Emergency Contraception: What to Do When You Are in a Big, Big Bind!

Accidents happen to the best of us. Let’s face it: we all make mistakes. When owned and recognized early, they can frequently be fixed. Contraception (or lack thereof) can fail. Pills can be forgotten, condoms can be broken, and timing can be off. Luckily, emergency contraception is available and if used appropriately can effectively prevent pregnancy in the majority of cases. Emergency contraception comes in two basic forms—oral and intrauterine (the Copper T IUD). As the oral form was the original and is available over the counter for women above the age of 17, it is the form that is much more well-known. In fact, it’s fair to say that most women are unaware that there is even another option out there!

Furthermore, the IUD (a.k.a. the “other” form) requires a visit to your OB/GYN as it must be placed in the uterus by a medical professional. But common things being common, the most commonly used oral emergency contraception is either a combination estrogen and progesterone pill or a progesterone-only pill. One regimen requires two doses administered twelve hours apart, and the other, just a one-time dose. These medications are currently available to almost all in need at the nearby CVS or Duane Reade; where the medications will be placed (over-the-counter vs. pharmacist) is dependent on age. The line in the sand has been drawn at 17; women younger than 17 require a prescription to get the goods, while women 17 and older can pick up the medication without a prescription.

When the medication is taken or placed (in the case of the Copper T IUD) is key; the success of the drug is dependent on how soon in relation to the “event” (a.k.a. unprotected sex or contraception failure) it is taken. After 120 hours (five days), emergency contraception is virtually ineffective. Simply stated, you can take it, but it won’t work. If taken within 72 hours, the chance of success is really high—here are the stats. Data from research done by the WHO (World Health Organization) show that, if taken with 24 hours, 95% of pregnancies are prevented, if taken in 25–48 hours 85% of pregnancies are prevented, and if taken within 49–72 hours 58% are prevented.

After that, we still see success but at a much lower rate. Not surprisingly, an IUD placed for emergency contraception works almost in overtime; less than 1% of women who use the IUD get pregnant. And with the IUD, the hits just keep on coming. It not only works for that act of unprotected intercourse but also serves as excellent contraception for the future. While side effects do exist, they are generally mild and fairly tolerable. The most common include nausea, vomiting, and irregular bleeding. The medications can throw off your menstrual cycle, causing irregular bleeding. Both are transient and will resolve fairly quickly. If the nausea is bad, an anti-nausea pill can be taken to help you keep things down.

Emergency contraception can be taken more than once in the same cycle and, if need be, again in future cycles. The medical data do not show that multiple doses are unsafe. However, keep in mind that emergency contraception is best used in emergency situations. Additionally, it is less effective at preventing pregnancy than almost any other form of contraception, and therefore, if you continually find yourself scouring the aisles of your local drugstore, you are overdue for a visit to your OB/GYN to discuss a reliable form of contraception. Just to make sure we are all on the same page, emergency contraception is not the same thing as an abortion. An abortion terminates or ends an existing pregnancy. Emergency contraception prevents a pregnancy from happening. If an embryo has already burrowed its way into your uterus and has begun to grow, emergency contraception won’t work.

No one really wants to take the morning-after pill or have an IUD emergently placed. But stuff happens. There are ways to prevent an unwanted pregnancy that have a really good chance of working. Go the drugstore, call your OB/GYN—take action. While you may be ready for a baby in the future, today is likely not the day. Know what’s available to you, know how to safely get what you need, and know that you are not alone. You are not the first person this has happened to, and you certainly won’t be the last!

Our Yearly Date: We Name the Place, You Name the Time

When your Google calendar and iPhone reminder flash GYN appointment, time to get a bikini wax, you probably think to yourself, Ugh, maybe I can come up with an excuse to cancel. And after a couple times of “I have a cold. I have a work event,” and simply, “I totally forgot,” you finally force yourself to come in and see us. The annual GYN exam is sort of like jury duty. You can run, but you can’t hide. At some point, your GYN needs will catch up with you, and you will have to sit in our “chair.” And while we are certainly not asking you to judge anything, we are asking you to recap your past year(s) and think about your future. Am I ready to have a baby? Should I be on contraception? Do I need a Pap smear, STD screening, or a breast exam? We want to break it all down and make sure that you are doing the best things for your body.

First things first. Your trip to the GYN should be yearly (at the least). Although acute issues (UTI, vaginal discharge, vaginal itching, abnormal vaginal bleeding) may require an immediate trip, the routine stuff doesn’t need to be dealt with more than yearly. And while this yearly meeting may no longer include a Pap smear, it should most certainly include a discussion on previous Pap smears and future Pap smear screening. The recommendations have been modified, and women in their 20s and 30s without a history of abnormal Pap smears may no longer need yearly cervical checks. However, that doesn’t mean you don’t need to check in with your OB/GYN. Despite the common misconception, we GYNs do a whole lot more than Pap smears!

