.
• Reducing the stress in your life will help, but you may require counseling
to repair your mental health and well-being completely.
11

12. Aging and Getting Older
• Aging is the one thing that seems to catch up to everyone no matter what.
• However, some women age much faster than others and feel its negative effects.
• Can prevent the painful symptoms of aging by maintaining a healthy lifestyle that includes diet, exercise,
and stress reduction.
• Keeping your heart, mind, and bones healthy is paramount to living a long and healthy life.
Insomnia and Sleep Disorders
• result of a high-stress lifestyle and a lack of a healthy diet.
• Sleep disorders often accompany anxiety and other mental illnesses.
• Medication and learning a sleep routine that works for you are the best ways to overcome insomnia and other
sleep disorders.
12

13. • Road traffic injuries are among the five leading causes of death for adolescent
girls and women of reproductive age in all WHO regions – except for South-East
Asia, where burns are the third leading cause of death. While many are the
result of cooking accidents, some are homicides or suicides, often associated
with violence by an intimate partner.
• Suicide is among the leading causes of death for women between the ages of 20
and 59 years globally and the second leading cause of death in the low- and
middle-income countries of the WHO Western Pacific Region.
• For women over 60 years of age in low-, middle- and high-income countries,
cardiovascular disease and stroke are major killers and causes of chronic
health problems. Another significant cause of death is chronic obstructive
pulmonary disease, which has been linked to women’s exposure to smoke and
indoor air pollution
• loss of vision – every year, more than 2.5 million older women go blind. Much of
this burden of disability could be avoided if they had access to the necessary
care, particularly surgery for cataracts.
• In low-income countries, trachoma is a significant, but preventable, cause of
blindness that affects women in particular. 13

14. 14

15. The 10 leading causes of death for
women in the world (2015)
• 1. Ischemic heart disease
2. Stroke
3. Lower respiratory infections
4. Chronic obstructive pulmonary disease
5. Alzheimer’s disease and other dementias
6. Diabetes mellitus
7. Diarrhoeal disease
8. Breast cancer
9. Kidney diseases
10. Hypertensive heart diseases
15

16. 16

17. Health Problems of Women above Forty Years
of Age in Rupandehi District of Nepal
17
International Journal of Health Sciences and Research 2013

18. •Abortion is
defined
as pregnancy
termination prior
to 20 weeks of
gestation. (WHO)
18

19. Introduction(1)

20. Introduction(2)
• Those who oppose abortion often argue that an embryo or fetus is a person
with a right to life, and thus equate abortion with murder.
• Those who support the legality of abortion often argue that it is part of
a woman's right to make decisions about her own body.
• Where abortion is illegal or highly restricted, women resort to unsafe means to
end unwanted pregnancies- self-inflicted abdominal and bodily trauma,
ingestion of dangerous chemicals, self-medication with a variety of
drugs, and reliance on unqualified abortion providers
• Also reported methods of unsafe, self-induced abortion include misuse
of misoprostol and insertion of non-surgical implements such as knitting needles
and clothes hangers into the uterus.
20

21. ABORTION
INDUCED
SURGICAL (up to 24
weeks)
DILATION AND
CURETTAGE WITH
SUCTION (less than
14 weeks)
DILATION AND
EVACUATION
(between 14 and 24
weeks)
MEDICAL (less than
11 weeks or that are
more than 15 weeks)
MISCARRIAGE
(before the 20th
week of pregnancy)
21
An abortion may occur spontaneously, called a miscarriage, or it may be brought on purposefully,
called an induced abortion.
Abortion generally refers to an induced abortion.

