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.

 

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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.

 

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About Endometriosis

Written by yvonnethornton on 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. http://endometriosis.org/support/support-groups/ 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.

 

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VBAC vs Repeat Cesarean Delivery

Written by yvonnethornton on March 6th, 2014

Not so long ago, a vaginal birth after a cesarean delivery (VBAC) was unheard of. Because the uterus was cut in such a way that weakened it and made it vulnerable to rupture in subsequent pregnancies, women were often scheduled for cesareans before they could even go into labor if they had had a cesarean delivery in the past.

Now, with improved surgical techniques, VBAC is a choice that many women get to make, depending on the reason for the original cesarean. For example, if the first cesarean was performed because of a too-large baby and a too-small pelvis, that reason will in most cases still exist in subsequent pregnancies. On the other hand, if an isolated event such as breech presentation mandated the first cesarean, the event does not reoccur, and the correct surgical procedure was used the first time, then attempting a VBAC is usually safe.

Benefits of VBAC

This is important for a number of reasons. The most important reasons involve the safety of both mother and baby. A vaginal birth is safer than a cesarean delivery. Although the risk of infection or hemorrhage is relatively low with a cesarean, it is still several times greater than with a vaginal delivery. Therefore, a cesarean should be a last resort whenever possible.

Another reason VBAC safety matters is because many women prefer the natural experience of childbirth. This, of course, should not be a reason to put her life or the life of her fetus in jeopardy, but when it’s feasible, childbirth is a nicer experience when it fulfills the mother’s wishes.

Other benefits of VBAC include avoiding an additional scar on your uterus, which is important if a future pregnancy is desired. The more scars on the uterus, the more likely the uterus is to rupture.  Also, the placenta is more likely to be more adherent to the scarred uterus and not separate naturally, causing a life-threatening condition known as placenta accreta and resulting in massive hemorrhaging which may lead to maternal death.

Vaginal birth also comes with an easier recovery period, less pain afterward, a shorter hospital stay, and a more active role for you and your partner in the birth of your baby.

Risks of VBAC

The possibility (however remote) still exists for the uterus to rupture at the site of the previous cesarean scar, and this is one of the main fears when attempting VBAC. If the uterus ruptures, an emergency cesarean and possibly hysterectomy will be required to prevent severe injury to both baby and mother. That is why it is so important to be delivered in a hospital or medical center that has 24-hour anesthesia and in-house obstetrical coverage with a good blood bank.   With that the said, the risk of uterine rupture after a VBAC is 0.2% compared to 0.1% in those patients who had scheduled another cesarean.  Both figures mean that in 99.8% to 99.9% of the cases, a VBAC does not result in uterine rupture.

If you are hoping to have VBAC, you should clearly discuss this with your doctor to see if it is a good fit for your individual situation. In addition, you will need to deliver in a facility that has the equipment and staff capable of handling any emergency that might arise.

If you and your doctor decide that VBAC may be safe for you, you will be able to have a “trial of labor,” or TOLAC (trial of labor after cesarean). This means that you will go into labor naturally with the goal of delivering vaginally. However, there are no guarantees. Some women who attempt VBAC end up with necessary cesareans anyway. A trial of labor is a safe choice as long as the conditions that necessitated the first cesarean no longer exist and the baby is monitored closely for signs of distress. For more information on this and other women’s health issues, see my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

 

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Pros and Cons of Robotic Surgery

Written by yvonnethornton on March 3rd, 2014

If you need surgery, you are likely to be presented with the option of robotic surgery. This means that instead of the surgeon working on you directly with his hands, he or she will manipulate a set of robotic arms with surgical instruments attached from a console. Should you go along with this, or should you question the practice?

It would be understandable if you were hesitant. Thanks to the media’s love of a good horror story, most people have heard of instances where patients were accidentally injured – or worse – during robotic surgery. Even the American College of Obstetricians and Gynecologists maintains that robotic surgery is neither the best nor the most cost-effective approach to hysterectomy.

