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This site is for informational purposes only and is not intended to provide medical advice. Please seek advice from a health care professional for any serious medical condition.

Frequently Asked Questions:

Frequently Asked General Questions
Do you have a Spanish interpreter in your office?
Where is your office located?
What are your phone and fax numbers?
How soon can I make an appointment to be seen?
May I speak to a nurse if I call the office?
What do I do if I need a prescription refill?

May I speak to the office manager?
May I speak to my health care provider on the phone?


Frequently Asked Obstetrical Questions
Do you take care of high-risk pregnancies?
What are the warning signs of pregnancy?
What are the symptoms of a urinary tract infection?
Is bleeding normal?
Can I drink or use any drugs when I’m pregnant?
Can I smoke?
Why do my gums bleed?
Can I have sexual intercourse?
Can I change my cat's litter box during pregnancy?
Is caffeine safe?
What types of tests are going to be performed during the pregnancy?
Are saunas and hot tubs safe during pregnancy?
If I am pregnant and a family member has or has been exposed to chicken pox, what should I do?
What can I do for headaches during pregnancy?
Are leg cramps normal?
Is it safe to paint during pregnancy?
Are hemorrhoids common during pregnancy?
Are herbs and extra vitamins safe during pregnancy?

Frequently Asked Gynecological Questions
What is a Pap test?
Who Should Get a Pap test?
What is a colposcopy?
What is a Loop Electrosurgical Excision Procedure (LEEP)?
What is Cryosurgery?
What happens during cryosurgery?
How will I feel during cryosurgery?
What happens after cryosurgery?
Why should I perform a monthly breast exam?
When should I examine my breasts?
What are vaginal infections?
What is abnormal vaginal bleeding?
Why is my period late?
What is menopause?
What is perimenopause?
What about testing for follicle-stimulating hormone (FSH)?
What do I do if I have urinary tract infection?

_______________________________________________________________________

Which doctors/providers are in your practice?
Dr. Steve Lies
Dr. John Welsh
Dr. Peter Roethling
Dr. Mike Brooks
Pam Phillips, NP


Where is your office located?

Near Wayne Memorial Hospital behind 3HC Home Health and Kitty Askins Hospice Center at
102 Handley Park Court
Goldsboro, NC 27534


What are your phone and fax numbers?

Phone- 919-734-3344
Fax- 919-735-3025


How soon can I make an appointment to be seen?

Appointments for routine exams are scheduled 3 to 6 months in advance. Emergencies are scheduled to be seen immediately. For annual and semi-annual checkups, a reminder card will be mailed to you.

May I speak to a nurse if I call the office?

Yes. We have 2 RNs that handle nurse and clinical phone calls. If the nurse is unavailable to answer your call or busy assisting another patient on the phone please leave a message. She will return your call as soon as possible. Please remember that the phone nurse also assists with patients in the office and may not be available immediately to answer your call. If you have an emergency, call 911 or go to the hospital emergency room. If you need a prescription refill, ask for the refill line.

What do I do if I need a prescription refill?

Call the office and ask for the prescription refill line or complete the online refill request form.

May I speak to the office manager?

Yes, just ask for her. If she is away from her desk or unable to take your call, please leave a message and she will return your call as soon as possible.

May I speak to my health care provider on the phone?

Yes. Please leave a message with the receptionist or nurse and the provider will call you back as soon as possible. Please remember that the providers are seeing patients in the office and at the hospital and may not be available to talk with you at the time of your call. Your call is very important to them and they will return your call as soon as possible.

Do you have a Spanish interpreter in your office?

Yes. Her name is Gabby Wilson and she is available to assist patients on the phone and in the office during appointments.


Frequently Asked Obstetrical Questions


Do you take care of high-risk pregnancies?

Inevitably, some pregnancies become high-risk after we begin taking care of them. However, depending on the high-risk reason(s), we may not accept some patients for care. When questions arise, these cases are evaluated individually by the physician.

What are the warning signs of pregnancy?