22. Spontaneous abortion/ miscarriage
• Spontaneous expulsion of the embryo or fetus from the uterus before the 20th week
of pregnancy, prior to the conceptus having developed sufficiently to live without maternal
support.
• An estimated 10 to 25 percent of recognized pregnancies are lost as a result of
miscarriage, with the risk of loss being highest in the first six weeks of pregnancy.
• Because many miscarriages occur prior to a woman knowing she is pregnant, the
actual prevalence of miscarriage is suspected to be higher than that reflected in the data
for clinically recognized cases
• Occurs for many reasons, including disease, trauma, genetic defect, or biochemical
incompatibility of mother and fetus.
• Missed abortion: a condition in which a fetus dies in the uterus but fails to be expelled.
22

23. Induced abortion
• Those abortions which are performed for reasons that fall into four general
categories:
• to preserve the life or physical or mental well-being of the mother;
• to prevent the completion of a pregnancy that has resulted from rape
or incest;
• to prevent the birth of a child with serious deformity, mental deficiency
or genetic abnormality; or
• to prevent a birth for social or economic reasons (such as the
extreme youth of the pregnant female or the sorely strained resources
of the family unit).
• When properly done, induced abortion is one of the safest procedures in
medicine 23

24. Surgical abortion
• In Surgical abortion the contents of the uterus are removed through the vagina.
• Different techniques are used depending on the length of the pregnancy.
1. Dilation and curettage (D and C) with suction
2. Dilation and evacuation (D and E)
• Dilation refers to widening the cervix. Different types of dilators may be used, depending
on how long the pregnancy has lasted and how many children the woman has had.
• If women wish to prevent future pregnancies, contraception, including
a copper or levonorgestrel-releasing intrauterine device (IUD), can be started as
soon as the abortion is completed.
• Hysterotomy- Surgical removal of the uterine contents, may be used during the second
trimester or later.
24

25. Medical abortion(1)
• Pregnancy (less than 11 weeks)- at home.
• Later in pregnancy- admitted to the hospital to take the drugs that will induce
labor.
• Drugs - mifepristone (RU 486), followed by a prostaglandin, such
as misoprostol.
• Practitioners confirm the completion of the abortion by one of the following:
• Ultrasonography
• A urine test to measure human chorionic gonadotropin (hCG) on the
day the drug is given and 1 week later (hCG is produced early in
pregnancy)
• At home -involves taking mifepristone tablet, followed by misoprostol taken 1
to 2 days later. The woman may take mifepristone and misoprostol on her own
or have a doctor give it to her. This regimen causes abortion in about
• 95% of pregnancies that have lasted 8 to 9 weeks
• 87 to 92% of pregnancies that have lasted 9 to 11 weeks
• If a medication abortion is unsuccessful, a surgical abortion may be required.
25

26. Medical abortion(2)
• Introduced in the late 20th century
• An artificial steroid that is closely related to the contraceptive hormone
norethnidrone.
• Works by blocking the action of the hormone progesterone, which is
needed to support the development of a fertilized egg.
• Mifepristone also makes the uterus more sensitive to the second drug that
is given (the prostaglandin)
• When ingested within weeks of conception, it effectively triggers the menstrual
cycle and flushes the fertilized egg out of the uterus.
RU
486 (mifepristone)
• Hormonelike substances that stimulate the uterus to contract.
• They may be used with mifepristone.
Prostaglandins
(misoprostol)

27. Global scenerio
27
According to center for reproductive rights 2021, fact sheet

28. 28

29. 257 million
women who
want to avoid
pregnancy are
not using safe,
modern methods
of contraception
172 million are
using no method
at all
121 million
unintended
pregnancies
happen
60 per cent of
unintended
pregnancies will
end in abortion
45 per cent of all
abortions are
unsafe.
29
26
24
23
20
fear and experience of side effect infrequent sex opposition to contraception breast feeding or post partum and not mensturatiing
Reasons for not using modern contraceptives ( UNFPA, 2022)

30. National Scenerio
• Half of women (51%) reported that they received services from an
authorized abortion facility. Less than one-third (31%) of women said
they went to a government health facility, while 27% went to a private
health facility. Over one-fourth (27%) of women had their abortion at
home (NDHS report 2016)
• The percentage of pregnancies ending in abortion is higher in urban
than in rural areas (11% and 7%, respectively).
• Maternal mortality in Nepal decreased from 548 deaths per 100,000
live births in 2000 to 258 deaths per 100,000 live births in 2015
30

