Everything You Wanted to Know about Egg Freezing But Weren’t Sure Who to Ask!

You’ve been thinking about it. You’ve been talking about it. You’ve been reading about it: egg freezing. Fertility preservation. Oocyte cryopreservation. Putting your eggs on ice. Whatever you call it, you’ve been considering it. And whether it’s been on your mind for weeks, for months, or maybe even for years, you can’t shake the feeling that this procedure is something you want to do—or at the very least, learn more about.

In the age of iPhones, blogs, and Facebook, there’s no shortage of information out there about the egg freezing process. You can get most of your questions answered without even walking out of your apartment! But while we’re big fans of community, particularly one that shares content and empowers women to make educated decisions about their bodies (#trulyMD), not all information sharing is created equal. Some of what’s out there is simply inaccurate. Content can be colored based on an individual’s experience: good or bad.

As fertility MDs, girlfriends, and exercise enthusiasts, we’ve chatted with patients, friends, and ladies we meet on the shower line in the locker room about egg freezing: what they know, what they want to know, and what they wish they knew.

Here are the top five questions we’re most frequently asked:

  1. How do I know if my eggs are any good?
    Hands down, this is the question that we’re asked the most. Will the eggs that I freeze today be good enough to make a baby in X number of years? And unfortunately, despite everything that we can do, answering this question accurately is not one of them. There is no way for any fertility doctor to predict whether the eggs that you make today will have what it takes to make healthy embryos in the future. Although we use factors such as age, follicle count, and hormone levels to guide us in guiding you, there’s nothing out there that can answer your question definitively. However, when all else fails, look at your birth date. Simply stated, age trumps everything. The younger you are when you freeze, the more eggs you’ll get and the better your chances are in the future.
  2. Will I feel crazy on the medications?
    No, you probably won’t. While it’s fairly common to fear the negative side effects the drugs can have on your mind, it’s fairly uncommon to have any such side effects. In fact, most women tolerate the medications without a problem. So, trade the negative energy for the positive vibes! You should feel empowered for going through with the procedure. Giving yourself two to three shots a day for about 10 days makes you a warrior, not a wimp!
  3. Will I gain weight on the medications?                                                                              Here’s the skinny (or the not-so-skinny) on egg freeing and extra lbs. You’re likely going to gain weight during the process. Your pants will probably feel tight, and leggings and loose dresses will be your wardrobe staple for about two weeks. However, for most women this is no more than a few pounds, and the extra weight that is added is shed during the period following the egg retrieval.
  4. Will I ruin my chances of having a baby in the future?
    Unfortunately, with eggs there is no collecting “comp time.” Simply stated, if you don’t use them, you’ll lose them. So, the eggs that we collect during that retrieval are not being taken from you but actually saved for you. There’s no loss, just gain!
  5. Does it matter where I freeze my eggs (a.k.a. should I pick the least expensive option)?                                                                                                                                                  The reality is that not all egg freezing centers/fertility clinics are created equal. Some are way more experienced and way more talented at the freezing process. They not only know how to freeze your eggs but also how to thaw your eggs, fertilize your eggs, and help your eggs become healthy embryos. And while you’ll be spending a lot of time at the fertility clinic for about two weeks, don’t pick a center based on their proximity to your apartment, the color of the waiting room, or the “deals” they’re offering. We’re talking about your eggs and your future fertility. This isn’t a place to play Let’s Make a Deal.

If it’s been on your mind, go and let it out by talking to your GYN or a fertility MD) While you may choose not to do it, you won’t regret not giving yourself that choice. Although you may still play the “should-a, would-a, could-a game,” when you look back on this decision in one, five, or 10 years, you’ll appreciate that you considered all the options and made an educated decision!

Does Breast Pain Always Mean Something Bad?

Although there isn’t a moment in our lives that “the girls” aren’t by our side (or rather on our front), on most days we are unaware of their presence. Sure, we have the daily AM bra conversation with ourselves…what color, what material, strapless vs. racer-back, but in reality we spend a very modest amount of time paying attention to our breasts. This is except when one or both starts to hurt.

Breast pain makes us say, hmm, what could that be? And while most of the time our mind goes to that scary place, the majority of breast pain is totally benign. Let us unveil the A, B, C, and Ds (and maybe even the double A or double Ds) of breast pain with these basic facts.