This annual aloha should first and foremost include a lot of talking. We will discuss eating habits, exercise, sleep patterns, work-life balance, stressors, medications (both prescription and supplements), and relationships. Have your parents, siblings, or grandparents acquired new diseases? Have there been new genetic findings in the family? Additionally, it is super important to address all things sex: sexual health, sexual orientation, and sexual activity (nothing is off limits with your GYN!). We also need to address drinking, smoking, and partying behaviors. While we are totally down with you having a good time, we want to make sure that you are safe. Lastly, no visit to the GYN would be complete without a period pow-wow. What’s going on with your period? What’s the cadence of the bleeding? Are you spotting, and are you having crazy cramps? Abnormalities in your period can shed a lot of light on what’s going on with your ovaries and uterus.

When it comes the exam part, it’s important to have your blood pressure checked and your height and weight measured every year. We also recommend a yearly breast and pelvic exam. For those who are sexually active, STD screening is a good idea (age and risk factors are used to determine whom to screen, for what disease, and how frequently). In women with a strong family history or a personal history of a particular condition, we may consider checking certain blood levels such as cholesterol and lipids (fat). If other symptoms arise—problems hearing, seeing, or headaches—we will address them with the appropriate tests. In many ways, the visit is a debrief, a review of what went well and what didn’t go so well the year before. Together, we can plan on how to attack your next year head on.

Without trust, you won’t be comfortable bearing it all—which is big-time important in making sure you stay healthy. Like all good partnerships, your relationship with your GYN of choice needs to be built on trust. Unlike the jury you may be called to sit on, we are totally not judging you (for what you do/did or if you waxed/shaved!). We want to take the evidence you present us with and make sure you are not doing your body or your brain any harm. Some actions can stay on your permanent record, no matter how good your lawyer is. Let us make sure your record stays clean!

Inflammatory Soup with a Side of Adhesion Bread: Endometriosis

There are certain subjects in school (think calculus, physics, and for some of us, poetry) that just make you want to go, “Ugh.” Looking at formulas or sonnets makes you want to rip your hair out. No matter what you do, you just don’t get it. In many ways, the same can be said for endometriosis (a.k.a. endo). It is sort of like that black box in gynecology and infertility. We know it hurts. We know it can cause infertility, and we know it can cause problems. But we’re still a bit unclear on the hows and whys. How does it get there? Why does it get there? How does it cause pain? Why does it cause pain? While many of these questions have the start of an answer, they lack a conclusion. The unknown can make them hard to diagnose, to manage, and to treat.

Welcome to Endo 101. Here, we will give you the abridged version. Endometriosis is the implantation of endometrial tissue (that is, the tissue that is supposed to stay inside your uterus and only your uterus) in other places. How these cells break free from their uterine jail is as much of a mystery as how El Chapo escaped from jail. However, once the inmates (or cells) have been released, it’s tough to get them back in.

Many of us in the biz or in the know refer to endometriosis as “endo.” The shortened nickname does not mean the symptoms and the negative side effects that its presence brings are in any way short. In fact, this laundry list is quite lengthy. Women often report symptoms ranging from pain (including pain with periods, intercourse, defecation, and urination), infertility, diarrhea/constipation, and a no-joke impact on one’s quality of life. Symptoms can even be as vague as back pain, chronic fatigue, or abnormal bleeding.

The degree of pain and even infertility can be mild, or it can be severe. And the worst part of it all is that the extent of disease doesn’t equal the degree of symptoms (it’s sounding even more like calculus!). The trickiest part about endo is that, to diagnose it, you must operate on it. Symptoms and even visuals (ultrasound images) can’t make the call (although they can come pretty darn close). You must go to the operating room and have the tissue sent to the pathologist for a diagnosis. Although you can be nearly certain that the diagnosis is endometriosis, you can’t prove it without a reasonable doubt until the eyes of your pathologist friend sees the evidence. The judge and jury here are pretty small.

If you are suffering from endometriosis, you have probably thought on many a night, “Why me?” How did I win this unlucky lottery? Endo is no $200 million Powerball—it is actually fairly common. In women undergoing surgery for pelvic pain, up to 30% will have endometriosis. It’s nearly impossible to know how common endo is in the general population because many women will have it but won’t even know it. Bottom line, it is likely way more common than we know.

What makes someone more likely to hit the “un-lottery” lottery has not been fully worked out. While we know that there is definitely a genetic component, the endo gene(s) have not yet been identified. However, if your mom, grandma, and sister have it, there is fairly good chance you will, too. Other likely originators of endo include:

  • Changes in the immune system,
  • Retrograde menstruation (when the blood goes backwards through the fallopian tubes into the pelvis rather than out of the cervix into the vagina), and
  • The passing of endometrial cells through the lymphatic system (think lymph nodes, which are actually located not just in your throat but throughout your whole body!).

Who will win a game of Roulette is anyone’s guess, but our money is on a mixture of all three. Additionally, women are less likely to have endo if they have had multiple children, breastfed for a long time, or got their first period later.  On the flipside, women are more likely to have endo if they have not had children, got their periods early, went through menopause late, bleed for longer duration with their periods, have more frequent periods, and variations in their reproductive anatomy (called Mullerian anomalies). While you may have gotten it without any of the above, we as fertility MDs are definitely more likely to look for it in certain women.