31. • Abortion rate among women of reproductive age is 42 per 1000 women of
reproductive age. (15-49 yrs). (DOHS)
• The safe abortion service has slightly decreased in FY 2077/78 in
comparison to last FY 2076/77. Abortion statistics shows a decreasing
trend from FY 2074/75.
• Post abortion contraceptive uptake is 76%(FY 77/78) but 72%(FY 76/77),
but only 15% have used LARCPMs indicating women after abortion are
relying on less effective methods.
31

32. 6666666666666666666666666666666666666666
666666666666666666666666666666666
32
TYPES OF ABORTION SERVICES USED BY ADOLESCENTS, FY 2073/74 TO FY 2077/78

33. 72
17
7
4
Types of abortion practiced in Nepal according to
NDHS 2016
Medical abortion Mannual vacuum aspiration D and E or D and C Others 33

34. 71
19
5
5
Types of provider
Doctor, nurse, or auxiliary nurse midwife Pharmacist or medical shop
HA or other health worker Others
34

35. 35
PERCENTAGE OF PREGNANCIES TERMINATE AMONG EXPECTED PREGNANCIES

36. The abortion law allows women to terminate their
pregnancy under the following conditions:-
• Fetus up to 12 weeks, with the consent of the pregnant woman
• Fetus up to 28 weeks , as per consent of such woman, after the opinion of the licensed doctor that
there may be danger upon the life of the pregnant woman or her physical or mental health may
deteriorate or disabled infant may be born in case the abortion is not performed.
• fetus remained due to rape or incest, up to 28 weeks with the consent of pregnant woman.
• Fetus up to 28 weeks with the consent of the woman who is suffering from H.I.V. or other incurable
diseases of such nature.
• Not to get abortion conducted forcefully.
• Not to commit abortion upon identifying sex.
• Maintain confidentiality.
(The Right to Safe Motherhood and Reproductive Health Act, 2075 and safe abortion service program
management guideline 2078) 36

37. Safe abortion services
• Nepal made abortion legal in September 2002, the procedural order
was passed in 2003, and the first ever comprehensive abortion care
service was started at the maternity hospital, Kathmandu, in March
2004.
• First-trimester surgical abortions were made available throughout the
country in 2004.
• Second-trimester abortion training began in 2007, and medical
abortions were introduced in 2009.
• The licensed health worker who has fulfilled the prescribed standards
and qualification shall have to provide the pregnant woman with safe
abortion service in the licensed health institution.
• The pregnant woman who wants to obtain the safe abortion service
shall have to give consent in the prescribed format to the health
institution which has obtained a license, or to the health worker who
has obtained a license. 37

38. • Medical abortion services are expanded at health post with additional training to the SBA.
• Comprehensive abortion care (manual vacuum aspiration [MVA]) services are available in all 77 district hospitals
and majority of PHCCs.
• A total of 912 sites for MA, 604 sites for both MA and MVA and 22 sites for abortion in/after second trimester
were listed to provide safe abortion services till the FY 2076/77.
• Similarly, a total of 1833 ANMs for MA, 743 nurses and 1853 doctors (MBBS) for MA/MVA and 92 OBGYN or
MDGPs have been listed for in/after second trimester safe abortion services till the FY 2076 /77.
• As per government policy, auxiliary nurse midwives are allowed to provide medical abortion care only up to 10
weeks’ gestation
• Staff nurses are allowed to perform both manual vacuum aspiration (MVA) and medical abortion up to 10 weeks’
gestation
• MBBS doctors are allowed to perform MVA up to 12 weeks
• Obstetrician-gynecologists and general practitioners are allowed to perform abortion at 13–28 weeks’ gestation
(second-trimester abortions).
38

39. Organizations working for safe abortion in
nepal
• Ipass Nepal
• Population services international Nepal
• Marie stopes international
• Fpan
• WHO Nepal
• UNFPA
39

40. Components of comprehensive abortion care
• Comprehensive abortion care is included in the list of essential
health care services published by WHO in 2020
• FWD has defined the four key components of comprehensive
abortion care as:
Pre and post counselling on safe abortion method and post-
abortion contraceptive methods.
Termination of pregnancies as per the national protocol.
Diagnosis and treatment of existing reproductive tract infection and
Provide contraceptive methods as per informed choice and follow up
for post abortion complication management.
40