A: Breast pain is one of the most common reasons women visit their GYNs.

B: The medical term for breast pain is mastalgia.

C: The easiest way to figure out what is bothering your breasts is to break out your calendar. Pain that moves with your menses (a.k.a. changes throughout the menstrual cycle) is considered cyclic. Cyclic breast pain is almost always caused by hormonal changes. Pain that comes on any calendar day (a.k.a. is constant) is considered noncyclic. Noncyclic breast pain is almost never caused by hormonal changes.

D: There are other structures (think of your muscles and your ribs) that are “roomies” with your breasts. Their close proximity to the breast can often masquerade as breast pain. So problems such as trauma to the chest, a fracture of the ribs, herpes, reflux, inflammation of the cartilage connecting the ribs, and angina make one think one’s breasts are in big-time trouble—when in reality they are nothing more than innocent bystanders!

Getting into the nitty gritty of it (or the double As and Ds as we like to say), hormonal or cyclic breast pain can occur from any medication that is either made from or modifies your hormones. Think OCPs (or any form of hormonal contraception), fertility medications, and medications used to treat abnormal vaginal bleeding.

When it comes to noncyclic breast pain, hormones are not the issue. While the breast is involved, the pain has nothing to do with your period. Think of things like trauma, infection, cysts, tumors, and cancers. Therefore, non-cyclic breast pain, specifically when it is in one breast, is intense, and is getting worse, makes us a bit more nervous. It definitely needs to be checked out.

In most cases, pain prompts a physical exam and an in-person chat: when did the pain start, what makes it better or worse, how often does it occur, and what where you doing when you felt it first? Depending on what these initial evaluations show, your doctor may decide to send you for a mammogram, a breast ultrasound, and/or an MRI. But because most breast pain winds up being no big deal (not cancer), the best thing to do is take a deep breath: it will very likely be okay. After this, it is not a bad idea to consider changing your bra (more supportive, better fitting) and changing your diet (less salt, caffeine, and fat). These modifications might just do the trick.

When nothing works, you may need to move on to medications. Starting an OCP or changing your OCP can help alleviate cyclic breast pain. Additionally, lowering the dose of a hormonal medication can also be helpful. Last, if the pain is non-cyclic and related to the muscles of the chest, an anti-inflammatory like Ibuprofen or Advil can certainly do the trick.  

Your breasts are sort of a big deal, no matter what size you are. And when they don’t feel right, you want to look into what’s making them hurt. While the pain is most likely from normal hormonal ebbs and flows, this is not a tide you should just watch roll in and roll out. Go looking for the lifeguard (your GYN) to make sure you weather this storm safely. It may be a pain (no pun intended), but it will keep you and your breasts protected.

Does Everything That Itches Equal Yeast? Vaginal Infections

When anything feels off down there, our mind usually goes to one place: yeast infection. No matter what the actual symptoms are, any discomfort seems to signal yeast. For whatever reason, for most of us vaginal discomfort reflexively equals yeast. And while some of us will call our GYN to get their take on what’s going on down there, most of us simply head over to the local Duane Reade or CVS for some sort of topical relief.

Whether you pick the one-day, the three-day, or the extended seven-day course, you leave with something to stop the itch, the burn, and the overall discomfort. It isn’t until your symptoms outlast the one-, three-, or seven-day regimen that you pick up the phone and call your doctor. It is usually here that you find out that not all burning, discharge, or itching is yeast—a.k.a. Monistat works, just not on a bacterial or urinary tract infection.

