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Bleeding during Pregnancy – What You Need to Know

Thursday, May 22nd, 2014

Vaginal bleeding during pregnancy is almost always a source of worry for a pregnant woman, but it’s not always a sign that something is wrong. Studies such as this one show that around 20% of pregnant women experience early bleeding, and little more than half of those pregnancies end in miscarriage.  Even in this study, the number of pregnant women may have been underreported and therefore, the true number of women who have bled in early pregnancy is not known.  However, it is a common occurrence, which must be investigated by your practitioner when it happens.

Less Serious Causes

One of the most common reasons for bleeding early in pregnancy is implantation. Implantation bleeding occurs around two weeks after conception and is the result of the fertilized egg burrowing into the endometrial lining. Sometimes this bleeding is mistaken for a normal period, so a woman may not realize she is pregnant until the following month. Those women who are Rh-negative should be very cognizant of this fact because what is believed to be a late normal period, actually may be a miscarriage in disguise and can cause problems for subsequent pregnancies with respect to alloimmunization. Please refer to my health book, “Inside Information for Women” for more on Rh-alloimmunization.

Other causes of bleeding during pregnancy that do not indicate harm to the fetus can include a cervix that is more sensitive and tender than usual, which can lead to bleeding, especially after intercourse. However, there is no way to know for sure what is causing your bleeding without an examination, so bleeding during pregnancy should always be evaluated by your doctor.

More Serious Causes

Ectopic pregnancy is another reason for bleeding early in pregnancy. These are pregnancies that implant in the fallopian tubes or other location outside the uterus. This type of bleeding may be accompanied by pain, either sharp pain or cramping, and lower-than-normal levels of hCG, or there may be no pain at all, that is, until it ruptures. Women who have had ectopic pregnancies before, pelvic surgery, or infection in the fallopian tubes are more likely to experience an ectopic pregnancy in a subsequent pregnancy. Untreated, an ectopic pregnancy can result in a ruptured fallopian tube, causing massive hemorrhage and may lead to death of the patient.

A miscarriage, which is the lay term for a spontaneous abortion, will also cause bleeding, and unfortunately, cannot usually be prevented or stopped. Most miscarriages occur during the first trimester (the first 12 weeks of gestation), and may cause vaginal bleeding, cramping, and the passage of tissue through the vagina. A miscarriage, while heartbreaking in many instances, is not a sign that the mother did anything wrong, nor is it a sign that future pregnancies are likely to end in miscarriage.

Bleeding in the second half of pregnancy is more likely than earlier bleeding to be caused by something serious. These causes can include placental abruption, or placenta previa. In placental abruption, the normally-implanted placenta separates from the uterine wall prematurely, such as after a motor vehicle accident or after a fall or other blunt trauma. In placenta previa, the abnormally-implanted placenta is positioned too low in the uterus, partially or completely covering the cervix. Any bleeding during pregnancy requires immediate attention in order to properly diagnose and treat the condition.

Again, to emphasize the importance of bleeding during pregnancy, let me reiterate: Any bleeding during pregnancy warrants an immediate call to your doctor to rule out serious causes or take appropriate measures to treat them.

– Yvonne S. Thornton, M. D., M. P. H

About Endometriosis

Monday, March 10th, 2014

Over five million women in the United States suffer from endometriosis. Most common in women in their 30s and 40s, it can occur in any woman who menstruates, and is one of the most common health problems experienced by women.

The word “endometriosis” comes from the word “endometrium,” the name for the lining of the uterus. Endometriosis is the condition in which this tissue is found growing in locations outside the uterus, such as the outside of the uterus, the ovaries, the fallopian tubes, or elsewhere.

Endometriosis Symptoms

Endometriosis often causes lower abdominal or pelvic pain, or lower back pain, mostly during the menstrual period. The amount of pain the woman experiences is not necessarily linked to the extent of the endometriosis; some women experience a lot of pain with just a few small growths, and other women may experience little to no pain even though large areas of their bodies are affected.

