Nausea in pregnancy is very common, affecting more than 50% of pregnant women. Though commonly called ‘Morning Sickness’, the symptoms can occur at any time of the day. Nausea of pregnancy usually improves by 14-16 weeks, but can continue throughout the pregnancy for some women. Nausea in pregnancy is usually not harmful to your developing baby, but may become more problematic when associated with consistent vomiting and weight loss.
The cause of Nausea in Pregnancy is not well understood. It may be caused by the elevated hormone levels of pregnancy and their effect on slowing overall gut motility. The GI tract is normally constantly moving food and stomach acid from the stomach, though the GI tract. The effect of slower gut motility can result in a feeling a nausea after eating a large (your standard sized) meal, where food isn’t moving out of the stomach at the same rate. With slower gut motility, stomach acids aren’t moving out of the area at a normal rate either, potentially also causing a feeling nausea when we go 3-4 hours without eating.
Dense breast tissue is an independent risk factor for breast cancer, both increasing our risk of breast cancer and decreasing the sensitivity of mammography to detect breast cancer. Increased breast density, as identified by mammography, can negatively impact the ability of mammography to detect breast cancer. Further, women with dense breast tissue have a 3-5 fold increased risk for breast cancer, over those without significant breast density.
“My husband wants me to discuss my lack of interest in sex”… As Gynecologists, this is a patient concern not unfamiliar to us. Has low sexual desire been a concern for you in your relationship? Would you ever consider the use of a medication for its improvement? Well I’d hope that most of my patients would want to first examine the possible reasons for low libido, even if their answer is ‘yes’ to trying a medication for it.
But herein lies the concern. Defining the sources of low libido in women is not easy. Research tells us that nearly 4 in 10 women experience some degree of female sexual distress at some point in our lives. The definition of Female Hypoactive Sexual Disorder is made by conditions characterized by loss of sexual desire, impaired arousal, difficulty in achieving orgasm, or sexual pain, with low desire and sexual pain being the most common.
The stages of female sexual arousal have been well studied, and fairly well defined, since the 1960’s with research done by Masters and Johnson. However, the components of female sexual desire remain complex. Sexual desire in women is likely a multi-factor phenomenon, involving biologic, psychologic and social factors, which can elude clear delineation.
Are you a woman still using douching as a method to ‘clean’ your vagina? If you are, you’re not alone. Studies say that up to 1 in 4 women use douching. But it’s time to kick the habit! Despite some cultural beliefs that douching ‘cleans’ the vagina, the truth is that douching may actually increase our risks for vaginal infections. The vagina is well equipped with a natural balance of good bacteria, and needs no ‘cleaning’. Douching can disrupt this balance of protective bacteria, and increase the chances for overgrowth of infectious bacteria, thus increasing our chances for vaginal infection.
Whether common knowledge or not, the Cesarean Section birth rate in the U.S. hovers around 31%. meaning that 1 of 3 babies in our country are born by Cesarean Section. In the last 2 decades, the rate of Cesarean Section births has continued to rise, even for first-time mothers. According to our national organization, ACOG, the most common reason for Cesarean Section birth among first-time mothers is abnormal progess in labor. The rate of Cesarean Section birth among first-time mothers varies throughout the country, raising their concern for the re-evaluation and standardization of the definitions of 'normal labor progress' among practicing Obstetricians in our country.
When considering a woman’s contraceptive options, IUDs bear discussion. Some women have familiarity with IUD use, others have “heard of them”, but don’t have a real concept of how they’re used or how they work. An IUD (Intra-Uterine-Device) is a contraceptive device placed inside the uterus, in an in-office procedure, that generally takes less than 5 minutes for your doctor to insert. Pregnancy prevention occurs by a ‘foreign body’ inflammatory reaction that occurs based on the metal or plastic frame (T-shaped, about the size of an open paperclip) and by the local effect of the medication released by the IUD (either copper or progesterone.) This ‘inflammatory reaction’ likely creates a toxic environment for sperm (spermicidal), as well, likely inhibits implantation.
Have you heard the theory that antibiotic use can lessen the effectiveness of your birth control pill? Though there is some truth to this theory, it’s fortunately NOT true for most commonly prescribed antibiotics.
Pharmacologic studies evaluating hormonal levels during antibiotic use have shown decreased hormonal levels (leading in theory to potential decreased effectiveness) with only one type of antibiotic, Rifampin (an anti-tuberculosis medication) whose use is fairly uncommon. Women taking this particular antibiotic should not rely on their hormonal birth control (OCP, DepoProvera, or implant) solely for contraception during its use. Use of a non-hormonal form of back-up birth control is recommended in these women.