Here are some tips on how to know if yeast is really the culprit…

  1. Discharge: While most of us associate vaginal discharge with some sort of problem or infection, news flash: a healthy vagina also secretes vaginal discharge. However, the latter is usually odorless, fairly clear, and doesn’t make you think or wipe twice! An infection, be it yeast, bacteria, or something else, will cause the discharge to change color, content, and quantity. While yeast is routinely associated with white, clumped (cottage cheese-like) discharge, discharge that is green or yellow is more commonly seen in bacterial infections (e.g., bacterial vaginosis or Trichomoniasis). And taking it one step further, urinary tract infections (which are often misdiagnosed as a yeast infection) will likely cause no change in the quantity or quality of the vaginal discharge. Bottom line, what the discharge looks like may “color” our diagnosis of what is causing your vaginal discomfort.
  2. Odor: Nobody wants to smell bad…especially down there! So, when something smells off, it should signal you that something is not right. However, that “not right” does not mean a yeast infection. Here’s the deal. A normal vaginal pH is about 3.8 to 4.5. Infections can alter the pH and change the vaginal odor. Select bacteria (think bacterial vaginosis, a.k.a. BV) can result in foul-smelling vaginal discharge. And although yeast can alter the pH, it doesn’t usually have a significant impact on vaginal odor. Therefore, when the odor seems way off you are likely dealing with something else.
  3. Itching: Vaginal itching and yeast infections sort of go hand in hand. In fact, this is the symptom that sends most of us straight to the drugstore. But while yeast is the infection that is most likely to cause an itching sensation, the vaginal mucosa, just like your skin, is sensitive to changes in body washes, soaps, and detergents. The same sort of itching that can occur on your arms, legs, stomach, and face when you change detergent or add a new skin care product can happen to your vagina. Before prescribing yourself Monistat, think about what has changed in your hygiene routine, and make sure that it is not what’s making you itch!
  4. Abdominal Pain: Most vaginal infections are limited to the vulva and the vagina. They rarely make their way to the cervix, the uterus, the tubes, and into the pelvis/abdomen. However, some sexually transmitted diseases (think chlamydia and gonorrhea) can move. They are frequent trespassers in the pelvis and pelvic organs. Therefore, when abdominal pain is accompanying your vaginal discharge the culprit is more likely to be a bug that can do damage on the inside as well as the outside rather than your garden-variety yeast. However, the pathogens that can move can do some major damage (e.g., infertility) if they are not treated.
  5. Fever: While most vaginal infections are super annoying, that won’t make you super sick. Therefore, when a woman reports a fever as well as vaginal discharge we start to think of things like gonorrhea, chlamydia, and even an infection in the kidneys. If your temperature goes up, you should get up and go right to your doctor!
  6. Pain with Urination: Although vaginal discomfort can make urinating super uncomfortable, pain with urination is usually the tell-tale sign of a urinary tract infection. Add to that urinary frequency and urgency (a.k.a. I have to go right now!), and urinary discomfort is more likely to be from a urinary tract infection rather than a vaginal infection.

So, while we all love to play Dr. Google not everything can be solved without a visit to a doctor. Not everything that itches, burns, or makes you feel uncomfortable is a yeast infection. Make sure you take note of everything that you are feeling. If your discharge comes with any one of the above, Monistat is not going to make it go away. Go and see your GYN!

 

Is “the” Seat Spoiling my “Seat”? Cycling and Your Bottom Line

As avid spinners (indoor cycling) ourselves, we get the “my bottom has gone numb sensation.” We also get the “um, things don’t feel so comfortable in the saddle” sensation. However, the bottom line is that your bottom line can tolerate a whole lot. While the pressure from constant sitting in a somewhat awkward position can cause numbness, it should not cause any long-term damage or have a negative impact on your sex life. And let’s face it, unless you are doubling and tripling (a.k.a. two or three back-to-back cycling classes), you are never in the saddle for more than 60 minutes, tops. However, if you are finding the ride particularly rough on your rear, here are some tips on how to smooth it out…

  1. Chafing: Thigh, bottom, and vaginal rubbing can happen to the best of us. And when it does happen, it can burn—big time. The best way to treat this is to apply Vaseline, Body Glide, or Aquaphor both pre- and post-ride. Keep the area lubricated, and make sure that all parts glide past each other without any friction!
  2. Outfit Change: While you may like the way a pair of pants looks, not every pair of pants was meant to go for a spin! Some are more comfortable than others. Try out different brands, materials, and sizes. Consider investing in a pair that has a cushioned bottom.
  3. Adjust Bike Settings: How you set up your bike can impact your body, from your head right down to your toes (and bottom). If things don’t feel right, don’t be afraid to readjust AND to ask a professional (a.k.a. the teacher or the studio staff) if things look right. Altering the position of the bike can change body mechanics and positioning. This alone can help combat some of the discomfort riders can experience. Different angles = different pressure points = no more discomfort.  If this doesn’t work, then consider adding extra padding to the seat. Most cycling studios have extra seat covers to give you extra padding if you need.
  4. Don’t be stationary: Although this may sound ironic, when sitting on a stationary spin bike, changing positions (from the saddle to second or third) can help get the blood flowing to different parts of your lower bottom. This can relieve the pressure on your bottom in a big way.
  5. Time it: When you ride and when you shave or wax is important. It’s probably not a great idea to do a class after getting a Brazilian wax. Following hair removal, the skin can be raw and sensitive. Sitting on a bike immediately after may not be the best idea.
  6. Space it out: No matter how much you love to ride (trust us, we get it!), it’s not a bad idea to take a break occasionally. A day off your bottom can often alleviate some of the discomfort. Additionally, it’s not a bad to explore new activities…you never know what you might find!

