Pregnancy Prep 101

If you are trying to have a baby or even just thinking about it, it's never too early to start getting ready for pregnancy. There are things you can focus on before and between pregnancies to increase the chances of having a healthy baby. For some women, getting their body ready for pregnancy takes a few months. For other women, it might take longer. Regardless of whether you're preparing for your first pregnancy or if you've had several children already, here are some things you can do to be the best you can be:

  • See Your Doctor -- Before getting pregnant, talk to your doctor about preconception health care. Your doctor will want to discuss your health history and any medical conditions you currently have that could affect a pregnancy. He or she also will discuss any previous pregnancy problems, medicines that you currently are taking, vaccinations that you might need, and steps you can take before pregnancy to prevent certain birth defects.
  • Take 400 Micrograms of Folic Acid Every Day -- Folic acid is a B vitamin. If a woman has enough folic acid in her body at least 1 month before and during pregnancy, it can help prevent major birth defects of the baby’s brain and spine.
  • Stop Drinking Alcohol, Smoking, and Using Street Drugs -- Smoking, drinking alcohol, and using street drugs can cause many problems during pregnancy for a woman and her baby, such as premature birth, birth defects, and infant death.
  • Reach and Maintain a Healthy Weight --People who are overweight or obese have a higher risk for many serious conditions, including complications during pregnancy, heart disease, type 2 diabetes, and certain cancers. If you are underweight, overweight, or obese, talk with your doctor about ways to reach and maintain a healthy weight before you get pregnant.
  • Get Mentally Healthy -- To be at your best, you need to feel good about your life and value yourself. Everyone feels worried, anxious, sad, or stressed sometimes. However, if these feelings do not go away and they interfere with your daily life, get help. Talk with your doctor or another health professional about your feelings and treatment options.
  • Have a Healthy Pregnancy -- Once you are pregnant, be sure to keep up all your new healthy habits and see your doctor regularly throughout pregnancy for prenatal care.

Talk to any of our doctors if you are considering becoming pregnant. Our team is here to help with all of you women's health and pregnancy needs!




Hysterectomy: Conditions, Symptoms, and Treatment

The decision to undergo a hysterectomy is not an easy one to make. Weighing the pros and cons of a surgery that involves removing the uterus, while dealing with health issues is a lot to handle. Add to that the many mixed emotions that some women deal with as well, and one might find themselves overwhelmed with the decision. However, the more informed you are, the less stressed you'll be. There are several conditions that might require gynecologic surgery.

Many benign (non-cancerous) conditions can affect a woman’s reproductive system, including the uterus, cervix, ovaries and fallopian tubes. Common benign conditions include: 

  • Fibroid
  • Endometriosis
  • Adenomyosis
  • Pelvic prolapse

Some of the more common symptoms of these conditions include: 

  • Pelvic pain
  • Heavy bleeding
  • Irregular periods
  • Fatigue
  • Unusual bloating
  • Pain during intercourse
  • Infertility

If you experience symptoms like these, your doctor may suggest medicine, lifestyle changes, or surgery. 

If your doctor suggests a hysterectomy, the most common ways to remove your uterus are: open surgery or minimally invasive surgery. Minimally invasive surgery refers to both traditional laparoscopy or robotically-assisted da Vinci Surgery. 

When using da Vinci Single-Site Surgery for benign conditions, your surgeon operates through a small cut in your belly button. This results in patients seeing almost no scar at all.

Da Vinci Single-Site Hysterectomy offers the following potential benefits when compared to other methods:

  • Low blood loss
  • Low rate of complications
  • Low chance of a blood transfusion
  • Low chance of surgeon switching to open surgery
  • Short hospital stays
  • Low levels of post-operative pain

Though it is often called a “robot,” da Vinci cannot act on its own. Surgery is performed entirely by your doctor. Your doctor controls the da Vinci System, which translates his or her hand movements into smaller, more precise movements of tiny instruments inside your body. 

The da Vinci Surgical System is designed to provide surgeons with enhanced capabilities, including high definition 3D vision and a magnified view. Together, the da Vinci System and Single-Site instruments allow your doctor to remove your uterus, fallopian tubes and/or ovaries through a single incision. As a result, you may be able to get back to life without the usual recovery that follows major surgery. Surgical options will depend on your exact condition, symptoms, and overall health. 

Drs. Strebel, Grolle, and Rosenbaum are all highly skilled, experienced surgeons and are experts with the da Vinci Single-Site Hysterectomy system. Call for an appointment at 702-438-2229.


How to Find the Right Gynecologist for You

Few places are more intimate than a gynecologist’s exam room, right? The small things that can make you tense – palm-sized speculums, questions about your sexual activity – these are the very tools used to define huge aspects of your health and wellness. Your gynecologist, OB-GYN or women’s health specialist screens you for diseases, helps you plan a family – whether that means assisting with or preventing pregnancies – troubleshoots below-the-belt problems and more. No matter what the reason for the visit is, there’s a good chance this person will throw on gloves, spread your legs, and put their face right in front of a very private part of your body. As such, it is extremely important to find the right doctor for you.