41. Consequences of inaccessible quality
abortion care
• risks to women’s physical and mental well-being
• risks violating a range of human rights of women and girls
• Physical health risks associated with unsafe abortion include:
incomplete abortion (failure to remove or expel all pregnancy tissue
from the uterus);
haemorrhage (heavy bleeding);
infection;
uterine perforation (caused when the uterus is pierced by a sharp
object); and
damage to the genital tract and internal organs as a consequence of
inserting dangerous objects into the vagina or anus.
41

42. 42

43. Introduction
• Infertility is a disease of the reproductive system defined by the
failure to achieve a clinical pregnancy after 12 months or more of
regular unprotected sexual intercourse (and there is no other
reason, such as breastfeeding or postpartum amenorrhea) (WHO)
• In the male reproductive system, infertility is most commonly caused
by problems in the ejection of semen, absence or low levels of
sperm, or abnormal morphology and motility of the sperm.
• In the female reproductive system, infertility may be caused by a
range of abnormalities of the ovaries, uterus, fallopian tubes,
and the endocrine system.
43

44. • Infertility can be primary or secondary.
• Primary infertility is when a pregnancy has never been achieved by
a person, and secondary infertility is when at least one prior
pregnancy has been achieved
• Fertility care encompasses the prevention, diagnosis and
treatment of infertility.
• Equal and equitable access to fertility care remains a challenge in
most countries; particularly in low and middle-income countries.
• Fertility care is rarely prioritized in national universal health
coverage benefit packages.
44

45. Risk factors
• Age. The quality and quantity of a woman's eggs begin to decline with
age. In the mid-30s, the rate of follicle loss speeds, resulting in fewer and
poorer quality eggs. This makes conception more difficult, and
increases the risk of miscarriage.
• Smoking. Besides damaging your cervix and fallopian tubes, smoking
increases your risk of miscarriage and ectopic pregnancy
• Weight. Being overweight or significantly underweight may affect
ovulation.
• Sexual history. Sexually transmitted infections such as chlamydia and
gonorrhea can damage the fallopian tubes.
• Alcohol. Excess alcohol consumption can reduce fertility.
45

46. Symptoms
• A menstrual cycle that's too long (35 days or more), too short (less than 21
days), irregular or absent can mean that you're not ovulating.
• There might be no other signs or symptoms.
When to see a doctor
• Up to age 35, most doctors recommend trying to get pregnant for at least a year
before testing or treatment.
• If you're between 35 and 40, discuss your concerns with your doctor after six
months of trying.
• If you're older than 40, your doctor might suggest testing or treatment
46

47. FEMALE REPRODUCTIVE ORGAN FERTILIZATION AND IMPLANTATION
47

48. What causes infertility?
• Tubal disorders such as blocked fallopian tubes→ caused by untreated sexually transmitted
infections (STIs) or complications of unsafe abortion, postpartum sepsis or abdominal/pelvic
surgery;
• Uterine disorders→ which could be inflammatory in nature (endometriosis), congenital in nature
(septate uterus), or benign in nature (fibroids);
• Disorders of the ovaries→ such as polycystic ovarian syndrome and other follicular disorders;
• Disorders of the endocrine system→ pituitary cancers and hypopituitarism causing
imbalances of reproductive hormones.
• Environmental and lifestyle factors→ smoking, excessive alcohol intake, obesity. In addition,
exposure to environmental pollutants and toxins can be directly toxic to gametes (eggs and sperm),
resulting in their decreased numbers and poor quality, leading to infertility
• In some cases, the cause of infertility is never found. A combination of several minor factors in
both partners could cause unexplained fertility problems. 48

49. Diagnosis of female infertility
• Physical examination – including medical history
• Blood tests – to check for the presence of ovulation hormones
• Pap test
• Laparoscopy – a ‘keyhole’ surgical procedure in which an instrument is inserted
through a small incision in the abdomen so that the reproductive organs can be
examined
• Hysteroscopy: In this test, a device called a hysteroscope (a flexible, thin device
with a camera) is inserted into the vagina and through the cervix. The healthcare
provider moves it into the uterus to view the inside of the organ.
• Ultrasound scans – to check for the presence of fibroids.
49