The upside to your rear side is that, for most riders, your bottom becomes pretty well acquainted with the saddle after a few rides. So keep on spinning. Who knows, your bottom may actually benefit from a couple of cycling classes.

The Enemy: Vaginitis

Vaginal discharge and its friends—itching, odor, and irritation—need no introduction. When they arrive, you know they’re there. They are some of the most unwelcome guests, and you’ll pretty much do anything to boot them from your bottom. As complaints go, they’re the cause of many calls and visits to the GYN and overall can leave you miserable.

Vaginal discharge usually indicates vaginitis (the medical way of saying “inflammation” or “infection”). Vaginitis is the umbrella term used to describe all the lovely symptoms listed above. And when they’re present, it’s a sure sign that something is off in the vagina. Let us share what these things usually are.

For starters, the vagina is an acidic place (a.k.a. the pH of the vagina is usually about 4.0 to 4.5). Acidity is important because it assists in keeping the bugs away—bacteria and fungus are more fans of a basic environment. When the pH is off and things are skewing in the basic direction, bugs start to flourish.

Anything from menstrual cycle phase to a foreign body to sex to antibiotics can throw things off (a.k.a. the pH) and set the stage for vaginitis. In come the bacteria or the fungus, and out goes your comfort (bacterial vaginosis, candida vulvovaginitis, and trichomoniasis are the most common culprits). When it comes to symptoms, the most common symptoms women with vaginitis complain of are vaginal discharge, itching, burning, redness, pain with intercourse, pain with urination, and even spotting.

It’s important to call your doctor when you get that “things don’t feel right down there” sensation. You should trek to their office for a chat (a good history can tell you more than any test), a pelvic exam, a vaginal plus or minus cervical culture, a pH test, and a close look at the discharge under the microscope. While there are some classic features of different bugs (trichomonas usually present with a greenish-yellow discharge, candidiasis with a thick, white, cottage-cheese-like discharge, and bacterial vaginosis with a thin, fishy-smelling gray discharge), it’s best to make the diagnosis before initiating any treatment.

If the tests come up without a clear diagnosis (which happens in about 25–35% of cases), your doctor will start delving deeper into some of the more unlikely causes (low estrogen, medications, hygienic practices, allergies). Whatever the cause, we may have ways to treat you and end your torture. Whether it is an oral medication or a vaginal cream, we can find the right medication to return the vagina and its pH back to normal.

Vaginitis can be super annoying. It can sideline you from doing a lot of fun things (no explanation needed) as well as some not-so-fun things (a.k.a. working). But you don’t have to suffer in silence. And you shouldn’t rely on self-diagnosis. While your intuition is probably pretty spot on, without a microscope and a pH test, you can’t be certain. Although it is usually bacteria or a fungus causing the problem, it’s important to confirm which one. This will ensure that you get the right treatment and get right back into the swing of things.

Dermoids: From Soup to Nuts, the Cyst That Has It All

What has hair, teeth, yellow gooey fluid, and likes to call your ovaries home? No, this is not a bad joke or a fictional character in a fantasy novel. It’s a dermoid cyst, and it’s pretty common in women under the age of 30. Dermoids, also affectionately known in the medical world as ovarian germ cell tumors or mature cystic teratomas, comprise about 25% of all ovarian cysts. The large majority are benign (phew!) but can be quite pesky and occasionally painful.

What makes them so notable is not whom they affect but how they affect them. Let’s take a quick trip back to Bio 101. In our body, we have three types of tissue: endoderm, mesoderm, and ectoderm. These big three make up the basis of every organ in our body, including our skin. Mature cystic teratomas (nickname deromids) are comprised of all of these three cell types. Hence, they have the ability to be whatever or whoever they want. That’s why when they are removed and opened, you can see anything from hair to teeth to nerve tissue to fat cells.