Does this mean that you should flatly reject robotic surgery? Not necessarily. Like any surgical instrument, a robot is as good as the surgeon using it. Furthermore, every patient profile is different. There are a number of considerations for anyone making a choice about robotic surgery.

In 2000, there were (worldwide) only 1,000 robotic surgeries. Last year, there were 450,000. Proponents of the practice say its benefits are responsible for its rising popularity. Less blood loss, less need for pain medication post-surgery, and shorter hospital stays are among these benefits, along with smaller scars (which is also a benefit of laparoscopic surgery). Robotic procedures are less taxing for surgeons, who don’t need to bend over an operating table, but instead, can sit at a console viewing the surgical field on a screen.

But some feel that robotic surgery does not offer significant benefits beyond those of laparoscopic or other types of surgery, and that the “wow” factor is one of the real reasons robotic surgery is catching on. In our love affair with new technology, it’s possible we have a tendency to move ahead too fast without enough standardized evaluation. To be sure, any new medical technology requires proper patient selection as well as a full explanation of all options and their risks and benefits for informed decision making.

What Does All of this Mean for You?

The wisest approach for a patient who needs surgery is to make sure to get an explanation from the surgeon about possible procedures, including what to expect in the postoperative period. The surgeon should also explain why he or she feels that a particular method is the best option in an individual patient’s case. There is no one-size-fits-all when it comes to surgery.

Another consideration is the cost of the surgery. Robotic procedures tend to cost more, but the patient may end up spending less overall. The need for longer hospital stays and pain medications is potentially lower with robotic surgery, and patients might have a lower chance of being readmitted for complications, all things which can lower a patient’s total costs.

For now, robotic surgery appears safe and effective, but it remains just one of the options available to patients. Ask your surgeon about his or her experience with any procedure he or she wants to use, and about complications that have arisen in the past. Remember that the right choice will be different for different people, so talk to your doctor, and let his or her expertise and experience guide you to make the right informed choice for your unique situation.

– Yvonne S. Thornton, M. D., M. P. H.

 

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Folic Acid’s Role in Preventing Neural Tube Defects

Written by yvonnethornton on February 27th, 2014

Neural tube defects (NTDs) are common birth defects that present an elevated risk of serious disability and infant mortality. NTDs include spina bifida, anencephaly, and encephalocele, and occur in about 1 out of every 1000 US births. Many of these pregnancies are either terminated or spontaneously lost, resulting in about 2,500 babies born with NTDs each year.

Spina bifida occurs when the vertebra do not form properly around part of the spinal cord. The disease can be mild, with no symptoms, or it can be debilitating, affecting every aspect of a child’s life. People with a very mild form may never even know they have it until some other problem prompts a back x-ray. In more serious cases, fluid can leak out of the spine and push against the skin, forming a bulge, or spinal nerves can push out of the spinal canal and sustain damage. This can cause problems with walking, coordination, and bladder and bowel control.

Anencephaly is a birth defect in which an infant is born without parts of the brain and skull. Most babies with anencephaly die shortly after birth. Encephalocele is a rare NTD that also affects the brain. In encephalocele, the brain and the membranes that surround it protrude through an opening in the skull. This defect is often linked to nervous system problems, such as uncoordinated movement, vision problems, seizures, and developmental delays.

Folic Acid Key to Prevention

Studies such as this one show that folic acid is instrumental in preventing neural tube defects. Folic acid is a synthetic compound used to fortify foods and supplements. The term “folate” means any compound containing the same vitamin properties of folic acid, and includes both folic acid and the natural compounds found in many foods.

Folic acid is water-soluble and has no known toxicity. (However, certain vitamins found in many multivitamin supplements are toxic at high doses, so do not continue a vitamin regimen that your doctor has not approved when you are considering becoming or are pregnant.) Women of childbearing age should be getting 0.4 mg of folic acid each day. Folic acid is highly bioavailable and one of the important ingredients in prenatal vitamins, a key reason why you should be taking them if you are pregnant or thinking of becoming pregnant.

