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FAQ:

How can I tell if I am in menopause?

  • Menopause is considered to be 1 year without a menstrual period.

What is perimenopause?

  • This is a stage of life when the ovaries gradually begin to produce less estrogen. It is characterized by hot flashes, breast tenderness, irregular periods, decreased libido, mood swings and difficulty sleeping.

What are the most common symptoms of menopause?

  • Hot Flashes, Night Sweats, Irregular Periods, emotional changes, Loss of Libido, and Vaginal Dryness.

Can I have a pap smear if I have my period?

  • Yes, if you have a light flow.

My mother has a history of breast cancer, when should I get my first mammogram?

  • If you are at a greater risk for breast cancer, beginning screening mammograms after age 40 is recommended. Before 40 generally ultrasonography (preferably high resolution) is suggested. Talk to your doctor about your particular risk factors.

How Is HPV Spread?

  • HPV is spread by skin-to-skin contact — usually during vaginal, anal, or oral sex.

How Is HPV Spread?

  • We offer the HPV vaccine for girls and women 12 to 45 years of age. Ideally, females should get the vaccine before becoming sexually active (when they may be exposed to HPV). Females who are sexually active may also benefit from the vaccine. The vaccine is not recommended for pregnant women.

Should I get the HPV vaccine?

  • We offer the HPV vaccine for girls and women 12 to 45 years of age. Ideally, females should get the vaccine before becoming sexually active (when they may be exposed to HPV). Females who are sexually active may also benefit from the vaccine. The vaccine is not recommended for pregnant women.

What are hot flashes?

  • Hot flashes are one of the most common symptoms of menopause. It is a sudden feeling of heat that rushes to the upper body and face. The skin may redden like a blush . A hot flash may last from a few seconds to several minutes or longer.

What do I do if I miss a birth control pill?

  • If you are less than 24 hours late, take your pill as soon as possible and return to your daily pill schedule. Use a back up method of contraception such as condoms or abstain from intercourse for the next 7 days. If you are 24 hours (or more) late, take the missed pill and today’s pill at the same time. Use a back up method of contraception or abstain from intercourse for the next 7 days. Throw away any other missed pills and take the rest of the pills on schedule.

What is the difference between a yeast infection and bacterial vaginosis (BV)?

  • A yeast infection is caused by an overgrowth of a fungus called Candida albicans. The candida yeast infection is not transmitted sexually, but is caused by baths, damp or tight clothes, or excess moisture in the vagina. Vaginal yeast infection symptoms often include inflammation, itching, and continued irritation. Other yeast infections signs include: pain during intercourse, frequent urination, and a thick, chunky, white discharge from your vagina.
  • Bacterial Vaginosis is caused by an overgrowth or imbalance of bacteria in the vagina. Many women experience no symptoms with BV. If you do experience symptoms they will likely include itching, irritation, and redness. Other common symptoms include a gray, white, or smelly discharge from the vagina.

Can I skip the placebo pills and start another pack to avoid getting my period?

  • Yes. Continuous use of birth control works best if you are taking a monophasic pill with the same dose in the 3 weeks of active pills. Triphasic pills have different amounts of hormones each week so using them continuously may cause break-through bleeding.

When should I call for pain and/or bleeding?

  • Bleeding:  call if:

    -cycle is less than 21 days or greater than 42 days
    -duration  is less than 1 day or greater than 8 days
    -volume: soaking regular pad or tampon/1hr or 6+/12 hrs  (Go to the Emergency Room)
    -pain w/ bleeding
    -chance of pregnancy

    Pain: call if:
    -associated w/ fever, chills, nausea, vomiting, diarrhea, or abnormal vaginal discharge
    -associated w/ UTI (urinary tract infection) symptoms or back pain
    -w/ unprotected intercourse, or exposure to STD`s

My daughter is 16 years old and her periods are very irregular. Is this normal?

  • In a normal menstrual cycle there is regular hormone production and thickening of the lining of the uterus. This cycle primes the endometrium (uterine lining) for implantation of a developing embryo. If no implantation occurs, the lining sheds, resulting in a menstrual period. There are two phases in the menstrual cycle: the follicular phase and the luteal phase. The follicular phase occurs prior to ovulation and involves thickening of the lining of the uterus. This phase usually lasts 10 to 14 days. The luteal phase is the period of time from ovulation to the onset of menses when the lining of the uterus undergoes stabilization prior to menses. This phase usually lasts 14 days.
  • During the first 2 years after the onset of menstruation, cycles are often irregular. These early cycles are often anovulatory-there is no ovulation during the menstrual cycle and therefore the luteal phase does not occur properly. Because of this a woman will experience irregular bleeding. As long as the menstrual cycles are no longer than 40 days, no shorter than 21 days, and the duration of bleeding is no longer than 7 days, this is considered normal in a woman who has recently started menstruating.
  • If irregular bleeding lasts longer than 2 years or the blood flow is excessive, your physician may suggest further evaluation.

Are there risks or benefits to douching?

  • Despite all the advertising by manufacturers of feminine hygiene products, there are no practical reasons for women to douche on a regular basis.

I have a headache every month just before or just after my period starts. Please help.

