November, 2012 browsing by month


What to Do about Bloating during Menstruation

Thursday, November 29th, 2012

Especially for women trying to lose weight through diet and exercise, fluid retention during each menstrual cycle can be especially disheartening. More commonly known as “bloating”, fluid retention will make your favorite jeans too tight and will make the numbers on the scale creep up more than you’d expect. Luckily, bloating is no indication of your actual weight, and it’s quite literally excess water in your body that has been stored between layers of tissue. During your period, your body holds on to this water because of hormonal changes and minor swelling of the tissue.  It is extremely common during menstruation, but it can be even more inconvenient than the usual cramps and back pain.

The only way to ensure that your bloating won’t get in the way of any major events is to plan those events around your period. You won’t want to try squeezing your bloated belly into your wedding dress or honeymoon bikini on the big day, but you’ll probably have planned your wedding around your period anyway. However, if you need to deal with bloating for one reason or another, there are some home remedies you could try to ease the discomfort.

First, make sure you eat a healthy and balanced diet during menstruation. Cut back on salt and sodium, as these will make your body retain even more water. Eat more vegetables and less fat and sweets to keep the fluids in your body moving properly through you. Next, exercise through your menstrual cycle. Not only will this ease any cramps you might have, but it will also help you sweat out the excess water trapped in your tissues. Although it seems counterintuitive, make sure you drink plenty of water. Proper hydration will keep the rest of your system working properly, so that when your period is finally over, the bloating will subside quickly and without incident.

Bloating is the modern woman’s worst nightmare. Months of exercise and healthy eating seem to go down the drain as menstruation begins and your designer jeans won’t even make it to your waist.  Luckily, the home remedies listed will help relieve the fluid retention somewhat. Until the relief kicks in, there’s no shame in sweatpants.

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


Should You Stop Smoking to Start Birth Control?

Monday, November 26th, 2012

You already know that smoking is bad for your health. If you’re a smoker, you’re already making the choice to ignore certain health warnings that could significantly alter your health for the rest of your life, and that’s a choice that no one else can make for you.  My telling you about all of the risks associated with smoking cigarettes would be a waste of time. However, I do feel it’s important that you know the increased risks associated with oral contraceptives for women who are smokers.

For the most part, modern oral contraceptives are safe. Even problems that have been tied to birth control for decades are now less common as the medicine improves and doctors work towards making the pill safer and with fewer side effects. However, by smoking while taking contraceptives, you’re increasing your risk for complications in multiple ways. Blood clots and stroke are both much more common in women taking birth control and smoking, especially in women who are 35 years old or older.  In fact, there is a ten-fold increase of death attributed to cardiovascular disease and the use of oral contraceptives in women who smoked above the age of 35 years.  [Link:]

The biggest risk for women who are smoking while on the pill is any cardiovascular complication and you’re increasing your risk by simultaneously restricting your blood vessels with the tobacco. The exact mechanism is not known as to the etiology of the increased risk, but according to a recent study, the risk of death due to such complications is low for women under 35 years old. Women who smoke while taking birth control are at a higher risk for heart attacks, high blood pressure, and increased blood vessel tension.

I’m not going to tell you to stop smoking, though as a physician, I certainly think you should. However, I urge you to take a closer look at the risks and benefits when it comes to combining your birth control with tobacco. If you feel that you need to continue smoking while taking your  oral contraceptives, consider looking other types of birth control that don’t use hormones, such as an intrauterine device or even the old tried and true diaphragm.

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


How Kegel Exercises Can Help You Long after Birth

Thursday, November 22nd, 2012

Of course you’ve heard about Kegel exercises before. In fact, you probably did some of your own when you were pregnant. When you perform Kegel exercises, you strengthen the floor of your pelvis, which is an excellent way to prepare your body for birth and push more effectively in the delivery room when the big day finally arrives. Believe it or not though, Kegel exercises can be helpful even if you’re not planning on giving birth any time soon. Actually, they’re extremely helpful for women going into menopause. Studies show that Kegel exercises are a great way to prevent incontinence.

As we get older, our ability to hold in urine when we really have to go lessens. It’s simply a part of aging, and it usually comes on during menopause. Whether you’re having a laughing fit with the girls over brunch or rushing to the bathroom at a crowded sports game, you just won’t be able to hold it in like you used to. It’s common and nothing to be ashamed of, but regular Kegel exercises will improve your ability to hold it until you find a bathroom.

