April, 2014

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What Your Home Pregnancy Test Can and Can’t Do

Monday, April 28th, 2014

If you have just noticed that your period is late, your first inclination may be to run out and buy a home pregnancy test (HPT). With various brands now purporting to be effective as early as the first day of your missed period, it’s understandably tempting. However, be aware that these claims may not always be exactly accurate. You can improve your odds of getting an accurate reading by being familiar with when and how to take one of these tests, but understand that HPTs are no stand-in for the reliability of a test administered by a doctor.  These tests are from the urine and are imprecise.  The pregnancy tests taken from a blood sample are more accurate and will allow your gynecologist to see a “trend” in the amount of hormones in your system, in case there is an equivocal result.

How Soon Can You Take a Home Pregnancy Test?

Don’t get too excited about those tests that claim to work before your period is even late. Wait until a little later for the best results – once your period is a week late, go ahead and test. By this time, if you are pregnant, you’ll have enough HCG (human chorionic gonadotropin, the hormone produced in your body when you become pregnant) in your blood for the test to detect. Earlier than this, some HPTs aren’t precise enough to detect the smaller amounts of HCG present in the first days of pregnancy.

False Positive/False Negative Results

There are several factors that could interfere with the results of an HPT, including the design of the test itself, taking the test too early, and certain medications such as fertility drugs. Both false negatives and false positives are possible, but false positives are much rarer.

A false positive could occur after taking a medication such as a fertility drug that contains HCG, or it could mean that there was a pregnancy that was lost very soon after the fertilized egg had attached to the uterine lining. An ectopic pregnancy may also produce a positive HPT result, and this requires immediate medical attention. Most often, however, a positive result indicates a normal pregnancy. Either way, a positive result warrants an appointment with your gynecologist.

A false negative result is more likely than a false positive. This means that your HPT will indicate that you aren’t pregnant when you actually are. This can be life-threatening, especially if you are pregnant in one of your fallopian tubes or your cervix or your abdomen (ectopic pregnancy).  The pregnancy may rupture in the fallopian tube or cervix and cause hemorrhage leading to death. You may end up with a false negative if you take the test too early, check the results too soon (without following the package directions explicitly), or using urine that is diluted – for example, if you have recently drunk a lot of water. That’s why even though many HPTs claim to be accurate at any hour, your best bet is to take the test first thing in the morning, when more concentrated urine boosts your chances of getting an accurate result.  In the final analysis, you need to have the result confirmed in a doctor’s office.

What to Do After Taking the Test

If the test is positive, make an appointment with your gynecologist to confirm the pregnancy with a pelvic exam and a blood test.  Of utmost importance is to confirm that the pregnancy is actually in your uterus and not an ectopic pregnancy where it has an increased risk of rupture and hemorrhage. The sooner prenatal care begins, the better, so make this call immediately.

If your test is negative, and you have missed a period, you need to make an appointment to see your gynecologist as soon as possible. There are lots of reasons why you may miss periods, including stress, weight loss, strenuous exercise, and illness. However, if you missed a period, you are pregnant until proven otherwise.    Read more about pregnancy tests and early pregnancy in my women’s health book, “Inside Information for Women”.


– Yvonne S. Thornton, M. D., M. P. H

Faced with an Unintended Pregnancy? Here Are Your Options

Thursday, April 24th, 2014

Half of all pregnancies are unintended.  Finding out that you are pregnant can be a shock even if you were trying – but even more so if you weren’t. If you have become pregnant without intending to, you have three basic options, but first take some time to let the news sink in and think about your choices. If you haven’t already, see your doctor as soon as possible to confirm the pregnancy. Then talk to him or her – or a counselor – to make sure you understand your options and are equipped to make the best decision for you. The choices you have are:

1. The Decision to Become a Parent

Parenting is both challenging and rewarding. The experience of growing a baby inside of you is unlike any other, and then you get to raise a child to be a unique individual with his or her own talents, interests, and personality.

If you choose this option, keep in mind that a good support system is essential. There are seemingly endless decisions to make: if you are single, will you marry the father? If not, what type of financial and parental support is he able to provide? Will you have the financial support you’ll need otherwise? How can you make raising a child fit in with continuing to strive for your personal long-term goals?