Other antibiotics have NOT been proven to affect the pharmacologic levels of hormonal contraception. Some of the more commonly used antibiotics, metronidazole, ampicillin, tetracycline, doxycycline, ciprofloxacin, or diflucan have not shown to decrease oral contraceptive levels in pharmacologic studies.
For women taking antibiotics (other than Rifampin) with birth control pills, back-up contraception is therefore, not required.
If you are sick, requiring antibiotic use or not, considerations for decreased effectiveness of your birth control pill may be due to missed pills, or due to vomiting, in which case back-up birth control would be recommended.
I'm often asked if "hormones" are the cause of decreased libido? Though declines in hormonal levels in the menopause may lead to physical symptoms causing decreased interest or painful intercoure, female hormonal fluctions are rarely the cause of decreased libido in reproductive aged women. Check out this article from WebMD.com discussing other life factors that could be affecting libido... Relationship issues, the demands of raising children, and negative body image were among the list of common concerns.
Suzanne Hall, MD (@drsuzyyhall)
Eastside Gynecology Obstetrics, PC
The flu season is definitely among us, with January being the peak season for influenza outbreaks. The CDC has predicted a more severe 2014-2015 flu season this year, with 91% of influenza infections thus far being due to the H3N2 virus. Unfortunately, because of the guesswork involved in manufacturer’s development of the upcoming year’s vaccine strains, this year’s flu vaccine has only a 48% match to the H3N2 viral strain. Nonetheless, flu illness does appear to be less severe in those having received the vaccine. Of particularly grave significance, is the prevention of the flu in pregnant women. Pregnancy infers particularly high risks for the development of severe illness in mothers to be. Pregnancy related changes in our immune systems make pregnant women at higher risk for developing severe complications of the flu, such as pneumonia, respiratory distress and even death. In the 2009 pandemic of the H1N1 influenza virus, 5% of deaths occurred in pregnant women, though pregnant women accounted for only 1% of the U.S. population. The CDC and ACOG strongly advise pregnant women to receive the flu vaccine, noting its safety in all trimesters of pregnancy.
If you’re pregnant, be sure to get your flu vaccine. The most common symptoms of the flu are fever, cough, nasal congestion, sore throat, headache, shortness of breath and muscle aches. Be sure to contact your health care provider if you’re experiencing any symptoms of the flu.
Suzanne Hall, MD Ob/Gyn (@drsuzyyhall)
Eastside Gynecology Obstetrics, PC
Macomb, Roseville, Grosse Pointe, Rochester, MI
Technology statistics tell us that 80% of consumers search for health-related information online. With so much of our lives consumed by mobile technology, have you considered health-related information another area to search while on the go? Is your doctor’s office or area hospital on Facebook, Twitter, Instagram or Pinterest, sharing health-related tips for your information?
Our practice, Eastside Gynecology Obstetrics, is active in the use of social media for sharing information regarding Women’s Reproductive Health. Drop by any of our informational sites and let us know what topics you’d like to see us address. Keep in mind, these avenues are for ‘information and educational’ purposes only. For reasons of your personal privacy, we are not able to share medical advice on ‘personal health’ concerns. This can get a bit tricky when you have concerns about your ‘personal medical health’. But address the concerns as a ‘topic’, and we’ll be happy to share educational information to address it.
The truth is, we’re all at different stages of our lives as women. Several of my friends, sisters, and I are at this very interesting time in our lives, the menopausal transition, and yes, just beginning to meet, “Ms. PeriMenopause” for the first time ourselves. Our 40-50 yo ‘girl-talk’ usually ends up with some discussion around the topics of hot flashes, or how much more difficult it is now to lose weight.
But what’s less often spoken of amongst my friends, are the symptoms of mood swings and irritability, which can also be symptoms of the peri-menopausal transition. Have you seen yourself go from ‘zero-sixty’ in irritability (or anger), or get easily tearful over things that you know before wouldn’t have upset you so easily? Well I certainly have. Hopefully this bit of information will help you to understand some of the hormonal and emotional shifts that can occur in the perimenopause, giving us some control over that feeling of our ‘raging’ hormones...
