Frequently Asked Questions

I am considering getting pregnant but should I see my obstetrician prior to conceiving?
Definitely yes. Your obstetrician can review your past family, medical and reproductive history and make recommendations to assure you are as healthy as possible prior to conceiving. Starting folic acid may help reduce certain types of neurological  birth defects. In addition, making sure all vaccinations and blood work are current  can all help achieve a healthy pregnancy.

What are the risks and benefits of the birth control pill?
For most healthy women, the benefits of the pill outweigh the risks. The benefits include easy light, predictable, painless periods. The pill improves acne. The pill can reduce your risk of developing ovarian and uterine cancer later in life. It reduces the incidence of fibrocystic breast disease, fibroid tumors of the uterus, and ovarian cysts. The risk of blood clots is minimal at 5/10,000 and there does not appear to be any increase risk of breast cancer. In healthy non-smokers you can take the pill through menopause up to age 55.

I am pregnant-what vaccines can or should I get?
The CDC recommends all pregnant women receive the flu vaccine if they are pregnant during flu season which usually runs from October through March. In addition, the Tdap  vaccine is recommended with each pregnancy for protection against whooping cough. If you are traveling out of the country or work in a field which exposes you to hepatitis, then you should receive the Hepatitis B and Hepatitis A vaccines which are safe in pregnancy.

How much weight should I gain in pregnancy?
The average weight gain in pregnancy is 30 lbs. which equates to ½ lb. per week in the first 20 weeks and then 1 lb. per week in the second 20 weeks. If you are underweight then the weight gain is expected to be 28 to 40 lbs. If you are overweight the weight gain is 15 to 28 lbs. For twins the expected weight gain is 35 to 45 lbs.

My doctor has ordered a saline sonohysterogram what is this?
A saline sonohysterogram is an office procedure where under the guidance of an ultrasound, saline is instilled into the uterus using a catheter. This distends the uterine cavity and allows the physician to see inside the uterus for polyps, fibroids, or tumors which otherwise may not be visible using traditional ultrasound alone.

I can’t remember to take the birth control pill. What else can I use?
If pills are not taken daily you do run the risk of an unwanted pregnancy. There is a birth control patch that is changed weekly and a vaginal ring that is changed at monthly intervals. Longer term options include a shot that is given every three months, an implantable rod that is effective for three years, or intrauterine devices that last for either five or ten years. If you have completed your childbearing, permanent surgical options are available. Talk to your doctor about the risks and benefits of birth control and what choice might be right for you.

I have been trying to get pregnant. How do I know if I am infertile?
Most women do not get pregnant on their first attempt. A percentage of women will get pregnant each month and by 12 months approximately 90% of those women trying will succeed. Women who are wanting to conceive should keep a menstrual calendar. If after one year you are unsuccessful see your doctor. If your periods aren’t regular however, see your doctor sooner. Your physician will discuss with you what studies need to be done to find out why you are unable to conceive. Also, if you are 35 years or older discuss with your doctor prior to 12 months.

I am 16 years old and started having sex 6 months ago, I read I needed a pap smear. What is a pap smear and do I need one?
A pap smear is a screening test for cervical cancer. During a pelvic exam cells from your cervix are obtained using a soft brush. Young women should get a pap smear at age 21 years of age. However it is important that once you are sexually active you see your doctor even though no pap smear is performed as screening for sexually transmitted diseases is recommended. Also, if you are not already on birth control you will need to consider your options and discuss this with your gynecologist.

Is dental care safe during pregnancy?
Not only is dental care safe during pregnancy, it is recommended. Poor oral hygiene and periodontal disease can cause problems with an otherwise normal pregnancy, including infections and even preterm labor. Local anesthesia, antibiotics, and even pain medications can be used. Don’t forget to discuss with your obstetrician and your dentist any allergies to medications that you might have. If needed, x-rays can be performed as long as the abdomen is shielded.

Can I still have sex during my pregnancy?
When you start routine pregnancy care your doctor will ask you questions about your history. You may have issues that will prompt your obstetrician to tell you to refrain from intercourse. As your pregnancy progresses, situations might arise where your doctor tells you not to have sex. However, for most women sex during the entire pregnancy is absolutely fine and causes no problems. If you have any spotting, bleeding, or pain then avoid sex and be sure to notify your doctor.