Just like their Houdini-like abilities to transform into everything and anything, they are often invisible when it comes to pain. Many women find they have dermoids totally by accident on an ultrasound for something else or during a physical exam.

Symptoms in general are a side effect of size. The larger the dermoid, the more likely you will have pain, pressure, cramping, etc. Occasionally, dermoids will present with acute pain, nausea/vomiting, and a trip to the operating room. This is called ovarian torsion. When cysts take up residence in the ovaries, the size of the ovary can increase substantially. The bigger an ovary, the more apt it is to twist.

Very rarely, a dermoid cyst will make itself known by rupturing, that is, opening up. When it does this, that yuck fluid escapes its “jail” and has now leaked all over your pelvis/abdomen. This can be pretty painful and almost certainly requires a surgery to do a major clean out. Your body can react very strongly to this unwelcome substance, and unless treated ASAP, major scar tissue and other serious issues can occur.

When dermoids say cheese to our camera (the ultrasound), they have a very characteristic smile. This is a good thing because it allows us to be pretty confident in what we are dealing with. Once it is confirmed, or as close to confirmed as we can get, a treatment plan is devised. Depending on the size (and symptoms) of the cyst, surgery may be recommended. Most of the time these cysts can be removed with the aid of a laparoscope (a.k.a. camera) and a few small incisions.

This minimally invasive approach allows women to come in and go home within a few hours. While the ovary is almost always left inside in women who still have babies and pregnancy on their brain, for women who are done with the baby thinking, it is ok to remove the entire ovary. Make sure that you discuss the surgical approach and strategy with your doctor before going in. You want to make sure that you are on the same page!

Although most are benign, there is a small subset of ovarian germ cell tumors that are bad (a.k.a. can cause cancer). The names of these are definitely going to be foreign, but we will make a quick intro in case you should run into them in a dark alley. They include dysgerminonams, yolk sac tumors, and mixed germ cell tumors. Luckily, most of us will never ever meet them ourselves or know anyone who will encounter them. However, if you do, make sure you see a GYN who specializes in ovarian cancer (a.k.a. GYN oncologists). Rare ovarian tumors are their bread and butter; they know the best surgery approaches, the best medical treatments, and the best way to tackle this problem.

You may have to travel to see them (not every town/city has one in their zip code), but it’s worth the trip. They may save your ovary, save your fertility, and most importantly, save your life.
When you hear the word cyst, you probably mutter a curse word and ask what does this mean?! And then, when it is followed up by “and it looks like it may have hair, teeth, and yellow stuff,” (and no it is NOT a baby) your psyche gets even more psyched out. But don’t despair. Although dermoids are sort of disgusting to look at, they are not divas to deal with. They are fairly easy to remove, almost always benign, and come back in only about 4% of cases. Find a good doctor who knows what they are doing, and your dermoid doesn’t stand a chance!

5 Things Never to Do While You Have Your Period

There are not many things that you want to do when you have your period except lay in bed, watch re-runs of “Sex in the City,” and eat coffee Haagen Dazs ice cream! But between work, family, and an endless list of responsibilities, you have to get out of bed and get moving. And even though you may have to move through your day on a massive amount of Advil, there are a few things that you should not do while on your period.

  1. Bikini Wax: As if a bikini wax wasn’t torture enough, try doing it while you have your period. Double trouble! Your pain receptors are extra heightened and your skin extra sensitive when you have your period. Add to that a pretty messy situation, and waxing while on your period is something you should not do. Period!
  2. Pro-Inflammatory Foods: Your period is a period of heightened inflammatory mediators—hence, menstrual cramps. While foods filled with inflammatory mediators (sugars, saturated fats, fried foods, artificial additives) are all you really want to eat, they are best avoided during your period.
  3. Breast Exams: The breasts are incredibly sensitive to changes in hormonal production. Fluctuations in estrogen and progesterone can make both breast exams and mammograms more uncomfortable. Additionally, cystic breast changes are more likely to be palpated on an exam, which can unnecessarily raise a red flag. While monthly breast exams are a very good idea, don’t set your alarm to the first few days of heavy flow.
  4. Unprotected Sex: While unprotected sex is never a good idea, it is a particularly bad idea when you have your period. Blood is a good medium for viruses and other bugs. Therefore, the transmission of things like HIV can be higher during this time period. Furthermore, the cervix is slightly dilated (a.k.a. open) when you have your period. This makes it easier for bugs to get from the vagina to the cervix and into the pelvis.
  5. White Pants and Bathing Suit Shopping: This likely goes without saying, but wearing white when you have your period is not the best idea you have ever had. While you may be super fashionable, now is not the time to showcase your new white jeans! On that same note, Aunt Flo is not who you want to go bikini shopping with. Aside from the technical difficulties (trying on bikini bottoms with a pad and/or a tampon), you are going to be extra bloated. This will make any bikini look blah at best!