The important warning signs of pregnancy are listed below and IF any of these occur please contact the office immediately:

  • Vaginal bleeding

  • Leaking vaginal fluid

  • Change or decrease in baby's movement (once you start feeling movement at 18-24 weeks)

  • Severe headaches accompanied by increased swelling in hands and feet and/or face and visual changes such as spots before your eyes

  • Burning with urination

  • Temperature above 100.4 degrees

What are the symptoms of a urinary tract infection?
Symptoms of a urinary tract infection include pain or burning with urination and increased frequency of urination. The urine may be cloudy or have a strong odor. Unexplained lower abdominal cramping, often accompanied by a backache, can also mean a UTI. An untreated urinary tract infection can cause premature labor, so do not delay seeking treatment. If you suffer from these symptoms you should call the office and we will arrange a urinalysis for you. It is essential to drink plenty of water (8 to 10 glasses a day) if you think you have a urinary tract infection. You should also avoid caffeinated and carbonated beverages, as they can irritate the bladder and increase your pain and discomfort.

Is bleeding normal?

Spotting of blood may occur in 40% of all normal pregnancies during the first trimester. If you are spotting, begin bed rest and call the office. Avoid heavy lifting, exercise, and sexual intercourse for 48 hours after the last episode of spotting.

Can I drink or use any drugs when I'm pregnant?

Alcohol - Alcohol can cause mental retardation and slow growth. Because medical researchers do not know how much alcohol it takes to affect the developing baby during pregnancy we recommend you do not drink. The fetus is especially vulnerable during the first trimester when all the major systems are forming.
Drugs - Recreational drug use, especially cocaine, can cause serious complications - miscarriage, fetal stroke, brain damage, and even fetal death. Your baby may become addicted to any drugs you take. If you have used such a substance during pregnancy, please alert your physician.


Can I smoke?

Smoking harms your baby! Women who smoke during pregnancy have a greater risk of smaller babies, premature births, miscarriage, stillbirth, and increased respiratory problems in the baby after birth because smoking interferes with the oxygen and nutrient supply. In addition, the fetus is exposed to carbon dioxide, tar, and nicotine. Some studies show an increased risk of Sudden Infant Death Syndrome (SIDS) in babies exposed to cigarette smoke during pregnancy. There is recent evidence linking smoking to learning disabilities and growth retardation.

Why do my gums bleed?

Your gums may bleed more easily when you are pregnant. This is because of the increased blood supply to the oral tissues during pregnancy. You should brush at least twice daily using a soft toothbrush and also floss once a day. You should continue routine dental care during your pregnancy but you must inform your dentist that you are pregnant. They will need to know this so that they can use the correct anesthetic and take the necessary precautions for X-rays.

Can I have sexual intercourse?

Unless you've been told to refrain or there is a specific problem with the pregnancy, such as bleeding, leaking bag of water, or preterm contractions, sexual intercourse is safe during pregnancy. It may be necessary to experiment to avoid discomfort. If intercourse is painful or causes bleeding or prolonged contractions (it is normal to have some contractions following intercourse), please talk with your physician.

Can I change my cat's litter box during pregnancy?

You should avoid changing the kitty litter if at all possible since cat bowel movements may contain a parasite that can cause a serious infection. These infections can lead to birth defects. If you have to change the litter, use rubber gloves, wear a mask and wash your hands afterward. You should also wear gardening gloves when digging in the dirt in an area the neighborhood cats may use as a kitty litter box.

Is caffeine safe?

Caffeine, in moderation, is safe. Moderation is considered two or fewer caffeine containing beverages per day. If a mother drinks more caffeine, the baby can be born with a caffeine addiction. This addition will interfere with sleep patterns and eating during the first weeks. Beverages that contain caffeine include coffee, tea, chocolate and many carbonated soft drinks.


What types of tests are going to be performed during the pregnancy?
We will do the following routine tests during your first visit:

  • Rubella Titer - We do this test to determine your immunity status to Rubella (German measles). If the test shows non-immunity, the immunization will be offered to you when you deliver.

  • CBC - A complete blood count is done to determine your body's ability to carry oxygen and nutrients through it to your baby. This is repeated when we do the glucose challenge test (see below) and sometimes at around 36 weeks if we find you are anemic on an earlier visit.

  • Blood Type and Rh, Antibody Screen - If you are Rh negative and the father of the baby is Rh positive, there is the possibility the baby could inherit the father's blood type which could cause a problem during this or future pregnancies. Fortunately, we can prevent this in most cases by giving you an injection of Rhogam - this prevents your immune system from responding to the baby's Rh-positive blood cells. If you are Rh positive, there is nothing to worry about.