The thing about endometriosis is that it only makes a peep when estrogen is around. If there is no estrogen (hence hormonal contraceptives, Lupron, or menopause), endo is quiet as a mouse! Because it can’t act without estrogen, it pretty much only impacts women during their reproductive years (late teens to 40s). For this reason, most of the treatments center on shutting down the production of estrogen. It’s like taking the logs out of the fire. Without fuel, nothing can burn! While this sounds all well and good, most of us can’t be without fuel for our whole life. At some point, you might want to get pregnant. This will require adding fuel back to the fire. For this reason, it’s not a bad idea to see a fertility specialist before you stir things up.

Endo plays a pretty bad game of hide and seek. (Basically, we can see it coming from a mile away!) When the decision is finally made to go into the operating room and take a look, the disease is often pretty easily spotted. While the most characteristic appearance consists of the blue/brown “powder burn” spots, the look of endo can be very Houdini-esque. Endometriosis can look like brown spots, red patches, yellow-brown discoloration, or white spots.

To know for sure what’s up, the tissue must be sent to the pathology lab for a thorough onceover. The most common places for endo to hang out are on the ovaries, on the tubes, in the pelvis, on the ligaments that hold up the uterus and the ovaries, in the colon, and on the appendix. Where it makes its home often translates into the symptoms that you have. Again, this is not always the case. Some women can have endo painting their ovaries, their tubes, their pelvis, and their colon and experience no symptoms.

While surgery is required to make a diagnosis, not everyone needs surgery. A good history, physical, and sometimes imaging can give us enough info to convict (a.k.a. start treatment). The treatments are plentiful (think Thanksgiving Day dinner) and will be passed around to see which “tastes” best for your body. Women who are trying to get pregnant ASAP will have to opt out of most of the dishes (although options still exist). The silver lining with endo is that, for almost all women, the symptoms disappear during pregnancy. While we don’t recommend getting pregnant simply for an endo time-out, it will make matters way better.

Unfortunately, endo is the gift that keeps on not gifting (or re-gifting things you don’t want!). And unlike a good gift giver, there is no receipt and no return policy. If it is yours, it’s yours for life. There are many ways to tailor that shirt or tighten those pants so that you can live with them. Same goes for endo. We can do a lot to make you pain free if we know what’s putting you out. It’s definitely a bumpy ride. You may need several fittings, but we know a pretty good tailor. Just make sure to be completely honest with your doctor, and do your research before committing to any treatment.

8 Symptoms That Suggest You May Have Endometriosis

Most of us have never even heard of endometriosis (a.k.a. endo) before our GYN throws it out there as a possible reason for those wildly unpleasant symptoms that wake you up every 30 or so days. When getting your period feels like getting hit by a sledgehammer, you very well may be suffering from endo (the implantation of uterine tissue on other organs in the pelvis/body). Here are some other red lights that should flash “endo” in your head.

  1. Painful Painful Painful Periods
    For most of us, no period is a fun period. Those three to five to seven days are never anyone’s idea of a good time. However, for women with endometriosis, these days can be debilitating (and they can start about 1–2 days before your period even begins)! The pain that comes with your periods can put you on the sidelines from work, from exercise, from socializing, and from life. Lying in your bed doubled over in pain is nobody’s idea of a good time. Medically painful periods are called dysmenorrhea. We GYNs ask about it all the time because it gives us a better idea about what you are going through when you get your period. It is the most common symptom associated with endometriosis (nearly 80% of women with endo report it). Therefore, if you are one of the unlucky ladies who languishes on the couch during your time of the month, it’s time to share this info with your doctor.
  2. Chronic Pelvic Pain (a.k.a. Pain All the Time)
    When you are singing the “pain, pain go away, come again another day” song, without any relief in symptoms, no matter where you are in your cycle, there is a pretty good chance that you have endometriosis. The pain can be sharp or dull, focal or diffuse—bottom line, it can be pretty variable. Chronic pelvic pain is seen in about 70% of all women with endo. It can cause a serious roadblock in one’s ability to function both at home and in the office and therefore needs to be cleared ASAP.
  3. Pain with Intercourse
    Women who have endo complain of pain with intercourse (medically termed dyspareunia) fairly frequently (about 45% of women with endometriosis report this symptom). The pain reported is generally a sensation of pain in the pelvis with intercourse (not pain with insertion or vaginal pain). As expected, it can have a serious impact on a woman’s quality of life, and while many women hold back in talking to their GYNs about sex, this is something you should definitely share.
  4. GI Distress
    Endometriosis is not picky in whom she decides to annoy. Lesions are not only limited to the reproductive system but also set up shop on the bowel (intestines). Where they lay their roots dictates what symptoms are felt. GI symptoms include diarrhea, constipation, bowel cramping, and difficulties going to the bathroom. Bleeding from the rectum can also occur. For some women, the GI symptoms can be worse than the GYN ones; it can be pretty intense.
  5. Infertility
    One of the biggest criminals in the infertility battle is endo. Endo can have a seriously negative effect on a woman’s ability to conceive—it can be a pretty formidable challenge for us in the Land of Fertility. The good news is that our treatments can also throw a pretty strong punch, and they can usually knock it out. Pregnancy is most certainly not impossible in women who have endo.
  6. Ovarian Cysts
    The most common site for endo to set up shop is in your ovaries. While the implants can be superficial and select, they usually form a cyst(s). The cyst (medically termed endometrioma) can cause some serious pain. It can also eat away at your eggs and reduce your egg quantity; this translates into what we call diminished ovarian reserve (low egg quantity). While surgery can help with cyst size, it can further hamper your egg reserve. Make sure that you consult with a surgeon who is skilled in endometriosis surgery before you make a date for the operating room. There is no frequent flyer program for surgery. Therefore, you want to limit the number of times you go to the operating room.
  7. Pain with Urination
    Although this may come as a shock, endometriosis can hang out in your urinary tract system. When it pitches a tent, it can cause urinary frequency, urinary urgency, urinary pain, and even retention. Not fun. These symptoms can be scary and confusing, especially when you are totally in the dark about the connection between the urinary system and the GYN system. The two are pretty close, and as a result, one can rub off on the other pretty easily. Definitely let your GYN know what your urinary system is up to.
  8. The Odd Ones
    Endo could be a US spy—it can slide and slink its way into almost every corner of the body. It has been reported in the lungs, the arm, the thigh, the diaphragm, and even surgical scars! So while it is unlikely to hide out in these spots, any atypical symptoms should be reported to your doctor, as it might break the code as to what’s going on in other parts of your body.

