FAQ's

How safe are hormones in menopause?

Recent studies have questioned the over all safety of HRT in relation to heart attack, blood clots, stroke, breast cancer, and most recently Alzheimer’s Disease. These results seem to be significant statistically and are of concern. However, overall the increased risks are minimal and therefore, there are still indications for the use of hormones in menopause. Each individual is different so it is important to discuss your situation with your physician prior to making a decision on whether or not to use them.

Charles J. Seigel, M.D.

What is the latest info from the WHI?

The Women’s Health Initiative study, which changed the use of HRT because of potential risks, completed its portion related to women taking estrogen alone. It found that the breast risk was not statistically significant, and that there may be an increased risk of Alzheimer’s, but that is still unproven. In short the recommendation for HRT remains the same-use only for severe symptoms at the lowest dose and shortest duration possible and for osteoporosis where other treatments cannot be used.

Charles J. Seigel, M.D.

What about alternatives to hormones for menopausal symptoms?

There are numerous other entities, both medicinal and herbal that can be used. In most cases these do afford some relief, but not to the extent of hormone replacement. There are pro’s and con’s in the use of any alternative therapies and your gynecologist is a resource in determining if any of these are right for you.

Charles J. Seigel, M.D.

Doesn’t postmenopausal hormone replacement prevent Alzheimer’s disease?

Recent findings of the Women’s Health Initiative showed insignificant probable increases in dementia. This will probably not change any guidelines. It is just more information on the lack of efficacy of hormones for prevention of chronic diseases of aging. It is reported that these studies were in older women and are not addressing the use of hormone replacement therapy in healthy 50 year olds on it for hot flashes.

Charles J. Seigel, M.D.

Why & when do I need a mammogram?

Every three minutes a woman in the United States learns she has breast cancer. Regular mammograms remain the key to early detection. Small breast cancers can be detected up to two years before they can be felt with a mammogram.

Low risk women should have a baseline mammogram around the age of 40. Factors such as a family history or previous breast disease may indicate the need for an earlier mammogram. After 40, a mammogram should be done annually. In addition to getting regular mammograms, women should also continue monthly self breast examinations and see their health care provider regarding any concerns.

Heather L. Arel, ARNP

I’ve heard there are certain foods you shouldn’t eat in pregnancy.

Pregnant women should avoid foods that can cause food poisoning or contain harmful pollutants. Food borne illness caused by certain bacteria can result in premature delivery, miscarriage, fetal death and/or severe illness of a newborn due to an infection.

Some foods to avoid are:

• Swordfish, shark, king mackerel, tilefish & certain game fish
• Raw fish, especially shellfish
• Because of its mercury content, limit consumption to one can of “white” tuna or two cans of “light” tuna per week
• Undercooked meats, poultry, seafood and hotdogs
• Deli/luncheon meats and hotdogs should be reheated until steaming hot
• All foods made with raw or lightly cooked eggs
• Certain soft cheeses
• Unpasteurized (raw) milk or juices
• Raw sprout

As always, it is important to wash your hands and surfaces often when preparing food, take care not to cross-contaminate, refrigerate perishable foods promptly and
cook food to the proper temperatures.

Heather L. Arel, A.R.N.P.

I’m a smoker. What are my risks if I’m trying to get pregnant?

Smoking is harmful before, during and after pregnancy. Smoking can make it more difficult to become pregnant or cause ectopic (tubal) pregnancy. While pregnant, there are risks to an unborn child. Some potential effects are miscarriage, preterm delivery, low birth weight or even still birth. In fact, there is a three times greater risk of sudden infant death syndrome (SIDS) for babies born to a smoker. The child is also more likely to suffer respiratory infections, bronchitis, pneumonia, and ear infections.

A clinician can help you make an individualized plan to quit smoking. Your baby is depending on it for his or her health.

Heather L. Arel, A.R.N.P.

What is folic acid & why do I need it before I’m pregnant?

Folic acid is a B vitamin. If women have enough folic acid before pregnancy it can prevent birth defects of a baby’s brain or spine. It is recommended that all women who could become pregnant take 400 micrograms of folic acid daily. This could prevent up to 70% of some types of serious birth defects. To do this, women need folic acid at least a month before they become pregnant through the first four weeks the baby is growing. Because by the time a woman finds out she’s pregnant, her baby’s brain and spine are already formed. The easiest way for a woman to get the folic acid they need is through a standard multivitamin.

Heather L. Arel, A.R.N.P.

How do I keep my bones healthy?

Taking care of your bones can help prevent osteoporosis, a disease
that makes bones weak, brittle and easy to break. There are simple
steps you can take to stay strong and active for life.

• Make sure you are getting adequate calcium and vitamin D every day. The recommended daily intake of calcium, for most people, is 1200 mg and for vitamin D is 400 I.U.  If you are getting too little calcium, through your diet, talk to your health care provider about taking supplements.
• Exercise regularly. The best types are those that have you on your feet.
• It is also important to avoid lifestyle habits that harm bone, such as smoking and alcohol abuse.

Heather L. Arel, A.R.N.P.