  • Hepatitis B - This test determines whether you have Hepatitis B, or if you are a carrier. If you are a carrier, your baby will need to be vaccinated at birth.

  • HIV - we recommend HIV testing to all pregnant women. If you are infected, you can transmit the virus to the baby. We can decrease the chances of this happening with medications and pregnancy management, which is why we like to perform this test. The test can be performed at any time during your pregnancy if you decide not to have it at your first visit.

  • Gonorrhea/Chlamydia/Syphilis - Testing for sexually transmitted diseases.

  • Pap smear - This test detects cancerous and pre-cancerous changes in the cervix (the opening to the womb, located at the top of the vagina).


Are saunas and hot tubs safe during pregnancy?

The use of saunas and hot tubs is not recommended in pregnancy. The extreme temperature could potentially damage the developing baby. Extremely hot baths are not recommended during pregnancy. Bath temperatures should be below 100 degrees Fahrenheit.


I
f I am pregnant and a family member has or has been exposed to chicken pox, what should I do?
Most adults are immune to chicken pox, either from having the disease or by forming immunity from a mild exposure. If you have had chicken pox in the past, you and your baby are protected. If you are not sure, ask your doctor to check your immunity with a blood test. If this shows positive immunity, you are both protected. If it shows no immunity, an injection of a medicine called Varicella Immune Globulin (VZIG) may be given to prevent chicken pox. In order to be effective, this injection must be given within 72 hours of exposure.

What can I do for headaches during pregnancy?

Headaches are common during pregnancy. Usually headaches do not signal a serious problem. How often they occur and how bad they are may vary. It is important to discuss with your health care team which medications you can use for the headache. You should contact your doctor if your headache does not go away, returns very often, is very severe, causes blurry vision or spots in front of your eyes, or is accompanied by nausea. You may use Tylenol (acetaminophen) two regular tablets or one extra-strength tablet for headaches.

Are leg cramps normal?

In the last three months of pregnancy, you may find that you have more leg cramps. Get plenty of calcium (three glasses of milk or supplement) and potassium (oranges or bananas.) Stretching you legs before going to bed can help relieve cramps. Avoid pointing your toes when stretching or exercising.

Is it safe to paint during pregnancy?

Latex paints manufactured before 1991 used small amounts of mercury as a preservative. There was some concern that this mercury could present a health hazard, so mercury is no longer used in latex paints. The fumes from latex paints are not felt to be a specific risk to a developing baby, but it is always wise to paint in a well-ventilated area. The fumes from oil-based paint, turpentine, paint thinner, etc., are best avoided by pregnant women. Also, remember when painting to avoid use of a ladder to reduce the risk of injuries due to a fall.

Are hemorrhoids common during pregnancy?

Very often pregnant women who are constipated also have hemorrhoids. Hemorrhoids are varicose (or swollen) veins of the rectum. They are often painful. Straining during bowel movements and having very hard stools may make hemorrhoids worse and can sometimes cause them to protrude from the rectum. Do not take drugstore cures while you are pregnant without first checking with your doctor or nurse. Hemorrhoids usually improve after the baby is born. Several things can help give relief or avoid the problem in the first place:

  • Avoid getting constipated

  • Eat a high-fiber diet

  • Drink plenty of liquids

Are herbs and extra vitamins safe during pregnancy?
No, your prenatal vitamins should be the only supplement used during pregnancy unless your provider specifically directs you to use an additional product.

Frequently asked Gynecology Questions

What is a Pap test?
The Pap test, or Pap smear, is a screening test for cervical cancer. The test can detect changes in the cells on the cervix (the opening to the uterus, or womb, at the top of the vagina). These changes may be cancerous, pre-cancerous, or caused by inflammation. Cervical cancer is almost 100% curable when diagnosed and treated in the early stages.

Who Should Get a Pap test?

Every woman should have regular pelvic exams and Pap tests beginning at age 21, or three years following the onset of sexual intercourse (whichever comes first).

Preparations for a Pap test
Avoid douching 24 to 48 hours before a Pap test. The solution may wash away cells shed from the cervix. You should not use any vaginal creams or gels (including medicinal creams) or have vaginal intercourse 24 to 48 hours before a Pap test. The creams, gels, or seminal fluids may hide cervical cells.


