Postmenopausal Bleeding

Written by yvonnethornton on April 17th, 2014

Once you have gone through menopause (and it has been a year since you’ve had a period), you should not be bleeding. More conservative doctors consider bleeding after six months of not bleeding to be a potentially worrisome sign. Not even spotting is considered normal after menopause, and should be evaluated by your doctor as soon as possible. Some of the conditions that can be responsible for postmenopausal bleeding include:

Polyps: These typically benign growths can develop on the cervix or in the uterus and can cause bleeding.

Endometrial atrophy: This is the thinning of the tissue lining the uterus, the endometrium. After menopause, lower estrogen levels are responsible for this condition, which can be a cause of unexpected bleeding.

Endometrial hyperplasia: Sometimes, when too much estrogen and too little progesterone are present, the endometrium can thicken, and this can cause bleeding.

Endometrial cancer: Endometrial or uterine cancer can cause bleeding. This is most common between the ages of 65 and 75.

Other potential causes for postmenopausal bleeding include infection, hormone therapy, certain medications (blood thinners, for example), and other types of cancer besides endometrial.

In order to find the reason for your bleeding, your doctor will want to take your medical history, perform a physical examination, and perform some tests. These tests may include a transvaginal ultrasound, a biopsy, a hysteroscopy (in which the inside of your uterus is examined with a small camera), a sonohysterogram (which is a transvaginal sonogram with saline solution instilled into the uterine cavity) or a D&C (dilation and curettage; during this test, uterine tissue is removed and sent to a lab to be analyzed).

Which treatment your doctor recommends will depend on the cause of the bleeding. If you have polyps, surgery may be necessary to remove them. Medication is typically used for endometrial atrophy; endometrial hyperplasia may call for both medication and surgery aimed at the removal of the thickened endometrial tissue.

What If It’s Cancer?

If it is determined that you have endometrial cancer, your doctor will probably want to perform a total hysterectomy, a surgical procedure in which your uterus and cervix are removed. Other parts that might need to be removed include the ovaries, fallopian tubes, part of the vagina, or nearby lymph nodes. You may also need radiation, chemotherapy, or hormone therapy.

Just keep in mind that while irregular bleeding during perimenopause can be normal, bleeding after menopause isn’t. Even if it’s very light, postmenopausal bleeding warrants an immediate call to your doctor to have it checked out. Chances are good that the bleeding is being caused by a minor problem, but there is always the chance that it could be something more serious. And if it is cancer, the earlier it is treated, the better, so don’t ignore even very light postmenopausal bleeding.

Read more about the menopause and other natural changes in your body in my health book, “Inside information for Women”.

- Yvonne S. Thornton, M. D., M. P. H

 

Understanding Group B-Streptococcus in Pregnancy

Written by yvonnethornton on April 14th, 2014

Group B β-Streptococcus (GBS or GBBS ) is a bacterium commonly found in the rectum, and vagina. Group B Β Streptococcus  should not be confused with the bacteria that causes strep throat (Group A); these are two different types of bacteria. Group B β-Streptococcus  infection is not generally serious for women and can usually be treated easily with antibiotics. But things change when a woman becomes pregnant.

There isn’t a surefire way to keep from passing Group B β-Streptococcus  from mother to baby during delivery. Group B β-Streptococcus  infection can be fatal to a newborn, and although this is rare, it does happen. That’s why it’s so important to do everything possible to minimize the risk.

Group B β-Streptococcus is one of those bacteria that a woman can carry without realizing it. Although it is transmitted sexually, it is not considered to be a sexually transmitted disease, like gonorrhea or syphilis. The chances of passing the bacteria on to the baby during delivery are high, but most babies are not affected. However, a small number will develop a Group B β-Streptococcus  infection, which can cause problems ranging from the mild to the severe, perhaps death.

Screening for Group B β-STREPTOCOCCUS

Some doctors choose to routinely test every pregnant patient for Group B β-Streptococcus between 35-37 weeks of gestation and treat the ones who test positive for the bacteria with antibiotics at the beginning of labor. This is the method that has been shown to be the most effective at catching Group B β-Streptococcus  colonization and preventing infection in newborns.  Because the urine in the bladder is sterile, any Group B β-streptococcal infection found on a urine culture indicates that the mother is a “colonizer” and she will need antibiotics during her labor.