These tips can help you in your search:

  • What are your needs? If you want to get your annual well-woman exam – which may include cancer screenings, breast exams, evaluation and counseling – a general gynecologist or women's health specialist and some nurse practitioners can administer this appointment. Well-woman exams, may also include a Pap test or pelvic and internal examinations.
  • If you want to get pregnant in the next five years, look for an obstetrician-gynecologist now. Think of the gynecologist-OB-GYN as your women's health specialist across your lifespan. Find an OB-GYN who you know and trust – who you'd trust to eventually deliver your baby. 
  • Make sure you and your doctor share the same values. For example, if you're going to the gynecologist seeking contraception and, upon discussing it at the appointment, discover that your doctor does not believe in birth control – red flag!
  • Value bedside manner. While all doctors should be respectful and compassionate, those qualities can be particularly important for those professionals looking between your legs. Discussing sex, family planning, fears, and your overall health could be quite difficult with someone who seems uninterested, judgmental, or short on time.
  • If you feel your doctor doesn't listen or have time for you, then he or she isn't the OBGYN for you. While credentials, experience, and expertise rank the highest when narrowing your doctor search, once you're in the office, comfort matters too. Discomfort (beyond the paper dress) is a red flag that should probably send you searching for a different doctor.

At WHASN, our doctors want to help and spend time with you. Call 702-438-2229 to schedule an appointment.


Prenatal Care: What to Expect, and When to Expect It.

Anyone thinking about becoming pregnant should also be thinking about prenatal care. This care is important for the mother’s health and the health of the child. Ideally, it should begin prior to pregnancy.

Schedule a visit with your health care provider prior to pregnancy to: 

  • Review your immunizations 
  • Start a prenatal vitamin with folic acid (which can prevent certain birth defects if begun prior to pregnancy)
  • Have a thorough checkup. 

Once you are pregnant, regular prenatal care visits during pregnancy are just as important to your baby’s future health as regular visits for well-child exams after birth.

A first prenatal visit, best done before the 12th week of pregnancy, typically involves:

  • A physical exam 
  • A pelvic exam
  • Lab work (on blood and urine)
  • Sexually transmitted infection screening (to check for Hepatitis B, syphilis, chlamydia, and HIV)
  • A Pap smear test. 

Your health care provider calculates your approximate due date at this first visit. Often, an ultrasound will be ordered to confirm how far along the pregnancy is. If you are at least 10 weeks pregnant, your health care provider might listen for the heartbeat. This can be difficult before 12 weeks of pregnancy.

Subsequent prenatal visits are every four to eight weeks until you are 28 weeks pregnant. At all prenatal visits, you can expect your health care provider to:

  • Weigh you
  • Check the size of your uterus
  • Check your blood pressure
  • Listen to the baby’s heart rate

An ultrasound at about 20 weeks is often done to view the baby’s organs and measure growth of the baby and the placenta.

Around 15 to 22 weeks, blood tests are available to screen for genetic and spinal cord abnormalities. At 26 to 28 weeks, expect to have blood tests to check for anemia and be encouraged to take a glucose challenge test to check for gestational diabetes.

From weeks 28 to 38, prenatal visits are every two to four weeks. The baby’s position will be checked to make sure the baby is pointing head down.

After 38 weeks, prenatal visits are weekly until delivery. Your health care provider may want to check your cervix for dilation and thinning as you get close to your due date or if you go past it without delivering.

A healthy baby depends on taking good care of yourself. Stay physically active, eat plenty of fruits and vegetables and an otherwise healthy diet, drink lots of water, take your prenatal vitamins, get good sleep, and see your doctor at WHASN throughout pregnancy.

AdobeStock_39642834 (1).jpeg

The Pill: Learn if it Could be Right for You

Birth control pills are a medication that women take daily to prevent pregnancy. Sometimes they are referred to as oral contraception or perhaps most commonly, “the pill."

Birth control pills work by releasing hormones. Hormones are chemicals that affect different parts of the body. Most women use a combination birth control pill, which contains both estrogen and progestin. However, there are also progestin-only pills available. 

These hormones prevent pregnancy by:

  • Making cervical mucus thicker, which prevents sperm from getting to the eggs
  • Stopping ovulation, so there is no egg for the sperm to fertilize

Birth control pills come in 21-day or 28-day packs depending on the type and brand you use. Both kinds of pills come with 21 “active” pills which contain hormones. The extra 7 pills in the 28-day pack contain placebo pills with no hormones. These extra 7 pills serve as a reminder so that you don’t forget to take pills when time to begin the active ones again. You are not required to take the placebos, but they will help you maintain the habit of taking a pill at the same time every day.

Most women get their period during the 4th week, when they are taking the reminder pills. However, experiences vary depending on body type. You may notice spotting throughout the month or you may not get your period at all.

Progestin pills only contain progestin -- no estrogen. They come in 28-day packs only and each pill contains hormones. This means all the pills in these 28-day packs are “active”. To avoid pregnancy, you must take every pill in the pack, at the same time every day. There is no week off, like with the combination pills. You may get your period on the 4th week, you may notice spotting throughout the month, or you may not have your period at all. It depends on your body. Talk with your doctor if you are concerned with irregular periods while taking birth control pills.

The pill is safe, simple, and effective to use, and sometimes women take it for reasons other than contraception. The combination and progestin-only pills can also:

  • Help your period become more regular and sometimes lighter
  • Reduce menstrual craps
  • Protect against pelvic inflammatory disease
  • Reduce acne
  • Help reduce headaches, depression, and other premenstrual symptoms
  • Prevent or reduce cysts in ovaries and breasts
  • Guard against iron deficiency (anemia)
  • Help prevent bone thinning

The pill can also be used to predict when you’ll get your period. Some pills are made for women to only have a few periods a year and others follow a regular, monthly cycle. 

Many women adjust to the pill with little to no problems, but some women do experience undesirable side effects. The most common side effects are bleeding between periods, nausea, vomiting, and breast tenderness. These usually occur within the first 2 to 3 months of use and fade after that.

Another side effect is the possibility of changes to your libido. Sexual desire may change because of the hormones in the pill. 

