female1What is abnormal uterine bleeding and what can be done about it?
Abnormal uterine bleeding may include:

  • Absence of menstrual cycles
  • Bleeding between periods
  • Bleeding after sex
  • Spotting
  • Any change in normal flow

Treatment for abnormal uterine bleeding will depend on the cause, ranging from a prescription of hormones such as birth control pills or other medications, and occasionally surgery. Your physician will discuss your many options and the best way to resolve abnormal uterine bleeding.

What is endometriosis and is there a cure?
Endometriosis occurs when the tissue that lines the uterus and is shed during menstruation, grows outside of the uterus-on the ovaries, fallopian tubes, the ligaments that support the uterus, and other organs in the pelvic cavity. It can lead to problems such as chronic pelvic pain, pain during sexual intercourse, painful menstrual discomfort and infertility. Treatment for endometriosis depends on the extent of the disease, your symptoms and whether you want to have children. It may be treated with medication, surgery or both. Endometriosis can be a very frustrating and trying condition; therefore, your physician will be able to guide you as you discuss your treatment plan.

How can I prevent osteoporosis?
Bone loss threatens millions of women and can remain undetected until a bone is broken. Being past menopause is a major risk factor for the development of osteoporosis. Other factors increasing your risk include:

  • Family history of osteoporosis or broken bones
  • Too much caffeine or alcohol
  • Thin or petite build
  • Too little exercise
  • Caucasian/Asian race
  • Smoking
  • Use of high doses of certain medications like steroids or thyroid hormone
  • Too little calcium and vitamin D

Safe, simple and painless bone density testing is the most accurate way to assess bone health.

Do I need a prescription for a vaginal infection?
Vaginitis is the inflammation of a woman’s vagina. As many as one third of women will have symptoms of vaginitis at some time during their lives. To diagnose vaginitis, your doctor will take a sample of the discharge from your vagina and look at it under a microscope. Treatment for vaginitis depends on the specific type the patient has.

There are several types of vaginitis:

  • Yeast infection
  • Bacterial Vaginosis
  • Trichomonas Vaginitis

The symptoms and treatment for each type are different and will be evaluated by your physician. Although vaginitis can be uncomfortable and unpleasant, with accurate diagnosis and treatment, it can be resolved.

I have difficulty controlling urination. I have even leaked at various times, which can be a real problem. Can this condition be corrected?
Women who have urinary incontinence may leak urine often. They may have to wear a pad to keep from wetting their clothes. Some women with incontinence feel such a strong desire to urinate that they cannot control it. This results in a loss of urine. There are many possible causes of urinary incontinence. These include infection, damage to organs and muscular disorders. Treatment plans vary as well. They include behavioral changes, medication, special devices or surgery. In most cases, urinary incontinence can be treated with success.

Are fibroid tumors dangerous?
Uterine fibroids are benign (not cancer) growths in the uterus. They are the most common type of growth found in a woman’s pelvis. They occur in about 20-25% of all women. Although most fibroids do not cause problems, there can be complications because of their size, number or location. Certain signs and symptoms may signal the need for treatment:

  • Heavy or painful menstrual periods
  • Bleeding between periods
  • Uncertainty whether the growth is a fibroid or another type of tumor, such as an ovarian tumor
  • Rapid increase in growth of the fibroid
  • Infertility
  • Pelvic pain

Fibroids may be treated by removing them with surgery. Certain drugs may be used to shrink fibroids temporarily and to control bleeding to prepare for surgery. Finally, getting regular checkups and being alert to warning signs will help you be aware of changes that may require treatment.

Do ovaries produce cysts each cycle? Should they be examined?
Ovarian cysts are quite common in women during their childbearing years. Most cysts result from the changes in hormone levels that occur during the menstrual cycle and the production and release of eggs from the ovaries. A woman can develop one cyst or many cysts. Ovarian cysts can vary in size-from as small as a pea to as big as a grapefruit.