What is a colposcopy?

A colposcopy is the painless viewing of the cervix and the vagina through a high-powered microscope called a colposcope. The colposcope looks like a pair of binoculars attached to a stand. It does not enter the vagina. Direct examination through the colposcope allows the detection of abnormalities on the cervix that can not be seen with the naked eye.

What preparation is there for the test?
You should make your appointment for a time when you will not be menstruating (on your period). You should also refrain from intercourse and the use of spermicidal jelly, vaginal medications, douches, or tampons for at least 24 hours before the procedure as they can interfere with the accuracy of the test.
If you would like you may take a non-steroidal anti-inflammatory medication such as Ibuprofen or Naproxen Sodium one hour before your appointment to be more comfortable.

What happens during the test?
You will lie on the examining table with your feet in the stirrups, just like a regular pelvic exam. The provider will use a speculum to separate the walls of the vagina, just like during a normal Pap test. The speculum will remain in the vagina throughout the procedure, causing you to feel a little pressure. A vinegar solution (called acetic acid) will be applied to the cervix to remove mucous and debris. The colposcope will be placed near the vaginal opening. The provider will be able to see your vagina and cervix under magnification. Any areas showing abnormal cells will be biopsied. In a biopsy, a tiny sample of tissue will be removed from the area with a tweezers-like instrument. An endocervical scraping from the os (the opening in the middle of the cervix) may be taken as this is often where abnormal cells begin. You may feel a pinch or cramping when the tissue samples are taken. The samples will be sent to a pathology lab to be examined.

What should I look for after the procedure?
If a biopsy was taken, you may have slight bleeding or spotting for a few days following the procedure. Additionally, you may notice a coffee ground or mustard-like discharge. This is normal. You may use pads, but no tampons for 48 hours following the procedure. You should also refrain from douching or having sexual intercourse for 10 days following the procedure. If you have any cramping after the procedure, you may continue the Ibuprofen or Naproxen Sodium for relief.


What is a Loop Electrosurgical Excision Procedure (LEEP)?

Cells on your cervix are constantly growing and changing. Unfortunately, these cells sometimes grow and change abnormally. These abnormal cells are usually first noticed on a Pap test. If you've had a Pap test or cervical biopsies come back showing dysplasia, a LEEP may be recommended as treatment for these cells. Dysplasia is not cancer, but can lead to cervical cancer if not treated. During a LEEP, your doctor can remove the affected tissue, including the transformation zone (where many problems begin). It is sent to the pathologist to be sure that:

No cancer is present, and all the affected tissue was excised.

About 95% of patients are cured of their problem following a LEEP.

The LEEP will be scheduled during the first half of the menstrual cycle and 4-6 weeks after the initial biopsy after you have stopped bleeding. The procedure begins like a Pap test in that you will put your feet in stirrups and a speculum will be inserted into your vagina and opened. Your cervix will be numbed with a local anesthetic and a mild vinegar solution (called acetic acid) will be applied. This solution turns the affected cells white. The doctor will use a colposcope (it looks like binoculars on a stand) placed outside your vagina to look at your cervix microscopically. This will help them decide the size and shape of the loop used to excise the abnormal tissue.

A fine wire loop with a high frequency current (hence the name - loop electrosurgical excision procedure) is used to remove the abnormal tissue from your cervix. The loop will seal blood vessels as it cuts, decreasing bleeding. To further decrease bleeding, a medicated paste or solution may be applied to your cervix. This solution often causes a dark coffee-ground like vaginal discharge for a few days after the procedure. The tissue removed will be sent to a pathologist for diagnosis.

Following the procedure, you may feel a few mild cramps for a few days and you will have a vaginal discharge sometimes for up to 4 weeks. You should not put anything in your vagina (including tampons or sexual intercourse) for three to four weeks after your procedure. You should also avoid heavy lifting and vigorous exercise for three to four weeks.

Your doctor or nurse practitioner will want to monitor your Pap test closely following your LEEP. To catch any problems early, it is very important that you see your doctor or nurse practitioner as directed.

You must call your doctor if you:

  • Suffer from heavy bleeding or bleeding with clots (a "coffee ground" discharge is normal)

  • Experience severe abdominal pain

  • Have a fever

  • Have a severely foul-smelling discharge


What is Cryosurgery?