Other symptoms can include painful sexual intercourse, painful urination or bowel movements, bleeding between periods, infertility, fatigue, and gastrointestinal disturbances.

Endometriosis is not cancerous, but it can still present a number of problems. Growths can expand month by month, causing increasing symptoms. Untreated, endometriosis can cause scar tissue, inflammation, and increasing pain. It can block the fallopian tubes; it can grow into the ovaries. Cysts can form as a result of blood trapped in the ovaries. Adhesions, tissue that can bind organs together, can form as a result of scar tissue.

Risk Factors for Endometriosis

Women who have never had children, have longer than normal periods, shorter than normal cycles, a family history of the disease, and cellular damage caused by a previous pelvic infection are at higher risk for developing endometriosis.

The cause of endometriosis isn’t well understood, but theories include:

  • Genetics
  • Immune system disorders
  • Endocrine system disorders
  • Unintended relocation of uterine tissue during surgery
  • Exposure to certain chemicals
  • Reflux of endometrial tissue into the abdomen during a woman’s period

Diagnosis and Treatment of Endometriosis

Be sure to talk to your gynecologist if you have symptoms of endometriosis. Your doctor will most likely want to perform certain tests, such as a pelvic exam, an ultrasound, and/or exploratory surgery.

If endometriosis is found, there is no cure, but a number of treatments are available that can help with symptoms such as pain and infertility. Your doctor should inform you of your options and help you select the ones that best suit your individual condition.

Pain medications, hormone treatments such as birth control pills or GnRH agonists and antagonists, which reduce estrogen, and surgery (best for severe cases) are all possible treatment options. Surgery may involve the removal of growths and scar tissue, or it may involve removing the uterus altogether (hysterectomy).

Endometriosis can be difficult to cope with on an emotional level. Talking with other women who have endometriosis can help. is a good resource for information and support. Above all, talk to your doctor about your symptoms and your options; learn as much as you can, and follow your doctor’s recommendations for treatment. Many women with endometriosis are able to find significant relief.

You can find more information on endometriosis in my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

Why Aren’t IUDs More Popular?

Thursday, January 30th, 2014

The IUD is one contraceptive device that seems to not be getting a fair shake. Birth control pills, contraceptive implants, condoms, and surgical sterilization are all more popular, despite the fact that most of these methods are either permanent or require perfect usage by the woman – in other words, remembering to take the pill every day at the same time, or being able to consistently use a condom in the heat of the moment. (Disclaimer: you should always use a condom if you aren’t in a monogamous relationship, but if you are, and you know that you are both free of STIs, a contraceptive method that frees you from having to use condoms can be a welcome change.)

An IUD is a small device shaped like a T which your physician must insert into your uterus. There are copper IUDS available as well as hormonal IUDS which release progesterone; both kill sperm and make the lining of the uterus inhospitable to fertilized eggs. Once inserted, an IUD can be left in place and forgotten for five to 10 years, depending on the type of IUD used. (However, it can also be removed at any time the woman chooses.) The IUD’s string hangs out through the cervix to enable the woman and her doctor to occasionally check that the device is still in place correctly.

IUDs may be a great option for sexually active teens, because they don’t require the same level of attention that birth control pills do – you can’t forget to use your IUD. In fact, IUDs are an excellent choice for any woman who may want to become pregnant eventually, but who knows she is a long time away from being ready. In addition, IUDs are extremely cost-effective when used for a period of several years.

The use of IUDs does not interrupt foreplay the way some methods can; it also does not require the cooperation of your sexual partner. IUDs are perfectly safe for women who are breastfeeding, and when an IUD is removed, fertility returns immediately. The bottom line is that IUDs are extremely effective, extremely safe, and extremely easy to use.