  • In a normal menstrual cycle there is regular hormone production and thickening of the lining of the uterus. This cycle primes the endometrium (uterine lining) for implantation of a developing embryo. If no implantation occurs, the lining sheds, resulting in a menstrual period. There are two phases in the menstrual cycle: the follicular phase and the luteal phase. The follicular phase occurs prior to ovulation and involves thickening of the lining of the uterus. This phase usually lasts 10 to 14 days. The luteal phase is the period of time from ovulation to the onset of menses when the lining of the uterus undergoes stabilization prior to menses. This phase usually lasts 14 days.
  • Treatment of menstrual migraines is similar to that for standard migraine headaches. The one advantage for women with menstrual migraines is that they can start their treatment earlier, since they will be able to anticipate when their migraine will occur. Lifestyle changes such as increased exercise and diet low in salt, fat, and sugar has been shown to help alleviate menstrual migraines. Non-steroidal anti-inflammatory agents such as ibuprofen or naproxen are often a good first-line choice of medication. In women with severe migraines, sumatriptan has been extremely effective. Women often experience relief within one hour of a subcutaneous injection.

I have a lot of bloating that begins about a week before my period starts. What causes this?

  • Premenstrual Syndrome (PMS) is a disorder experienced by many women. This syndrome has many associated symptoms. One of these symptoms is bloating. This often begins approximately 1 to 2 weeks prior to menses and is characterized by bloating and weight gain. Often women notice a significant reduction in their weight immediately after menses.
  • Initial treatment for PMS is lifestyle changes such as exercise and changing your diet to decrease salt, caffeine, and chocolate intake. If you have a significant amount of bloating prior to your menses and it is affecting your daily life, your physician may prescribe a diuretic to be taken during the second half of your menstrual cycle. This is known as a “fluid pill” in lay terms and is often used to treat people with high blood pressure. A common diuretic used for premenstrual bloating is spironolactone. To date, studies on diuretics have been conflicting, and it is not clear if they truly help premenstrual bloating. Although no good studies support their use, many women report improvement in symptoms with the use of birth control pills.

What is the thick substance that I get a couple of days into my period?

  • What you are describing is a normal pattern of menstruation and a normal menstrual period. A normal menstrual period last about 5 to 7 days, the bleeding is heaviest during the first couple of days and then slows for the remaining 3 or 4 days. As your bleeding slows, the blood clots. This could be what you are seeing. Another possibility is that you are seeing a portion of the uterine lining (endometrium) which is the tissue that is shed during menstruation. In short, you should be reassured that your period is normal. Because you are of reproductive age, you should make certain that your diet is rich in folic acid and that you are getting enough calcium and iron. You might consider supplementing your diet with these vitamins and minerals.

At what age should a girl start going to a gynecologist as opposed to her pediatrician?

  • Females should have their first gynecological exam by the age of 20, or when they become sexually active. At this point they should begin having yearly pap smears and pelvic exams. Many pediatricians are comfortable taking care of their patients’ gynecological problems. If this is the case, your pediatrician may continue to see you for your gynecological exams. If you or your pediatrician feel that it would be more comfortable for you to see a gynecologist, you may be given a referral to one. Should your gynecological issues become more difficult, seeing a gynecologist may be to your benefit.

At what age should my periods start?

  • Periods are also known as menstrual cycles. The onset of menstrual cycles (menarche) occurs during the teenage years. Menstruation continues until a women is in her 50s and reaches menopause. The average age of menarche is 9 to 17 years of age, with a median age of 13.
  • Primary amenorrhea is a condition where a woman fails to start her menstrual cycles. If you have other signs of puberty, such as breast development or pubic hair, but fail to start your menses by the age of 16, you should see a physician. If you have no signs of puberty by age 14, you should see a physician.

Can a woman have a baby at age 49 and everything be okay?

  • Over the last twenty years the number of women waiting until their 40s to conceive has nearly doubled. One of the main determinates of having a healthy pregnancy is being healthy as you enter pregnancy. However, no matter how healthy you are, there are still risks beyond your control. Medical conditions such as high blood pressure and diabetes are more common when a woman reaches her 40s. Also, the number of chromosomal disorders, such as Down syndrome, increases as your age increases. For example, the risk of Down syndrome at age 25 is one in 250. At age 35 is the risk is about one in 300. At age 45 the risk is one in 30, and at age 49 the risk is one in 11. Your total risk for chromosome abnormalities is a bit higher too. At age 35 it is one in 200, while at age 45 the risk increases to one in 21, and to 1 in 8 at age 49. Women in their 30s and 40s have an increased risk of miscarriage. This is most likely due to the increase in chromosomal disorders. In addition, it appears that older women also have an increased risk of requiring a cesarean section. In summary, yes you can have a healthy pregnancy, but your risks at age 49 are SIGNIFICANTLY HIGHER.

I am 40 years old. I don’t really want to have my tubes tied. What are some types of birth control that I can use?