In a recent ruling from the Hobby Lobby case, The Supreme Court has ruled that ‘for-profit’ businesses can now evoke the religious rights disclaimer regarding contraceptive coverage. This means that non-religious business can now forgo the previous ACA mandates requiring contraceptive (no co-pay) coverage for women, an exception previously afforded only to religious based business with objection to this mandate for religious reasons. According to a recent article in Medscape.com, “The Court ruled 5-4 that closely held corporations, or companies with a small group of shareholders, may refuse to cover methods of contraception that they oppose for religious reasons.”
In the last few years, the guidelines on the required frequency of cervical cancer screening (Pap smear) have changed, and more recently, even the importance of your Yearly/Annual Pelvic exam has been up for debate amongst established medical societies. The American College of Obstetricians and Gynecologists, ACOG, recently released their rebuttal statement, reconfirming their support for the importance of the Annual Pelvic Exam. Their statement was made in response to the recently released article from the American College of Physicians supporting the contrary, recommending against the annual pelvic exam in asymptomatic women, thus bringing into question the utility of the exam.
‘Tis the season for high school graduations, and thus that (sometimes dreaded) question for graduates, "What are you gonna do?" Though college bound, I can still remember that question being pretty awkward for me, because I had no real clue of what my career interests/aspirations were. I found that a simplistic answer, like “business”, seemed to satisfy most of those that asked, though I barely even had a clue of what a focus in “business” really meant. If not for a great career counselor at my university helping to identifying my strengths in math/science, and directing me towards potential careers stemming from those interests…you wouldn’t know me as Dr. Hall!
New cases of ‘Whooping ‘ cough/Pertussis infections are on the rise in the US. The CDC reports 48,000 new Pertussis infections in 2012, the highest number since 1955. Pertussis infections can result in serious illness, especially for the newborn, where the condition can be life-threatening.
The CDC and ACOG recommend the Tdap vaccine (tetanus/diphtheria/pertussis) in pregnancy. The vaccine is considered safe in all trimesters of pregnancy, though recommended at 27-36 weeks gestation. Receiving the vaccine during pregnancy improves the chances of your baby receiving ‘passive’ immunity from the infection. If the vaccine was not received during the pregnancy, vaccination in the immediate postpartum time period is the next recommendation. Close contact and the baby’s caregivers should also be vaccinated. Pregnant women should be re-vaccinated with each pregnancy.
Cesarean Section Delivery isn’t Failure…It’s ‘Plan B’
If I had a nickel for the many times I’ve heard a laboring patient say, “I really don’t want a Cesarean Section!” In addressing their labor concerns, often times I try re-clarifying with them what they really mean in saying “I don’t want a Cesarean Section”. I believe what most of our patients really mean is:
“I’m really ‘hoping’ for a vaginal birth”…
“If I had a preference for delivery, it would be vaginally, rather than by Cesarean Section”…
“If circumstances arise for which a Cesarean Section would be better for the health and safety of my baby, I’d definitely agree to Cesarean Section delivery”…
Losing weight can be a challenge for many of us. For those of us that exercise regularly, further weight loss can also be frustrating. When beginning your commitment to a diet and exercise program to lose weight, it seems initially the weight does come off in manner that can be fairly satisfying.
But for those of us that have already been committed to healthier food choices, and regular exercise, the challenges of (further) weight loss can continue. It’s not uncommon to hear exercising women relate the difficulties of losing any more weight. And for me, like others, we may watch the scale actually start to ‘increase’ despite regular exercise and healthy food intake! I’ve had to reach back to my medical references to feel some sense of comfort for why this may be happening.
In our society today, women have a choice as to where to deliver their babies. Though home births have been on the slow increase (with some ‘popularization’ by certain celebrity backing,) we should be careful not to ‘over-glamourize’ the concept of home birth. Before considering the option of home birth, it’s vitally important for us to understand the risks of delivering a baby at home, even when those desires for home birth are based on concerns for a more private, comfortable, or ‘natural’ birthing experience.
Though the risk of neonatal death from a home birthing experience is (overall) considered low, findings from a new Cornell University study on home births show us that the risk of neonatal death is nearly 4X higher for babies delivered at home than those delivered in a hospital setting. According to lead author Dr. Amos Grunebaum, a professor of clinical obstetrics and gynecology at Cornell University's Weill Cornell Medical College, the predominant reason why “Home birth is more dangerous”, is that births occurring at home don't have the advantage of a hospital delivery, where immediate critical care is available for the baby if a complication arises. "There's insufficient equipment and personnel available [in the home] to address complications," Grunebaum says. Woman should know these risks before considering a home birth.