Cervical cryosurgery or cryotherapy is a gynecological treatment that freezes a section of the cervix. Cryosurgery of the cervix is most often done to destroy abnormal cervical cells that show changes that may lead to cancer. These changes are called precancerous cells. Your gynecologist will probably use the term cervical dysplasia. Cryosurgery is done only after a colposcopy confirms the presence of abnormal cervical cells. Cyrotherapy is also used for the treatment of cervicitis or inflammation of the cervix. Cryosurgery is not a treatment for cervical cancer.

What happens during cryosurgery?

Cryosurgery is performed in your doctor's office while you are awake. It is similar to a pelvic exam:
You will be asked to undress from the waist down, lie on an exam table with your feet in stirrups, and a speculum will be inserted into your vagina to hold the vaginal canal open so that your cervix can be seen.

However, that's where the similarity ends.

  • Cryotherapy uses special instruments called cryo probes.

  • During cryosurgery the cryo probes are inserted into your vagina until they firmly cover the abnormal areas of cervical tissue.

  • Next, liquid nitrogen begins to flow through the cryo probes at a temperature of approximately -50 degrees Celsius.

  • This causes the metal cryo probes to freeze and destroy superficial abnormal cervical tissue.

  • The most effective treatment result is obtained by freezing for three minutes, letting the cervix thaw, and repeating the treatment for three more minutes.

How will I feel during cryosurgery?

  • You may feel some slight cramping.
  • You may experience either a sensation of cold or of heat.
  • How effective is cryosurgery for cervical dysplasia?
  • Cryosurgery is an adequate treatment for most cases of cervical dysplasia destroying all of the abnormal cervical tissue in over 85 percent of cases. However, when the cervical changes are located in the upper section of the cervix a cone biopsy, rather than cryotherapy, is recommended.

What happens after cryosurgery?

  • You can return to most normal activities the day after cryosurgery; however, there are a few things you should take note of for the first two to three weeks following treatment:

  • It is normal to experience a watery discharge for the first few weeks. This is caused by the sloughing of dead cervical tissue.

  • Do not insert anything into the vagina for at least four weeks or as long as the discharge lasts. This means no tampons, no douches, and no sexual intercourse.

You should call your health care provider if any of the following occur:

  • Fever- Your doctor should inform you before you leave the office what amount of fever is cause for alarm following cryosurgery.

  • Vaginal bleeding that is heavier than you normally experience during your menstrual cycle.

  • Pain- Some slight cramping is normal; however, any severe or increasing pelvic pain should be reported to your doctor immediately.

  • Foul smell or yellowish vaginal discharge- These can indicate an infection which may need immediate treatment.

  • Cryosurgery is relatively risk-free, producing fewer complications than any other gynecological procedure. After cryosurgery you will need Pap tests every three to six months for a period of time. Once you have had several normal Pap smears in a row, your doctor will discuss with you how often you need future screening for cervical cancer.

Why should I perform a monthly breast exam?
Every year more than 200,000 women in the United States are diagnosed with breast cancer. That's why it is vitally important for a woman to regularly examine her breasts. In fact, nearly 90% of breast lumps are found by the woman herself. Unfortunately, many women appear to be hesitant about performing this exam because they are not sure how to do it or what to look for.

However, if you perform a self-exam each month, you will become an expert on your own breasts and you will be able to notice a potential problem before your doctor or nurse practitioner. Only by doing this task every month will you become familiar with your breasts and make it more likely to notice any changes. And, changes are what you are looking for. If you find any lump, hard knot or thickening you should contact your doctor or nurse practitioner immediately. Don't worry that it may be nothing. It is much better to be safe than sorry.

When should I examine my breasts?
If you are still having periods, you should do the exam seven days after your period begins. Your breasts are least likely to be tender and swollen at this time. If you no longer have periods, choose a day each month for the exam, such as the first of the month.

In Front of a Mirror
inspect both breasts with your arms at your sides. Next, raise your arms over your head. Look for any changes in the shape of each breast - swelling, puckering, dimpling, or scaling of the skin. Gently squeeze your nipple and look for a discharge. Report any discharge to your doctor or nurse practitioner. Next, put your hands on your hips and press firmly to flex your chest muscles. The left and right breasts will not exactly match - this is normal.