  • Contraceptive options for women over age 40 are similar to those for a younger woman. Types of contraception include:

    Barrier contraception

    • Spermicide – spermicide is a jelly or cream that is toxic to sperm. It is placed into the vagina before each episode of intercourse. The effectiveness rate is 74% to 94%.
    • Condoms – condoms are devices, often made of latex, that are placed over the penis to provide a barrier between the penis and the vagina. This form of birth control is the only method that also provides protection from sexually transmitted diseases. The effectiveness rate is 86% to 97%.
    • Diaphragm – A diaphragm is a round rubber shield that is inserted into the vagina and placed against the cervix. This device is used in conjunction with spermicide. It may be inserted up to 2 hours prior to intercourse and must be left in place for at least 6 hours after intercourse. The effectiveness rate is 80% to 94%.

    Barrier methods of contraception are useful for women of all ages, and are as effective for women in their 40s as they are for younger women.

    Intrauterine Device An intrauterine device (IUD) is an extremely effective form of contraception. IUDs are inserted into the uterus by a physician. These devices release a small amount of copper or progesterone that cause an inflammatory response within the uterine cavity. This inflammatory response provides the contraceptive benefit. The effectiveness rate is 98% to 99.9%. This form of birth control is a good choice for someone in a monogamous relationship, and is often a good choice for older women.

    Methods

    • Oral Contraceptive Pills – Oral contraceptive pills are a common form of contraception. Oral Contraceptives are well tolerated in older women unless they are over 35 and smoke, or have high blood pressure. These factors increase the risk of cardiovascular complications. The effectiveness rate of birth control pills is 97% to 99.9%. There has been no evidence in the literature that contradicts oral contraceptives in general in older women, nor is there associated increased risk of breast cancer. Oral contraceptive use is safe all the way to menopause.
    • Depo Provera – DepoProvera is injected progesterone. Injections are administered every 3 months. Effectiveness rate is 99.7%. The greatest complaint from users of DepoProvera is irregular bleeding.
    • Implanon – Implanon is a small, thin, implantable hormonal contraceptive that is effective for up to three years. It was approved in July, 2006 by the U.S. Food and Drug Administration.

    All the hormonal forms of birth control have been shown to be safe for a healthy woman in her 40s. Discuss with your physician which of the above options is best for you.

I am 28 years old and married. Sexual intercourse is painful for me. What could be causing this and what can I do to make the pain go away?

  • Painful intercourse is also known as dyspareunia. Causes of painful intercourse range from simple problems that are easy to treat, to more complex problems that may require extensive testing and treatment.
  • One of the most common causes of painful intercourse is lack of adequate lubrication. This situation can be remedied by longer foreplay prior to intercourse, or by using lubricating agents such as K-Y jelly or Astroglide
  • Another common cause of painful intercourse is vaginal infection or irritation. Yeast infections, trichomonas vaginitis, and bacterial vaginosis may all have associated pain with intercourse. Also, certain douches, spermicides, and condoms have agents that are irritating and result in inflammation with associated painful intercourse.
  • Women who experience pain on deep penetration during intercourse may have a pelvic infection, pelvic mass, endometriosis, or bowel problems. If you have pain with deep penetration you should see your physician for further evaluation.
  • Finally, some women experience dyspareunia due to psychological factors. Factors leading to the pain may include prior unpleasant sexual experiences and/or prior sexual abuse. Relationship difficulties may also lead to pain with intercourse.

What is the role of testosterone as part of hormone replacement therapy?

  • Testosterone has been used as a component of hormone replacement therapy in certain circumstances. This component is usually used in women who have decreased sexual drive, also known as decreased libido. Decreased sexual drive in women may be due to decreased testosterone levels. The ovaries normally produce small amounts of testosterone even after menopause. Women who have had their ovaries removed surgically may benefit greatly from replacement of testosterone.
  • Testosterone can be replaced in two forms, as a pill in conjunction with estrogen, or as an injection. It has been shown that testosterone may cause an adverse effect on cholesterol levels. Therefore, testosterone supplementation should be used only on an individual basis.

I am a healthy 27-year-old woman who has no desire for sex. Is there anything I should try?

  • Lack of desire is the sexual problem most frequently reported by women. It manifests as a disinterest in or avoidance of sex, and in many cases is reflected as a discrepancy in the couple’s desired frequency of sexual contact. Lack of sexual desire is a problem that presents both partners in a relationship with a confusing dilemma. Couples often question the level of commitment and caring for one another when one or both lack sexual interest. A cycle often develops resulting in their undergoing increasing levels of stress in daily interactions that negatively impact problem-solving skills and communication patterns.
  • Physiological and/or medical problems may contribute to a decrease in sexual functioning. Medical evaluations often focus on assessing hormone levels, thyroid function, use of medications such as anti-hypertensive medications, vaginal infections, or any other illnesses or conditions that may affect sexuality. In addition, the use of alcohol, drugs and the excessive use of chemicals can drastically decrease sexual interest and may be confused with sexual dysfunction. The lack of sexual desire is a frustrating problem for many couples regardless of the cause.
  • Once all physiological components have been ruled out, you should focus on communication, sexual expectations, stress levels, and the amount of time set aside for emotional and sexual contact.
  • If you decide to go in for couples’ counseling, treatment is usually structured over a several week period. It begins with individualized touching exercises that the couple does at home. They learn to be together physically and emotionally without the pressure and demand to feel or be sexual. Verbal and nonverbal communication is enhanced as attitudes, behaviors, and relationship dynamics are explored and modified. Each person learns that they are in control of their sexuality and can choose if and when to turn on or turn off their feelings.