There are different types of ovarian cysts, and each causes a variety of symptoms. All cysts can bleed, rupture, twist and cause pain. Most cysts are benign-not cancerous. A few cysts, though, may turn out to be malignant (cancerous). For this reason, all cysts should be checked by your doctor.

Is there a cure for genital herpes?
Genital herpes is a sexually transmitted disease. It is spread through close contact, most often during sexual activity. Genital herpes is probably best known for the sores and blisters it causes that occur around the genital organs. One way your doctor can diagnose herpes is to examine the genitals. There are also a number of tests to detect infection. There is no cure for genital herpes; however, there are oral medications to help control the course of the disease. Medication can shorten the length of an outbreak and help reduce discomfort. Over time, most people with herpes find ways to cope with the disease.

If I miss a birth control pill, what should I do?
As a general rule, take two pills the next day. DO NOT STOP YOUR PILLS! Additionally, it is helpful to use a barrier method for the remainder of the month. You may experience light breakthrough bleeding when you miss a pill, and could have two periods that month.

I recently had surgery. I am concerned I might have a post-operative problem. How can I know for sure what is normal?
Gynecologic surgery runs the gamut of multiple procedures, both major and minor. The things you should look out for are listed below:

  • SEVERE pain
  • Fever consistently 100.4 or higher
  • Marked redness, swelling or tenderness in a wound
  • Heavy bleeding
  • Foul-smelling discharge
  • Severe calf pain

If you experience any of the above symptoms, notify your doctor immediately. Light bleeding after a hysterectomy or laparoscopic procedure from either wound or vagina is quite common, and generally nothing to be worried about. If there is any question, however, it is always best to see your doctor or go to the emergency room if it is a night or weekend. If you are having a problem not related to the surgery such as urinary tract infection symptoms, bronchitis, etc., you should also contact your doctor.

I think I have a vaginal infection. What should I do?
Common infections include yeast vaginitis, bacterial vaginosis, and trichomonas vaginallis. The first is a fungus, the second bacterial, and the third, parasitic. Yeast and trich usually have both discharge and itching. BV generally presents as “fishy” discharge, but without itching. It is perfectly reasonable to try over-the-counter anti-fungals, such as Monistat 7 if you are fairly certain you have yeast. The other infections usually require a visit to your doctor or the nurse practitioner to diagnose and treat.

What symptoms might constitute a GYN emergency, or near-emergency?
Certainly heavy bleeding, menstrual or otherwise, could be such a time. The upper limits of normal for bleeding is seven days or more, and if you have soaked a box or more of pads or tampons. Similarly, if there is severe pain with bleeding or fever, you should be evaluated expeditiously. If you have pelvic pain and fever, it could be a pelvic infection and needs to be treated as soon as possible, particularly if you are young, sexually active, and desirous of further children. If you have chronic pain without fever, this could be indicative of conditions such as endometriosis, old pelvic scarring, or ovarian cysts secondary to any number of causes. These will require an exam by your physician, possibly ultrasonic testing, and sometimes surgery.

What constitutes a normal or abnormal period?
As far as the amount of bleeding, please see above. The menstrual interval is defined as the period of time between the START of one period and the START of the next. Off of birth control pills, this interval can vary greatly. Twenty-one to forty-seven days, while a wide range, is considered normal. Women understandably become concerned when their cycles are not as regular as clockwork, but this is usually no cause for alarm, particularly if you have been stressed or ill in any way. While pills and other hormonal contraceptives give more regularity, it is also not uncommon to vary several days month to month. On modern low-dose pills, it is even extremely common to miss a period altogether. If you have taken your pills correctly, there is little likelihood that you are, in fact, pregnant. If you are concerned, contact your doctor or carefully do a home pregnancy test. Be sure to precisely follow the instructions of the test.

My Pap Smear came back “Abnormal”. Does this mean I have cancer?
Probably not. Abnormal Paps vary from simple cervical infection to pre-cancerous conditions, and generally after only a very long period of time do these develop into invasive cancer. Your doctor will discuss this with you and perform whatever tests and treatment are appropriate.