In the Shower
examine your breasts during a bath or shower. Your hands will glide easily over the wet skin. Press the sensitive pads of your fingers flat against the outer part of the breast, moving gently over every part of each breast. Start at the nipple and go around in a circular motion, enlarging the circle each time you reach the point where you began. Completely examine the breast and chest area from your collarbone to the base of a properly-fitting bra, and from your breastbone to your underarm.

Lying Down
Repeat this procedure lying flat on your back. Place your left arm over your head and a pillow or folded towel under your left shoulder. This position flattens the breast and makes it easier to examine. Repeat on the other side.

What are vaginal infections?

Vaginal infections are the most common gynecologic disorder and are usually caused when the normal vaginal flora that are found in the vagina become imbalanced. Symptoms of vaginal infections can range from mildly annoying to extremely uncomfortable. The key to successful treatment lies with an accurate diagnosis of the agent causing the infection. Therefore, before you use any over the counter medication such as a treatment for vaginal yeast infection you should be sure it is the right drug to treat the problem. Using the wrong sort of medication may make the situation worse. If you have any doubt you should consult your doctor or nurse practitioner.

The Most Common Vaginal Infections:

Yeast Infections
These infections are caused by a fungus called Candida. Yeast may be found in small amounts in the normal vagina. When there is an imbalance in the normal vaginal flora, the yeast can take hold and overgrow. Taking antibiotics that may kill the lactobacilli found in a normal vagina can cause this imbalance. The classic symptoms of a yeast infection include vulvar itching, redness and irritation. In severe cases, the vulva may be swollen with fissures, or breaks in the skin. When there is a vaginal discharge, it is thick, white and "cheesy" or curd-like. Your health care provider can diagnose the infection by vaginal culture, or looking at a drop of the vaginal secretions under a microscope. There are many treatments for yeast infections including oral and vaginal medications, prescription and over-the-counter.

Bacterial Vaginosis (BV)
Bacterial Vaginosis is the most common vaginal infection. The bacteria that cause the infection occur naturally in the vagina. The infection occurs when there is an overgrowth and the normal vaginal bacteria are replaced. The primary symptom of BV is a thin, white, or grayish discharge with an unmistakable fishy odor. The odor usually increases after intercourse or during menstruation. There may be mild irritation or itching, but quite often it is the offensive odor that causes the woman to seek treatment. The diagnosis is made by checking the vaginal pH (it is abnormally high with BV), evidence of the discharge upon exam, the fishy odor, and the abnormal appearance of cells that line the vaginal wall. BV is treated with antibiotics, either orally or intravaginally. These medications are only available with a prescription. It is important to finish all the antibiotics as prescribed.

Trichomoniasis
"Trich" is a common sexually transmitted disease (STD) that is caused by a protozoan. Although it is usually transmitted through sexual intercourse, in rare instances it has been passed through wet towels, washcloths or bathing suits. Trichomoniasis can occur without symptoms. When there are symptoms, they are usually within 4 to 20 days after exposure, although it may be years before the symptoms appear. The symptoms in women include a yellow-green vaginal discharge that may be frothy. The labia may be irritated, red and itchy. There may be spotting after intercourse, and a foul vaginal odor. If the infection involves the urinary tract, there may be burning with urination. Trichomoniasis is usually diagnosed by culture or by identifying the protozoan under a microscope. Sometimes the infections may be picked up on Pap smear. The infection is treated with oral antibiotics for the woman and her partner. It is important that both be treated so as to prevent re-infection.


What is abnormal vaginal bleeding?

From time to time, every woman suspects that her menstrual cycle is abnormal for one reason or another. However, often what we think is an abnormal period is actually normal menstruation. How do you know when you're experiencing abnormal periods? What are the signs and symptoms of abnormal periods? You may be experiencing an abnormal period, abnormal uterine bleeding, or an abnormal menstrual cycle if...

  • Your menstrual cycle is longer than 31 to 42 days apart, or less than two weeks from day one of your period to day one of your next period.

  • You need to change tampons or sanitary pads after only one or two hours.

  • Your period lasts longer than 7 to 10 days.