My mother and sister had breast cancer at the age of 40 and 55 respectively. What test should I have to find out if I am at increased risk of getting breast cancer?

  • Breast cancer is the second leading cause of death in women. About 5% of breast cancers have a genetic component-a possible mutation in the BRCA1 or BRCA2 gene. These genes are normally involved in suppression of tumor cells. Women who have the BRCA1 mutation have an approximately 80% risk of developing breast cancer. They also have an approximately 40% risk of developing ovarian cancer.
  • If you have a strong family history of breast cancer with multiple first degree relatives with the disease, get tested for mutations in the BRCA1 or BRCA2 genes. A family member with the disease must be tested first. If that person has the mutant gene, tests will be done on you to look for the same mutation. If you are found to have the mutation, you may want to consider mastectomies (removal of your breasts) or oopherectomy (removal of your ovaries) as a preventative measure.
  • At this point, BRCA1 and BRCA2 testing is not beneficial as a screening tool unless you have a strong family history of the disease. In addition, negative tests do not rule out the possibility of developing breast or ovarian cancer later.
  • One important issue to consider is the impact genetic testing may have on your future. It is still unclear how insurance companies will react to a positive screening. You must consider the chance that an insurance company will classify a positive test as a preexisting condition, with the possibility of limited medical coverage in the future.

What can be done about the lumps in my breasts?

  • Fibrocystic changes of the breasts are very common, especially from the ages of 20 to 50, and are thought to be directly related to estrogen. Fibrocystic breast masses usually occur on a cyclic basis in relation to the menstrual cycle. They can be quite painful and often appear rapidly with the onset of menses, and then disappear afterward.
  • The most important characteristic of a fibrocystic lesion of the breast is that it resolves on its own. If your masses/cysts do not resolve, especially after a menstrual cycle, you need to see your physician so that the mass can be further evaluated to assure that it is not a cancerous lesion. This evaluation may necessitate cyst aspiration or biopsy of the mass.
  • Often people with fibrocystic changes of the breasts notice associated breast tenderness. This pain may be alleviated by wearing a tight bra for support. Although there is no good evidence to support its use, many physicians advocate use of vitamin E and reduction of caffeine to alleviate some of the symptoms.
  • If you have cysts under the skin, rather than in your breast tissue, you may need other treatments. You should see your physician to exclude this possibility.

What causes yeast infections, and can they be prevented?

  • FIt is thought that 45% to 75% of women experience yeast infections (also known as vulvovaginal candidiasis) in their lifetime. It is thought that 45% to 75% of women experience yeast infections (also known as vulvovaginal candidiasis) in their lifetime. In over 80% of cases, infection is caused by an organism known as Candida albicans. This is a fungus that resides in the vagina of a significant number of women. Several situations allow overgrowth of Candida albicans including recent antibiotic use, pregnancy, and diabetes.
  • The signs and symptoms of a vaginal yeast infection often include itching, a thick white vaginal discharge often described as being similar to cottage-cheese, and redness of the vulvar and vaginal areas.
  • Treatment of a yeast infection is variable. The most common treatment involves using a topical antifungal cream in the vaginal area (such as Gyne-Lotrimin or Monistat). An applicator full of cream is placed in the vagina at bedtime from 1 to 7 days. The medication can be obtained over-the-counter, but should only be used by someone who has been diagnosed by a physician or has had similar symptoms in the past where a diagnosis was made. An oral treatment is now available by prescription and is given as a single dose. This is known as Diflucan. After a single treatment with this medication, symptoms often resolve in 3 to 4 days.
  • If you have chronic yeast infections, your physician may start you on a monthly regimen of treatment, usually for a total of 6 months.

What could be a possible problem when blood is found in the urine? My sister is a 53-year-old woman and blood was detected in her urine?

  • Blood in the urine is called hematuria and should never be ignored. It is important to determine exactly where the blood is coming from. In women, the blood may appear to be in the urine when it is actually coming from the vagina or rectum. Discoloration from drugs or foods can mimic hematuria. A catheterized urine sample is an important diagnostic test to make sure that the discoloration is really blood and that the bleeding is coming from the bladder. Also, there is a condition called microscopic hematuria, in which the urine has microscopic amounts of blood that cannot be seen with the naked eye. In the majority of cases tests will be negative and no treatment is necessary. However, before you can make this diagnosis, other more serious causes must be eliminated.
    The most common cause of hematuria is a bladder infection, which is more common during pregnancy. Other possible causes include:

    • Kidney or bladder stones
    • Tumors in the urinary tract (urethra, bladder, ureter, or kidney)
    • Infection in the kidney (pelonephritis)
    • Infection in the urethra (urethritis)
    • Trauma (Fracture of the pelvis, bruised kidney, etc.)
    • Surgical procedures, including catheterization, circumcision, surgery, and renal biopsy
    • Certain drugs can also cause hematuria
      • anticoagulants
      • cyclophosphamide
      • metyrosine
      • oxyphenbutazone
      • phenylbutazone
      • thiabendazole

    Depending on the particular situation, tests that may be used to isolate the cause of the blood include:

    • Blood studies such as a CBC
    • Urinalysis
    • Cystoscopy
    • Kidney biopsy
    • IVP
    • Abdominal ultrasound
    • CT scan of the abdomen

    Blood in the urine should never be ignored. It is important to see your physician and have the problem isolated and treated.