The pill does not protect against STI’s. If infection is a concern, a condom should be used.

This birth control method is over 99% effective at preventing pregnancy, when taken correctly at the same time every day. This allows the correct amount of hormones to enter your body every 24 hours.

If you're considering taking the pill, speak with your doctor. He or she will provide insight based on your medical history and how the pills could react with any other medications you are taking. Call for an appointment!




Pelvic Vs. Pap - Do You Know the Difference?

Do you know the difference between a Pap smear and a pelvic exam? Many women think they are the same thing, but there are important differences between the two.

What’s a Pap smear?

A Pap smear, or Pap test is a medical screening used to detect any changes in cells on the cervix. The test looks for changes that could indicate cancer of the cervix or any cervical abnormalities that might lead to cancer. 

Your doctor performs the screening by using a small plastic spatula and brush to collect cells from the cervix. Your physician will check internal organs and will take a small sample of cells to examine for abnormalities. The cells are then examined under a microscope in a laboratory.

What is a Pelvic Exam?

During a pelvic exam, your physician will check for signs of illness or abnormalities. Your doctor looks for medical problems in your pelvis, vagina, and the pelvic floor. He or she will examine your external genitalia, vagina, and pelvic organs such as the uterus, cervix, fallopian tubes, ovaries, and bladder.

All women should see a doctor every year for a well-woman visit. However, many women do not need a pelvic exam every year. When they do need one, it usually takes place as part of an annual well-woman visit with their physician.

During your well-woman visit, discuss whether you need a pelvic exam and whether and when a Pap test would be appropriate for you. Of course, don't wait for your yearly exam if you have any issues with bladder function, sexual function, or any concerns. 

Talk to your doctor about the best pelvic exam and cervical cancer screening schedule for you based on your health and family history. Your doctor may recommend more frequent screening if you have certain health indications, such as a history of cervical cancer or a weakened immune system. Our doctors are here for you. 


Mastitis - Know the Symptoms and When to See Your Doctor

Mastitis is a condition that results in a woman's breast becoming painful, swollen, and red. It is most common in breastfeeding women, although this condition can also occur in women who aren't breastfeeding.

With mastitis, signs and symptoms can appear suddenly and may include:

  • Breast tenderness or warmth to the touch
  • Generally feeling ill
  • Breast swelling
  • Pain or a burning sensation continuously or while breast-feeding
  • Skin redness, often in a wedge-shaped pattern
  • Fever of 101 F or greater

Risk factors for mastitis include:

  • Breastfeeding during the first few weeks after childbirth
  • Sore or cracked nipples, although mastitis can develop without broken skin
  • Using only one position to breastfeed, which may not fully drain your breast
  • Wearing a tight-fitting bra or putting pressure on your breast from using a seatbelt or carrying a heavy bag, which may restrict milk flow
  • Becoming overly tired or stressed
  • Previous bout of mastitis while breastfeeding
  • Poor nutrition

If mastitis isn't adequately treated, or it's related to a blocked duct, an abscess can develop in your breast and form a breast mass or area of firmness with thickening. An abscess usually requires surgical drainage. To avoid this complication, talk to your doctor as soon as you develop signs or symptoms of mastitis.

Minimize your chances of getting mastitis by following these tips:

  • Fully drain the milk from your breasts while breastfeeding.
  • Allow your baby to completely empty one breast before switching to the other breast during feeding.
  • Change the position you use to breastfeed from one feeding to the next.
  • Make sure your baby latches on properly during feedings.

Often, you'll feel ill with flu-like symptoms for several hours before you recognize that your breast has an area of tenderness and redness. As soon as you recognize this combination of signs and symptoms, it's time to contact your doctor.

Oral antibiotics are usually effective in treating this condition, but your doctor will probably want to see you to confirm the diagnosis. If your signs and symptoms don't improve after the first few days of taking antibiotics, see your doctor right away to make sure your condition isn't the result of a more serious problem.

Sometimes mastitis leads a mother to wean her baby before she intends to. However, continuing to breastfeed, even while taking an antibiotic for the mastitis, is better for you and your baby. Talk to any of our doctors if you have any questions.



Breastfeeding baby AdobeStock_84427408 (1).jpeg

Treating Pain During Pregnancy

When you're pregnant, treating a simple ailment can seem complicated. Because of fear about the use of medicines during pregnancy, some pregnant women would rather suffer than treat their pain. Consequently, it is possible that such women are at risk of undertreatment, or no treatment, for painful conditions. Chronic, severe pain that is ineffectively treated is associated with hypertension, anxiety, and depression, and none of those are good for a healthy pregnancy either. 

In general, it's best to avoid any unnecessary medications in your pregnancy. But that doesn't mean you should suffer. If you truly can't get by without medication, your doctor can tell you which over-the-counter and prescription drugs are safe to take at your stage of pregnancy. Your healthcare provider can also suggest drug-free options that might ease your symptoms.

A cold compress, rest, and staying well hydrated can help alleviate headaches and muscle pain during pregnancy, but if you need additional relief, your doctor may recommend acetaminophen (the active ingredient in Tylenol). When this drug is used as directed, it's usually a safe option. However, it's best to avoid aspirin and nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (the painkiller in Advil and Motrin) and naproxen (the active ingredient in Aleve). Some studies suggest that taking these medications near conception or in early pregnancy may increase the risk of miscarriage and birth defects.

Ultimately, medications used in therapeutic doses for acute and chronic pain appear to be relatively safe in pregnancy. To minimize fetal risk, most prescribers will start with the lowest effective dose, especially in late pregnancy, and select analgesics only after careful review of a woman’s medical or medication history.