  • You suddenly begin experiencing severe menstrual cramps. While it's normal to experience a small amount of cramping during your period and some women never experience cramps during menstruation, it's not normal to experience severe menstrual cramps. If you suddenly begin having severe cramps you should be evaluated by your health care provider to determine the cause of the increased pain you experience during your period.

  • You see blood clots which are actually clots of tissue in your menstruation -- don't worry, this is a normal occurrence and is no cause for alarm. Blood clots such as these are perfectly normal because menstruation involves the shedding of the lining of the uterus.

  • You have recently experienced the onset of menstruation, don't worry if you skip periods or have irregular periods for the first few years. This is a normal process that most young ladies experience.

  • You're extremely active in sports activities; periods are often skipped for long periods of time. Nobody is sure why this occurs, but it's a normal occurrence for many women who regularly participate in intense sports or other activities.

  • You're a woman who is postmenopausal or younger than eleven should see a doctor immediately if you experience any amount of vaginal or uterine bleeding.

  • You are over 16 and haven't had a period yet. In this case your health care provider should be consulted to determine the cause. One possibility that you should be sure and ask about is polycystic ovarian syndrome or PCOS.

Things to Remember About Menstruation:

-Normal menstrual bleeding lasts about 5 days.
-The normal amount of blood lost during menstruation is about 2 to 8 tablespoons, although it may seem like more than that.
-The average menstrual cycle is 28 days from Day 1 to Day 1 of your period. However, anywhere from 25 to 31 days between periods is considered a normal menstrual cycle.
-The best thing to do when you suspect that you're experiencing abnormal bleeding or menstrual cycles is to consult with your health care provider.

Why is my period late?

  • Pregnancy is the most common cause of absence of menstruation (amenorrhea), but many times, other things can cause an absence of menstruation.
  • Breastfeeding mothers will often experience amenorrhea; however ovulation may still occur and pregnancy is possible even without menstruation.
  • Emotional stress is another possible cause of absence of menstruation. Eliminating the stress usually will cause menstruation to resume.
  • Certain medications such as contraceptives (oral, implanted, and injected), oral corticosteroids, antidepressants, antipsychotics, thyroid, and some chemotherapy drugs may cause amenorrhea for some women.
  • Polycystic ovarian syndrome is a common form of hormonal imbalance which may cause amenorrhea, as well as other symptoms that can include the other extreme with excessive bleeding (menorrhagia).
  • Women who are malnourished or extremely underweight often experience amenorrhea. This occurs often in women with eating disorders such as anorexia or bulimia.
  • Vigorous exercise or athletic training can cause amenorrhea.
  • Millions of Americans suffer from undiagnosed thyroid disease -- another possibility that should be explored by your health care provider.
  • If you have a chronic illness, or have been sick for an extended period, your menstrual cycle may be temporarily delayed. Once your body is well your period will usually return.
  • Although rare, a pituitary tumor (a usually benign tumor) can cause an overproduction of prolactin which can interfere with the regulation of your menstrual cycle.
  • If you have missed 3 or more menstrual cycles, and you haven't already sought professional medical advice, it's time to seek medical care to determine the underlying cause. Only a qualified health care provider can determine the cause of amenorrhea. You should also be alert to other signs that signal a need for medical attention.

These signs include:
Headaches
Hair loss
Vision changes


Breast secretions or milk production

  • Your health care provider has several choices for diagnosing the cause of amenorrhea. He or she can do a progestin challenge with 7 to 10 days of medication to see if it triggers bleeding. This will tell your provider if menstruation stopped because of a lack of estrogen. Thyroid disease and pituitary disorders can be determined by blood testing. Pituitary tumors can be detected with diagnostic imaging equipment.
  • How absence of menstruation is treated depends on the cause. The treatment can be as simple as lifestyle changes (diet, exercise, stress reduction), or can include hormone replacement therapy, as well as other medications when appropriate.

What is menopause?
Menopause is a normal, natural event - defined as the final menstrual period and usually confirmed when a woman has missed her periods for 12 consecutive months (in the absence of other obvious causes). Menopause is associated with reduced functioning of the ovaries due to aging, resulting in lower levels of estrogen and other hormones. It marks the permanent end of fertility. Menopause occurs, on average, at age 51. The years between puberty (when periods start) and menopause are called premenopause.

What is perimenopause?