What could cause blood in your stool or bloody bowel movements?

  • Blood in the stool or bloody bowel movements is also known as rectal bleeding. Most of the time rectal bleeding is due to non-serious conditions such as hemorrhoids or anal fissures (anal tears). However, certain serious conditions may present as rectal bleeding. These conditions include rectal cancer, colon cancer, polyps, and inflammatory diseases such as Crohn’s disease or ulcerative colitis to name a few.
  • It is of utmost importance to contact a doctor if you notice blood in your stool. If you are over 40, there is an increased risk of colon cancer. If your physician is concerned about the blood in your stool and there are no obvious causes (such as hemorrhoids), he or she may order several tests for further evaluation. These tests include anoscopy, examination of the anal canal and lower rectum for hemorrhoids and tears. If the results are normal, he may order a sigmoidoscopy or colonoscopy. Both of these tests involve placing a light into the rectum with a camera attached so that the inside of your rectum and colon can be viewed. If any suspicious lesions are present, your physician may biopsy them. Always contact a physician if you experience rectal bleeding.

How are hormones related to stress in women?

  • Stress affects our bodies in ways that we do not yet understand. Scientists know that many types of stress activate the body’s endocrine (hormone) system, which in turn can cause changes in the immune system, the body’s defense against infection and disease (including cancer). On the positive side for women, there is some evidence that women who breast-feed their infants produce lower levels of stress response hormones, such as adrenalin and cortisol, than do women who bottle-feed.

I have a small cyst on my right ovary. Should I be concerned?

  • The question you have asked is a very important one, but its answer is dependent on a couple of factors which you haven’t included. First, it is dependent on your age. Since you are continuing to have periods, I am assuming that these are “natural” periods and that you are not menopausal. If this is true, then having a small cyst on the ovary is not uncommon. In fact, you make a cyst each month as your follicle develops and you ovulate. If the cyst is classified as a simple cyst, meaning that it is fluid filled and doesn’t have any solid tissue included in it, no other treatment or follow-up is needed. If you were menopausal, the treatment would also be based on the size and type of the cyst. If the cyst is simple (no solid component) and less than 4.0 to 5.0 cm in size, the likelihood that the cyst is a cancer is extremely unusual. In some cases it might be helpful to obtain a CA-125 blood test. If this test is in normal range, the cyst is simple and small, and there is probably no reason to seek any additional treatment. You also asked whether you should talk with your gynecologist. Absolutely, you should always feel free to talk with your physician about any concern that you have.

I have been trying to get pregnant for about two years. My doctor told me he thought I had endometriosis. How would I know?

  • Endometriosis is a condition in which tissue that normally lines the inside of the uterus (the endometrium) spreads and implants in areas outside of the uterus. Often the site of the implantation is somewhere in the abdominal cavity. In patients with endometriosis, these implants of endometrium grow on a cyclic basis just as the normal endometrium does. When the normal endometrium sheds during your menstrual cycle causing your period, so do these endometrial implants. They can cause a small amount of bleeding within your abdominal cavity which results in pain.
  • Symptoms of endometriosis are often described as menstrual cramping and pain that begins before the onset of menstrual bleeding, and continues through the menstrual cycle. The severity of endometriosis often does not correlate with the degree of pain experienced with endometriosis. Often women with a small amount of endometriosis will have significant cyclic pain, and often women with a large amount of endometriosis will have minimal pain. Endometriosis is often seen in women who previously had pain-free menstrual cycles, and have gradually noticed a worsening in their pain.
  • The definitive diagnosis of endometriosis can only be made through surgery (laparoscopy) where the endometriotic lesions can be seen and sometimes biopsied to make the diagnosis.

I have had three bladder infections in the last three months. What should I do about it? Can these be prevented?

  • Bladder infections or urinary tract infections are also known as cystitis. Women often notice an abrupt onset of symptoms, which include burning with urination, urinating more frequently than usual, and abdominal pain. If a urinary tract infection has spread to the kidneys (also known as pyelonephritis) a woman may experience fever and back pain.
  • Urinary tract infections are caused by spread of bacteria that normally reside in the rectum into the urethra and bladder. Several situations increase your risk of getting a urinary tract infection, among them, recent intercourse, delayed emptying of your bladder after intercourse, and use of a diaphragm.
  • Many women with one urinary tract infection will have multiple urinary tract infections. Your physician will grow out your urine before and after treatment to be sure treatment is completely irradicating the bacteria. Additionally, it may be helpful to empty your bladder completely after each episode of intercourse. The ultimate treatment for recurrent urinary tract infections will be up to your doctor. She may recommend staying on a medicine that suppresses bacteria consistently, taking medication after intercourse, or taking medication as soon as you notice symptoms.

I am 38 years old. How often should I have a mammogram?