Your physician can help you learn how to do Kegel exercises if you’ve never done them before, but once you get the hang of it you’ll be able to do them anywhere.  Your daily Kegel routine will involve contracting and relaxing the muscles for a short period of time every day.  As stated in my women’s health book, Inside Information for Women, it takes about one to two hundred repetitions a day in divided segments of twenty at a time.  It’s important that you don’t do your Kegel exercises while urinating though, as this could lead to a urinary tract infection. Never interrupt the flow of urine once it begins. These exercises are especially helpful in obese women who have reached menopause and are experiencing incontinence.

It makes sense that Kegel exercises can help you better control the flow of your bladder. Just like any other muscular exercise, you will become stronger over time and have more control in general. The best part about the exercises is that you don’t need a gym or even privacy to do them. They are extremely discrete, so you could even do your routine at your desk or anywhere else you can sit comfortably. Of course, speak with your physician if your incontinence is seriously affecting your daily routine, but if it’s only a minor inconvenience, Kegel exercises might be the only treatment you need.

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

Stopping UTI’s before They Start

Monday, November 19th, 2012

I could tell you that urinary tract infections (UTI’s) are common in women all over the world, but it would be an understatement. The fact is, they are extremely common, and few women make it to age forty never having experienced one.  They’re relatively easy to treat and harmless when taken care of early, but they’re also inconvenient and uncomfortable. Treating them is as easy as taking abstinence from intercourse. If caught early enough, your gynecologist might even simply prescribe more water. However, most women don’t catch their UTI’s until they feel the symptoms of burning and frequent urination. By that point, antibiotics are usually necessary.

That means treatment requires a quick trip to the doctor and a prescription. However, to make your life even easier, you should try to prevent UTI’s before they even start. Some women are more susceptible to UTI’s than others because their urinary tract is short or shaped in a way that traps bacteria. If you get them often, you need to be even more diligent in taking the proper steps to prevent them. UTI’s will clear up easily with treatment, but without treatment they could creep up your system and turn into a kidney infection (pyelonephritis), which could eventually kill you. A UTI will require antibiotics, but a kidney infection could require hospitalization.

The easiest and most beneficial way to prevent UTI’s is to drink plenty of water. You should be drinking at least eight glasses a day already, and getting that recommended amount will help flush out any bacteria that might get caught in your bladder. While it has long been believed that cranberry juice can help prevent all-too-common bladder and kidney infections, a new study from the well-respected Cochrane Library says its unlikely to do any good. (   Taking proper measures to keep your bladder free from bacteria is also important. Always remember as well to wipe from front to back, and urinate after intercourse to flush out bacteria that made its way into your system. Of course, good personal hygiene in the shower helps, and you should always wear clean, cotton underwear that keep those germ-sensitive areas covered.   Recent studies have concluded that the best way to prevent uncomplicated urinary tract infections is to abstain from sexual intercourse (link to New England of Medicine).   However, being the healthy females that we are, intercourse is a fact of life and refraining from intimacy may be a price to big to pay for not having a urinary tract infection.

Urinary tract infections are inconvenient and sometimes painful. They’re extremely common, but by practicing good health and hygiene you’ll increase your chances of avoiding them. Even if you feel like one might be coming on, plenty of fluids, short hiatus from intercourse can ward it off before you even call the doctor.

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

Why Aren’t Teens Getting Screened?

Thursday, November 15th, 2012

Teen pregnancy is consistently a major social problem in the United States. While teen pregnancy has been on the decline over the past few decades, it is still an issue and more than 34% of girls will have a baby by the time they’re twenty years old. For that reason, the results of a recent study might be surprising to you. The study showed that when receiving care in the emergency room, only 19% of teen girls across the country were tested for pregnancy. Even those with abdominal pain were given other tests, and some doctors didn’t even bother asking whether or not the girls were sexually active.

Not testing for pregnancy can be extremely dangerous. Of the girls who complained about abdominal pain, 28% were given tests that included radiation.  With that said, although there is stark hysteria when it comes to inadvertent exposure to radiation from diagnostic imaging, a chest X-ray or an X-ray of the abdomen would not harm the growing embryo or fetus.  There is no evidence that suggests that there is increased fetal risk of malformations, growth restriction or abortion from a radiation dose of less than 5 rads.  Most diagnostic imaging procedures using radiation are calculated to be in millirads (one-thousandth of a rad).  Case in point, a chest X-ray exposes the fetus to only 0,07 mrad which is exceptionally small and without any significant risk to the fetus at any gestational age.   Nevertheless, not checking for pregnancy in teenage girls can result in not diagnosing an ectopic pregnancy, which carries with it an increased risk of death to the teenage mother.   Moreover, many medications could also be extremely harmful to a growing fetus.   When shown the results of the study, a few doctors claimed that their resistance to giving a pregnancy test was partly because few teen girls come to the ER alone. When a large number of family members are present, ER doctors don’t want to offend the people in the room. These doctors are almost always strangers to ER patients, so they don’t know the family history or teen’s background.