In spite of these benefits, less than 4% of women choose IUDs as their birth control method. Why is that? Part of the issue may simply be that doctors are not recommending IUDs with great frequency, and therefore many women may not even be aware of the availability or the benefits of IUDs. Surveys show that many doctors (about 30%) have doubts concerning the safety of IUDs, such as the possibility that IUDs may increase the risk of infection or jeopardize fertility. These were common concerns when IUDs first appeared on the market, but it is now understood that these fears are unfounded and IUDs are safe for use.

– Yvonne S. Thornton, M. D., M. P. H.

What Is a Normal Period?

Monday, November 18th, 2013

Women, especially younger women, are usually anxious to know whether their bodies are normal. After all, the menstrual cycle isn’t something you bring up every time you meet another women, so it’s not likely you’ve conducted your own informal research to find out how your cycle compares to those of your friends. Many women have read in books or heard from someone else, like their mother or a doctor, that a “normal” cycle last 28 days and that bleeding lasts for five days. So when their cycle fails to match this textbook version, they worry. Or, women who have always had “normal” cycles see frequency or duration changes happen in their 20s, 30s, or 40s and become concerned that something is wrong.

The truth is that there is a wide range of normal ( when it comes to the menstrual cycle. “Average” means just that – the average of all the possibilities. In the majority of cases where a woman goes to her doctor concerned about menstrual changes or problems, there is nothing wrong. Irregular periods, especially in adolescents, are almost always normal. Even when a cycle is regular, it may be a 25-day cycle or a 40-day cycle, anything in between, or even something outside of this range.

It is a very good idea for women to maintain a calendar or chart in order to keep track of her cycle. This is imperative if a woman is trying to conceive, but even if she’s not, a chart can give her something more reliable than her memory to fall back on should she need to see a gynecologist for any related reason. She will need to be able to tell her doctor when her last period was, whether her cycle is usually regular, and any other information her doctor might need.

When a sudden change in a woman’s menstrual cycle does happen, there are several things that can cause it, such as weight gain or loss, beginning a new exercise program, stress, an interruption of the woman’s normal routine, or even just routine changes that happen with age.

When Concern May be Warranted

If a 16-year-old girl has had no periods at all, there may be a hormonal issue that needs attention. Likewise, when periods suddenly stop in women who have previously had regular periods, and pregnancy can be ruled out, an examination is in order to discover the underlying cause. Unusually frequent bleeding should be investigated to rule out polyps or hormonal issues. Severely painful cramps or unusually heavy bleeding should also prompt a woman to check with her doctor.

Anytime you have a question about whether or not something is normal, check with your gynecologist to be on the safe side. But realize that what constitutes a “normal” period simply means what is normal for your individual body.  Using that as an internal standard is the best definition of “normal”.  And, if something is different “your” normal, then you should seek medical attention as soon as possible.

– Yvonne S. Thornton, M. D., M. P. H.

Natural (and Not-so Natural) Ways to Ease PMS Symptoms

Thursday, August 29th, 2013

Any woman who has ever had premenstrual syndrome knows that it is real. It may range from barely noticeable to debilitating, and it changes from woman to woman and from month to month in the same woman. But for women who have come to expect it and live with it for a week or so every month, it is a significant challenge. And it doesn’t help when many people seem to believe it’s “all in your head.”

In my book, Inside Information for Women, I explained that PMS is the body’s response to excess hormones after ovulation if the egg is not fertilized. Different women’s bodies respond to these hormones differently, so the symptoms of PMS can vary greatly, but they may include bloating, acne, breast tenderness, fatigue, and volatile emotions, among other things.  Less commonly, PMS symptoms may become so severe that they interfere with a woman’s daily life – for example, her job or relationships. Women with preexisting psychological disorders seem to be more susceptible to this severe form of PMS, known as premenstrual dysphoric disorder (PMDD).