  • A mammogram is an important screening tool used in the prevention of breast cancer. Breast cancer is the second leading cause of death for women. Appropriate screening for this deadly disease is of utmost importance.
  • Several guidelines for mammographic screening are recommended. For women with no family history of breast cancer and no prior history of breast cancer, initial screening is recommended at 40 years of age. Although the benefit of breast cancer screening in the 40s is still under debate, the American College of Obstetrics and Gynecology recommends starting to screen patients at the age of 40. Between 40 and 49 years of age screening is recommended every 1 to 2 years. The benefit of breast cancer screening in the 50 to 69 age group has been clearly established. Women in this age group should receive yearly mammograms. Over age 70, the benefit of breast cancer screening has not been clearly established. Due to the increasing risk of breast cancer with age, however, most physicians still advocate yearly screening after 70 years of age.
  • You should have your first screening mammogram by age 40. Discuss the frequency of subsequent mammograms with your physician.

I am 51 years old and perimenopausal. Is there a type of vitamin that will give me more energy?

  • I would recommend a multivitamin. You may be noticing a decrease in your energy levels from the decreased calorie intake on your new diet. However, if the diet is continued, many women notice a subsequent increase in energy. I would reevaluate your diet to be certain that you are not leaving out any of the major food groups. Provided your diet is balanced, adding a multivitamin to your regimen should be adequate.

What are the effects of antibiotic use on birth control pills?

  • Some antibiotics and certain other medications have the potential to reduce the effectiveness of birth control pills. Some antibiotics slightly reduce the amount of hormones absorbed by the system.
  • Among the suspect antibiotics are those in the penicillin family, including penicillin, amoxicillin, and ampicillin; tetracycline, and related drugs such as doxycycline and erythromycin. Some epilepsy drugs, tranquilizers, barbiturates, anti-inflammatories, and laxatives may also reduce the effectiveness of oral contraceptives. The same effect may also occur if you have an intestinal illness that causes diarrhea or vomiting.

I would like to know the difference between taking oral estrogen/progesterone versus the patch?

  • The difference between oral hormones and transdermal hormones involves the route of absorption. Oral hormones are absorbed in the gastrointestinal tract and metabolized in the liver. Transdermal hormones, however, are directly absorbed into the blood stream. Therefore the difference between the two routes may account for some difference in gastrointestinal symptoms. Additionally, for people with elevated triglyceride levels, transdermal hormones have been found to be beneficial.
  • To date, hormone replacement therapy has not been linked to weight loss or weight gain. There is also no evidence to suggest hair loss or acne are related to the low levels of hormones supplied by hormone replacement therapy. The progesterone component of hormone replacement therapy has been associated with bloating. However, it is not safe to take estrogen without progesterone unless you have had a hysterectomy. Sometimes changing the type of progesterone used can be of benefit.
  • It is unlikely that changing from oral to transdermal hormone replacement therapy will improve all of your symptoms.

Is it possible for a woman diagnosed with Polycystic Ovarian Syndrome to become pregnant?

  • Polycystic Ovarian Syndrome is a condition associated with anovulation and was first described in 1935 by Drs. Stein and Leventhal. Thus, the condition is also known as Stein Leventhal Syndrome. As originally described, the condition was associated with decreased menstrual flow, hirsutism, and obesity. However, we now know that the condition is much more complex than originally described. The cause or the event that precipitates the problem is unknown. Because you are not ovulating on a regular basis, you are less likely to conceive. As a result, many women with Polycystic Ovarian Syndrome require medication in order to precipitate ovulation. In general, if you have no other problems that would contribute to infertility, the majority of women are pregnant within three to five cycles. As they say, ‘individual results may vary’ since everyone is a bit different. With this said, you should feel encouraged. Most women with Polycystic Ovarian Syndrome can have a very successful and healthy pregnancy.

How long should I wait for an accurate result from a home pregnancy test?

  • Q: How long should I wait for an accurate result from a home pregnancy test?
  • If your periods are normally every 28 days, then you will ovulate on Day 14. With that in mind, you would ovulate on the 10th. Again, if your periods occur every 28 days, your next period would be on the 25th. The home pregnancy test will detect pregnancy on or about the time for your next period. I would wait and see if your period starts on time. If it does, then obviously you are not pregnant. If it doesn’t, then repeat the pregnancy test.

I am concerned that I will not be able to have children in the future. Should I stop taking the pill after a certain period of time?

  • This a very common question asked by many women who are currently taking oral contraceptives. Women who use oral contraceptives have no reduction in their fertility once they stop taking the pill. There are a number of myths or misconceptions about the use of oral contraceptives. For example, you do not have to stop the pill or switch pills after a certain period of time. In fact, there is no reason to stop the pill until you are ready to have children. Furthermore, there is some evidence that using oral contraceptives actually helps to preserve a woman’s future fertility. For example, women taking oral contraceptives have a reduced incidence of endometriosis and have a reduced incidence of ovarian cyst formation. Unless you experience side-effects with the pill or you are ready to become pregnant, you should continue your oral contraceptives without fear of them reducing your future fertility.

What is the best time in a woman’s cycle to get pregnant?

  • Most women ovulate approximately 14 days prior to the onset of their menstrual cycle. Therefore, if you have regular 28-day periods, you should be ovulating on approximately Day 14. The best chance of pregnancy is 3 to 4 days before ovulation and approximately 2 days after ovulation. Therefore, intercourse during this time frame would have the highest likelihood of being successful. There are ways to test for ovulation such as measuring your basal body temperature or testing your urine for a luteinizing hormone (LH) surge. This may help a woman determine the time of ovulation if her cycle is irregular.