While you’re probably not an ER doctor, you can still learn from this study and apply it to your own life. Especially if you have a teen daughter, you should always make sure that she receives a pregnancy test before undergoing any other procedures in the emergency room. If the doctor doesn’t offer one as part of his or her diagnosis, bring it up and have your daughter tested. Your teenager might look at you in utter disgust, but the temporary hatred you elicit from your teen is preferable to the potential misdiagnosis and misguided plan of care formulated, which was based on an incomplete evaluation because a pregnancy test was not done.

As an obstetrician, my credo is that any young woman from 12-56 is pregnant until proven otherwise.  Emergency room doctors are trained to test for pregnancy in adult females, so it might slip their mind to test teen girls who come in. However, teen pregnancy is a serious issue, so if you have any control in the situation, always make sure your teen is tested for pregnancy before any other procedures are conducted.

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


There’s Something Genetic about Twins

Monday, November 12th, 2012

If you’re a mother of twins, you’ve probably had people come up to you and ask if twins run in your family. Many women have heard this before, but few are entirely certain whether or not the likelihood of giving birth to twins is truly genetic, or if it simply happens by chance. You might be surprised to find out that the notion isn’t entirely a myth. To understand the genetic forces behind having twins, you first need to understand how twins are born.

There are two types of twins a woman can have. Monozygotic twins are the ones that are identical, and their genetic build is essentially the same. These twins were formed after the mother’s egg was fertilized. The egg split into two and became two separate eggs, and eventually two separate people. Rest assured that this is simply a strange bodily occurrence, and there is nothing genetic about it.  It is nature’s cloning.

On the other hand, dizygotic twins are those that are fraternal. They might be different genders, and they look no more alike than regular siblings. These twins were actually formed when the mother released two eggs at the same time. Both eggs were fertilized separately and two people began to form. Here is where genetics come into play. If a woman has released two eggs at the same time, she is predisposed to hyperovulation. Most women release a single egg with every cycle, but women with dizygotic twins release two (or sometimes more in the case of multiples). Hyperovulation is in fact genetic. If your mother or grandmother experienced hyperovulation, you probably will too. Certain tribes in Africa are prone to multiple ovulation and consequently a high incidence of twinning.  Women of color, older women, women with several children (high parity) are more likely to have twins.  Conversely, Asian mothers are about half as likely to have dizygotic twins.

Women taking fertilization treatments using Clomid or Pergonal will be more likely to hyperovulate resulting in a dizygotic (or monozygotic) pregnancy or even higher-order multi-fetal gestations, such as Octomom.  Also, those women who are undergoing artificial reproductive technologies, such as in vitro fertilization, which may insert more than one fertilized egg into the uterus may have twins.   But these women are not genetically predisposed to carrying twins.  The bottom line is that if you or other members of your blood-related family are dizygotic twins and you’re trying to conceive, you might want to stock up on twice the amount of baby supplies.

Exercise Regularly to Maintain Physical Function in Menopause

Thursday, November 8th, 2012

We all dread menopause. We can lie about our age as much as we want to friends and family, but menopause will rear its ugly head about the time we’re 55 whether or not we’re still “39.” There is obviously a wide range of side effects from menopause. Hot flashes, irritability and frequent urination are some of the most common. Unfortunately, many women also experience a decrease in their physical function when they enter menopause. This is one of the worst symptoms, because as we try to stay positive and feel young, our bodies simply can’t perform like they used to.


Researchers aren’t entirely sure why our physical abilities decrease so rapidly when we start menopause. Some studies suggest it might be because the increase in estrogen causes bone mass to decline. Others show that women in menopause tend to gain weight and lose muscle, which makes simple chores such as bringing in the groceries or picking up a baby feel strenuous. A recent study showed that three-quarters of menopausal women now have some type of physical limitation that they had never experienced before.