You can also up your intake by eating plenty of leafy green vegetables, citrus fruits, and whole grain breads, pastas, and other foods enriched with folic acid. And plant foods, in particular, contains many compounds that are essential for your health and which you can’t get from a pill, so don’t let your vitamin supplement be a substitute for a healthy diet. The bottom line is that when it comes to optimal prenatal nutrition, both prenatal vitamins and a healthy, balanced diet are essential.

– Yvonne S. Thornton, M. D., M. P. H.

 

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Just How Important Is Calcium?

Written by yvonnethornton on February 24th, 2014

Through every stage of life, calcium is an important component of a woman’s diet. Calcium is involved in many aspects of overall health. It is believed to be important for bone health, prevention of cardiovascular disease, blood pressure regulation, weight management, and prevention of some types of cancer.

How Much Calcium Do You Need?

The recommended daily allowance of calcium for women between 19 and 50 years of age is 1,000 mg. That recommendation does not change when you are pregnant, but meeting it does become even more important, because you are providing nutrition for your baby as well, and his or her bones and teeth need calcium for proper development. In addition, when you don’t get enough calcium for a long period of time, you are at risk for developing osteopenia, which can lead to osteoporosis.  What’s the difference? Osteoporosis is a disease that breaks down the tissue in our bones, making them fragile and more likely to break. Osteopenia is not a disease, but a term that describes low bone density. Both can lead to painful fractures.  While osteopenia is not considered a disease, being diagnosed with osteopenia requires further monitoring. Preventive measures should be taken since osteoporosis may develop if bone density loss increases.

Actually, the real protection against osteoporosis begins when one is a teenager, because porousness of the bones is the end stage of a long process. Continuing to drink milk after childhood through the teenage years is like putting calcium in the bank to be drawn on later. Unfortunately, teenagers favor sodas over milk and not many drink the two glasses of milk a day that would allow them to meet more than half their daily calcium needs.

Which food has more calcium?  A cup of collard greens or a cup of whole milk?  The answer is collard greens!  Eight ounces of skim milk contains almost 300 mg – even more than whole milk, and in a healthier, fat-free package. Yogurt and cheese are good sources of calcium too, but remember that dairy products are just one of many ways to get the calcium you need. Salmon, kale, broccoli, and calcium-fortified orange juice are just a few of the other many places to find calcium.  I don’t believe that my orange juice should be calcium-fortified, but the manufacturers are offering the option.  Just drink milk!

What about calcium supplements? Their safety is often called into question, although for now they appear to be harmless. The real issue is that supplements are not a stand-in for natural foods that contain calcium, because they lack the protein, vitamins, and minerals that you, and your growing baby if you are pregnant, both need. With just a little effort you can get all the calcium you need easily through a healthy diet.

Calcium need during menopause is 1200 milligrams per day. After menopause, it increases to 1500 milligrams per day.  We once thought that calcium and Vitamin D supplementation should be taken to prevent bone fractures in postmenopausal women.  However, the United States Preventive Services Task Force, an independent panel of experts in prevention and primary care, recently issued a draft statement in June, 2012, recommending that healthy postmenopausal women should NOT take low doses of calcium or Vitamin D supplements to prevent fractures.  Why?  Because the supplements were found NOT to prevent fractures and only increased the risk of other problems, such as kidney stones.  So the risks outweighed the benefits and taking these supplements may actually be harming you.

 

Lactose Intolerance

Lactose intolerance is a common condition in which unpleasant symptoms such as bloating or diarrhea occur after consuming lactose, milk’s natural sugar. This happens when an individual does not produce enough of the enzyme lactase to properly break down the lactose. Lactose intolerance can unsurprisingly make it more of a challenge to consume enough calcium. However, some individuals can consume a small amount of milk without issue. Yogurt is often a good alternative.  However, there are many products today designed for lactose-intolerant individuals. In addition, there are many non-dairy sources of calcium available such as kale, broccoli, collards, and foods fortified with calcium.