Some doctors, however, choose to treat only mothers who are at high risk for passing Group B β-Streptococcus on to their babies. These women include those who go into labor prematurely, those whose membranes rupture early and labor looks like it will be long, those with unexplained fever, those who have had a baby with Group B β-Streptococcus  infection before, and those who have or have had a kidney or bladder infection caused by Group B β-Streptococcus.

The test itself is simple and painless, and involves inserting a special cotton swab into the woman’s vagina and rectum. The swab is then placed in a solution in which the bacteria will grow if present. This is called a culture.

Treatment for Group B β-STREPTOCOCCUS

When an expectant mother tests positive for Group B β-Streptococcus , or is at high risk for passing it on to her baby, she is given antibiotics when she goes into labor. Giving the antibiotics earlier on, during pregnancy, is not as effective, as this allows the bacteria time to re-grow before delivery.

As for babies, they can develop one of two types of infections. The most common (and most dangerous) is early-onset disease, wherein the baby is infected while moving down the birth canal. Symptoms of this type of infection appear during the first week of the baby’s life, and the infection can be severe and difficult to treat. Antibiotic treatment during labor is designed to prevent this type of Group B  β-Streptococcus  infection in the baby.

The other type of Group B β-Streptococcus  infection is late-onset disease, and babies do not show symptoms of this until after their first week. These babies may have contracted the disease from their mothers during delivery or from contact with her or someone else carrying the disease after birth. This type of infection is not prevented by antibiotic use during labor, but can be treated with antibiotics after the baby is born.

However, whether early- or late-onset, Group B β-streptococcus is an infection not to be taken lightly and could result in disastrous results for your newborn.  So, make sure you keep your prenatal visits during the last weeks of your pregnancy in order to be tested for Group B β-streptococcus.

- Yvonne S. Thornton, M. D., M. P. H

 

Newly Discovered Dangers of Secondhand Smoke

Written by yvonnethornton on April 10th, 2014

Researchers already know that secondhand smoke, or passive smoking, is linked to myriad risks, including an increased risk of hearing loss, diabetes, and obesity. Now they have discovered new risks to add to the growing list: the increased risk of ectopic pregnancy, miscarriage, and stillbirth.

The new study points out that while smoking during pregnancy is known to be related to a higher risk of birth complications and miscarriage, more information was needed to determine whether passive smoking by pregnant women has similar effects. The study included over 80,000 women who had been pregnant at least once and gone through menopause.

Some of the women were current smokers (around six percent), some were former smokers, and some had never smoked. The women who had never smoked (or, more specifically, had smoked fewer than 100 cigarettes in their lifetimes), were divided into groups according to their secondhand smoke exposure as children, adults at home, and adults at work.

The study found that women who had been smokers during their reproductive years had a 44% higher risk of stillbirth, a 43% higher risk of ectopic pregnancy, and a 16% higher risk of miscarriage than the women who had never smoked and had not been exposed to secondhand smoke.

This was probably not a huge surprise to anyone, but the really interesting results were found in the group of never-smokers. The ones who had experienced secondhand smoke exposure also had a higher risk of miscarriage, stillbirth, and ectopic pregnancy compared with the ones who had never smoked and had not been exposed to secondhand smoke. In addition, the increase in risk was directly related to the level of secondhand smoke exposure the women had experienced.

The women with the highest levels of secondhand smoke exposure – over ten years either as a child, as an adult at home, or as an adult at work – had an extremely elevated risk of miscarriage, stillbirth, and ectopic pregnancy. The risk of having an ectopic pregnancy was a whopping 61% percent greater than that of women with no cigarette smoke exposure, and they were also 55% more likely to have experienced a stillbirth and 17% more likely to have had a miscarriage.

With many states enacting bans on smoking in public places and places of business in recent years, we are certainly headed in the right direction. However, the new research certainly highlights the need for more progress, especially in the states that still have no bans on smoking in public places whatsoever, in order to further protect women and their future babies from secondhand smoke, which appears to be even more harmful than previously thought.  

- Yvonne S. Thornton, M. D., M. P. H

 

Getting the Facts on Genital Herpes

Written by yvonnethornton on April 7th, 2014

Herpes is a common sexually transmitted infection (STI) caused by one of two types of viruses, herpes simplex type 1 and herpes simplex type 2, and that anyone who is sexually active can get. Most of the time, individuals with the virus have no symptoms, and it’s important to understand that even those with no symptoms can still spread it to sexual partners.