Physical signs of menopause begin many years before the final menstrual period. This menopause transition phase is called perimenopause (literally meaning "around menopause"). It can last 6 years or more, and by definition, ends 1 year after the final menstrual period.

Perimenopausal changes are brought on by changing levels of ovarian hormones such as estrogen. During this transition time, estrogen levels gradually decline, but they do so in an erratic fashion. Sometimes they can even be higher than during the reproductive years. Irregular menstrual periods, hot flashes, sleep disturbances, and mood swings are common, normal signs of perimenopause. Some women experience low libido (sex drive) and/or vaginal dryness. During perimenopause, a woman may be able to conceive, although fertility is very low. If pregnancy is not desired, contraception is necessary until menopause is reached.

When a woman suspects she is experiencing perimenopause, it is an excellent time to have a complete medical examination by a qualified health professional. The diagnosis of perimenopause can usually be made by reviewing a woman's medical history, her menstrual history, and her signs and symptoms. In most cases, testing hormonal blood levels is not recommended because in menstruating women hormone levels are changing all the time. However, in younger women (below 40) menstrual irregularity is infrequently a sign of menopause, so hormone testing may be a useful tool to test whether menopause has occurred. Testing blood hormone levels can also be helpful in assessing a woman's fertility and potential for pregnancy. Results can help women make decisions about beginning or adjusting medications and help them understand their personal biological clock.

For some women, it may make sense to test for other causes of symptoms that can mimic perimenopause, such as thyroid disease.


What about testing for follicle-stimulating hormone (FSH)?

Sometimes, elevated FSH levels are used to confirm menopause. FSH is a hormone produced by the pituitary gland that triggers the ovaries to secrete estrogen. As the ovaries' production of estrogen declines around menopause, the pituitary gland releases more FSH into the blood to try to stimulate estrogen production. So, when a woman's FSH blood level is consistently elevated, and she is no longer having menstrual periods, it is generally accepted that she has reached menopause. However, a single FSH level can be misleading in perimenopause because estrogen production doesn't fall at a steady rate from day to day. Instead, both estrogen and FSH levels fluctuate from fairly high to fairly low during perimenopause. Also, if a woman is using certain hormone therapies (such as birth control pills), an FSH test is not valid.

Some healthcare practitioners recommend testing a woman's saliva for estrogen levels, but there is no conclusive evidence that this test provides useful information around menopause.
What is Bioidentical Hormone Therapy?

Amidst the confusion surrounding the use of custom-compounded bioidentical hormone therapy for treatment of menopause-related symptoms such as hot flashes, The North American Menopause Society (NAMS) confirms its support of the US Food and Drug Administration (FDA) and other scientific organizations that have warned women about the potential harm from these products.

The term "bioidentical hormone therapy" is often used to describe a medication containing estrogen, progesterone, or other hormones that are chemically exact duplicates of hormones produced by women, primarily in the ovaries. Many of these bioidentical hormones (e.g., estradiol, progesterone) are commercially available in several well-tested, FDA-approved, brand-name prescription drugs. A list of government-approved bioidentical hormone therapy products in the United States and Canada is posted on the North American Menopause Society site.

Concern arises with the bioidentical hormone medications that are "custom-compounded" (custom-mixed) recipes prepared by a pharmacist following an individual prescriber's order for a specific patient. These medications do not have FDA approval because individually mixed recipes have not been tested to prove that the active ingredients are absorbed appropriately or provide predictable levels in blood and tissue. Further, there is no scientific evidence about the effects of these compounded medications on the body - both good and bad.

Salivary and blood testing of hormone levels used by custom compounders is meaningless for midlife women as their hormone levels vary throughout the day, and from day to day.

What do I do if I have urinary tract infection?
Call the office and speak to the nurse. A urinalysis and possible urine culture can be done by the nurse in the office. If needed, you will be given a prescription for antibiotics. You will not be required to see a provider before being treated unless your symptoms necessitate an exam. Symptoms of a urinary tract infection include pain or burning with urination and increased frequency of urination. The urine may be cloudy or have a strong odor. Unexplained lower abdominal cramping, often accompanied by a backache, can also mean a UTI. You should also avoid caffeinated and carbonated beverages, as they can irritate the bladder and increase your pain and discomfort.

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