50. Treatment for female
infertility
• Surgery
• Ovulation induction (using hormone
treatment)
• Artificial insemination (IUI)
• Assisted reproductive technologies
(ART) including in-vitro fertilisation
(IVF) and intracytoplasmic sperm
injection (ICSI)
50

51. Surgery for female infertility
INDICATIONS
• Fibroids – non-malignant tumours growing inside the uterus
• Polyps – overgrowths of the uterine lining (endometrium)
• Endometriosis – the growth of endometrial tissue outside the
uterus, which can block the fallopian tubes
• Abnormalities of the uterus – such as a uterine septum
• Ovarian cysts – which can be drained or removed.
51

52. Ovulation induction for female infertility
• Used if a woman is not ovulating or not ovulating regularly.
• It involves taking a hormone medication (tablets or
injections) to stimulate ovulation.
• The response to the hormones is monitored with ultrasound and
when the time is right, an injection is given to trigger
ovulation.
• Timing intercourse to coincide with ovulation offers the chance
of pregnancy.
52

53. Artificial insemination or IUI
• It involves insertion of the male partner’s (or a donor’s) sperm
into a woman’s uterus at or just before the time of ovulation.
• IUI can help couples with so called unexplained infertility or
couples where the male partner has minor sperm
abnormalities.
• IUI can be performed during a natural menstrual cycle, or in
combination with ovulation induction (OI) if the woman has
irregular menstrual cycles.
• If a pregnancy is not achieved after a few IUI attempts, IVF or
intracytoplasmic sperm injection (ICSI) may be needed.
53

54. In-vitro fertilization
Assisted reproductive technologies (ART) includes in-vitro fertilisation (IVF) and intracytoplasmic sperm
injection (ICSI), which is used when there is a male cause of infertility.
ART involves hormone stimulation to make the ovaries produce 10 to 15 eggs rather than the one which
normally matures every month.
When the eggs are ‘ready’ they are retrieved in an ultrasound-guided procedure.
In the case of IVF the collected eggs are then mixed with sperm from the male partner or a donor, and in
the case of ICSI each egg is injected with a single sperm.
Two to 5 days later an embryo is transferred to the woman’s uterus using a thin tube that is inserted
through the cervix. If there are more embryos than needed, these can be frozen for future use.
54

55. IVF success rates
• Under 34: 44 per cent chance of a live
birth
• 35-39: 31 per cent chance of a live
birth
• 40-44: 11 per cent chance of a live
birth
• 44 and above: one per cent chance of
a live birth.
• (Research using the Australian and New
Zealand Assisted Reproduction Database,
calculated the chance of a woman having a
baby from her first cycle of IVF according to her
age)
55

56. 56

57. Donor conception is the process of having a baby using donated sperm, eggs or embryos through
self-insemination or fertility treatment such as IVF.
Sometimes it involves surrogacy, too. Donor conception involves a donor (the person donating sperm,
eggs or an embryo) and recipient parent(s) who receive the donation. A child born as a result of the
donation is known as a donor-conceived person.
• There are many reasons why donor sperm, eggs or embryos may be needed.
 Donor sperm:
• a male partner does not produce any sperm or normal sperm
• there is a high risk of a man passing on a genetic disease or abnormality to a child.
• by single women and women in same-sex relationships. The process of donor insemination is the same as IUI.
• If the woman also has an infertility problem, donor sperm can be used in IVF treatment.
 Donor eggs
• a woman doesn’t produce eggs or her eggs are of low quality.
• a woman has experienced several miscarriages, or
• there is a high risk of the woman passing on a genetic disease or abnormality to a child.
 Donor embryos
• Donor embryos can be used if a person or couple requires both donor sperm and donor eggs to achieve a pregnancy. Although rare, some people
who have frozen embryos that they don’t need, choose to donate them for someone else to use.
57