We all have our “go tos” during that time of the month. Heating pads, teas, soups, and stretches…whatever helps you relieve the pain, the discomfort, and the all-around blahs is okay in our book. However, when the pain is unbearable, the discomfort distressing, or the blahs are making you more than blue, you should think about talking to your GYN. They will likely have a “go to” that can make you good to go during everyone’s favorite time of the month.

When to Take the Plunge…Am I Getting Hot?

Arguably the most popular question we are asked, whether in our office or in the Women’s locker room, is when I should freeze my eggs (a.k.a. at what age). And while in our office we can give you a personalized opinion, it’s hard to tell you exactly what to do while waiting in the shower line (although we will try). But what we do tell everyone (friends, patients, and gym acquaintances) is that the reason to freeze and when is often very personal. And although there are better times to do it, there is really no best time. Here are three tips that should get you “hotter” to getting your eggs “colder.”

  1. How old are you?
    Although you may not look a day older than 25, no matter how much sunblock you use, how healthy you eat, or how many times you hit the gym your eggs don’t really care. Egg quantity declines from the moment you take your first breath (and actually even before that!). Nothing you do or don’t do (minus a bad tobacco habit) will halt egg decline, except egg freezing. Egg freezing offers you the chance to freeze a subset of eggs at a particular age, whatever that age is. And just as egg quantity decreases as you age, so does egg quality. Therefore, the younger you are when you freeze eggs, the better quality those eggs will be. So, while yes, it would make sense for us all to freeze our eggs in our twenties when our eggs are at their peak, most of us won’t need to freeze our eggs. Most of us will not experience infertility and will not need to use frozen eggs to achieve a pregnancy. With all of that being said, if you are looking for that magic age at which you are getting “hot” to the “cold,” we would suggest that you pencil egg freezing into your calendar on your 32nd birthday. For most women, 32 offers you a balance between good egg quality and adequate egg quantity at not too premature a point in your life. Happy birthday!

2. Where are you in your relationship?
While we are not asking you to check the single or married box, we are asking you to evaluate where you are in your relationship. Is it serious, are you on the same page about having children, what is your timeline (and do your timelines match up)? Although these are very rarely fun conversations to have, they are super important. Men will make sperm for nearly their entire lives. They can wait way longer than we can to pull the goalie. Make sure he (or she) knows what you want—and when. This should help you decide when and if you should freeze your eggs.

3. What happened in your past?
We are not here to judge; trust us (we went to college, too!). The past that we want to know about is your medical and GYN history (medications you have taken, surgeries you have had, the pain you feel with your period) as well as your mom’s, sister’s, aunt’s, and grandma’s fertility history. Did your mom have an early menopause? Did your sister have a hard time getting pregnant? We not only mirror our female relatives when it comes to our physical appearance but also how our ovaries function. Therefore, in many ways, before you can move forward, you need to look backwards!

By combining all three—age, relationship status, and your past—we can sum up when and if you should freeze your eggs. And if it adds up (a.k.a. you are getting “hot” to your eggs getting “cold”), the best way to kick the process off is to get real information (#trulyMD) on what the process is like. Not everything you hear or read is true. So, the best advice we can give you is to talk to your GYN, talk to a fertility doctor, or talk to us at Truly MD in the gym locker room about the process. We can help you decided when it’s time to take the plunge!