Fortunately, there are things you can try to alleviate your symptoms. There is no one-size-fits-all PMS remedy, so there will probably be some trial and error involved. Different women respond to different approaches, so be patient and figure out what works for you. Some things that might help are:

  • Getting enough sleep – at least 7 ½ hours a night will eliminate the added stress of being tired and help your body and mind function at their most efficient
  • Meditation and/or relaxation – to promote feelings of relaxation and well-being and relieve stress
  • Altering your diet – try eliminating refined sugar, caffeine, or alcohol to see if it has a positive effect on your symptoms
  • Working regular exercise into your routine – it doesn’t take much to enhance your heart health and make you feel stronger and more energized

But what about when these measures aren’t enough? What if you are one of the unlucky women who responds to the monthly hormonal surge in a more severe way? Ask your doctor about trying an antidepressant.  Studies show some success with SSRIs (selective serotonin reuptake inhibitors), for PMDD, with continuous use having the best effect.

Basically, get to know your own body. If you are having trouble with PMS, start with the above suggestions. You can even try keeping a journal of what you tried and how you felt during a given month. Maybe you will notice a trend and find an effective plan for handling your individual PMS. If not, there are effective medicines available.

– Yvonne S. Thornton, M. D., M. P. H.

Soy is the Secret to Hot Flash Reduction in Menopause

Monday, February 4th, 2013

There’s no sugar coating it – menopause is the pits. We become more and more irritable until our family members can’t take it, we wake up drenched in sweat in the middle of the night, and we can’t even sit through a movie without taking a few bathroom breaks. Many women would gladly take their periods back to avoid these uncomfortable menopause symptoms. While menopause is largely out of our control, a recent study shows that there is one symptom we can actually reduce by altering out diet.

Hot flashes and night sweats are both considered vasomotor symptoms. They’re caused by the reduction of hormones that are meant to regulate the dilation of your blood vessels. Menopause greatly decreases the levels of estrogen in your body, and your blood vessels will expand quickly for reasons unbeknownst to you in that moment. When the blood rushes through your body, you’ll feel as though you are suddenly sitting inside an oven, which is a hot flash. Night sweats occur for the same reason.

How can your diet control these symptoms? An adjustment in your dietary intake which includes decrease in caffeine intake and avoidance of hot, spicy spicy foods is an excellent start. Research shows that women who eat more soy in their diets experience fewer hot flashes and night sweats. Soy is one of the single best sources of phytoestrogens, which have been shown to have a modest effect on hot flashes, but there are no conclusive evidence-based or long-term studies. For that reason, younger women are advised against eating too much, as the human body can only take so much at a time. However, for women who are going through menopause and have less estrogen than ever before, soy may be the perfect solution. This could easily be the reason only 7% of Japanese women experience hot flashes during their menopause. Their diets are rich in tofu and natural bean ingredients. Considering 55% of American women suffer from vasomotor symptoms, it might be time to take the hint.

As if this news wasn’t good enough, adding more soy to your diet isn’t hard at all. Many of the foods that are rich in soy are also delicious and offer fun alternatives to the usual American diet. To get more soy, consider adding tofu, miso, soymilk, soy nuts, and soy sauce. However, I must admit that soy in these forms is an acquired taste.  I don’t want to be hypocritical, but my palate wasn’t too thrilled with soy intake.  Though it might take time to get used to these new tastes, if you’re not already used to them, they’ll all taste delicious when you consider the alternative.

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

Calcium Will Ease the Pains of PMS

Thursday, December 27th, 2012

It’s almost that time of the month. Your skinny jeans don’t fit, you’re crying about the dishes in the sink, and chocolate is all you want for dinner. Premenstrual syndrome (PMS) affects at least 85% of all women in some way. Some don’t have the same symptoms as others, but many women will have at least one as part of their cycle. You might get acne, tender breasts, fatigue, bloating, cravings, muscle pain, trouble with memory, irritability, mood swings, and anxiety all at once. In many ways, these symptoms interfere with everyday life by making even the most simple and mundane tasks more difficult. The fatigue can feel paralyzing, and the mood swings can make you feel like a monster. Even the most casual conversations can turn into fights or tear-jerkers.