I had an abnormal mammogram. Do I have breast cancer?
Most abnormal mammograms are simply unusual areas that require additional views and short-term follow-up, i.e. six months. Certainly, if the mammogram is suspicious for cancer, additional consultation and probable biopsy will be scheduled. Additionally, if you have a normal mammogram, but have an enlarging breast mass, it should be evaluated. This is especially important if the breast mass is accompanied by pain or skin changes over the mass.

Will hormones give me breast cancer?
Hormones have been used safely and with great effect for nearly seven decades now. Several years ago a study called the Women’s Health Initiative, or WHI, was published. It suggested a potentially VERY SLIGHT increase in the risk of developing breast cancer and cardiovascular disease in women who were taking a continuous combined hormone preparation called Prempro. No other continuous combined drug was studied. In women who were taking estrogen alone, there was no increased risk. As a woman, you have a 12% chance of developing breast cancer over the course of your entire life, with most of this risk being in the later years. If you have close family history of breast cancer, your own personal risk is greater. You should discuss the benefits and risk of hormones with your doctor.


How much weight should I gain during pregnancy, and is there a special diet I should follow?
A 20-25 pound weight gain during the entire pregnancy is optimum. Because most gain is in the last two trimesters, you should try to maintain your pre-pregnancy weight during the first trimester, when most nausea and vomiting take place. In general, try to gain ½-3/4 pound per week. There is no “magic” diet during pregnancy, however a sensible diet comprised of the four basic food groups will help achieve a healthy pregnancy.

What medications are safe to take during pregnancy?

  • Folic Acid (.4 mg daily) Should be taken until 12 weeks, and then discontinued.
  • Prenatal Vitamins -Vitamins and iron prior to 12 weeks may worsen nausea and vomiting. Discontinue prenatal vitamins at this stage if you have this problem. Remember that at this early stage of pregnancy, the vitamin is actually larger than the baby.
  • Tylenol and Extra-Strength Tylenol -safe at any stage of pregnancy
  • Sudafed - used for symptoms of the common cold
  • Chlortrimeton - used for symptoms of the common cold
  • Antacids - used for heartburn and indigestion
  • Milk of Magnesia - used for constipation
  • Children’s cough or cold formula
  • Ginger extract (200 mg. Four times daily) - May help early nausea & vomiting
  • B-Complex vitamins - May help early nausea & vomiting
  • Maalox - used for heartburn and indigestion
  • Mylanta - used for heartburn and indigestion
  • Pepcid AC - used for heartburn and indigestion
  • Prilosec OTC - used for heartburn and indigestion
  • Peptobismol - used for diarrhea
  • Kaopectate - used for diarrhea
  • Monistat 7 and other Antifungal agents - used for fungal/yeast infections
  • Tavist-D - used for cold symptoms
  • Robitussin HC - used for cold symptoms, cough
  • Novahistine D - used for congestion and cold
  • Prescription medications prescribed by your physician



Is it true that smoking may be harmful to my baby?
Yes, absolutely. There is not one single complication of pregnancy that is not increased in women who smoke, including unexpected and sudden intrauterine fetal death. If people around you smoke, avoid close contact when they are indulging this habit.

Can I drink alcohol during my pregnancy?
You should avoid alcohol during your pregnancy. High doses cause a definite malformation known as Fetal Alcohol Syndrome. We do not know what the safe threshold is, so avoid its use except for small amounts that might be present in some medications. If you used alcohol before you realized you were pregnant, do not worry. It appears that chronic alcohol use is the main culprit of Fetal Alcohol Syndrome.

What about illegal drugs, including marijuana—would occasional use be acceptable?
Absolutely not. You should not have any use of any illegal or recreational drug, including marijuana. Don’t even think about it!

Is it safe to have sexual relations during pregnancy? If so, when should we stop?
In general, having sexual relations is okay until approximately 36-37 weeks. It is important, however, to refrain from sex if you are bleeding, think you might be leaking fluid, or having contractions. Sex should be discontinued once it becomes uncomfortable for you.