Put them all together, and what do you get? No, not bibidi bobidi boo, but rather a pretty bad case of the blues. The symptoms of endometriosis can take quite a toll on your quality of life. They can cause you to withdraw from friends, family, and all sorts of fun. Don’t suffer in silence. There are not only thousands of women who are in a similar situation but also several physicians who are well equipped to treat your pain. We just need to know what’s bothering you, how bad it is, and how best to fix it. Together, we can knock this out!

Oops, I Missed a Pill…Did I Mess Everything Up?

One of the most frequently Googled GYN questions is “What do I do when I miss my pill?” Pill oversights, although common, can cause a lot of panic and fear. Getting pregnant now is not an option! Staring at the pack and realizing you are up to Tuesday but it is Thursday can be horrifying. However, the reality is that, if you haven’t at some point in your pill-taking career missed a pill, you deserve a medal. Almost all of us have had an oops or an uh-oh over our one, five, ten, or fifteen years of taking the pill. You are most certainly not alone.

When you miss a pill, the first question to ask yourself is, how many did I miss? When you miss just one pill, it’s no big deal. Just take the missing pill as soon as soon as the light goes off in your head. If it is not until the next day, take the missed pill plus that day’s pill together.

If you miss two-plus pills, that is slightly more of an issue and requires some more effort. Again, once you have your “a-ha I missed my pills moment,” take both ASAP. Then resume your daily pill schedule.

However, forgetting to take a pill is like forgetting to brake when approaching a red light. The ignition will rev up, and you may roll right through an intersection. Without the daily suppressive effect of the pill, your brain may start to develop a follicle and get ready to release an egg. So to prevent pregnancy, the best thing to do is use an additional form of contraception (a.k.a. condoms) until you have taken seven days of active pills.

If the oops was in the last week of the active pills, don’t take the placebo week; restart a new pack a week early.

If the error was in the first week and you had unprotected sex, you should strongly consider emergency contraception (a.k.a. Plan B) as well as continue with your current pack for maximal protection. Call your doctor, and let him or her know what happened so that together you can design a plan that will prevent pregnancy.

When thinking about pill errors, think in terms of sevens:

  • It takes about seven days of continuous pill use to prevent ovulation.
  • Never take fewer than 21 consecutive active pills.
  • Never have more than seven pill-free days (any longer than this gives the body a chance to ovulate).

While seven may not be your lucky number, if you follow those rules you will make sure you stay lucky (and not pregnant)! One notable news flash: if you forgot to take the sugar pill (a.k.a. the placebo one), don’t sweat it. Those pills are not doing anything more than keeping you in the habit of taking a daily pill. However, if you miss any of the active pills, even if you followed the back-up schedule, take a pregnancy test. Although many women on the low dose or the low, low dose pills don’t get a period, it’s best to check and confirm a negative.

The majority of unintended pregnancies on the pill occur from missed pills. If you are one of those who seem to suffer from forgetfulness as it relates to the pill, then oral contraceptives are probably not right for you. There are several other forms of reliable hormonal and non-hormonal contraception that can do the same trick without requiring the daily light bulb to go off.

Remember, mistakes happen. Most of these momentary lapses are not a big deal. In an effort to minimize these hiccups, pair your pill pack with a daily activity that you never forget—brushing your teeth, washing your face, taking your contacts out. This will help minimize mistakes and maximize effectiveness. We want this to work for you until you are ready to work on becoming a mom!