Women should avoid using NSAIDs after 32 weeks because of the possibility of antiplatelet or prolonged bleeding effects. Opioids should also be used with caution, especially in higher doses in late pregnancy when the infant should be observed carefully in the neonatal period for any signs of withdrawal (neonatal abstinence syndrome).

If you are pregnant and experiencing chronic or acute pain, you don't have to suffer. Ask your doctor what relief methods or medicines might be right for you.

pregnant woman lying on her side.jpeg

da Vinci® Single-Site® Hysterectomy - Less Pain and No Scar

If your doctor suggests a hysterectomy, it's important to know your options. He or she can tell you about traditional open surgery and about minimally invasive/laparoscopic methods also in use currently. If you are a candidate for laparoscopy, ask about da Vinci Single-Site Hysterectomy. Doctors and patients are choosing it because hysterectomies done with the da Vinci robotic arm via a single incision result in very little downtime and virtually no scarring.

Hysterectomies, which once required large abdominal incisions with long hospital stays and extensive recovery time can now be done without those previous drawbacks.  

Why da Vinci Surgery?

Clinical data suggests a da Vinci Single-Site Hysterectomy offers the following potential benefits compared to other laparoscopic procedures:

  • Low blood loss
  • Fewer complications
  • Less chance of need for a blood transfusion
  • Low chance of surgeon switching to open surgery
  • Shorter hospital stays
  • Less post-operative pain

Surgeons can remove the uterus and fallopian tubes through a single half-inch incision in the navel using the da Vinci surgical robot. The robot’s arms and wrists can be manipulated with greater agility than that of its human counterpart, while the 3D high-definition viewing system provides the surgeon better overall control.

During the surgery, a port for the robot’s arms (guided by your surgeon at a nearby station) is placed in the patient's belly button. The 3D high-definition camera provides magnified images of tissues, nerves, and uterus for better visualization during the surgery.

All the steps in traditional surgery—cutting, clamping, or sewing—can be done with the da Vinci surgical robot through one tiny incision. As a result, the robotic-assisted, single-site hysterectomy offers decreased risk of infection and quicker recovery times.

The da Vinci System has provided minimally invasive surgery to more than 3 million patients worldwide and the surgeons at WHASN are helping women in the Las Vegas area with this state-of-the-art technology. Call 702-438-2229 to schedule a consultation.


hysterectomy-incision-comparison-single-site (3).png

Resolutions You Can Keep that Really Make a Difference

When it comes to New Year's resolutions, health-related goals are definitely in the top three. For many women, however, the path to good health is not an easy one, with too many obstacles along the way. Procrastination, family obligations, work demands, and lack of time and energy are only a few of the excuses that can stop even the best of intentions. If your goal is to lose those last 10 pounds -- for the fifth year in a row -- why not consider making a new, more easily-done resolution that has equally big health payoffs?

Take your pick of these attainable resolutions that you can actually stick to this year:

  • Get More Sleep – Want more energy, improved mood, and help losing weight? Try sleep! The body repairs and regenerates during sleep. Getting enough sleep is the best way to help your mind and body function at its best. Optimum sleep time varies from person to person, from 4 to 11 hours a day. An easy way to find your optimum sleep time is to sleep until you wake up without an alarm clock or other interruption. Do this two or three days in a row, and you'll know what the ideal amount of sleep is for you.

  • Eat a Veggie or Fruit with Every Meal -- The evidence linking vegetable and fruit consumption to disease prevention makes this a smart resolution anyone can make and gain rewards from. To work in more healthy additions try slicing a banana into your morning cereal or yogurt, have an apple as dessert with your lunch, and start every dinner meal with a salad. Eating fruits and vegetables increases your fiber intake, which helps fill you up, making you less likely to eat unhealthy foods. In addition, fruits and veggies are full of vitamins and antioxidants, which your body needs for a strong immune system.

  • Find a Form of Exercise That You Love – Just because you don't like to jog or do aerobics doesn't mean you should give up on exercise. What works for one woman doesn't always work for everyone else. It can take some trial and error to find which forms of exercise are enjoyable for you. Try making a list of five new forms of physical activity that you haven't tried—like yoga, rowing, or swimming laps -- and give each a try for two weeks. Then, pick the ones that you enjoy most. Try new machines and/or classes; look for news about new exercise trends; do whatever it takes to keep your workouts consistently fun. That's what will ultimately get you working out more regularly.

  • Cook More at Home -- Relying on restaurant food after a long day of work is certainly convenient, but it can have health consequences. A lot of restaurant food is served in huge portions with more calories, fat, and sodium than a home-cooked meal. Cooking at home can be just as easy as calling for takeout. It only takes a little bit of planning. Planning your meals for the week can also ensure that you don't get caught short and have to order pizza -- again.

  • Cut Back on Sugar – This does not mean you must live your life without your favorite flavor of ice cream. You don't have to give up your favorite indulgences to make this resolution work. Just by taking a look at the added sugar in foods and trying to eat as little of the sweet stuff as possible, your body will thank you. Too much sugar is basically too many calories without any nutritional benefit for your body. More than likely, if you're consuming too much sugar, your diet may be lacking in healthy foods, increasing your chance for disease, decreased energy, and unhealthy skin.

Happy New Year from all of us at WHASN! We wish you a very healthy 2018.


Healthy Diet for Healthy You!

Women often are the ones who make sure that their families eat healthily. Unfortunately, many women are prone to neglecting their own dietary needs. Excuses such as being too busy to eat right or trying to adhere to an extreme diet are common, but that kind of eating just leaves you short on vital nutrients and feeling cranky, hungry, and low on energy.