Should I stop my workouts and refrain from physical exercise during pregnancy?
Physical exercise is highly recommended during pregnancy. You should, however, avoid activities where coordination and timing could risk your own safety. You should also avoid becoming overheated. Good examples of safe exercises would be walking, light jogging, low-impact aerobics, treadmills, stationary cycling, light weights, etc.

Please explain Fetal Status Testing. How, Why, When?
On your first pregnancy visit, a vaginal ultrasound is performed
, provided the pregnancy is early. This is an important test, allowing us to establish accurate dates and assures us that the pregnancy is as it should be.

Another ultrasound is performed at 18-24 weeks gestation. This exam reassures that the baby’s anatomy is normal, as best as it is possible to tell within reason. If you desire to know the baby’s gender, often it can be determined at this exam. It is also acceptable not to have a midtrimester scan. Some insurance companies will not pay for this ultrasound examination. If there is concern about a potential problem, this scan is necessary. Other testing, such as triple-marker screens, amniocentesis, etc. are reserved for special situations, and should be discussed with your doctor, if necessary.

After 28 weeks, a fetal movement count can be helpful. It is a simple home test you do daily to assure yourself that the baby is doing well. Simply eat a meal, let the meal digest 30-40 minutes, then count the baby’s movements during the following 3 hours. You should feel 10 movements of the baby during the 3 hours. Generally, babies that are moving are healthy. If your baby fails to move the appropriate number of times, call your doctor. You need to be evaluated. If it is during the day, go to your doctor’s office. If it is a night or weekend, go to labor and delivery at the hospital. In all probability, nothing is wrong, but further testing must be done to evaluate the situation.

I am having a lot of aches and pains during the pregnancy. What is normal, what is labor, and when do I call the doctor?
Aches and pains are very common during pregnancy. Usually, they are due to normal contractions of the uterus, stretching of tissues, and loosening and separation of pelvic bones. If the pain is not too severe, and provided there are no other symptoms (bleeding, urinary tract infection symptoms, fever, etc.), then it is probably normal.

If you are early pregnant and experiencing pain or light bleeding, it is recommended for you to get off your feet, rest, and avoid anything in the vagina. If the pain is severe, or bleeding is heavy, you should be seen by your doctor during regular hours, or go to the emergency room at night or on weekends.

True labor contractions at term or near term will be regular, painful, generally hurt in the back and spread to the front. Your stomach will get extremely hard, as well. You could also experience bloody vaginal discharge, or leaking/rupture of your membranes. If you feel you are in labor or have broken your water, please do the following:

During office hours, go to the doctor’s office to be checked.

If it is a night or weekend, go directly to the hospital.

There is no need to call the emergency number first!

Because it is impossible to diagnose labor or ruptured membranes by telephone, you MUST BE EXAMINED! In general, if you experience contractions as described above, lasting for a minute, as close as five minutes apart, go to the hospital for examination. You must also be seen if you think you are leaking fluid, or have ruptured membranes, even if there are no contractions. This is exceptionally important if you are premature. In this case, PLEASE go to your doctor’s office, or to labor and delivery at the hospital.

When should I speak directly with the on-call doctor?
You should speak to the on-call doctor directly if you are having an urgent problem that might be handled by telephone, such as:

  • Severe nausea and vomiting, or diarrhea which has not responded to the measures described above.
  • Significant symptoms of urinary tract infection.
  • Severe bronchitis

Please respect the after-hours number as the emergency number that it is. The physician on-call is often dealing with true emergency issues, delivering babies, operating, etc., with very little time for rest and sleep in between. Accordingly, the emergency number should not be used to ask routine questions that can and should be taken care of in the office. Additionally, you should find most subjects covered in this text.

After hours number for the Pulaski County Medical Exchange: 501-663-8400

The emergency number should not be used to request prescription refills, such as prenatal vitamins, birth-control pills, etc.