58. Surrogacy
• Surrogacy involves a woman (the surrogate) carrying a child for
another person or couple with the intention of giving the child to that
person or couple after birth.
• The supreme court’s final verdict announced on December 12, 2016,
and holds that surrogacy is legal for infertile married couples but
illegal for singles, transgender and foreign nationals.
• It’s a popular option for male same-sex couples who want to have a
family and also can be used by people who are single in other
countries.
 Traditional surrogacy
• The surrogate provides her own egg, which is inseminated with the
parent’s sperm. This can be done using (IVF) or artificial insemination.
In this case, the baby is biologically related to the surrogate.
 Gestational surrogacy
• In this type of pregnancy, an embryo is transferred into the
surrogate’s uterus. The embryo is formed from the egg and sperm
of the intended parents or from donors, using IVF. 58

59. Risks of
assisted
reproductive
technologies
59
Ovarian hyperstimulation
syndrome (OHSS)
an increased incidence of
multiple pregnancies
an increased risk of premature
labour and low birth weight
an increased risk of caesarean
delivery

60. Global scenerio
• This problem was able to draw the attention of government leaders and
reproductive health experts in ICPD, 1994. This conference recommended
all members countries to include infertility as part of their reproductive
health care program.
• 48 million couples and 186 million individuals live with infertility, half of
these couples are living in Sub-Saharan Africa (SSA) and South
Asia globally. (WHO)
• 1 in 4 couples in developing countries is affected by infertility. (WHO,
2004)
• The use of assisted reproductive technology (ART) by infertile couples is
increasing by 5% to 10% per year.
• Nearly 2% of live births in the U.S. are a result of assisted reproductive
technology. (CDC, 2017)
60

61. 61

62. Causes of infertility amongst couples visited
at infertility centre Kathmandu Nepal
62

63. National Level Advocacy Workshop On Infertility: Causes
And Consequences Of Violence Against Women
• WOREC in support of Swiss Network for International Studies and Graduate Institute of
International and Development studies Geneva conducted National Advocacy Workshop on
Infertility: January 27, 2020.
• The main objective of the workshop was to explore the perception of infertility, its causes and
consequences and health-seeking behavior among women and their husbands in order to
develop a strategy for action and policy setting.
• Conclusions
• Among all causes of infertility in the global south, it has been seen that 50 percent of the problem
lies within men whereas 90 percent of burden is borne by the women.
• Men are also victimized because of infertility and considered impotent (Napunsak). (a/c study in
2018)
63

64. • Infertility is a pretext of polygamy in all ethnicity whereas the social stigma of infertility is high among Brahmin
and Chettri.
• Depression and suicidal attempts are high in infertile women so it is better not to ask any couple when are we
going to hear good news? When I will get the chance to become an Aunt or Uncle and so on.
• Infertility has various dimensions like bio-medical, social, science and technology. The issue of infertility
should not be left alone with bio-medical treatment rather it should go clubbing with a social dimension too.
• Safe Motherhood Act 2075, has also incorporated the issue of infertility as one of the reproductive morbidities
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65. 65

66. Introduction
• Menopause is the time that marks the end of menstrual cycles in women. It's diagnosed after you've
gone 12 months without a menstrual period.
• Most women experience menopause between the ages of 45 and 55 years as a natural part of biological
ageing.
• Some women experience menopause earlier (before 40 years of age). This ‘premature menopause’
may be because of certain chromosomal abnormalities, autoimmune disorders, or other unknown
causes.
• Menopause is caused by the loss of ovarian follicular function and a decline in circulating blood
oestrogen levels.
• Menopause can affect physical, emotional, mental and social well-being.
• Menopause can also be induced as a consequence of surgical procedures that involve removal of
both ovaries or medical interventions that cause cessation of ovarian function (for example radiation
therapy or chemotherapy).
66

67. Stages of menopause
• Perimenopause: This is the transitional
time that starts before menopause and
includes the 12 months after person’s last
period.
• Menopause: This starts either after 12
months of the last period or when
menstruation has stopped for a clinical
reason, such as the removal of the
ovaries.
• Postmenopause: Postmeopause refers
to the years after menopause, although it
can be difficult to know when menopause
finished and postmenopause starts.
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68. 68