In addition to making choices about your future lifestyle and choices about parenting, there are even more immediate concerns, and those include the fact that you have gotten pregnant without first preparing your body and ensuring that you were doing everything you could to be as healthy as possible. Prenatal care is especially important, and be sure to discuss with your doctor any medications you have been taking, including herbal or “natural” supplements. You’ll need to start taking care of yourself and your baby immediately, but don’t worry – your chances of delivering a healthy baby are excellent.

2. The Decision to Place Your Baby for Adoption

Adoption has come a long way, so if raising a child isn’t a good option for you and abortion isn’t right for you either, you should be aware of the wide range of options available to mothers looking to place their babies for adoption today.

Benefits of adoption include being able to choose the adoptive family, having considerable control over many of the details that will affect your child’s future. You can also choose what type of relationship, if any, you would like to have with your child over the coming years. Remember that you can change your mind at any point in the process, up until the child is six months old in many states. Support groups and other counseling services can help you work through your feelings and feel good about your choice – whatever that choice turns out to be.

3. The Decision to Have an Abortion

The decision to have an abortion is never an easy one, but sometimes it is the right one. Learning about the different types of procedures and the risks they carry can help you make an informed decision.

Every woman’s situation is unique, and women choose abortion for many reasons, including not being ready to be a parent, not being financially able to support a baby, feeling that having a baby would make school, work, or caring for other children too difficult, being too young to be an effective parent, feeling that her family is already complete, having health problems, and having a pregnancy that is the result of incest or rape.

Talking to someone you trust who has had an abortion can be helpful, as can learning as much as you can about the laws in your state regarding abortion. Think about your values and your views on abortion, as well as your reasons for choosing this option. Talk to your doctor about any concerns you have about how an abortion might affect your health, relationships, or future fertility.

Unintended pregnancy is never easy, but getting as much information as you can about your choices, talking to someone who can help you through the process, and being honest with yourself about your individual situation can help you make the right decision for you.

– Yvonne S. Thornton, M. D., M. P. H

Making the Most of Your Annual OB-GYN Appointment

Monday, April 21st, 2014

Too often, women have a list of questions or concerns in their heads in the days leading up to an appointment with their doctors, only to forget most or all of them once in the exam room. Or, they leave the doctor’s office without feeling they received all of the information they needed. You don’t get a lot of time with your gynecologist, so it’s a good idea to be aware of some strategies for making sure you get as much as you can out of the visit. Here are some tips for making sure you and your doctor communicate well and that you get what you need out of your visit.

1. Know when your last period was. Mark it on a calendar and know the date – your gynecologist needs to know this. If you are experiencing irregular bleeding, a calendar tracking your periods as far back as possible is preferable.

2. For a couple of days before your visit, do not douche (which you should not be doing anyway) or have sex. Both of these things can interfere with the results of your pap test.

3. Bring a written list of all medications you are taking, including herbal supplements and vitamins. Know the doses and names of all of them.

4. Bring a list that you have prepared ahead of time of all questions you want to ask or concerns you want to bring up. Even if there are only a few items on the list, write them down – it’s too easy to forget them during the visit.

5. Ask for clarification. If the doctor says something you don’t fully understand, speak up. If you aren’t sure, repeat it back to the doctor in your own words to make sure you get it. Also ask if he or she can recommend any books or other resources for information on any condition you may have.

6. Be completely honest. Never lie about drug or alcohol use, your sexual history, or any other issues your doctor asks about, no matter how embarrassing the conversation may feel. Not being truthful can lead to a wrong diagnosis or the wrong advice.

7. If you need to discuss a specific problem you are having, take some time to make some notes before your appointment and know the answers to questions such as: When did the problem begin? What have you tried to improve your symptoms? What worked and what didn’t? Has any other doctor seen you for the condition; have any tests been done? What were the results? What makes the problem worse and what alleviates it? Include any information you can think of that might be relevant.

Most women don’t look forward to their annual gynecologic checkup, but it is one of the most important things you will do all year. Following these tips for making the most of your visit can ensure you get the highest quality care possible.

– Yvonne S. Thornton, M. D., M. P. H

Postmenopausal Bleeding

Thursday, 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

Monday, 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

Thursday, 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

Monday, 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

Thursday, 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.