Eating in a healthy manner shouldn't be difficult. According to, to help prevent heart disease, stroke, and perhaps other diseases, women should eat mainly:

  • Fruits and vegetables
  • Grains (at least half of your grains should be whole grains, such as whole wheat, oatmeal, and brown rice)
  • Fat-free or low-fat versions of milk, cheese, yogurt, and other milk products
  • Fish, skinless poultry, lean red meats, dry beans, eggs, and nuts
  • Polyunsaturated and monounsaturated fats

Also, you should limit the amount of foods you eat that contain:

  • Saturated fat
  • Trans fat
  • Cholesterol
  • Sodium
  • Added sugars

If you choose to drink alcohol, do so in moderation. For women, that means one drink per day. One drink is defined as:

  • 12 fluid ounces of regular beer
  • 5 fluid ounces of wine
  • 1.5 fluid ounces of 80-proof distilled spirits

Just because you're trying to follow a healthy eating plan doesn't mean that you can't indulge once in a while. If you generally eat a healthy diet, it won't hurt to indulge in a rich dessert or serving of fried food every once in a while.

Women tend to need fewer calories than men, but requirements for certain vitamins and minerals are much higher. Hormonal changes that come along with menstruation, child-bearing, and menopause make women have a higher risk of anemia, weakened bones, and osteoporosis, requiring a higher intake of nutrients such as iron, calcium, magnesium, vitamin D, and vitamin B9 (folate).

A balanced diet is one of the cornerstones of good health. Women should enjoy a variety of foods, such as whole grains, fruits, vegetables, healthy fats, low-fat dairy and lean protein, but keep in mind that women also have special nutrient needs, and during each stage of a woman's life, these needs change.

Talk to any of our doctors about eating a healthy diet and what vitamins or nutrients you might need more of during this time in your life. Remember, nutrient-rich foods provide the energy you need for your busy life as well as help prevent disease.


healthy diet.jpeg

Perimenopause: Recognizing Symptoms and Knowing how to Treat Them

Once a woman has not had a menstrual period for 12 consecutive months, she is medically considered to be in menopause. However, some women are unaware that the time preceding menopause is referred to as perimenopause.

There is no strict medical definition of perimenopause, but it typically refers to the time approaching menopause during which a woman starts to develop symptoms of declining estrogen levels. During this time, the ovaries begin to decline in function and this continues until menopause is reached.

Perimenopause usually begins in the 40s, but may start as early as the late 30s. During this time, a woman may exhibit a number of symptoms that are largely due to abnormal hormonal fluctuations.

Some of the symptoms of perimenopause include:

  • hot flashes
  • night sweats
  • weight gain
  • mood changes
  • vaginal dryness
  • vaginal pain
  • pain with sexual intercourse

Not all women experience all the symptoms of perimenopause to the same degree, and symptoms vary among women.

Treatment of perimenopausal symptoms includes hormone therapy and lifestyle changes such as diet, exercise, and smoking cessation. Estrogen therapy may decrease the severity of symptoms of perimenopause.

Management of the perimenopause is largely dependent on the severity of symptoms. However, there are certain risk factors which may indicate that a woman is prone to more serious problems. If you are in one of these high-risk groups, you should seek care as soon as any of the symptoms of perimenopause begin.

These include:

1.    Cigarette smoking: Carbon monoxide from cigarette smoke is found in the bloodstream in high concentrations during the act of smoking. This compound causes net loss of bone calcium. If a woman smokes and is perimenopausal, she should seek professional care from a health-care professional who can assist her with efforts at smoking cessation.

2.    Steroid usage: Many patients use steroids chronically for the treatment of many diseases (for example, asthma). Steroids affect the bones by depleting calcium. Such individuals are at high risk of osteoporosis if their overall estrogen production is erratic or low.

3.    Family history: If there is a family history of early menopause, it may be prudent for a woman to seek medical care shortly after experiencing the onset of perimenopausal symptoms.

4.    Small body frame: If a woman is thin with small bones, her bone mass is, for practical purposes, deficient in calcium. She should see her doctor in order to formulate a plan to proactively prevent further skeletal deterioration.

In addition to the high-risk groups listed above, a woman should consult a health-care professional if she experiences extremely heavy or irregular vaginal bleeding. Occasionally uterine cancer is found in a woman whose ovaries are not working optimally.

If you believe you are experiencing symptoms of perimenopause, talk to any of our doctors. We can help you as you enter this new phase of womanhood.



Vaginal Health: Bacterial Vaginosis

Bacterial vaginosis (BV) is a common gynecologic infection that impacts 1 in 3 women. Also known as vaginal bacteriosis, BV is the most common cause of vaginal infection for women of childbearing age.

Although it frequently develops after sexual intercourse with a new partner, BV is not considered a sexually transmitted infection (STI). A woman who has never had sexual intercourse can have it because an imbalance in vaginal bacteria can lead to bacterial vaginosis.

What are the Symptoms of BV?

Most women with BV have no symptoms. If symptoms occur, they include vaginal discharge, burning, and itching.

Vaginal discharge may:

  • Be watery and thin
  • Be gray or white in color
  • Have a strong and unpleasant smell, often described as fishy

Less commonly, there may be:      

  • A burning sensation during urination
  • Itching around the outside of the vagina

What Causes BV?

BV is caused by an imbalance of naturally occurring bacterial flora, the usual bacteria found in a woman's vagina. It should not be confused with candidiasis, a yeast infection, or Trichomonas vaginalis (T. vaginalis), or trichomoniasis, also known as trich. These are not caused by bacteria.