What are menstrual flow problems in adolescents?

The initial two years of menstruation can be variable. On average, flow lasts 5 days, 21-40 day interval between flows, and blood loss is about 7 teaspoons. When blood loss falls outside these parameters, consider:
infections (STD’s), endocrine problems such as PCOS (increased acne and hair growth), anatomic obstructions to vagina, eating disorders, and pregnancy complications.

David R. Levene, M.D.

Why is ultrasound performed during pregnancy?

Ultrasound is used to evaluate the growing fetus inside the mother’s uterus. In a way, it serves as a type of physical exam of the baby. It can provide valuable information to you and your health care provider about your baby’s health and well being. Ultrasound uses sound waves and is safe in pregnancy. 

Ultrasound is used to determine:

• Age of the baby
• If the baby is growing at the correct rate
• Location of the placenta
• Fetal position, movement, breathing and heart rate
• Amount of Amniotic fluid in the uterus
• Number of babies
• Detection of some types of birth defects

Karen Glenny, RTR, RDMS, RDCS

What can I do for nausea and vomiting of pregnancy?

• Eat whatever sounds best to you. Don’t be worried about a balanced diet at this time.
• Eat small frequent meals.
• Avoid getting dehydrated. Drink small amounts of fluids during the day.
• Avoid stress and fatigue. Try to rest and get plenty of sleep at night.
• Take your prenatal vitamin with food. If it’s still a problem, try a multivitamin or a chewable.

Be sure to call your doctor if you are unable to keep fluids or solids down for a 24 hour period, or if you are losing weight.

Remember-You will feel better soon

David Levene, M.D.

I’m 45 and have irregular/heavy bleeding but I don’t want to have a hysterectomy, what are my alternatives?

Hysterectomy can usually be avoided, as a treatment for irregular or heavy bleeding. You should be evaluated for potential anatomic causes such as fibroids, polyps, overgrowth of the uterine lining or cancer. Hormone levels may be assessed. If all studies are normal it is considered “dysfunctional uterine bleeding.”

Treatment includes correction the underlying cause (simple procedures to remove polyps or fibroids or correction of hormones). Hormonal treatment with birth control pills or progesterone may be considered. An off label use of a progesterone IUD may decrease bleeding. Another procedure called an endometrial ablation may also be performed.

Fletcher R. Wilson, M.D.

I want to get my tubes tied what should I consider?

Tubal ligation (trying and/or cutting the fallopian tubes of a woman) is a procedure done in the operating room using a type of surgery called laparoscopy, which is operating through tiny incisions in the abdomen. The failure rates are generally considered to be about 1% lifetime risk. It takes a few days to a week to fully recover. One thing to remember about these are they are considered permanent procedures and the regret rates for women who have the procedure when they are less than 25 are as high as 65%. 

The alternatives are vasectomy (cutting and tying the vas deferens in a man) or the IUD (intrauterine device), which is the only easily reversible alternative.

Fletcher R. Wilson, M.D.

Why should I get a pap smear when there is no cancer in my family?

Since the advent of pap smears in the 1940’s cervical cancer has gone from one of the largest killer of women to one of the least. It is not a cancer that travels in families. The cancer is believed to be caused by “high risk” strains of virus called HPV. The virus is in about 50% of the population. It is passed most frequently by intercourse but any sexual contact can transmit it. At this point we have cure for the virus but we can detect precancerous cells on the cervix and thus remove them before they progress to cervical cancer.

Fletcher R. Wilson, M.D.

Am I the only woman who leaks urine? Is it treatable?

Studies generally show 25 to 50% of women experience incontinence at some point in their life. The two major causes in women are STRESS Incontinence (leaking with laughing, sneezing, running etc.) and URGE incontinence (where you feel urgency prior to leaking). Treatment for stress incontinence begins with exercise like Kegel’s or physical therapy (75% cure rate) and if that fails possible surgery. Treatment for urge incontinence usually entails behavior changes, timed voiding, and if that fails sometimes medications are needed. Don’t suffer; talk with your healthcare provider.

Fletcher R. Wilson, M.D.

My husband and I have been trying to conceive for 3 months, should we be concerned?

Infertility is a condition affecting over five million couples annually. It is defined as the inability to achieve pregnancy for a year or more. There are many factors which may contribute and a full evaluation should be undertaken after a year. Approximately 35% of infertility can be attributed to underlying female factors, 35% to male factors, 15% to both and the remainder is unexplained. In older women, the work-up may be done sooner as fertility is known to decline after the age of 35. Improved diagnostic and therapeutic approaches have allowed many couples to ultimately achieve pregnancy.

David Levene, M.D.

What are my options for pain control in labor? I’ve heard that epidural anesthesia in labor is dangerous.

Labor results in severe pain for many women. There are many options available to treat such pain. Some women choose non-pharmacologic approaches, such as walking, showering or laboring in a tub. Other options include short-acting narcotics and regional anesthesia such as an epidural or intrathecal. Regional anesthesia offers the most effective form of pain relief and is generally considered safe. Most of the complications associated with epidural anesthesia are preventable or treatable.

David Levene, M.D.