Of people in the United States between the ages of 14 and 49, about one out of six has genital herpes. It is spread through vaginal, anal, or oral sex with an infected individual. The fluid in herpes sores carries the virus, and infection can be the result of contact with those fluids. However, the virus can also be released through the skin, so you can even get herpes from someone who is not showing symptoms, or may not even be aware that he or she is infected. The flip side of this, of course, is that if you are the infected partner, keep in mind that you can still spread the virus to your sexual partner(s) even when you have no symptoms.

Realize that condoms may not fully protect you from herpes infection. That’s because outbreaks can occur in areas that aren’t covered by a condom. You should still use a condom every time you have sex, of course, unless you are in a long-term monogamous relationship and you and your partner have both had negative STI test results. The only other way to fully protect yourself from genital herpes is to avoid having sex.

Genital Herpes Symptoms

Herpes often causes no symptoms, or symptoms that are very mild. Mild symptoms may not even be noticed, or they may be mistaken for a skin condition such as an ingrown hair. This is why so many people have herpes and don’t know it.

When there is an outbreak, herpes causes sores that appear as blister(s) in the genital area. When the blisters break, they form painful sores that can take weeks to heal. The first time an infected individual experiences an outbreak, the sores may be accompanied by flu-like symptoms such as fever or swollen glands.

Genital Herpes and Pregnancy

Prenatal care is even more important for pregnant women with genital herpes. Be sure to tell your doctor if you have herpes or if there is any chance you may have it. Because herpes can cause pregnancy complications and is dangerous to your baby, it is important to avoid being exposed to it during pregnancy. At 36 weeks of pregnancy, women with a history of herpes are given an antiviral oral medication in order to decrease their likelihood of having a recurrence.  However, if any symptoms at all or evidence of a lesion are present when it is time for you to deliver, a cesarean delivery will most likely be performed.

If You Have Herpes

Herpes cannot be cured, but there are medications that can shorten outbreaks or help prevent them in the first place. Certain medications are also available that are taken daily and lower the likelihood that you will spread the infection to any sexual partner(s) you may have.

It is very important to inform any potential sexual partners of the fact that you have genital herpes and discuss the involved risks. Not having symptoms and using condoms are two things that can lower the risk of infection, but again, not remove it.

It is possible to spread a genital herpes infection to other parts of your body, such as your eyes, so you should not touch the sores or the fluid from the sores. If you do, you should immediately wash your hands.

Talk to your doctor about how herpes may affect your relationships and overall health, if these are concerns. Realize that while herpes isn’t curable, it is manageable. Talk to a doctor, take the medications he or she recommends, and be cautious about spreading the infection to others. You can find more information on this and other topics in my book, Inside Information for Women.

- Yvonne S. Thornton, M. D., M. P. H

 

Dropping Preschool Obesity Rates an Encouraging Sign

Written by yvonnethornton on April 3rd, 2014

The news is mixed when it comes to obesity rates in the United States. The good news is that the obesity rates in preschool-age children appears to be dropping. The latest data shows a decline in preschool obesity, from 14% to 8% since 2003. However, at the same time, obesity rates in women over 60 seems to be going in the opposite direction. The overall obesity rate hasn’t changed in the last ten years.

By analyzing data from the CDC’s National Health and Nutrition Examination Survey (NHANES), researchers determined that there has been a significant drop in obesity rates in two- to four-year-old children, particularly those from low income families who participate in federal nutrition programs. The news is encouraging because it means that there is hope for affording even more widespread and long-term changes.

One piece of information the new data does not provide is the precise reasons for the changes. However, in recent years, there has been an increasing initiative at both local and regional levels to provide enhanced opportunities for increased physical activity and improved nutrition in child care centers and schools, probably playing a role in the positive changes that are occurring. For example, consumption of sodas and other sugary drinks has declined, which is most likely one major factor.

The CDC also reported last year that only one in five adults gets enough exercise, something that could certainly contribute to the rising obesity rates in older women. Healthy adults over 65 should strive for the equivalent of 30 minutes of brisk walking five days a week plus strength exercises twice a week. Children need much more; those under 18 should be getting around an hour a day of aerobic exercise, plus muscle and bone strengthening activities.