The Centers for Disease Control and Prevention (CDC) estimate that 29.2 percent of American women aged 14-49 experience BV, but 84 percent of them report no symptoms. Doctors say treatment is not required if a woman has BV but no symptoms. Sometimes BV can appear and disappear for no apparent reason.

We know that bacterial vaginosis is linked to an imbalance in the bacteria that are normally found in a female's vagina, but why this imbalance occurs is unclear. All parts of the body have bacteria, but some are beneficial while others are harmful. When there are too many harmful bacteria, problems can arise.

The vagina contains mostly "good" bacteria and some harmful bacteria. BV occurs when the harmful bacteria outgrow the good bacteria. A female's vagina should contain bacteria called lactobacilli. These bacteria produce lactic acid, making the vagina slightly acidic. This prevents other bacteria from growing there.

Lower levels of lactobacilli may cause the vagina to become less acidic. If the vagina is not as acidic as it should be, this can give other bacteria the chance to grow and thrive. However, exactly how these harmful bacteria are linked with BV is not known.

Any woman can develop BV, but some behaviors or activities can increase the risk.

These include:

  • Douching, or using water or a medicated solution to clean the vagina
  • Having a bath with antiseptic liquids
  • Having a new sex partner
  • Having multiple sex partners
  • Using perfumed bubble baths, vaginal deodorants, and some scented soaps
  • Smoking
  • Washing underwear with strong detergents

BV cannot be caught from toilet seats, bedding, swimming pools, or touching objects.

How is BV Diagnosed and Treated?


Any woman with an abnormal vaginal discharge should see their doctor as soon as possible. A doctor can diagnose BV and rule out other infections, such as gonorrhea or trich.

If you have any questions or concerns about vaginal health, don't hesitate to talk to any of our doctors about it. We are here to help!


Bone Up on Osteoporosis

As you get older, your doctor may talk to you about osteoporosis, a disease that occurs when the creation of new bone doesn’t keep up with the body’s removal of old bone, resulting in bones becoming fragile and brittle. Osteoporosis affects mostly older women, but prevention starts when you are younger.

No matter your age, you can take steps to build bone mass and prevent bone loss. One of the best ways to prevent weak bones is to work on building strong ones. Building strong bones during childhood and the teen years is important to help prevent osteoporosis later.

As you get older, your bones don't make new bone fast enough to keep up with the bone loss. After menopause, bone loss happens even more quickly, but you can take steps to slow the natural bone loss with aging and to prevent your bones from becoming weak and brittle.

  • Get enough calcium and vitamin D each day.
  • Get active. Choose weight-bearing physical activities like running or dancing to build and strengthen your bones.
  • Don't smoke. Smoking raises your risk for broken bones.
  • If you drink alcohol, drink in moderation (for women, this is one drink a day at most). Too much alcohol can harm your bones. Also, too much at one time or mixed with certain medicines can affect your balance and lead to falls.
  • Talk to your doctor about whether you need medicine to prevent bone loss.
  •  Most people with osteoporosis don’t experience any symptoms. Bones can deteriorate without any pain or weakness. Some people may only find out they have osteoporosis after they break a bone.

There are many good treatments now available to prevent the risk of fractures and even to help reverse osteoporosis. In addition to calcium and vitamin D, there are prescription medicines that can treat osteoporosis effectively. The most common class of medicines used to treat osteoporosis is called bisphosphonates. Your doctor will recommend the one that is best for you.

If you have any questions about what you should be doing to prevent or treat osteoporosis, ask any of our doctors at your next appointment. We have the information you need.


Breast Cancer Awareness What do You Need to Know?

Most women may know the basics, but they may not know how to ensure they’re in good hands during screening or after diagnosis. The following facts can help you determine your risk factors and know what you can be doing to diminish your chance at a breast cancer diagnosis.

Are you at risk?

Breast cancer isn’t just one kind of cancer; it is many different types. Knowing that it is ductal or lobular carcinoma is no longer enough.

Within its cell structure are many specific features informing scientists that breast cancer is made up of hundreds of different types. This also helps scientists better understand why it has been so hard to cure and prevent.

Know your risk factors.

  • Family history of breast or ovarian cancer
  • Taking Hormone Replacement Therapy (HRT)
  • Drinking alcohol
  • Smoking
  • Obesity
  • Having atypical cells on a breast biopsy

Don’t have any risk factors? Well, being female is technically a risk factor, however 85% of women diagnosed don’t have the risk factors listed above. 1in 8 women will be diagnosed with breast cancer by the age of 85.

Know the geography of your breasts.

You should know your breasts better than anyone. Even though they may be lumpy and bumpy, those lumps and bumps are “your normal,” and you should be checking your breasts monthly, at the same time of the month, to see if there is any change.

Take an active role in reducing your risk.

Follow a healthy lifestyle with regular exercise, maintaining a normal weight, avoiding smoking, limiting alcohol, and adhering to a healthy, well-balanced diet that’s rich in green and orange veggies.

Facing a diagnosis.

An accurate diagnosis leads to the right treatment plan. Make sure the pathologist reading the breast biopsy specimen slides as well as the pathology slides from breast surgery specializes in breast cancer. If the pathology is wrong then the treatment will also be wrong.

Survival and beyond.

The goals of treatment today should no longer be limited to just survival. Women deserve to also have their life goals preserved—fertility preservation, staying on track for the next promotion, becoming a professional musician. If the treatment team doesn’t know what these life goals are, treatments given to the patient may cause her to forfeit these life goals. 

