May, 2009 browsing by month


When are irregular periods or spotting cause for concern?

Friday, May 29th, 2009

Are your periods coming at different intervals than in the past? And, if so, should you worry?

That depends.

Some women have regular periods every two months. Others have regular periods every 21 days. So, if your periods aren’t on a 28-day schedule, it may not be a problem at all, as long as it’s regular for you. And your cycle’s schedule may change over time. In your 20s, you may menstruate every 30 days, then every 33 days in your 30s. In  your 40s, the intervals could change again. There’s no one-size-fits-all cycle.

If you’re used to getting your period every 28 days and it’s now 45 days without a sign of menstruation, the first thing you should do is to see your gynecologist.  A blood test (not urine testing) for pregnancy would probably be ordered.

But what if you haven’t been sexually active? Ask yourself, what else in your life has changed? Have you been on a starvation diet? Undergone some very stressful event? If so, mention these changes when you discuss your menstrual cycle with your doctor.  The menstrual irregularity may be the first sign of thyroid dysfunction, or other metabolic or endocrine disorders.

The “take home” message here is that you should always be sure to keep an accurate menstrual calendar every month so you can tell your doctor when your period started, when it ended, when you had intercourse, and when you have spotting.

Speaking of spotting between periods, sometimes it’s a sign of a problem but often it’s not. Certain women will spot right in the middle of their cycles, when they ovulate. This sort of spotting can be perfectly normal. There’s even a German name for it: mittelschmerz,  But, if it continues, even in the middle of your cycle or if you’re spotting at odd intervals, like three days after your period ends, it’s time to make a gynecologist’s appointment.

– Yvonne Thornton, MD, MPH

Why newborns wear hats in the nursery

Wednesday, May 27th, 2009

When I began my faculty OB practice at The New York Hospital-Cornell Medical Center Lying-In Hospital in 1982, I made sure that all the babies I delivered were outfitted in little Thinsulate® turbans: blue for boys; pink for girls.

At first, some of the other obstetricians thought this looked a bit strange but I wasn’t making a fashion statement. Newborns can have difficulty stabilizing their body temperature when they first leave the womb. There is a precipitous drop in temperature from in utero existence (~99 degrees F.) to room temperature 72 to 75 degrees F. in the delivery room and the nursery. Up to 50 percent of your new baby’s body heat can escape through the head as he or she adjusts to life outside mom’s cozy body. This heat loss differential is lessened by drying the infant, placing him or her under a radiant warmer and covering its head.

Today, almost all hospitals cover newborns’ bald little noggins to compensate for this heat loss. As a side benefit, they do look cute in their blue and pink caps.

– Yvonne Thornton, MD, MPH

Those scary “ask your doctor” commercials

Friday, May 22nd, 2009

You know the ones. The narrator tells you that, if such and such happens to you, say, you get two eyelashes caught in your eye per week, you may have eyelash-balding disease (okay, I’m making this up but, you know what I mean). Often, the commercial is about some disease you’ve never heard of before. Or maybe, it tells you about a new medicine for a health concern you already have.

Should you “ask your doctor” to write a prescription for the “medicine-of-the-month”?

Maybe a few other questions should be answered first. Has the narrator of the commercial examined you? Factored in whether the trade-off between symptomatic relief and side-effects is worth it? Compared it to your current prescription and determined, based on your health history, that this is a superior choice?

Well, of course not. The narrator is an actor, paid to convincingly read a script that is meant to do one thing only: sell stuff.

So, think twice before responding to direct-to-consumer advertising about prescription medications. When it comes to marketing these new drugs, the “consumer” should be the physician, who has knowledge of your health history and needs, as well as specialized training and understanding about the potential benefits and risks of drugs. The drug company has a vested interest in selling you their product. And remember that we’ve seen significant consequences with former “medicines-of-the-month,” such as Vioxx or Phen-fen.

If you’re concerned about a symptom, or if your current medication isn’t working as well as you’d hoped, make an appointment with your doctor. Ask your doctor about side-effects including how a medicine interacts with other prescriptions or nutritional supplements you are taking or if your medical history precludes its use.

Remember, you can’t diagnose yourself based on a commercial or an article in a magazine (or a blog post, even one written by a doctor).

So, go ahead, ask your doctor. Just be sure to ask the right questions. Don’t simply ask for a prescription based on what you saw on TV.

– Yvonne S. Thornton, MD, MPH

Can you use the “morning after” pill as your main form of contraception?

Wednesday, May 20th, 2009

Some women wonder whether, since the morning after pill (a.k.a. “Plan B”) can prevent pregnancy, they can take it whenever they have intercourse and skip other forms of contraception.

Here’s the short answer: No.

Okay, now for the longer answer. Plan B delivers a wallop of hormones – at least twice the amount that you’d get in a high dose birth control pill. We doctors just don’t know what effect such a massive dose of hormones might have on a woman’s body over time, including an increase in the risk for blood clots and strokes. That’s because there have been no studies done on using the morning after pill as anything but a one-shot emergency contraceptive.

If you try to use Plan B as ordinary contraception, you will be, in effect, going into the “do-it-yourself” research business, with yourself as chief guinea pig. You’ll be risking your health while not developing a responsible approach to birth control. There are plenty of effective, tested contraceptives on the market. Use this medicine only for the purpose it was intended to serve.

– Yvonne S. Thornton, MD, MPH