Luckily, we can prevent the onset of this limitation by staying physically active as menopause bears down on us. If you’re over the age of forty, it’s time to start preparing for menopause by starting an exercise routine. You don’t necessarily have to pump iron with the meatheads at the gym, but even regular walks or a class at the YMCA will help you build muscle mass in preparation for your menopausal decline. Even taking the dog out for a walk around the neighborhood on most days of the week will help. By building muscle and increasing cardiovascular function early on, it will take longer for your body to decline. Therefore, you’ll only start feeling limited when it’s a result of your old age—not your menopause.


Don’t let menopause stop you from getting a workout. Always check in with your doctor before starting a routine, but keeping your muscles as strong as possible will help you offset some of the inevitable limitations brought on by menopause. The longer you keep up your physical function, the longer you’ll be able to fool your friends about your age.


– Yvonne S. Thornton, M. D., M. P. H.

Obesity Impairs Fertility More in Black Women

Monday, November 5th, 2012

Infertility can be heartbreaking to women trying to conceive. Dreams of holding a newborn baby in the delivery room are often put on hold as women who have been diagnosed as infertile seek alternative methods of conception. Infertility is technically defined as a woman’s inability to get pregnant after a year of trying with no contraceptive methods. There are numerous causes of infertility, but sometimes doctors are unable to determine the cause on a case-by-case basis. Often, infertility is a result of obesity. A recent study showed that obese black women are often more infertile than white women.


Healthy black women do not necessarily have a harder time getting pregnant than healthy white women. However, black women who are obese will have a harder time than white women in the same situation. Specifically, a larger hip-to-waist ratio was associated with infertility. The study could not confirm why women heavier in the lower body and hips area had a harder time getting pregnant, but it could be a result of inhibited estrogen metabolism caused by a large amount of fat. An increase in the resistance to insulin might also be to blame.


The results of the study should be an incentive for obese black women looking to conceive to lose weight. In addition to increasing fertility, a healthy weight prior to conception will make for an easier pregnancy and a healthier baby. However, the results should also be taken with a grain of salt. The results failed to study the health of the potential fathers, who might also have been obese. Obesity in men could lower their sperm count, which would make it even harder for obese couples to conceive.


Obese women, whether black or white, will have a harder time getting pregnant. Though these results suggest that infertility is more common in black women who are obese, women of either race should attempt to reach a healthy weight before trying to have a baby. Fertility will be increased, and you’ll have a happier and healthier pregnancy. If you’re having trouble conceiving, you should talk to your physician about ovulation treatments and the potential for an IVF.


– Yvonne S. Thornton, M. D., M. P. H.

Is Your Birth Control Making You Gain Weight?

Thursday, November 1st, 2012

All medications have side effects. From Advil to Zantac, every medication we need for common ailments might have a drawback. For women, birth control can be a bittersweet prescription. On the one hand, women who take it will be protected from pregnancy. However, those same women might experience some unwanted side effects such as moodiness, fatigue and a change in their sex drives. One of the major concerns about birth control—especially for women in the United States—is the potential for weight gain as a side effect. We all try to maintain a healthy weight, so adding birth control into the mix of challenges can be disheartening. Luckily, recent studies show that weight gain might not actually be a side effect of modern birth control.

Every birth control is different, but they are all combinations of the same hormones. They either contain progestin and estrogen, or progestin on its own. However, the levels of each are low, and they have no real effect on weight gain or weight loss. So, why do women think birth control causes weight gain? Many brands list this as a side effect to cover themselves, but the notion started in the 1960’s when birth control became available. The pills back then contained almost 1,000 times the amount needed to prevent pregnancy, so side effects ran rampant.

The hormones themselves might not cause weight gain anymore, but that’s not to say the weight you gain while taking a contraceptive isn’t related to the pill, ring, or patch. Birth control has many other, real side effects that could easily affect your weight. For example, the hormones might cause changes in your mood, which could leave you feeling down in the dumps more than usual. If you’re like most women, you might eat when you’re sad, so weight gain will be inevitable in that scenario. More bad days will lead to more overeating, which will lead to weight gain. You might feel (and act) like a bottomless pit at every meal. Most pills also cause water retention in one form or another, so you might feel especially bloated.

If you notice significant weight gain and feel that it’s related to your birth control, talk to your doctor about switching brands. The hormones alone do not do it, so there’s a good chance your side effects are especially strong. Different brands affect people differently, so try your luck with another.

– Yvonne S. Thornton, M. D., M. P. H.