However, it’s important to recognize that adding more exercise into your daily routine alone will most likely not be enough to achieve significant weight loss. If you have extra weight to lose, and you are ready to get started, realize that while exercise plays an important role, nutrition plays a much more important one. This is partly because many people overestimate the number of calories they burn exercising, or they are hungrier after they exercise and eat more to compensate.

Sometimes creating small changes in your diet may be all you need; others will need to make more dramatic changes. Either way, making the changes gradually will probably help you develop more lasting habits and ultimately see better results. Focus on natural, healthy foods, and try some helpful tricks such as eating more slowly, planning meals ahead of time, and getting more sleep, if you don’t tend to get enough. Lots of helpful information can be found here.

The bottom line is that the unchanging overall obesity rate means that there is an ongoing need for education and initiative. However, the decline in preschool obesity is an encouraging sign that the scales may be starting to tip in the right direction.

- Yvonne S. Thornton, M. D., M. P. H.

 

What Is Endometrial Ablation?

Written by yvonnethornton on March 31st, 2014

Endometrial ablation is a procedure in which a layer of the uterine lining is permanently removed in order to reduce or stop abnormal bleeding. The procedure is performed only on women who do not wish to have any more children. In some cases, it is performed in place of a hysterectomy.

The techniques used to perform endometrial ablation vary and include electrocautery, radiofrequency, cryoablation, and hydrothermal procedures, among others. The procedure is performed on women who are experiencing abnormal bleeding (bleeding between periods) or menorrhagia (prolonged or extremely heavy periods). Abnormal bleeding can be so severe in some cases that daily life is interrupted and some women may even develop anemia.

Reasons for abnormal bleeding and menorrhagia include hormone disorders or imbalances, fibroid tumors, polyps, or endometrial cancer. However, as stated earlier, the lining of the uterus is destroyed during ablation and is no longer able to function normally; therefore, bleeding is significantly lessened or even stopped entirely, and it is important to know that the woman also will no longer be able to become pregnant.

Endometrial ablation carries the same risks as any surgical procedure, including infection, bleeding, perforation of the uterine wall, or complications due to medication sensitivities the patient is not aware of (or neglects to inform the doctor of). In addition, women with certain medical conditions should not have this procedure, and these include vaginal infections, cervical infections, pelvic inflammatory disease, weakness of the uterine muscle, abnormal shape or structure of the uterus, and having an IUD in place, among others. In my health book, “Inside Information for Women”, I discuss this technique under “Resectoscopy”.  Endometrial ablation with cautery via a resectoscope or any other modality is a little tricky if the patient ultimately is found to have uterine cancer.  Why?  Because all the evidence regarding the extent of the disease (cancer) is burned away and the physician will have difficulty in staging the cancer, which is important in formulating the best management for a patient with uterine cancer. 

If your doctor and you decide that endometrial ablation may be right for you, your doctor should explain the procedure to you thoroughly and give you a chance to ask any questions you have. If you are to have a procedure that requires general anesthesia, you will be asked not to eat or drink before the procedure, most likely for at least eight hours or after midnight the night before. Be sure to tell your doctor if you may be pregnant, are allergic to any medications, or are taking any prescription drugs or herbal supplements.

Your procedure may take place in a hospital or in your doctor’s office on an outpatient basis. Recovery will depend on the type of anesthesia and the type of ablation used. In general, you can expect to need to wear a sanitary pad for a few days after the procedure, as bleeding during this time is normal. Also for the first few days, you may experience cramping, frequent urination, nausea, and/or vomiting.

Your doctor will probably instruct you not to use tampons, douche, or have sex for at least a few days. Usually restrictions on other activities are also necessary, such as heavy lifting and strenuous exercise. Let your doctor know if you experience fever, chills, severe pain, difficulty urinating, excessive bleeding, or foul-smelling discharge.

This information applies in general to most ablation procedures, but because each woman and situation is unique, the most important thing to remember is to follow your doctor’s specific instructions, and ask any questions you may have.

- Yvonne S. Thornton, M. D., M. P. H.