Can You Get Too Much Calcium?

Like anything other good thing, too much calcium can present potential problems. Hypercalcemia can cause renal and vascular problems, as well as kidney stones. It can also cause constipation. However, it’s important to realize that you would have to consume more than three times the recommended daily allowance of calcium for problems to begin to occur. Given the average American diet, this is just not a real concern. So drink plenty of skim milk and enjoy lots of other calcium-rich foods as part of your balanced nutritious diet, especially while you are pregnant, lactating or postmenopausal.

For more information about the risk factors associated with postmenopausal osteoporosis, I refer you to my health book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

 

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Gynecology Board Reverses Male Patient Ban

Written by yvonnethornton on February 20th, 2014

Back in December, I covered the issue of gynecologists treating male patients at high risk for certain types of cancer. At that time, the American Board of Obstetrics and Gynecologists had disallowed the practice. However, in response to protests from both patients and doctors, the board has lifted the ban and said that gynecologists who choose to do so are free to treat men.

The board’s executive director issued the following statement: “This change recognizes that in a few rare instances board certified diplomates were being called upon to treat men for certain conditions and to participate in research. This issue became a distraction from our mission to ensure that women receive high-quality and safe health care from certified obstetricians and gynecologists.”

This past fall, gynecologists who chose to treat male patients were ordered to stop and threatened with loss of certification for noncompliance. The board prohibited treatment of male patients with the exceptions of newborn circumcision, transgender patients, and men who were part of a couple undergoing fertility treatments.

The decision was made then in order to protect patients and uphold the integrity of the specialty of gynecology. This was due in large part to gynecologists who were branching out significantly into other areas, such as cosmetic surgery, for instance, and even advertising their services and identifying themselves as “board certified” without specifying that they were gynecologists. This practice could have misled patients who believed that they were being treated by board certified plastic surgeons, or other types of specialist.

However, one group of patients that the directive directly affected was men at high risk for anal cancer. The gynecologists who treated them said that not enough doctors had experience in this type of screening, and they feared the ban would interfere with patient care as well as government-funded studies aimed at determining the effectiveness of these cancer screenings.

In December, the board relented and agreed that gynecologists could continue to treat their current male patients, but not accept any new ones. And after further pressure, the board in January stated that the ban on treating male patients no longer existed. Gynecologists are now free to treat male patients as long as they devote “a majority” of their practice to gynecology – a change from the specific 75% that used to be the minimum portion of a gynecologist’s practice that must remain within the specialty.

Interesting, since the board’s own definition of what a gynecologist is includes, “Obstetricians and Gynecologists provide primary and preventive care for women and serve as consultant to other health professionals.”

Some are calling the board’s decision a victory for patients, but is it? As I stated back in December, “…there is no reason that I can see why the specialty of gynecology should expand into unrelated disciplines. The very reason why we have specialties is so that specific areas of medicine can be studied thoroughly and the treatments we are able to provide kept up to the minute. A gynecologist should specialize in gynecology – delivering babies, taking care of women. Other practices and treatments are important and helpful, but they aren’t gynecology.”

– Yvonne S. Thornton, M. D., M. P. H.

 

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Should Birth Control Pills Be Available Over the Counter?

Written by yvonnethornton on February 17th, 2014

It’s a hot debate topic: should women really be required to obtain a prescription for birth control pills? Shouldn’t the most popular form of birth control be available over the counter (OTC)?

Proponents of making oral contraceptives prescription-free say that more access to the pill would lead to fewer unintended pregnancies. To be sure, there are women who would take birth control pills if they didn’t have to see a physician to get them and if the overall cost were lower. Women commonly site access, convenience, and cost as reasons why they do not use a consistent contraception method.

Those in favor of OTC oral contraceptives also say that the benefits of making them more available outweigh the risks, as these pills are widely prescribed and generally safe. There is no argument that access to birth control is very important. Unintended pregnancy has devastating emotional and financial effects on a woman’s life, often ensuring poverty, inability to continue her education, and much more.