Am I Ready to Be a Parent? Single Parenthood

Of all the questions we ask ourselves, “Am I ready to be a parent?” is probably the biggest one (followed by “What should I wear on that first date?” and “Should we go for dinner or drinks?”). But all kidding aside, knowing when the time is right to become a parent can be downright difficult. Even us non-lawyer types can convincingly argue both sides and sway even the toughest of juries (ourselves, our besties, and our family) to see it our way. Add to that deciding to go at this on your own, and the decision can be even more difficult. When embarking on single parenthood, you need to think about things like sperm source, fertility medications, inseminations, and ultrasounds. Sorting this stuff out can make even the most level-headed among us a little loopy.

But just like any legal battle, evidence is needed before a decision can be made. And to get to that decision, it takes time, research, and a whole lot of effort! Deciding if, when, and even how to have a baby without a partner is no different. It takes a lot of thought and evidence before you can reach your decision. And although it is unlikely that we will be sitting with you when your personal verdict is delivered, we can offer some advice on how to craft your argument about if single parenthood is right for you (#PROSandCONS).

PROS

  • You are ready to be a mother. You don’t want to freeze your eggs and think about becoming a parent in the future but are ready to become a parent (without a plus one) today.
  • You no longer want to wait for someone else to do this with—you are pretty sure that you can do this on your own.
  • You spoke with a fertility specialist, reviewed all options, and are cleared for pregnancy (a.k.a. you are in good health, your reproductive organs ready, and you have selected a sperm source).
  • You have thought about your decision for a while; it was not made in haste.

CONS

  • You are not physically your best you. While most of us can tolerate pregnancy (aside from the back pain, the constant urge to pee, and the swollen hands and feet), there are some medical conditions that preclude us from getting pregnant. Although most of them can be fixed (blood pressure can be controlled, diabetes can be regulated, and seizure medications, changed), it is super important that you deal with all of this before you get pregnant.
  • You are not financially stable. Kids cost money! And while you certainly don’t need to be a billionaire before you bring a baby into this world, you do want to make sure that your financials are in order before you start a family.
  • You are not emotionally ready. Children require A LOT of attention and time. They are pretty much all-consuming all of the time. Make sure you are ready to give of yourself to someone else before you go all in.
  • While you want to be a parent, you don’t want to be a single parent by choice.

Odds are that, although our list may not match your list, there is probably a good amount of overlap. Minus the few additions or subtractions, at the heart of it lies the big question: “Are you ready to do this on your own?” And while we as physicians can’t tell you which way your “jury” will go (a.k.a. are you ready to do this?) we can tell you if your uterus, your ovaries, and your body are ready do this.

Furthermore, no matter how long that list is, we can assure you that while you may be thinking of this as single parenthood or as “having a baby on your own,” you are really never alone. You have friends, you have family, you have your fertility team, and you have an entire community of individuals who have also become single parents (many who are eager to share their experiences and offer advice). Go and speak to your OB/GYN and/or a fertility doctor—they can not only provide you with the information about the process but also help you make this baby thing happen.

We will make this closing argument brief. If you want to be a parent, you can become a parent. The modern family has many different faces. Find out what you want yours to be, and shape it. In this courtroom, you write your own verdict. While the process of becoming a parent may take a slightly circuitous path, with a knowledgeable physician and a good support system, you can certainly do this—case closed!  

My Vote Doesn’t Matter, Anyway: Why Not Caring About Your Reproductive Health Is The Worst Thing You Can Do!

Apathy stinks. No matter what you are apathetic about: your job, your partner, your country’s politics, or your body, it is a major bummer. And while it may seem a long way away, you should not only care about things that affect your world but also things that affect your womb. Unprotected sex can lead to some pretty unpleasant things (a.k.a. sexually transmitted infections—think gonorrhea, chlamydia, syphilis, HIV, and herpes), which can cause some pretty serious damage to your fertility (specifically, your fallopian tubes) down the road.

So, here’s why your vote matters.

Sexually transmitted infections are no fun. But unfortunately, they are sort of frequent. Approximately one in four women will be diagnosed with an STD during their lifetime—and given that many who contract an STD never seek treatment, this number is likely a lot larger. In fact, there are about 19 million new cases reported every year in the United States.

The problem with STDs is not only the possible itching, burning, and oh-so unpleasant discharge but also the long-term effects like chronic pelvic pain, scar tissue, and infertility. Infections like gonorrhea and chlamydia can leave a mark that even the best of treatments can’t erase. However, the earlier you seek treatment, the less the negative impact will be. Therefore, don’t be shy about sharing your secrets with your doctor. We never judge!

While prevention is the key (think condoms), sometimes the door has already been opened—think sex without condoms. In this case, curtailing what could potentially happen next is the goal.

Lesson 1, share everything with your doctor. Make sure we know what you are doing and whom you are doing it with.

Lesson 2, if it is a new partner or one that you are not in a monogamous relationship with, you should undergo STD testing.