 

Dealing with Painful Intercourse

Written by yvonnethornton on March 27th, 2014

Pain felt during sex is known as dyspareunia, and it can cause a number of problems for you and your relationship. Besides the physical discomfort, painful intercourse can have emotional side effects as well, so this problem should be dealt with as soon as you become aware of it.

Causes of Painful Intercourse

Sometimes the reason for pain during intercourse is as simple as insufficient vaginal lubrication. Taking more time with foreplay or using a water-based lubricant will often solve the problem. However, sometimes there is a condition responsible for the discomfort that needs to be addressed. Conditions that may cause dyspareunia include:

  • Vaginal infections, such as a yeast infection or bacterial vaginosis
  • Menopause, which can cause a significant reduction in natural lubrication, as well as thinning of the vaginal tissues which can lead to discomfort
  • Vaginal dryness not caused by menopause – this can also be triggered by breastfeeding and certain medications
  • Injury to the vagina or vulva, such as a tear or episiotomy from childbirth, or
  • A sexually transmitted infection (STI)
  • Vaginismus, a condition in which the vaginal muscles contract involuntarily
  • Endometriosis, in which the tissues that normally line the inside of the uterus grow elsewhere
  • Problems involving the uterus, such as myoma (fibroid tumors)
  • Problems involving the ovaries, such as cysts
  • Problems involving the cervix, such as infection
  • Ectopic pregnancy

Treatment for Painful Intercourse

If you aren’t sure why you are experiencing pain during intercourse, a visit to your gynecologist is in order. For example, in the case of dryness caused by menopause, your doctor can prescribe estrogen creams or other medications. Most infections and endometriosis can be treated by your doctor as well.

When no apparent cause is found, therapy might be helpful. Sexual activity is deeply intertwined with emotion; therefore any type of negative emotion such as anxiety, depression, fear, or feelings of low self-esteem can play a role in painful intercourse. Issues such as guilt, negative emotions regarding past abuse, or conflicting feelings about sex can also cause physical reactions that make sex unpleasant. It can be difficult to tell whether pain has psychological or physical causes (or a combination), so a conversation with your doctor about all possible issues is the best course of action.

When you see your doctor, be sure to mention additional symptoms that you may be having in addition to pain, such as bleeding, irregular periods, genital lesions, unusual discharge, or involuntary contractions of the vaginal muscles, that may give him or her the clues needed to diagnose and treat your problem effectively.

- Yvonne S. Thornton, M. D., M. P. H

 

What Is a Pap Test Used For?

Written by yvonnethornton on March 20th, 2014

The term  “Pap test” or “Pap smear” is known by almost every woman in the United States.  However, over the past few years, its annual frequency has been questioned and the actual manner in which it is performed has been enhanced in many gynecologists’ offices. One of the components of a gynecologic exam that you have undoubtedly undergone is the Pap test (or Pap smear).  As stated in my health book for women and many times before on this blog, A Pap smear is NOT a pelvic exam.  The purpose of a pelvic (gynecologic exam) is to check all of your reproductive organs, which includes uterus, ovaries, vagina and vulva.  The Pap test is only to check for cellular changes in your cervix (the mouth of the womb) that may signal cancer or precancer. This is why regular appointments with your gynecologist are so important – because a precancerous condition can be treated before it becomes invasive cervical cancer, but the only way to detect a condition like this is with a Pap test.

Make no mistake – a Pap test can save your life. The chances of treating cervical cancer successfully are far, far higher when it is caught in its early stages. In most cases, precancerous cell changes can be treated before they ever become cancer at all. If you are wondering why you need a Pap test, or have been putting off making an appointment for your annual visit to the gynecologist, remember: a Pap smear is the absolute best way to prevent cervical cancer.

With that said, a Pap test is not recommended for women less than 21 years of age.  However, between the ages of 21 and 65, most women need an annual Pap test. Even though the American Cancer Society recommends Pap tests every three years, the American College of Obstetricians and Gynecologists recommends this screening test every year, because three years is a long time for cancer to grow and spread. Why wait three years when your cervical cancer could have been caught in its precancerous stage two years earlier?

Even if a woman has had a hysterectomy, she still needs a Pap test if her cervix is still in place, which is the case with certain types of hysterectomies (known as subtotal or supracervical hysterectomies). Either way, she still needs an annual pelvic exam; you can find more information on this in my book, Inside Information for Women.