However, the risks of taking birth control pills without medical advice are substantial. If they were to start being sold without prescriptions, it’s a safe bet that many women would not receive important medical counseling. For example, one of the reasons birth controls require prescriptions is that they have known drug interactions and potentially dangerous side effects.

For example, antibiotics can interfere with the effectiveness of the pill. Physicians counsel women on drug interaction dangers like this when they dispense prescriptions. Women who buy the pill over the counter may not realize that if they also take an antibiotic, they need a backup method of birth control that month. In addition, birth controls pills are completely useless against sexually transmitted infections (STIs). They are not a replacement for condoms.

And if a woman doesn’t have to see her doctor to obtain a prescription for birth control pills, might she be more likely to skip seeing her doctor altogether for longer periods of time? This certainly would not be an issue for all women, but the ones who go to the doctor only because they must to get the pill would encounter the additional risks involved in not obtaining regular preventive checkups, which can reveal health problems such as STIs and some cancers in their early (and treatable) stages.

In addition, women who smoke and take birth control pills have a much higher risk of strokes, heart attacks, and death.

Birth control pills are a great option for contraception. They are easy to use, can’t be neglected in the heat of the moment (although they be forgotten earlier in the day), are noninvasive, and do not have lasting effects on fertility. However, the risks of using them and the need to use them properly call for medical advice before beginning them, at the very least.

You can find more information on birth control pills and other contraceptive methods in my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

 

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Strenuous Exercise Temporarily Decreases Fertility

Written by yvonnethornton on February 13th, 2014

A study from NTNU (Norwegian University of Science and Technology) suggested that the combination of strenuous workouts and achieving pregnancy may be too much for the body to handle. Therefore, female athletes or heavy exercisers may want to ease up a little if they want to become pregnant.

It is well known that women who are involved in elite sports struggle with fertility more than others. Now it appears that women who participate in other types of extreme exercise may encounter more fertility problems as well. In a study that included 3,000 women, researchers at NTNU discovered that frequent and strenuous exercise may reduce fertility – but only temporarily, or while the hard training lasts.

None of the women in the study had experienced a history of problems with fertility, and all of them were of childbearing age and in good health. Two groups of women showed a higher risk of fertility problems: those who trained nearly every day, and the ones who exercised until they were completely exhausted. The ones who fell into both groups experienced the most fertility problems.

In addition, the effects of strenuous exercise on fertility appear to be transient, ending when the hard training slowed down.

The theory is that extremely demanding physical activity requires so much energy that the body can actually experience periods of a deficiency of energy, in which the amount of energy needed to maintain the mechanisms, hormonal and otherwise, to enable fertilization just isn’t there.

It is important to note that women who engaged in low to moderate activity had no fertility impairments, so there is no reason for women to stop exercising altogether while trying to conceive. In fact, exercise can reduce stress, which is good for fertility. Moderate exercise has been previously shown to improve insulin function and promote better fertility as compared to complete inactivity.

It appears that the worst choices for women trying to conceive fall at both ends of the spectrum: extreme physical activity and extreme sedentariness. Pinpointing what constitutes the perfect level of activity, however, can be tricky, because it can be unique to individual women. If your menstrual cycle is particularly long or nonexistent, this could be a sign that you are exercising enough to negatively affect your fertility.

A woman is considered to be infertile after a year of unprotected intercourse without a pregnancy occurring. In women older than 35, it makes sense to see a doctor sooner; perhaps after four to six months of trying unsuccessfully to conceive. There are many factors that can affect fertility in women, including problems with the fallopian tubes, the ovaries, or the uterus, problems with ovulation, and hormonal issues. Sometimes the reason for infertility cannot be pinpointed, and sometimes it may the male partner who has the fertility problem and not the woman. A doctor’s evaluation is the only way to find out for sure.

– Yvonne S. Thornton, M. D., M. P. H.

 

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