69. Complications
After menopause, your risk of certain medical conditions increases.
• Heart and blood vessel (cardiovascular) disease. When your estrogen levels decline, your risk of cardiovascular disease increases.
For example, blood pressure, LDL and triglycerides tend to go up after menopause. (Nearly a third of women develop cardiovascular
disease, the AHA says)
• Osteoporosis. This condition causes bones to become brittle and weak, leading to an increased risk of fractures. Women are 4 times as
likely as men to develop osteoporosis
• Urinary incontinence. As the tissues of your vagina and urethra lose elasticity, you may experience frequent, sudden, strong urges to
urinate, followed by an involuntary loss of urine (urge incontinence), or the loss of urine with coughing, laughing or lifting (stress
incontinence). You may have urinary tract infections more often.
• Weakening of the pelvic support structures. increasing the risk of pelvic organ prolapse due to Loss of bone
• Sexual function. Vaginal dryness from decreased moisture production and loss of elasticity can cause discomfort and slight bleeding
during sexual intercourse
• Weight gain because metabolism slows.
• Skin: The decrease in estrogen, as well as aging itself, causes a decrease in the amount of collagen (a protein that makes skin strong)
and elastin (a protein that makes skin elastic). Thus, the skin may become thinner, drier, less elastic, and more vulnerable to injury.
69

70. LGBTQIA+ and menopause
• Menopause can affect anyone who is born with ovaries.
• If a person starts taking supplementary testosterone as part of
their transition, they may experience menopause symptoms when
their ovaries stop producing eggs.
• The symptoms of menopause will be the same as those of
cisgender women.
• It is essential that transgender people have access to healthcare
providers who understand their needs and can address them
effectively.
70

71. Menopausal Health Status of
Nepalese Women
JNMA 2017
71

72. Treatments
72

73. References
1. https://www.msdmanuals.com/home/women-s-health-
issues/family-planning/abortion
2. acog.org/advocacy/facts-are-important/abortion-is-healthcare
3. https://www.acog.org/clinical-information/policy-and-position-
statements/statements-of-policy/2022/abortion-policy
4. https://www.who.int/news-room/fact-sheets/detail/abortion
5. https://reproductive-health-
journal.biomedcentral.com/articles/10.1186/s12978-019-0755-0
6. https://en.wikipedia.org/wiki/Abortion
7. https://www.britannica.com/science/abortion-pregnancy
73

74. 8. Raymond EG, Grimes DA (February 2012.. "The comparative safety of legal induced abortion
and childbirth in the United States
9. Bearak J, Popinchalk A, Ganatra B, Moller A-B, Tunçalp Ö, Beavin C et al. Unintended
pregnancy and abortion by income, region, and the legal status of abortion: estimates from a
comprehensive model for 1990–2019. Lancet Glob Health. 2020 Sep; 8(9):e1152-e1161. doi:
10.1016/S2214-109X(20)30315-6
10. Ganatra B, Gerdts C, Rossier C, Johnson Jr B R, Tuncalp Ö, Assifi A et al. Global, regional, and
subregional classification of abortions by safety, 2010–14: estimates from a Bayesian
hierarchical model. The Lancet. 2017 Sep
11. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J et al. Global causes of maternal
death: a WHO systematic analysis. Lancet Glob Health. 2014 Jun; 2(6):e323-33.
12. Singh S, Maddow-Zimet I. Facility-based treatment for medical complications resulting from
unsafe pregnancy termination in the developing world, 2012: a review of evidence from 26
countries. BJOG 2015; published online Aug 19. DOI:10.1111/1471-0528.13552.
13. Vlassoff et al. Economic impact of unsafe abortion-related morbidity and mortality: evidence and
estimation challenges. Brighton, Institute of Development Studies, 2008 (IDS Research Reports
59).
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75. 1. https://www.who.int/news-room/fact-sheets/detail/infertility
2. https://www.mayoclinic.org/diseases-conditions/female-
infertility/symptoms-causes/syc-20354308
3. https://www.betterhealth.vic.gov.au/health/conditionsandtreat
ments/infertility-in-women
4. https://www.singlecare.com/blog/news/infertility-statistics/
• https://www.mayoclinic.org/diseases-
conditions/menopause/symptoms-causes/syc-20353397
• https://www.who.int/news-room/fact-sheets/detail/menopause
• https://www.healthline.com/health/menopause#outlook
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