To help ensure accurate Pap test results, you should not douche for a couple of days beforehand. That was a trick question, you should not be douching in the first place!!). Also avoid sex, vaginal creams or suppositories, deodorant sprays or powders in the vaginal area before a pelvic exam and Pap test.  Although some gynecologists prefer that the patient is not menstruating, a Pap test can be performed during your menses and they are not mutually exclusive.  If there are cancer cells present, they will be present whether you are menstruating or not.

What Does a Pap Test Involve?

The Pap test is done as part of the pelvic exam, and is very quick. The doctor places a bi-valved instrument called a speculum (hopefully warmed) in the patient’s vagina, which allows the cervix to be visualized.  The word “speculum” comes from the Latin “to see”. The doctor then uses a special brush (cytobrush) or swab (similar to a Q-tip) to collect cells from the cervix. These cells are placed on a slide and examined in the lab under a microscope. That is the traditional Pap smear.  Recently, liquid-based Pap tests have essentially replaced the conventional Pap smear.  In this test, after the cytobrush or the Q-tip has collected the cells from the cervix, it is submerged into a small vial of liquid preservative for transport to the laboratory, where it is then processed and smeared on the slide.  The presence of Human Papilloma Virus (HPV) can also be tested with this technology.  Some spotting is not unusual after a Pap test, but the test does not hurt. If the test shows a potential problem, your doctor will let you know that further testing is needed. Although this can be scary, remember that abnormal test results do not necessarily mean you have cancer.

Most insurance plans cover Pap tests as part of the gynecologic visit. However, if you are uninsured and not participating in the coverage afforded by the Patient Protection and Affordable Care Act, there are facilities that offer free or low-cost Pap tests

- Yvonne S. Thornton, M. D., M. P. H.

 

Trying to Conceive? Read This

Written by yvonnethornton on March 17th, 2014

Making the decision to have a baby can be overwhelming and frightening, but it can also be extremely exciting. Most people are able to conceive without difficulty. For some women, it happens very quickly, but for others it can take longer. Around 30% of women trying to conceive will do so within one month; 75% will succeed within six months. For some women, it can take as long as a year.

The first thing you should do is schedule an appointment with your gynecologist and inform him or her that you are planning to become pregnant. Talk to your doctor about any medical conditions you may have and how they may affect your pregnancy, such as diabetes, high blood pressure, heart problems, or a family history of any hereditary conditions such as sickle cell anemia.

Be sure to discuss any medications you are taking with your doctor, and do not stop taking them without talking to your doctor first, particularly if you are taking them for a medical condition. Obviously, you should not be taking any recreational drugs if you are trying to get pregnant; you should also avoid alcohol and tobacco, as should your partner.

Once you stop using contraception, your fertility will return to normal, as will your periods. There may be a short delay in ovulation after you stop hormonal contraception, but after this, your fertility will not be affected by these methods of birth control. It’s also fine if you get pregnant very quickly after stopping a hormonal method of birth control. This is not dangerous to your baby.

You can improve your chances of getting pregnant by making healthy lifestyle choices – both you and your partner.  I have found in my practice that if a woman is having difficulty conceiving and she is obese, the first order of business is to lose weight and to attain a normal body mass index (BMI = 18.5–24.9;kg/m2 ) before she pursues pregnancy.  One of the most important things you can do is to make sure you are eating a healthy, balanced diet. Eat a wide variety of fresh, whole foods to help ensure that you get all the vitamins, minerals, and other compounds you need. You should also have a pre-conceptional visit with your gynecologist and most likely (s)he will recommend you start taking folic acid (0.4 mg per day) – and not just an all-purpose multivitamin.

Some patients want to know when they can expect to be fertile. I personally believe that this is a recipe for disaster, i.e., trying to calculate when you are fertile rather than enjoying your partner and having intercourse at least three times a week.  My dictum is, “A watched ovary never ovulates.” Nonetheless, you may want to be familiar with your menstrual cycle. The “average” length of the menstrual cycle is 28 days, but this can vary pretty significantly from woman to woman and still stay within the realm of perfectly normal. The key is to know your individual cycle. Count the first day of your period as day one. If you haven’t already, start keeping track of this on a calendar (a menstrual calendar). After a few months’ worth of counting, you will get an idea of the timing of your menstrual cycle..