Lesson 3, while many sexually transmitted infections don’t announce themselves: “Hello, my name is Chlamydia, and I am here to annoy you,” if you are experiencing atypical symptoms (abnormal vaginal discharge, abdominal/pelvic pain, vaginal itching, or burning and fever), you need to go and get things checked out.

Lesson 4, use your voice to effect change. If you test positive for an STD, make sure to share this with your partner(s). They too will need treatment; you don’t want go into the ballot box on this decision alone. Be vocal about what’s going on with anyone who too is at risk.

Lesson 5, don’t take shortcuts when it comes to your course of treatment. Some antibiotic regimens can be lengthy and can require commitment in the form of a couple of weeks. Finishing what you started in terms of medication is mandatory to make sure you have rid yourself of these unwanted guests.

Lesson 6, while STDs come and go, even those that are treated can leave their mark in the form of scar tissue and tubal damage. Therefore, while we don’t recommend you wake up each day remembering the STD you contracted five years ago, when you start thinking about starting a family, you should consider seeking fertility assistance early in your fertility journey. Making the acquaintance of a fertility doctor early can make the path from potential parent to parent much shorter and smoother.

Not caring about what happens is a bad thing. Your voice and your vagina matter (spoken like true gynecologists!). The decision you make today can affect your health and your fertility in the future. While you may not walk out of the GYN’s office with a sticker that says, “I got tested for STDs,” you will get a clean bill of health.

And although this does not ensure that when you are ready to have a baby it’s smooth sailing, it does increase the chances that things get off to a good start. Giving up on yourself, particularly your health, is not an option. So, get out, and vote for your future. In this election, it’s a victory either way!

No Period, No Problem?

For many of us, that time of the month is filled with moods, monster breakouts, and mounds of chocolate. We dread its arrival and plan our white pants-wearing days around it. However, if you ever or are now missing periods, this “period piece” is timely. Your period (while off hormonal contraception, remember that no period on the pill is a totally different non-alarming situation) is sort of like the sixth vital sign; it provides a lot of information about the health of your reproductive system.

The arrival of a girl’s first period is sort of a big deal. In many cultures, for many centuries, it has marked the transition from girlhood to womanhood. Historically, it indicated the promise of life, new beginnings, and the start of something. While today the pomp and circumstance around this event are much more hush hush, it is still a very intimate moment shared by mothers and daughters.

And despite the unpleasant cramps and cravings, menses does mark the culmination of puberty and the commencement of the reproductive years. So (playing off the graduation theme), when do you order your cap and gown? When will this process begin? The answer, while seemingly simple, is really somewhat complicated.

Your ethnicity, your family history, your genetics, your weight, your living environment (urban versus suburban), your fitness level, and your stress level all play a role regarding when you go through puberty. In fact, even the century that you live in plays a role in the timing of this event. (In the past 60 years, we have seen a decrease in the age at which girls get their periods.) While the arrival of a period is usually abrupt (wow, what is that?!?), the process that brought this to you actually took years. A period marks the end of the process of puberty.

Puberty encompasses many physical changes (breast development, pubic/underarm hair) as well as cognitive and psychosocial changes (sorry, Mom, for all those wild emotional tirades!). While all these things seem to occur at once, there is actually an orderly transition to this process; increases in a hormone called LH and FSH lead to the production of estrogen. Estrogen stimulates the development of breasts. Androgens from your adrenal glands stimulate the production of pubic and underarm hair (oh joy…get out the razor!). Somewhere in the midst of this, all you have a growth spurt, and then ultimately, your period arrives.

For most girls, puberty begins with the development of breasts at around 10 years (range 8–12). On average, from start to finish, the process takes between 1 and 4 years. African-American and Hispanic females, girls who live closer to the equator and in urban areas, girls who are overweight, and girls whose female family members went through puberty early are more likely to start the process at an earlier age. On the contrary, Asian and Caucasian girls, girls who are underweight, girls who are athletic, and girls whose female family members went through puberty late are more likely to start the process at a later age.

Although that first period marks the beginning of a brave new world, one period does not write the entire story. It suggests that the system has been primed but does not mean it is ready to run on autopilot. Now, while it is quite common for periods in the first two years to be irregular (many cycles during this time period occur without ovulation), after this point, they should start to follow some order. This pattern is not only good for wardrobe planning but also for demonstrating the system has matured.

Regular periods offer a visual that the following systems are a go:

1) About two weeks before the period, ovulation (egg release) has occurred (ovaries: check!)

2) A uterus with an open path for the blood to exist is present (uterus: check!)

3) The signal from the brain to the ovaries has been activated (hypothalamus / pituitary: check!)

Medically speaking, the lack of a period is called amenorrhea (for all you Latin buffs, a- in Latin means without, and menorrhea is menses). When a girl has not gotten her period by age 14 without evidence of breast development or by 16 with evidence of breast development, this is called primary amenorrhea (primary because there has never been a period). When a female has had a period(s) and then they stop for whatever reason, this is called secondary amenorrhea. While some processes can cause both, the causes of the two are usually different.