Women need to speak up, and make their doctors aware of what their life goals are. They should request that they be factored into the decision making about treatment options. Women should only give breast cancer the time it requires to get rid of it. It doesn’t deserve to take away her social time, personal time, work time, or family time.

There is some good news in all of this. More women with metastatic disease are living longer—even decades—thanks to improvements in treatments.

Talk to any of our expert doctors at WHASN about your risk factors and what screenings or tests are right for you. We are here for all of your gynecological and obstetric needs.


Screen Shot 2017-10-24 at 5.36.14 PM.png

Pickles and Ice Cream! What Causes Food Cravings During Pregnancy

Food cravings are a well-known and common companion of pregnancy. As a matter of fact, somewhere between 60 to 80% of moms-to-be say they have a distinct urge for certain foods while expecting. Why is this? What causes pregnant women to yearn for pickles and ice cream or be overcome by the immediate need for a tuna fish sandwich?

We don’t know exactly what causes food cravings during pregnancy. They may be related to all the hormones that are active in pregnancy. These hormones can make your sense of smell stronger, which can affect your sense of taste and make you want certain foods.

There haven't been many rigorous studies focusing on cravings, but some researchers have discovered interesting trends when it comes to pregnant women and food preferences. Nutrition scientists at the University of Connecticut found that, depending on the trimester of pregnancy, moms taste certain flavors more intensely and either prefer or dislike them.

In the first trimester, for example, moms in their study found bitter tastes especially potent and aversive. Evolution likely shaped a mom’s perception of bitter flavors this way, so that she would be leery of strong-tasting plants or spoiled foods, which are more likely to contain a toxin that could hurt the baby. Early on, this could be why some moms who formerly love such treats turn up their noses at coffee, alcohol, or spicy foods. As pregnancy progresses (and the baby’s critical organ formation completes), moms tend not to feel sick at the thought or smell of pungent foods anymore.

It’s usually okay to satisfy your food cravings, as long as what you eat is safe and you don’t eat too much of it. Eating too much of what you crave—especially sweet, spicy or salty foods—can cause problems, such as heartburn or gaining too much weight.  You only need 300 extra calories a day during pregnancy to support your baby’s growth, so grabbing fast food or snacking on chips every day to satisfy a craving may put you over the calorie count.

Here are some ways to help curb your food craving:

  • Work your cravings into your everyday eating. Add salsa or relish to your meal for a bit of spice. Add sweetness with citrus fruits, melon and juices.
  • Find healthier options. Instead of regular potato chips, try the reduced-fat kind. If you’re looking for something crunchy, go for carrots or a crisp apple. Try fresh fruit to satisfy your sweet tooth.
  • Don’t buy in bulk. When you can, buy single-servings of foods you crave. Don’t buy a whole bag of chocolate candy. Just buy one or two pieces.
  • Plan your snacks. Knowing what and when you’re going to eat between meals gives you something to look forward to.
  • Distract yourself. Do something to take your mind off your craving. Go for a walk. Call a friend.

Some pregnant women crave things that aren’t food. This kind of eating problem is called pica. Eating nonfoods during pregnancy can cause problems for you and your baby. If you’re filling up on nonfoods, they may not be safe, and they may make you feel full, which could keep you from eating healthier foods.

Nonfoods include:

  • Ice
  • Clay
  • Laundry starch
  • Wax
  • Coffee grounds
  • Dirt

If you crave nonfoods, tell your health care provider.

The bottom line is that, although we have some interesting ideas as to what might be causing the specific cravings of pregnancy, we still don’t really know.  More research is needed. If you have any questions or concerns about food cravings or aversions during your pregnancy, talk to your doctor about it at your next appointment or call us to schedule a conversation.

AdobeStock_142955490 (2).jpg

Uterine Fibroids: Seek Treatment as Soon as Symptoms Begin

You may be surprised to learn that 8 in 10 women will develop uterine fibroids by the age of 50.  Uterine fibroids are common, non-cancerous growths of the uterine muscle consisting of smooth muscle cells and connective tissue. A woman may have one fibroid or groups of several fibroids, and they can range in size from less than 1 inch to more than 8 inches across. For some women, fibroids will go undetected and not cause any symptoms or trouble. But at least 25 percent of women with fibroids will experience a broad range of symptoms from mild to very severe, and will require treatment.

Here are key findings from a survey published in the American Journal of Obstetrics and Gynecology and the Journal of Women’s Health:

  • Women with fibroid symptoms often wait many years before seeking treatment or diagnosis from a health care provider.
  • African American women are disproportionately affected by fibroids, have more severe symptoms, wait even longer to seek a diagnosis, and have a greater need for information.
  • Most women reported fears associated with their fibroids, including being afraid that they will grow (79 percent), as well as fears regarding relationships, sexual function, body image, loss of control, and hopelessness.
  • Two-thirds (66 percent) of women were concerned about missed days from work due to their symptoms, and 24 percent of employed respondents felt that their symptoms prevented them from reaching their career potential.
  • Women strongly prefer treatment options that are not invasive and can protect fertility.

Women experiencing fibroid symptoms have many treatment options available to them. Speak to a health care provider as soon as possible about symptoms. Fibroid symptoms include:

  • heavy, prolonged or erratic menstrual bleeding
  • menstrual pain or cramping
  • passing blood clots
  • bloating
  • abdominal enlargement
  • constipation
  • urinary frequency or difficulty urinating
  • infertility
  • painful intercourse
  • chronic watery discharge
  • Fatigue

A delay in diagnosis can limit the effectiveness of treatment options available (due to unnecessary growth of fibroids, for example). The earlier one gets a diagnosis of fibroids, the more treatment options available, enabling one to choose a treatment based on health, lifestyle and professional needs, and family preferences.