This is important, because ovulation will occur somewhere around 14 days before your next period starts, so this can give you an idea of when you will be most fertile. I am not a fan of patients sticking their fingers into their vaginas in order to assess their cervical mucus.  But, some are compelled to do so.  The character of the cervical mucus  changes with the timing of ovulation: around the time of ovulation, it becomes clear, slippery, and stretchy (Spinnbarkeit). At other times it may be creamier and thicker.  Whether thick or thin mucus, a patient should engage in sexual intercourse frequently throughout the month if she wants to conceive.

If patients want to get the Cadillac of tests detecting ovulation, they purchase an ovulation kit. These kits are used to test the urine for the luteinizing hormone, which will increase a day or so before you ovulate. If your partner feels forced into intercourse based on these ovulation kits (“performance anxiety”), then there needs to be a serious discussion about the ovulation kit’s effect on the dynamic of the relationship.  Many women find that these kits are unnecessary and that getting to know their own bodies and menstrual cycles is enough.

Despite their best efforts, many women aren’t able to get pregnant within the first few months of trying. Several factors can affect whether or not you conceive, including whether or not you ovulate (see your doctor if you think you might not be ovulating), whether implantation takes place successfully, your weight (obesity is a deterrent to conception, as is severe anorexia), your age (women over 35 may find that it takes longer to conceive), and the quality or quantity of your partner’s sperm.

If it seems to be taking too long for you to conceive (a year for most couples, six months or so if you are over 35), talk to your doctor about the possibility of fertility testing (for both you and your partner) to determine whether there is a physical problem that may need to be addressed. Finally, if you do conceive but have a miscarriage, the odds of you having a successful pregnancy in the near future are still very good.

- Yvonne S. Thornton, M. D., M. P. H.

 

Supplements No Substitute for Healthy Diet

Written by yvonnethornton on March 13th, 2014

Bad news for vitamin-lovers: it appears they are not helping you prevent cardiovascular disease (CVD). A study carried out by the American Heart Association concluded that “the scientific data [does] not justify the use of antioxidant vitamin supplements for CVD risk reduction,” and that there is no consistent evidence which suggests that consuming micronutrients in higher amounts than those found in a balanced, healthy diet is beneficial in regards to CVD risk reduction.

What’s more, your vitamin supplements aren’t helping you prevent cancer, either, as outlined here by the American Cancer Society. Other organizations such as the Academy of Nutrition and Dietetics and the American Academy of Family Physicians have reported similar findings. 

In most cases, vitamin supplements are not harmful, and the results of the latest research do not mean that supplements offer no benefits whatsoever. But if you are taking them to lower your risk of CVD or cancer, the newest evidence suggests that you are wasting your money.

There is currently no official recommendation on either taking or avoiding vitamin supplements for healthy individuals, with a couple of exceptions. One such exception involves beta carotene, which studies such as this one show can actually increase a smoker’s risk of lung cancer when taken in the high doses found in many supplements. This is in direct opposition to the previously popular belief that high doses of beta carotene were beneficial in cancer prevention.

What has been shown to have a beneficial effect on CVD and cancer risk is nutrition – a diet consisting of mostly vegetables, fruits, whole grains, low-fat dairy, and lean meats, particularly seafood. A diet like this offers plenty of fiber, antioxidants, and Omega-3 fatty acids. These nutrients offer a number of health benefits, including weight control, blood pressure control, and heart disease and cancer prevention. What the new studies show is that if you are hoping that your vitamin supplements allow you a bit more leeway in your diet, you’re shortchanging yourself.

What about Prenatal Vitamins?

It’s important to note that these studies do not mean that women who are pregnant or planning to become pregnant should toss all of their supplements. Folic acid should be taken to help prevent neural tube defects; the prenatal multivitamins prescribed by a woman’s doctor should be taken as directed. Also make sure your doctor knows about any vitamin supplements you are taking, because some can be harmful. High levels of vitamin A, for example, may be linked to birth defects.

And again, just because you are taking a prenatal vitamin – which you should if you are pregnant – does not mean your diet is not important. Healthy, natural foods contain many compounds not found in supplements, so a combination of prenatal vitamins and a healthy diet will help protect your baby as he or she develops.

- Yvonne S. Thornton, M. D., M. P. H.