Q: We're excited to begin our family. I stopped taking birth control in December. I had two "regular" periods starting January 7th and then again on January 21st. Since then I haven't had a period. I'm wondering if I need to come in? Or if it is normal to get back in the swing of things once you stop birth control? My annual appointment isn't until the end of April, but should I try to get in sooner?
A: If your periods were irregular before taking birth control they may become irregular again once you stop using it. Skipping two months is certainly not normal. Assuming you have a negative pregnancy test we may want to do some other testing to figure out why your cycles are so irregular. I can see you sooner if you would like. Call for an appointment and tell our scheduler you're having irregular cycles and trying to get pregnant and would like to be seen sooner to discuss the problem. Thanks! ~Lisa
Tuesday, March 16, 2010
Monday, March 8, 2010
First GYN exam
Q: When should my 13 year old daughter have her first gynecology visit? At what age do you start pap testing?
A: It is recommended that a young woman start having yearly gynecologic exams and pap smears when she is 18 or sooner if she becomes sexually active, anticipates becoming sexually active or has problems such as painful or irregular menstrual cycles, pelvic pain, breast problems or vaginal discharge.
If your daughter is not having any problems a visit between the ages of 13-15 may still be helpful to establish a baseline, build trust and explain what to expect at future visits. I would not anticipate doing a pelvic exam at that visit unless she was having problems. I would also gather information using the least invasive technique possible. For example, I'd prefer ordering a pelvic ultrasound on a girl who is young and has not been sexually active than doing a pelvic exam because it is less traumatic.
I understand that young women are very nervous for their first exam. I will explain what I am going to do, explain normal female anatomy, show her the speculum,etc. before the exam. I will also explain what I'm doing during the exam and make it as comfortable as possible. ~Lisa
A: It is recommended that a young woman start having yearly gynecologic exams and pap smears when she is 18 or sooner if she becomes sexually active, anticipates becoming sexually active or has problems such as painful or irregular menstrual cycles, pelvic pain, breast problems or vaginal discharge.
If your daughter is not having any problems a visit between the ages of 13-15 may still be helpful to establish a baseline, build trust and explain what to expect at future visits. I would not anticipate doing a pelvic exam at that visit unless she was having problems. I would also gather information using the least invasive technique possible. For example, I'd prefer ordering a pelvic ultrasound on a girl who is young and has not been sexually active than doing a pelvic exam because it is less traumatic.
I understand that young women are very nervous for their first exam. I will explain what I am going to do, explain normal female anatomy, show her the speculum,etc. before the exam. I will also explain what I'm doing during the exam and make it as comfortable as possible. ~Lisa
Monday, March 1, 2010
Weight management with PCOS
Q: I have Polycystic ovarian syndrome (PCOS) and can't seem to lose weight with diet and exercise. What are my options for weight loss?
A: Weight gain and difficulty losing weight are common problems with PCOS. Although diet and exercise play an important role in weight management sometimes they aren't enough. I typically recommend patients with PCOS who are not trying to become pregnant, use an oral contraceptive pill to regulate cycles and decrease testosterone production. Glucophage (Metformin) can help the body better use insulin and decrease insulin resistance which can lead to weight loss. Anti-testosterone medications (such as Spironolactone) may also help with weight reduction by lowering testosterone levels. Appetite suppressants (like phentermine) and fat blockers (like Zenical or Alli) can also be very effective adjunct therapy. Of course, close medical supervision is recommended with all prescription medication use.
For people with PCOS achieving and maintaining optimal weight is very important and will decrease the risk of PCOS complications such as infertility, adult onset diabetes and cardiovascular disease. I recommend dietary counseling or following a diet plan (such as Weight Watcher's) in addition to exercising 3-5 times a week. Being consistent over time is very important. You are less likely to get frustrated and give up if you are seeing measurable improvement. I recommend you don't just focus on weight loss. Take measurements of your upper arms, breast, waist, hips and thighs so you can watch the inches drop off along with the pounds. Having a good support system will also help you stay focused. Having to "weigh in" at your health care provider's office or your Weight Watcher's meeting may serve to further motivate you. Hang in there you are not alone. 10 percent of the population has PCOS. It is very manageable with the right support! ~Lisa
A: Weight gain and difficulty losing weight are common problems with PCOS. Although diet and exercise play an important role in weight management sometimes they aren't enough. I typically recommend patients with PCOS who are not trying to become pregnant, use an oral contraceptive pill to regulate cycles and decrease testosterone production. Glucophage (Metformin) can help the body better use insulin and decrease insulin resistance which can lead to weight loss. Anti-testosterone medications (such as Spironolactone) may also help with weight reduction by lowering testosterone levels. Appetite suppressants (like phentermine) and fat blockers (like Zenical or Alli) can also be very effective adjunct therapy. Of course, close medical supervision is recommended with all prescription medication use.
For people with PCOS achieving and maintaining optimal weight is very important and will decrease the risk of PCOS complications such as infertility, adult onset diabetes and cardiovascular disease. I recommend dietary counseling or following a diet plan (such as Weight Watcher's) in addition to exercising 3-5 times a week. Being consistent over time is very important. You are less likely to get frustrated and give up if you are seeing measurable improvement. I recommend you don't just focus on weight loss. Take measurements of your upper arms, breast, waist, hips and thighs so you can watch the inches drop off along with the pounds. Having a good support system will also help you stay focused. Having to "weigh in" at your health care provider's office or your Weight Watcher's meeting may serve to further motivate you. Hang in there you are not alone. 10 percent of the population has PCOS. It is very manageable with the right support! ~Lisa
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