Treatment options include:

  • Watchful waiting - recommended when fibroids are not currently causing any symptoms.
  • Hormonal therapy - involves the use of birth control pills or other hormones to shrink fibroids or control fibroid related bleeding.
  • Non-hormonal therapies - includes a class of drugs called “antifibrinolytics” recently adopted in the United States to decrease heavy bleeding.
  • Focused ultrasound - a newer, noninvasive, no-incision technology that uses waves of ultrasound energy to heat and destroy fibroid tissue.
  • Uterine fibroid embolization (UFE) - involves surgery to block the uterine artery with small particles to decrease blood supply to fibroids.
  • Myomectomy procedures – can be either hysteroscopic, laparoscopic, abdominal, or robotic – involve surgical removal of fibroids from the uterus.
  • Hysterectomy (including laparoscopic, vaginal, abdominal or robotic) involves removing the uterus entirely, eliminating any possibility of fibroid recurrence.

If you suspect you have fibroids, make an appointment with one of our doctors and begin learning about treatment options. The closer you are to the onset of your symptoms, the more likely it is that you will have a range of treatment options available to you for symptom relief and better quality of


The Skinny on Eating for Two

Most women are aware that diet affects a baby's development in utero, but many pregnant women still make eating errors--mainly because they don't know any better. Even women who try to eat nutritious foods get caught up in the idea that pregnancy is the time for indulgence. After all, haven't we heard that moms-to-be are "eating for two" our whole lives? Unfortunately, this dangerous myth can not only make it harder to lose the excess weight after delivery, but it also puts one at increased risk for gestational diabetes and high blood pressure. The myth of “eating for two" endures partly because it kind of makes sense, but mainly because it is so appealing. Here's the truth:

  • During your first trimester, you don't need any additional calories.
  • In the second trimester, you need 340 more calories/day.
  • In the third, you need 450 more calories/day.
  • The U.S. Department of Agriculture recommends that pregnant women consume 71 grams of protein per day.
  • The number of extra calories you require is small compared with the amount of extra nutrients recommended, so get your additional calories from high-nutrient foods: fruits, vegetables, nuts, beans, legumes, low-fat dairy products, and lean meats. All of these give you lots of nutritional bang for your calorie buck.

While some women take in too many calories, others consume too few because they are terrified of gaining weight and scared it won't come off afterward, so they restrict their diets. This is a big mistake. For example, if you don't get 1,000 milligrams of calcium daily, the baby's skeleton will be built with calcium leached from your bones.

Don't deprive yourself of necessary nutrients during pregnancy, as your fetus will not get what it needs for healthy growth and development. If you are obese, consult a dietitian who specializes in pregnancy nutrition to determine the proper prenatal diet for you.

Here are some tips for maximizing nutrition during pregnancy:

  • Eat a variety of foods to meet your daily needs for protein, calories, carbohydrates, healthy fats, and key vitamins and minerals during pregnancy.
  • Try to minimize "extra" foods that have calories but few nutrients – sugary beverages, fried foods, foods with extra fat and sugar. Instead, choose meals and snacks that pack the most nutrition per calorie. Adding a few nutrition-packed snacks – like yogurt, nuts, a hard-boiled egg, some fresh fruits or vegetables – to your daily intake is a great way to get the healthy calories your baby needs.
  • Choose foods that are as close to their natural state as possible. Pick whole-grain bread or brown rice over refined white bread or white rice, and fresh fruits or frozen unsweetened fruit over canned fruits in sugar syrup, for example.
  • Eat fats, oils, and sweets sparingly. Be sure to choose healthy fats like those found in avocados, nuts, and olive oil.

If you have any diet or nutrition questions during your pregnancy, be sure to address them with your doctor at your next appointment. We are here to help!


Exercising while Pregnant

Society often depicts pregnancy as a time of binge eating and unrestrained weight gain, but practicing healthy habits during these nine months is not only possible, but highly recommended. Of course, with a baby on board, your exercise regimen will change from what you are used to.

The American College of Obstetricians and Gynecologists and the National Institutes of Health (NIH) say almost all women can and should be physically active during pregnancy, recommending that pregnant women get about 30 minutes of moderate exercise most days of the week. The NIH reports that exercising during pregnancy helps reduce pregnancy discomfort, lowers the risks of gestational diabetes, improves sleep, improves mood, helps with an easier labor, and helps provide a faster recovery after delivery.

Here are some tips to keep in mind when it comes to exercising through pregnancy:

  • Research has shown that the mothers of infants who exercise generally have more desirable/healthy body composition. In other words, if you keep up an exercise routine throughout pregnancy, you will have an easier time going back to your pre-pregnancy weight once the baby arrives.
  • Stay well hydrated while exercising; stop exercising if you feel exhausted or overheated or if you feel dizzy.
  • Keep the weather in mind, and if it’s hot outside, avoid exercising in the heat, so you don’t become overheated.
  • For many active women, there is no reason to dramatically cut back on exercise during pregnancy. Most women can maintain the program and routine that they are accustomed to doing.
  • Listen to the body, and it will guide you. If you’ve never exercised, then you should take it easy on starting a plan, but if you’re an avid exerciser or athlete, keep pushing on with some minor modifications.

If you have any questions or concerns about exercise and how to have the healthiest pregnancy, talk to any of our doctors at your next appointment. All women and all pregnancies are different. We can help you figure out the best options for your unique situation.