What do I do if I missed one or two days of birth control pills?

  • First, read the instructions that came with your pill. Generally speaking, if you miss one pill, take two pills the next day. If you miss two pills, take two pills on each of the next two days. It’s best to use a backup contraception method such as condoms for the remainder of the month.

Should I be tested for HPV?

  • If you are sexually active, you are at risk of exposure to human papillomavirus (HPV, or genital warts). Please discuss HPV testing with your doctor during your visit. When your Pap smear is performed the cells can be tested for HPV.

Should I get the HPV vaccine?

  • The HPV vaccine is recommended for adolescent girls who are not sexually active. Females who are sexually active may also benefit from the vaccine. The HPV vaccine is not recommended for pregnant women

When should I schedule my first prenatal visit?

  • If you’ve tested positive with a home pregnancy test, give us a call. We will schedule an appointment for you approximately eight weeks from your last menstrual period.

Is it safe to have sex during pregnancy?

  • For most women, there is no medical reason not to have sex during pregnancy. Unless your pregnancy is classified as high risk or if there are other safety concerns, you and your partner can have sex without fear of harming your baby.

Is it safe to exercise when I’m pregnant?

  • It is safe to exercise in moderation during pregnancy, unless your obstetrician advises against it. Some exercises can help with childbirth.

Is it safe to travel when I’m pregnant?

  • It is usually safe to travel by airplane up to 35 weeks into your pregnancy. If you need to travel after 35 weeks, check with your physician. To reduce your chances of getting a blood clot during a flight, get up to stretch your legs several times.

What medications can I safely take when I am pregnant?

  • Prenatal vitamins, which are now available without a prescription, are safe to take during pregnancy. For any other medications, vitamins, herbal remedies or supplements, check with your physician.

What medications can I take for a cold during pregnancy?

  • If you are pregnant and you get a cold, check with your physician before taking any over-the-counter cold or cough medications, especially if they contain aspirin or ibuprofen. In most cases, it is safe to take Tylenol (acetaminophen) for minor aches and pains. Saline nasal sprays or steam inhalation may help with congestion. Remember to drink lots of fluids.

What medications can I take for a cold during pregnancy?

  • If you are pregnant and you get a cold, check with your physician before taking any over-the-counter cold or cough medications, especially if they contain aspirin or ibuprofen. In most cases, it is safe to take Tylenol (acetaminophen) for minor aches and pains. Saline nasal sprays or steam inhalation may help with congestion. Remember to drink lots of fluids.

Should I get the flu shot when I am pregnant?

  • We recommend that you get a flu shot if you are pregnant during flu season. It’s safe to get a flu shot even if you are in the first trimester.

Is it safe to get my hair colored during pregnancy?

  • Since very little of the chemicals in hair dye are absorbed into your system, it’s probably safe to dye your hair during pregnancy. However, if you’re concerned, you might consider waiting until the second trimester, when your developing baby is less vulnerable. You might also consider streaking, highlighting, frosting or other options in which the chemicals have little or no contact with your scalp.

I have just started basal body temperature charts (BBT) in order to try to conceive. I had a temperature drop on day 14 and a rise on day 15. The rise just stood until day 22 and then started to drop below my cover line. How do I also detect the LH surge?

  • To be sure of ovulation, you need either a self-administered urine test called an ovulation predictor kit, or a blood test at your doctor’s office. If you use the ovulation predictor kit you should use it under the direction of your doctor.
  • By BBT, sometimes you can suspect ovulation by a small drop in temperature just before the rise in temperature in the progesterone phase. The finding is not that reliable to go by however, which is why most specialists recommend the ovulation predictor kit.

Based on the menstrual period, how can I figure out when ovulation occurs? I was told by a friend 15 days, but want to be sure. How long does ovulation last? I went off the BC pill and want to know during what period I can get pregnant.

  • A general way to figure out when ovulation occurs is to subtract 14 days from how often you have a period. (e.g., if menses occurs every 30 days, then 30 -14 = 16.) So on day 16 of your cycle (your cycle begins on the first day of your period) is the time ovulation is most likely to occur. Your most fertile period is 7 days before (because sperm hangs around in the cervical mucus for up to 7 days) and 2 days after ovulation. I hope this helps.

What are my chances of getting pregnant after discontinuing birth control pills? How long does it take? Can it be possible to get pregnant within a few weeks of discontinuing BC’s in the middle of the pack?

  • It is possible to get pregnant after you discontinue your birth control pills. It may be as high as a 20-30% chance on your first cycle after the pills, assuming you didn’t have any problems with skipping periods prior to going on the pill. In fact, you can get pregnant on your BCP’s but the chances are very low. Once you stop the pills your cycle will begin and allow you to continue a regular cycle. About 60% of women get pregnant within 6 months of trying and 80% within one year.

What are some suggestions as to the best time to become pregnant?