Primary amenorrhea cases require more detective work and are much less common. They are more likely to be genetic in origin, a sign of poor ovarian development, or a uterine-vaginal blockage (septum)…basically, the rarities of medicine.

Secondary amenorrhea is something that GYNs deal with almost on a daily basis. (Trivia question: what is the most common cause of secondary amenorrhea? Answer: pregnancy!) But aside from pregnancy, common causes are polycystic ovarian syndrome (PCOS), thyroid disease, over-exercise, and stress. Although a few months off from Ibuprofen and tampons feels good, you shouldn’t let this go on for very long without contacting your GYN.

Even though the arrival of Aunt Flo just in time for that weekend beach party is no one’s idea of pleasant, it isn’t all negative. Getting regular periods, while sometimes a pain, can be a plus. It shows us that the system is functioning. While there is absolutely no problem with going on some form of hormonal contraception (pill, patch, ring, IUD) and keeping your periods at bay for a vacation or big work deadline, this is VERY different than not getting period while off hormonal contraception.

Think of the reproductive system as an orchestra. The conductor is the brain, and the ovaries, the uterus, and the fallopian tubes are the instruments. So if the periods abruptly stop or never start, the conductor called off sick, or one of the instrument players have gone on strike, it is our job as GYNs to find out who is sleeping on the job and try to fix it! Although it might be easier to play over the group who’s gone, the music won’t sound or come out right. Periods mean something, and if they stop, someone needs to hear about it.

Contraception: When You Just Can’t Comprehend Conceiving

For many, the birds and the bees are as simple as the As, Bs, and Cs. If you have unprotected sex, you are putting yourself at risk for pregnancy (as well as a plethora of some pretty nasty infections). While there will likely come a day and time that seeing a smiley face on the pregnancy stick brings a smile to your face, now is probably not that time. You are career focused. You are education focused; you are you focused (at least for now). We totally get that.

But while you are not ready today, you don’t necessarily want to give that option up in the future and commit yourself to abstinence. We are here to review with you the many reversible forms of contraception that are available, effective, and reliable. (Note that reversible is bolded. We will not be addressing irreversible forms of contraception, a.k.a. tying anyone’s tubes  LINK: Done and Done).  

When you think birth control, two options probably come to your mind first—condoms and pills. And while these are very popular methods, they are not the only ones out there. They require some brainpower and even willpower and therefore are not right for everyone. So here is a list, with the pros, cons, and everything in between on what’s out there (in as few words as possible!). 

  1. Male Condoms:
    • Pros: Cheap, easily available, minimal planning, reversible, protect against STDs
    • Cons: Must be used consistently; applied correctly, can break…
  2. Female Condoms:
    • Pros: You are in the driver seat, no need for a prescription, does not require a fitting, can be placed before intercourse starts
    • Cons: Cumbersome, hard to find, can’t be reused
  3. Oral Contraceptive Pills (OCPs) (known by most of us as “the pill”)
    • Pros: Highly effective when taken correctly, other positive bodily features (decreased risk for ovarian and uterine cancer, goodbye to acne and unwanted hair growth, shorter/lighter periods, less cramps), when stopped periods/regular cycles return pretty quickly
    • Cons: Not highly effective when not taken correctly, many reasons why women can’t take the pill (headache variants, high blood pressure, etc.), does not protect against STDs
  4. Hormonal Patch
    • Pros: Does not have to be swallowed (for all of you who have trouble with pills), does not require daily administration (patch is changed once/week), reversible
    • Cons: Must “make weight” to use this option (women heavier than 195 pounds have decreased efficacy with this option), not ideal in women with sensitive skin or dermatologic conditions, slightly higher risk of blood clots (versus the oral route)
  5. Hormonal Ring
    • Pros: Can be placed in the comfort of your home (and does not need to be sized), more private (not worn like a patch or taken like a pill), offers all the benefits of the pill (decreased cancer risk, shorter/lighter periods, less cramping with your period)
    • Cons: Higher rates of vaginitis/vaginal wetness, requires a prescription, some report feeling it
  6. IUD (non-hormonal = Copper T, hormonal = Mirena, Skyla, Liletta)
    • Pros: Most effective form of reversible contraception, once it’s properly placed in the uterus, it’s pretty much smooth sailing for five to 10 years, does not interfere with the spontaneity of sex, can be used in women who need to avoid estrogen
    • Cons: Must be placed by a medical professional, can be expulsed, “mal-placed,” or broken, strings can get lost and require surgical removal, placement can (in very rare cases) cause pelvic inflammatory disease
  7. Depo-Provera (aka “depo”)
    • Pros: Is taken every three months (does not require daily administration), eliminates monthly menses, can be taken by women who can’t take estrogen (Depo-Provera contains only progesterone), reduces the risk of migraines
    • Cons: It’s a shot, can cause weight gain, can lower bone mineral density, menses can take many months to return
  8. Implantable Devices (Implanon, Nexplanon)
    • Pros: Effective for several years after placement, can be used in women who can’t take estrogen, does not need to be placed before intercourse
    • Cons: Must be placed and removed by a medical professional, often causes irregular bleeding, discomfort/pain at site of implant
  9. Diaphragm/Cervical Cap
    • Pros: Provides contraception without delivering hormones, can be carried in even the smallest of purses! Can be used while breastfeeding, cannot be felt by you or your partner
    • Cons: Requires a fitting, can be difficult for some women to place/insert, can be pushed out by certain sexual positions, not as effective as hormonal contraception
  10. Withdrawal
    • Pros: Can be used in a real bind (requires nothing but commitment!), no medical/hormonal side effects, free, no prescription required
    • Cons: Not really a reliable method for contraception. Simply stated, it’s an ineffective way to prevent pregnancy, requires trust, and is not good for men with premature ejaculation or men who are not sure when to “pull out”
  11.  Rhythm Method (Fertility Awareness-Based Methods = FAMs)
    • Pros: Minimal cost, no medication required, safe, can be stopped at any time
    • Cons: Timing is key (you must be really in sync with your body and know when you are ovulating), not the most effective way to go about preventing pregnancy, there are several days in the month where sex is off (requires a committed partner), no protection from STDs

