Four operations: Can I still have one more?

I have had caesarean section (CS) four times. Can I still go once more? My husband is pestering me because I have only given birth to girls – Ngozi, Makurdi

You can go for a fifth CS provided there were no serious complications in the previous pregnancies and operations. However, make sure you register in a standard hospital with an experienced obstetrician. This is because of risk of complications from adhesion.

Let me ask you, or better still your husband, a question what if the fifth is still a girl; are you going to continue? Remember, there is higher risk of complication like postpartum haemorrhage in grand multiparous women.

We have to really address this issue of girl-child versus male child. Is it worth risking the life of the woman in order to have a male child?

No menses after delivery

My wife gave birth last December and since then she has not seen her menses. I hope this will not cause any problem. Also, can she be pregnant in this situation? – Aliu

Is she still breastfeeding? If yes, what she is experiencing is called lactational amenorrhea. It does not cause any problem as it is a natural means of family planning.

Concerning pregnancy; yes she can be pregnant without seeing her menses because ovulation occurs before menses.

Bleeding after menopause

I am 52 two years old. I stopped menstruating two and half years ago. I had bleeding for which some tests were done and I was told I had endometrial hyperplasia. The doctor advised me to remove my womb but I am not willing to do it. Since it’s not cancer, is there no other way out? – Bunmi, Lagos

Hyperplasia is the excessive proliferation of cells. In this case you have endometrial hyperplasia. How many children do you have? If you have completed your family, then it may be better to remove the whole womb: that is Total Abdominal Hysterectomy and Bilataral SalpingoOopherectomy (TAH-BSO).

Before conservative management of your case, grading hyperplasia is important, whether it is low or high. For simple cystic hyperplasia, conservative management can be done. However, at your age, with probably high grade hyperplasia, I will advise TAH-BSO.

Peeling of the skin

I recently noticed that the skin on my thighs is peeling and the area looks whitish. The peeling is accompanied by itching which makes me uncomfortable – Billy, Abuja

It is a form of dermatitis. I will suggest you see a dermatologist. Meanwhile, because of the itching you can use any anticholinergics.