Which doctors/providers are in
your practice? Dr. Steve Lies
Dr. John Welsh
Dr. Peter Roethling
Dr. Mike Brooks
Angel F. Etheridge, WHNP
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
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
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
Leaking vaginal fluid
Change or decrease in baby's
movement (once you start feeling movement at 18-24
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
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
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
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
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
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
- 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
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.
If 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
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
Avoid getting constipated
Eat a high-fiber diet
Drink plenty of liquids
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
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
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
About 95% of patients are cured of their problem following
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
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
Experience severe abdominal
Have a fever
Have a severely foul-smelling
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
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
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.
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
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
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.
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.
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
The Most Common Vaginal 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
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.
"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
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
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
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
-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
-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.
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
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
These signs include:
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.
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
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
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
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
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.