I’m having an itchy vaginal discharge. Should I be seen?
An itchy vaginal discharge for most women usually means a yeast infection. Over the counter creams can be used to relieve your symptoms. If your discharge continues then you need to be seen by your doctor to determine if other causes exist. Sometimes your doctor can diagnose the problem just by examining you, but often cultures need to be performed to determine the appropriate treatment. If your discharge has other qualities such as an odor, color other than white or clear, or you are having pain then you should visit your doctor prior to trying over the counter remedies.

What is HPV?
HPV (Human Papilloma Virus) is a group of viruses that cause, among other things, genital warts and cervical cancer. HPV is transmitted via intimate contact. Certain types of HPV can cause change in the cells of the cervix and if left undetected, may lead to cervical cancer. Regular gynecologic exams and PAPs aid to detect HPV and its effects. Your doctor may choose to test for HPV at the same time as doing a PAP. While HPV is common (8 out of 10 women will be infected with HPV), it is usually transient.

What is Gardasil, the HPV vaccine? Should I get it?
Gardasil is a vaccine that helps protect against infection with HPV. HPV (Human Papilloma Virus) is the cause of genital warts and cervical cancer. Gardasil is FDA approved and recommended for girls and women ages 9-45 years old. It is safe and very effective in preventing infection with the most common types of HPV that cause genital warts and the most common types of HPV that cause cervical cancer. It is most effective when given prior to the onset of sexual activity, and is a series of  two to three injections given over 6 months.

What is a minimally invasive hysterectomy?
A hysterectomy is the removal of the uterus. Sometimes the ovaries are removed at the same time as well. Traditionally, hysterectomies have been performed by a large incision on the abdomen and require a several day stay in the hospital and a 2-3 week recovery at home. Today, many hysterectomies can be performed laparoscopically, using instruments through a number of small incisions on the abdomen. This requires only a brief stay in the hospital, and many return to work within 1-2 weeks. Your doctor can determine if this surgical approach is appropriate for you.

What is Herpes (HSV)?

Herpes is a virus that is transmitted through intimate contact. It is responsible for sores on the lips and mouth (usually type 1) and also for sores on genitals (usually type 2). The outbreaks of sores are typically recurrent, and can occur up to many times a year. Although there is no cure for herpes, the number of outbreaks can be greatly reduced through medication. Herpes can be transmitted to others even when no sore is present. Taking medication daily can also dramatically reduce the risk of transmitting herpes to an uninfected partner.

Can I travel during my pregnancy?
There are many misconceptions about common activities and their safety during pregnancy. Unless your pregnancy is complicated by certain high-risk conditions (such as preterm labor or abnormalities of the placenta), travel is appropriate for pregnant women until the last month (36th week) of pregnancy. It is always a good idea to take your doctor’s contact information with you when you travel, in case a problem arises far away from home, and records may be needed. During any prolonged trip in a car or plane, you should periodically take short walks to help prevent a blood clot from forming in your legs.

My friend is due to have her baby soon and she is GBS positive. What is GBS?
Group B Strep (GBS) is a bacteria that is common in the vagina of women and can be passed to a baby during delivery. Most babies exposed to GBS do not have any problems, but a few may become sick. To help prevent transmission during delivery, all pregnant women are tested the month before they are due to see if they are a carrier of GBS. Since your friend is a carrier of GBS, she will receive antibiotics during labor to help prevent transmission to the baby. Your friend is not alone; up to 30% of women test positive for GBS.

My periods are very heavy, but the idea of a hysterectomy sounds dramatic. Is there anything else I can do?
After excluding serious medical causes such as cancer, there are many options ranging from medication to surgery. Often medical treatments such as birth control pills or progesterone can be effective. Minimally invasive surgery including endometrial ablation can also be a good solution. This procedure destroys the inner lining of the uterus and can result in a significant decrease or elimination of bleeding. Of course, not every option is appropriate for every patient. Ultimately, a hysterectomy may be needed, but new surgical approaches using minimally invasive techniques may be appropriate and can dramatically reduce post-operative pain and shorten recovery time.

How Do I take my Birth Control Pills?

New start instructions:

Option #1: Start on the Sunday that follows the 1st day of your next menstrual cycle. If you cycle begins on a Sunday, start taking the pills on that day. If they start on any other day Mon-Sat. start on the Sunday that follows day 1 of your cycle. It is ok to start the pills if you are still bleeding.