  • Your fertile period is 7 days before and 2 days after ovulation from the ovary. Ovulation from the ovary usually occurs 14 days BEFORE your next menstrual period (range 12-17 days). If you have very regular menses starting every 28 days.then most likely fertile period is day 7 after start of menses (7 days before ovulation) to day 16 after menses. The problem becomes if your menses are not always that regular, the timing gets changed. To optimize pregnancy chances, having intercourse every other day (at least) starting on day 12 thru day 16 (or longer if your cycle is sometimes longer than 28 days).
  • While the above are general rules of thumb, ovulation prediction has become much more sophisticated. You may want to discuss these with your doctor.

I miscarried very early in my pregnancy, at about 4 weeks. Is there some amount of time I should wait before trying to conceive again? I have heard anything from no time to 3 months.

  • There has always been concern, with data to support it, that if a woman gets pregnant sooner than about 6 months after a previous pregnancy, the complications such as low birth weight, placental problems and preterm labor are more frequent than in a woman who has waited longer after her pregnancy to become pregnant. There are many factors involved in the choice or circumstances of becoming pregnant. Also, we do not know if the outcome after a previous term pregnancy is going to be the same as after a pregnancy that miscarries.
  • You would think that it would be easy to determine when the best time is to get pregnant after a miscarriage to minimize a future miscarriage (spontaneous abortion) or minimize a problem with a low birth weight or premature infant. It is not easy however, because the decision to try to conceive depends upon many factors which are influenced by a woman’s previous reproductive performance. If a woman knows she has difficulty conceiving or is getting older and feels time is running out, she will try to conceive as quickly as possible after a previous pregnancy loss. We know that women who are older or who are subfertile will have higher miscarriage rates so if you include their data, it will always look as if a short interpregnancy interval will lead to a higher miscarriage rate.
  • As far as getting pregnant after a miscarriage, you can start trying whenever you want because we do not know of adverse data following just a spontaneous miscarriage. In fact some older data implies that there is no increase in the abortion rate in women who quickly conceive following a previous spontaneous abortion. Following a pregnancy, it appears that the best time to conceive with the least frequency of complications is about 18-23 months. Under 6 months the percent increase in problems is enough that most physicians do not recommend becoming pregnant.
  • You may want to know what the chance of having another miscarriage is if you have had one or more already. Based upon clinically recognized pregnancies, not chemical ones, the chance of a subsequent miscarriage according to one study is:
  • • Overall general rate 11%

    • After one miscarriage 16%

    • After two miscarriages 25%

    • After three miscarriage 45%

    • After four miscarriages 54%
  • While the evidence does not clearly indicate that conceiving too soon leads to an increased incidence of miscarriage, there is indirect evidence that if you do get pregnant sooner than 6 months after a pregnancy of any type, that the outcome may lead to complications if pregnancy occurs. For that reason, I support taking a break of at least 6 months before trying to conceive again after a miscarriage. If you do get pregnant in that time, o.k. But don’t put nonstop pressure on yourself to conceive.

I recently had a tubal reversal, how long does it take for your tubes to be fully healed?

  • It takes about 4-6 weeks. Your doctor will probably have you wait two cycles before trying to get pregnant. miscarriage. If you do get pregnant in that time, o.k. But don’t put nonstop pressure on yourself to conceive.

My period is a month late. Is it too soon to take a pregnancy test?

  • If you have regular monthly periods and you are now one month late (i.e., 2 months since the first day of your last normal menstrual period); then no, it is not too early to take a pregnancy test. In fact if you are pregnant you would probably see a heart beat on ultrasound by now.

My mother had a complete hysterectomy at 45 because of fibroids. My sister 6 years younger than I, recently had a hysterectomy. She only had 1 fibroid but she said the lining was in pieces with ovaries o.k. Now I have the same problem, is this a hereditary problem

  • As far as we know, fibroids are not hereditary. They do have a strange genetic pattern, however, in that many fibroids are monoclonal (derived from the same cell). In other words, if a woman has multiple fibroids, sometimes all of those fibroids come from a single cell as if that cell were cloned. This has led some people to postulate that a virus is involved in producing the fibroid cells that then grow and replicate like a cancer, but in a controlled, non-invasive fashion. If that is true, (we’re really guessing) then people in the same family could be susceptible; not because of genetics, but because of exposure to the same virus.

Two days ago my doctor told me that I have an 8cm long, 4cm tall, 6cm wide fibroid. What’s most bizarre about this growth is that it isn’t in the uterine lining or in the uterus, but it’s attached to the outer part of my uterus by a stalk. I am going for more tests to monitor it, and am quite freaked out by this stalk (medical term is “pedunculated”)

  • Pedunculated fibroids are not as common as ones in the main uterine muscle but in a way they are less of a problem. The fibroid is a benign muscle growth, usually one cell that has just replicated itself over and over. It’s not a malignant or invasive process although sometimes they can grow quite big. The pedunculated ones generally do not cause abnormal bleeding because they are remote from the uterine lining sloughed each month during menses. The pedunculated ones can occasionally twist (torsion) and cause severe pain. For the most part though, they don’t usually produce many symptoms unless they are big enough to just cause abdominal fullness like a pregnancy feeling. A fibroid the size you describe may well be able to be removed laparoscopically alone or laparoscopically with a vaginal incision to deliver the fibroid rather than a major abdominal incision.