Birth control, like those who use it, comes in many shapes and sizes. And in almost all cases, one of the shoes fits. While you may never, ever choose to wear a diaphragm or test out the female condom, at least you know what’s out there. Unwanted and unplanned pregnancies happen, sometimes even while using contraception. But by utilizing a form of birth control that works for you, you can dramatically reduce the chance that it will happen to you. While we fully support a night out at the casino, we do not recommend gambling on the possibility of pregnancy. Unlike the blackjack table, here, the risk is not worth it.

Will the Eggs I Freeze Make a Baby?

Of all the questions we wish we had the answer to, “Doctor, will these eggs make a baby one day?” is at the very top of that list. But despite our white coats, our medical degrees, and our fancy instruments, we don’t know it all. We actually aren’t even close to knowing it all, especially when it comes to egg quality. Currently, we have really no way of looking at an egg, even under a microscope on high-power magnification, and knowing its potential.

Will it make an embryo that will be ready for transfer (ET), or will it barely survive the subsequent thaw? Will it result in a baby, or will it barely make it past the fertilization stage? Unfortunately, we still have no good way of predicting this. Therefore, while we can give you percentages based on your age, your fertility history, your family history, and your ovarian reserve, we can’t give you definites.

If you choose to egg freeze, you should be aware of this. You should be comfortable with the notion of possibilities, potentials, and perhaps—because in reality, this is all that any fertility MD can really give you.

Before a woman chooses to egg freeze, she will most likely meet with a fertility specialist to talk about the procedure, both in generalities and in particulars. What the overall process is like, what to expect on a day-to-day basis, and what the recovery period is like: these are the “generals.” As a result, you will get a lot of general answers.

Following this, your doctor will probably personalize the generals and add the specifics based on you, your medical/GYN history, your family history, and your ovarian reserve. Based on all of these factors, we can give you a projected response to the medications (a.k.a. how many eggs will you get). And this is the important stuff, the info you really need to know. Speaking in broad terms is nice, but it isn’t super helpful. You want to know how you will feel, how you will react to the medicine, and how this will determine your chances of having a baby in the future. Make sure you get this. Even if it’s speculative, it’s better than simplifications.

So if we can’t answer your burning fertility questions, what does egg freezing teach you? Is it even worth doing? (You could do a lot of good online shopping with that money!) So here’s what it for sure teaches you:

  • You have eggs.
  • How you will respond to fertility medications.
  • Your ovarian reserve (we measure hormones like FSH and AMH to get an idea on how to dose the hormones).
  • You are a tough cookie to take shots every day for several days—and you are a proactive, no-nonsense woman in the know for even asking these questions about your fertility future.

But with all the good it does, what it won’t tell you is if those eggs that you made will make a baby or the answer to your huge question: am I fertile? Fertility is one’s ability to conceive. And unless you are out there trying, we can’t really tell if you are fertile or infertile. Even women who respond poorly to fertility medications, make only a few eggs, and have abnormal ovarian reserve testing (low AMH or high FSH) can be fertile. We’ve seen it many times!

Don’t let the number of eggs you make in an egg-freezing cycle make or break your baby-making future. It could mean very little.

So while your eggs are a potential insurance policy, they are not your guarantee. Don’t look at eggs like babies because they are not; they are only just the beginning. We promise we aren’t Nelly Negatives or Debbie Downers. There are no bigger fans of egg freezing and reproductive choice then us at Truly, MD. We believe women should have options when it comes to their bodies, particularly their gametes (a fancy word for eggs).

But we are also big fans of honesty, transparency, and truth. You should know the truth about what egg freezing can tell you and what it can’t. It can’t give you complete clarity about your reproductive future, but it can give you choice. It can’t give you answers, but it can give you options. It can’t give you a slam dunk, but it can give you a shot. And even one shot can be the winning point.