For women who are predisposed to it, PMS is impossible to avoid. Sometimes, contraceptives can ease the symptoms, but other times they actually become much worse. There are also a few easy remedies you can try to ease symptoms, such as exercise and diet adjustment. By exercising, you release much of the tension and stress built up in your body, which will make each problem seem a lot less intense. Avoiding junk food and alcohol can also make symptoms fade away faster, but this only works for some women. However, there is one easy treatment for PMS that has been repeatedly proven to work in a clinical setting. An increased intake of calcium will help ease the symptoms of PMS. In the study, women who increased their intake by 1200-1600 mg every day had significantly less symptoms than before they began the supplementation.

Always consult with your doctor before making any changes to your diet, but increasing the amount of calcium you eat while you are experiencing PMS is easy. You don’t even need to pay for the supplements if you try adding more calcium-rich foods to your diet. Milk, yogurt, beans, tofu, kale, spinach, and orange juice are all excellent sources of calcium. When that time of the month rolls around and you feel too bloated to function and too emotional to face your friends, stock up on calcium rich foods to get over your PMS before it gets the best of you.

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

What Causes Breakthrough Bleeding?

Monday, December 24th, 2012

Vaginal bleeding outside the schedule of your normal menstrual cycle is always disconcerting. Many women feel a rush of panic when they notice blood on their underwear during a random trip to the bathroom, and rightfully so. Bleeding is usually a sign that something is wrong with us internally. If you’re not on birth control, you should see your physician immediately to make sure nothing is wrong and also to receive a pregnancy test. If you’re bleeding randomly and you are on oral birth control medication, this is probably breakthrough bleeding or spotting. Though it’s frightening, it’s actually not something you should be overly concerned about. It’s common, and it’s a harmless side effect of contraception. Of course, it will still be a surprise when you notice it, so learning the cause might help you feel less worried when you do notice a bit of abnormal bleeding while taking contraception.  As always, with breakthrough bleeding, abstinence or an alternate form of contraception is in order.

Studies show that breakthrough bleeding on contraceptives is caused by the hormones they produce, such as lower dose progestins, which are forms of synthethic progesterone. Since the 1960s , the estrogen dose in oral contraceptive has decreased from more than 150 mcg of ethinyl estradiol to 35 mcg or less. The reduction in dose of the hormone has reduced the incidence of venous thrombosis and clots but also increased the incidence of breakthrough bleeding because of the lower dosage.  Without enough hormone to stabilize the lining of the uterus, the lining prematurely sheds causing breakthrough bleeding (metrorrhagia).  Progesterone-only implants and vaginal rings particularly have an increase in the prevalence of breathrough bleeding, specifically with the active component of etonorgestrel.  To solve this problem, many women find it helpful to go on a different type of contraceptive with a different ratio of hormones to see if their body might react differently.

If you do notice large amounts of blood outside of your normal menstrual cycle, you need to contact your  gynecologist. Though it might be normal spotting caused by your birth control, there is also a chance that it could be a sign of something more serious, or even pregnancy. If you find out it is in fact caused by your contraception, speak with your gynecologist who may switch brands, doses or types of hormonal contraception. In addition to making you worry, spotting and breakthrough bleeding is extremely inconvenient, so the sooner you solve the problem the better off you’ll be.

You can read more about abnormal bleeding and contraception in my women’s health book, INSIDE INFORMATION FOR WOMEN, now in paperback.

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


It’s Called an Annual for a Reason

Thursday, August 2nd, 2012

It’s not news to OB/GYNs that women don’t exactly look forward to their annual exam.  We understand that it may feel more like a chore than a checkup when you’ve been told you have to do it every year.  Some experts though, have new recommendations, saying most women don’t need yearly cervical cancer screenings.  Before you start celebrating though, you may want to consider the many long-term benefits annuals have on your health.  As I have mentioned many, many times on this blog, ”A PAP SMEAR IS NOT A PELVIC EXAM.”

