General Questions

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.

Examples of foods to avoid:

  • Swordfish, shark, king mackerel, tilefish, and Albacore (White) tuna
    • These large fish contain high levels of mercury.
  • Raw fish, especially shellfish
    • May cause transmission of Hepatitis A
  • Deli/luncheon meats and hotdogs should be reheated until steaming hot
  • Unpasteurized milk or certain soft cheeses
    • May cause transmission of Listeria
  • All foods made with raw or lightly cooked eggs
    • May cause transmission of Salmonella

Unfortunately, nausea is a common symptom experienced by many women usually in the first trimester. Although not directly correlated, there seems to be an association with nausea and the rise in the level of the "pregnancy hormone", BHCG. As the level of that hormone begins to plateau, toward the end of the first trimester, so does the feeling of nausea. Additionally, another hormone that rises in pregnancy contributes to the slowing of the gut, thereby worsening the symptomatology. Things that can be taken over-the-counter include Vitamin B6 (10 mg by mouth up to three times per day) and ginger containing products (Ginger-ale and ginger tablets). If uncontrolled, you doctor can discuss prescribed forms of therapy.

Yes. The hormonal changes that occur during pregnancy cause the mucous producing glands within the cervix to grow thereby contributing to the quantity of discharge produced.

We never want to see any kind of bleeding during pregnancy. However, there are some things that do occur normally that may produce a small amount bleeding during early pregnancy. It is thought that bleeding may occur as a result of implantation of the embryo into the uterine wall. It is also possible for the sensitive cervical glands, under the influence of the hormonal changes of pregnancy, to either spontaneously bleed or bleed as a result of minor trauma (intercourse, cervical exam). Unless the pregnancy has been documented to be within the uterine cavity, we must also acknowledge the possibility of an abnormally located, or ectopic, pregnancy. If associated worsening pain is occurring, be sure to notify your doctor. Lastly, bleeding may signify the possibility of an impending miscarriage. Reassurance can easily be achieved through the auscultation of the fetal heart.

Many women experience lower abdominal pain early in pregnancy that can unfortunately continue throughout the pregnancy. These pains are due to stretching of the pelvic floor muscles as well as pulling on ligaments that function to support the uterus in the pelvis. For that reason the pain is referred to as "Round Ligament Pain". Often times the pain can be relieved through rest and the use of acetaminophen (Tylenol). As the pregnancy progresses, many women also employ the use of maternity support belts. However, cramping pain associated with spotting or bleeding should be further evaluated by you physician.

There is no scientific data on this question. As a precaution, however, waiting until the second trimester when all of the baby's organs have formed may be preferable.

The amount of exercise one can tolerate during pregnancy is dependent on the amount of activity prior to pregnancy. Pregnancy is not the time to begin a hard exercise regimen. However, active women can safely continue exercise regimens within reason. It is advisable to not engage in sporting activities that may lead to injury.

Healthy women without any complication associated with the pregnancy can safely continue working throughout the entire pregnancy. Modifications can usually be made when more physically demanding jobs contribute to fatigue, shortness of breath, or pain with walking.

Calcium and potassium are necessary components of muscle contraction. Being low can lead to instability of the normal resting tone of the muscle. Getting plenty of calcium (three glasses of milk a supplement) and potassium (oranges and bananas) daily can often help reduce the frequency of cramps. Other techniques that may help include stretching your legs before going to bed and avoiding toe pointing when stretching or exercising.

For a healthy woman with a normal pregnancy, intercourse is safe into the last weeks of pregnancy. For your comfort, you and your partner may wish to attempt different positions. You may be advised to limit or avoid intercourse if problems should arise in your pregnancy.

Yes. Progesterone is a hormone that rises normally in pregnancy. Its main function is to maintain a normal pregnancy during the first ; however, it has other effects in the body. It also acts as a smooth muscle relaxant, thereby affecting smooth muscles in your intestines, stomach, and esophagus. Food, thus, moves slower through your intestines and empties slower from your stomach. That allows more time for food to move up the esophagus. Also, the muscle that prevents food from coming up from the stomach relaxes and contributes to the reflux.

Things that may help include:

  • Eating smaller, more frequent meals (5-6 small meals instead of 2-3 large meals).
  • Avoiding foods that cause gas, such as spicy or greasy foods.
  • Avoiding meals near bedtime
  • Waiting 2 hours after a meal before exercising
  • Use of over-the-counter antacids such as TUMS, Rolaids, or Maalox.
  • Discussing other forms of therapy with your physician if symptoms do not improve.

Gynecology Questions

The most recent large study, The Women's Health Initiative, documented an increased risk of heart attack, stroke, blood clots, breast cancer, and most recently, Alzheimer's Disease associated with the use of hormone replacement therapy. However, as the data was more closely analyzed and separated by age groups, these risks were not bestowed on women who initiated therapy at the onset of menopause. Thus, hormones still play a vital role in the transition through a women's most symptomatic years of menopausal life. The goal is to treat patients with the lowest dose for the shortest amount of time so as to obtain the benefits (fewer mood swings, fewer flashes, more sleep, less risk of osteoporosis and colon cancer) without incurring the risks.

Non-hormonal forms of treatment that have shown varying results include herbal remedies such as soy products and black cohosh. A prescribed medication that usually functions as an antidepressant has been shown to reduce the number of daily hot flashes experienced and improve the response to them.

Annual screening mammography is currently recommended to begin at the age of 40. Tests can be ordered sooner if warranted by a patient's symptoms or family history. A woman with a positive family history of premenopausal breast cancer would be encouraged to begin screening 10 years prior to that family member's diagnosis. Mammograms are still the mainstay of screening as they detect 90% of all breast cancers. As they miss 10% of all breast cancers, it is still important to perform monthly self-breast exams after each cycle. Other screening modalities, such as MRI, may be employed in high risk patients.

HPV is a virus known as Human Papilloma Virus spread through sexual contact and is responsible for abnormal pap smears and 99.7% of cervical cancers. There are more than 100 different types with approx. 30 types responsible for infection in the genital tract. Low-risk types cause genital warts and high-risk types cause abnormal pap smears. 90% of the time, your body naturally rids itself of the virus much the same way its does with many other viruses. About 10% of the time, the virus persists and continues to cause abnormal pap smears that can progress to cancer over time. Usually, definitive therapy can be carried out before cancer ensues. For that reason, appropriate follow-up is of utmost importance.

The time period when a woman naturally experiences changes in her cycle prior to menopause is referred to as PERIMENOPAUSE or "around the time of" menopause. The changes in circulating hormone levels are thought to result from the decrease in ovarian function. When irregular bleeding occurs in this age group however, care must be taken to insure no significant intrauterine pathology, namely cancer, exists. This can usually be determined through a patient's history in addition to diagnostic tests such as endometrial biopsy and ultrasound. If no obvious pathology is identified, medical management of irregular bleeding can usually be attempted. Often times, benign conditions such as UTERINE FIBROIDS or ENDOMETRIAL POLYPS may be less responsive to medical management and require surgical excision. Although hysterectomy may be an option, other less invasive approaches, such as ENDOMETRIAL ABLATION are available which provide long-term results.