Why Am I Making Milk…I Have Never Even Been Pregnant! Prolactinomas

Looking down at your shirt and seeing two stains over the nipples can be disconcerting, to say the least. Yes, if you are breastfeeding it’s par for the course (words from girls in the know…never leave home without nipple pads postpartum!), but if you are eons away from pregnancy it can be beyond confusing. However, there are certain instances, which are not super uncommon, where this can happen. In most cases, it comes from the overproduction of a hormone produced in the brain called prolactin. Here’s a preview of what this prolactin can do.

Think Ps…prolactin is made in a part of the brain called the pituitary. While you can’t see it and probably have never even heard of it, the pituitary is a pretty powerful hormone in the world of OB/GYN reproductive hormones. The pituitary is not only known for its good looks and funny personality but also for the production of hormones that initiate periods, help with pregnancy, and promote overall health and wellness. While post-pregnancy you want that pituitary to be making prolactin in overdrive, pre-pregnancy, you don’t want to hear more than a peep from it.

Normally, prolactin production is kept in check by other hormones. They control the production and release of prolactin into the bloodstream. However, when these hormones are not functioning properly or there is a tumor that is producing prolactin, that’s when things can get milky.

Although classically we talk about women and breast discharge, in reality most women who have elevated prolactin levels may never know it. Contrary to popular belief, the levels actually need to be fairly elevated for milky breast discharge to occur (FYI: the medical term for this discharge is galactorrhea). Most women come to the doctor complaining of irregular or lack of periods and/or infertility. In the evaluation for these conditions, the elevated prolactin is identified. In many ways, it’s a good problem to have. It is most often easily fixed and causes no significant medical problems.

Prolactin tumors, prolactinomas, are some of the most common benign brain tumors. They can be small (micro) or large (macro) and are often the culprits for elevated prolactin and milky discharge from the nipples. While the word tumor can send everyone into a tizzy, they are most often treated with oral medications. The medications, bromocriptine and cabergoline, work to decrease the prolactin levels and therefore decrease the symptoms. For most women, taking them can be a no brainer—they can reduce your prolactin levels, reset the system, and ultimately turn your periods and your fertility back on.

While prolactinomas are definitely at the top of the list for causing elevated prolactin, there are other problems that could cause this problem. Culprit No. 1 is pregnancy. Even if you don’t think you could be pregnant, we are always going to ask. Other potential causes include medications (particularly antidepressants), chest wall stimulation (massage) or a lesion (think herpes zoster), hypothyroidism, or other tumors in the brain.

When trying to determine what, where, how, and why (it sounds like a game of Clue!) the prolactin is elevated, we usually start with a repeat blood test. Yes, you read that correctly. We have you come in and repeat the levels to confirm that they are actually elevated! However, this time we ask you not to eat and to come in first thing in the morning. Food and late-night fun can throw off the accuracy of the prolactin hormone test.

If the repeat levels are high, then it’s the real deal. Our next move is to send you for an MRI of the brain. This will tell us if it is coming from a benign tumor in the brain, and if so, how big it is. The bigger, the more bothersome and the better chance that you will need surgery. Luckily, most prolactinomas are “micro” (less than 1 cm), requiring only medical treatment. If the MRI is negative, we start the hunt for Professor Plum in the kitchen with the candlestick (a.k.a. we look for other potential problems).

Why do we care? Well, it’s not just that milky discharge is driving up your dry cleaning bill! It may also be preventing you from getting regular periods and getting pregnant. Additionally, no period means low estrogen, which means a risk for bone breakage. For women who are nowhere near being ready for a baby, the easiest thing to do is to put them on the birth control pill. This will control their periods and make sure they are getting the appropriate amount of estrogen. For women who are ready for a plus one, we initiate medical treatment (cabergoline or bromocriptine) to drive down the prolactin levels and allow ovulation to occur.

For many, prolactin is a word as foreign as incinta (that means pregnant in Italian!). You may never say it, hear it, or think of it. However, it doesn’t mean you won’t find yourself in Italy pregnant and need to know how to say pregnancy! In the same vein, you or one of your girlfriends may experience milky breast discharge and start to freak out.

Don’t freak out. You are not a cow. You are not alone. This is not uncommon. Go speak to your GYN—they will get to the bottom of this, get treatment going, and stop the milk from flowing.