Option #2: Start the first day of your period, keeping in mind that birth control may not be effective for the first month and you may increase your chances of experiencing breakthrough bleeding.

Take the pill at the same time every day. Choose a time that you will be awake and will remember to take the pill regardless of the day of the week. Some people find it helpful to set an alarm on their phone or with a meal to ensure they don’t forget. Taking it at bedtime or wake time may change depending on the day of the week, so that is no longer recommended.

Your period should occur during the last row of pills (4th row). Periods can be lighter or shorter while taking the pill. Some women’s periods may be so light that it is only a dark spot or light bloody show when they wipe. This is ok. If you have no menses, please do a home pregnancy test. If the test is negative, continue on the pill as usual. If the pregnancy test is positive, please call the office to schedule an appt.

Common side effects:

Breakthrough bleeding is common during the first 3 months of any new birth control pill. Taking the pill at the same time every day will reduce breakthrough bleeding. Notify your provider if you experience breakthrough bleeding into pack # 4 if you are taking it consistently, as a change in your formulation may be needed.

Nausea is typically transient and resolves within the first month of use. You can minimize nausea if you take your pill with food or at night before you go to bed.

Notify your healthcare provider if you experience negative side effects that are severe or even if mild side effects are not resolving over time.

Some women need more estrogen than others and some women respond better to a specific type of progesterone. It is important that your provider work closely with you to find the right formulation for you. this may mean needing to try several brands in order to find the best fit.

If you miss a pill:

a.) If you miss 1 pill, take 1 as soon as you remember then the next at the usual time

b.) If you miss 2 pills in a row, take 2 pills daily for 2 days and also use a back up form of birth control for the next seven days.

c.) If you miss 3 or more pills in any row at anytime, then discard the pill pack and start a new pill pack. Use back up birth control for the next 7 days.

Condoms are recommended with “EVERY” sexual encounter to prevent transmission of sexually transmitted infections and as a back up to birth control.

Plan B may be purchased at the pharmacy without a prescription if you miss a pill and you did not use a condom or if the condom broke. It is  progesterone, similar to the one found in your birth control pill and one dose can prevent a pregnancy if it is taken within the first 72 hours of sexual intercourse. The sooner you take Plan B the more effective it will be. IT WILL NOT TERMINATE AN EXISTING PREGNANCY. This is not “RU 486” or the so called “abortion pill.” It may cause breakthrough bleeding or a change to your menstrual cycle.

I have an abnormal PAP what does this mean?

HPV Positive-Your pap smear is positive for the Human Papilloma Virus, or HPV. This is a virus transmitted through intimate skin to skin contact. Certain strains of this virus can increase your risk of developing cervical cancer. Knowing you have been exposed to HPV helps us monitor you more closely to ensure we identify if cells are changing and, if needed, remove them to prevent cancer from developing.

8 out of 10 people in the general population have been exposed to HVP. Most people who have an HPV infection never have problems with cancer, but it is hard to know who will be affected, which is why screening pap smears are so important.

Most people do not have any symptoms when they get infected with HPV. And, often, the infection will get better on its own but, we can monitor. Long lasting HPV infections have a higher chance of developing cervical cancer, mouth or throat cancer or genital warts. These problems usually happen many years after a person was first infected.

There is no way to know when you were infected. But….we can monitor you from this point forward to ensure that if HPV is causing changes to your cervix, we can offer you treatments to reduce your risk of developing cervical cancer.

HPV Vaccine (Gardasil)- is a vaccine that prevents infection with multiple types of HVP that can lead to cervical cancer and also genital warts. It is administered via injection in a series of 2 or 3 vaccines, depending on the patient’s age. It is hoped that this vaccine will reduce the number of women with cervical cancer and pre-cancer. Recommended for boys and girls ages 9-45, most effective if administered before onset of sexual activity. It can be given to patients who have already been exposed to HPV. Pap smears are recommended starting at age 21 and this vaccine does not change pap recommendations.

Abnormal Squamous Cells of Undetermined Significance-  ASC-US refers to abnormal changes to the cervical cells that do not reflect precancerous changes but the cells do not appear normal and cannot exclude precancerous cells. Closer monitoring of these cells is typically recommended.

Low-Grade Squamous Lesion– LSIL shows mild cellular changes to the cervix and colposcopy is recommended.

High-Grade Squamous Lesion-HSIL refers to moderate to severe changes in the cells of the cervix and colposcopy is recommended.