The new recommendations by the U. S. Preventive Services Task Force and the American Cancer Society were released March 15, 2012.   They recommend:

  • Women between ages 21 and 65 without risk factors (such as DES exposure or immunodeficiency) should undergo cytologic screening (a Pap smear) every 3 years.
  • Those aged 30 to 65 wishing to extend the screening interval could undergo screening with both cytologic exam and human papillomavirus (HPV) testing every 5 years.
  • Women younger than 21 should not be screened.
  • Women older than 65 who have been adequately screened previously should not be screened.

 The above recommendations may cause women to shirk going to their OB/GYNs for that dreaded pelvic examination because they are not having an annual Pap smear.

However, as we age, there’s no doubt our bodies change.  For the most part, those changes are normal.  Sometimes though, medical issues can develop.  Every time you go to an annual exam, you are getting checked to make sure everything is in healthy working order.  If you catch issues before they get too big, treatment and even cures can be more effective.  With the rise in so many types of cancer, you’ll want a professional checking to make sure there are no signs of tumors.  That is why pelvic exams, mammograms and cervical screenings are so important.  If you were to wait two or three years, it may be too late.  My health book, Inside Information for Women will explain all the aspects of a pelvic exam and an annual gynecologic examination.

You also have the chance during your visit with an OB/GYN to discuss your health and how it’s affecting your life, or how your life is affecting your health as the case may be, and that can bring up symptoms that you didn’t even realize were connected.  It can also provide you with valuable advice that will help you take care of your body.  With all the change people go through in a single year, it’s nice to know that someone with knowledge and compassion is there to make sure you remain in good health for many years to come.

The fact is women are such multi-taskers trained to take care of everyone that we forget to take care of ourselves. The point is, if we don’t take care of ourselves, we won’t be there to take care of others. Don’t have time for your annual checkup? It’s time that you find the time.


– Yvonne S. Thornton, M. D., M. P. H.

Early Menopause is Bad News for Women and Their Bones

Monday, May 7th, 2012

Let’s face it.  None of us looks forward to getting old, but we try to do it with as much grace as possible.  For some women though, menopause, a hormonal change that should come later in life, comes sooner than expected.  Instead of dealing with hot flashes, night sweats, mood swings and all the other symptoms of menopause in their 50s, they’re facing it in their 40s or even younger.  And as if early menopause isn’t bad enough, studies now show that it increases their risk for osteoporosis and even shortens their life expectancy.

Swedish researchers from Skane University Hospital in Malmo conducted a study of almost 400 women over the course of just under 30 years.  They found that of the women who started menopause before the age of 47, 56 percent developed osteoporosis compared to just 30 percent in the women who started menopause later in life.  Women suffering from osteoporosis are at greater risk for bone fractures, bone pain, and loss of height due to bone loss.  Their findings also showed that women who had undergone early menopause had a greater risk of fragility fracture and death with a rate 17 percent higher than the women with later menopause.  The rate of fractures in women with early menopause was 44% compared to 31% in those women who entered menopause later.

The cause of early menopause is not yet clear, though there seems to be a link between it and premature ovarian failure, hysterectomies, chemotherapy, and possibly even stress.  Premature ovarian failure has been associated with Fragile X syndrome, so there may be a genetic link. Unfortunately, preventing and reversing early menopause is not yet possible, but there are ways to decrease your risk of osteoporosis.  The bone masses of most women peaks in their 20s.  You can increase yours by getting plenty of calcium, vitamin D and exercise.  A balanced diet and thirty minutes of weight training or other moderate exercise every day can make big difference when it comes to your bone health.

The association found between early menopause, osteoporosis, and death is causing some to call for more studies to determine a more definite correlation. The higher mortality rate in women with early menopause does need further study in order to address the confounding variables, such lifestyle, medications and smoking.  In the meantime, we should take the results as a warning to take care of our bodies, particularly our bones, as early as possible.

— Yvonne S. Thornton, M. D., M. P. H.