Fibroid: What to Do When Fertility Is Not on Your Mind

If you have fibroids, you are probably saying a choice curse word every time you think of your little (and in some cases) big uterine friend(s). Like a bad house guest, they can be a big pain in the rear end. They can cause bleeding, pain, pressure, and infertility. Bottom line, they are not fun. And unfortunately, this un-fun party is very well attended; nearly a quarter of reproductive-age women have fibroids. Furthermore, fibroids are the cause for about 2% of infertility cases.

Simply stated, you are not the only person who RSVPed “yes” to the fibroid gala. While there are many ways to treat them, not everything works for everyone at every point in their life. Women at different stages of their lives (a.k.a. reproductive “stages”) and symptomology warrant different procedures. For those of you who are nowhere near ready for anything to do with the F word (FERTILITY) but want it in the future (be it near or distant), here’s what we recommend.

Fibroids can be treated medically and/or surgically. Medical treatments include oral contraceptive pills (a.k.a. OCPs or the pill), the intra-uterine device (a.k.a. the IUD), Lupron (a.k.a. “I feel like I am in menopause with these hot flashes and vaginal dryness”), progesterone receptor modulators (mifepristone or ulipristal acetate), SERMs (raloxifene), aromatase inhibitors (letrozole), and anti-fibrinolytics. While some of the medical options are better at improving some of the symptoms (for example, OCPs will improve heavy bleeding but not the pressure symptoms), they very rarely fix it all.

Just like when you’re selecting the OCP you want to marry, you may have to shop around for medical options before you land at your symptom-free spot. While Lupron (a GnRH agonist) will do it all, it will cost you in the side effect department. Hot flashes, sleep problems, vaginal dryness, muscle and bone pains, and even changes in mood/thinking often come along with the reduction in fibroid bleeding, pain, and pressure. It’s because of the side effect profile that we don’t go with Lupron as our first medical treatment.  

Surgically, the options are limited for women who have not yet had kids. It’s basically a myomectomy or bust. Fibroids have been nicknamed myomas; -ectomy means removal so myomectomy = fibroid removal. While a myomectomy is the only option for you ladies who are not yet ready to part with your uterus, what varies in the myomectomy part is how you “myomectomize.”

The procedure can be performed abdominally (through a bikini-cut incision), laparoscopically (through a camera), robotically (through a robot), or vaginally (no explanation needed!). The approach depends on the size of the fibroid(s), the location of the fibroid(s), and the number of fibroid (s). It also depends on your surgeon’s experience and preference. Make sure you are comfortable with all of the above before you commit to anything or anyone.

As with most things, there are pros and cons to both medical and surgical options. If you like lists (we love them!), here are the important points to note. For most young women who have not had kids but want them in the future, we like to go medical first. Most of the medical options are transient and provide birth control (killing two birds with one stone!). While they will not rid you of your “f”riends, they will decrease many of your symptoms:

Bleeding, check.

Pain, check.

Protecting your future fertility, check.

In many cases, with medical treatment, the fibroids will shrink. Fibroids feed off estrogen, so low estrogen equals famine for fibroids, and hopefully your symptoms will dissipate. If medical management doesn’t do much to alleviate your symptoms, you may have to amp up your treatment to surgery.

Surgery will almost definitely bring the bothersome bleeding, pain, and pressure to a halt. However, it can increase your chance for scar tissue (both within the uterus and the pelvis) and other surgical complications. Surgery, no matter who does it, is the real deal. For this reason, you want to avoid going under the knife unless it is absolutely necessary.

The only absolute cures for fibroids are menopause and/or a hysterectomy. For women who have baby making on their mind and in their future (be it near or distant), neither of the above is a good option: major con! It is for this reason that we need to find a way to temporize the symptoms until you get the pregnancy process started. We usually recommend starting low and going high, but only if you have to. Give the easy or simpler stuff a shot first before you shoot in out of the park.

Just a side note: while fibroids are pretty pesky for most of us, some women are completely unaware of their presence. They find out totally by accident during an ultrasound, a pelvic exam, or during pregnancy. And just like if it isn’t broken don’t fix it, fibroids that are causing no symptoms are really no big deal. They can hang with you for as long as you both shall live. No divorce in sight.

If they don’t bother you, don’t do anything with them until you have to. Prophylactic or preventative therapy to avoid future problems is not recommended—no pre-nup here! Fibroids need to be fixed only if you can’t take them anymore. Otherwise, do your best to forget they even exist!