September is Polycystic Ovary Syndrome (PCOS) awareness month

September is Polycystic Ovary Syndrome (PCOS) awareness month. PCOS is the most common reproductive endocrine disorder. It is a life-long disorder which presents with different symptoms at various stages of life. Symptoms include irregular periods due to lack of ovulation, excessive hair growth and acne in adolescence and early adulthood. Weight gain can frequently accompany PCOS which may lead to medical issues seen later in life such as metabolic syndrome. Metabolic syndrome is a constellation of symptoms including insulin resistance leading to prediabetes or overt diabetes, high cholesterol, and high blood pressure. Women with prolonged amenorrhea also may be at risk for uterine cancer later in life.

The diagnosis of PCOS is simple and can be mostly achieved based on clinical presentation. Irregular menses, such as going months without a period due to lack of ovulation, excessive hair growth and/or acne/oily skin may be sufficient to make the diagnosis.  An ultrasound exam may be helpful establishing the diagnosis but not always necessary if women have the aforementioned symptoms. Blood work may be necessary if your physician is concerned about other disorders that may present like PCOS.

The treatment depends on the patient’s age and the goals she would like to achieve. If the goal is to get pregnant, the majority of women respond simple oral fertility treatments such as clomiphene or letrozole. In some women, further treatments may be necessary such as injectable hormone therapies to induce ovulation or in vitro fertilization (IVF). If reproduction is not an immediate goal then control of menstrual cycles and metabolic syndrome is of utmost importance. Menstrual cycles can be regulated using birth control pills or cyclic progesterone pills. Metabolic syndrome can be best controlled through weight loss. Combination of diet and exercise is required to prevent weight gain or to achieve weight loss. Studies have shown that 10% weight loss may resume ovulation in up to 90% of women. High protein and low carbohydrate diets have been shown to successfully assist in desired weight loss.

Your physician at HART Fertility can help assist proper diagnosis and management of PCOS. For help, call us and schedule an appointment to discuss your health and reproductive goals today.

Breast Health & Checkups

No matter what age you are, it is essential that you know your breasts well.  Knowing what your healthy breasts normally feel like will help you to recognize when they feel different and something has changed.

Just as you pay close attention to your skin and notice when you get new moles, it is equally if not more important to recognize new changes in your breasts. Although some research says that self-checks are not the most reliable method of detecting cancer, the better you know your breasts and any changes in them, the better.


What is normal, and what isn’t?

It is normal to have one breast smaller than the other, or to have hair around your nipples, or to experience extra sensitivity or tenderness around your breast during your period.

Warning signs to be aware of include:

  • A firm lump that you’ve never felt before
  • Blood or other fluids (besides milk) leaking from your nipples
  • Swelling around your collarbone, breast or armpit
  • Dry, red, cracked, or thickened skin around your nipple
  • Itching or warmth in and around your breast area

Even if you experience changes that aren’t listed above, it is advisable to discuss these changes with your doctor to ensure that you are looking after yourself and your breast health.


How to do a breast self-check

  1. Begin by facing a mirror with your shoulders straight and your arms by your side. You should start by checking that your breasts and nipples are their usual size, shape and color. Also, notice any changes like dimpling, redness, swelling, or nipple changes, and check for fluids leaking from nipples.
  2. Next, raise your arms and look for the same changes.
  3. Examine your breasts while lying down, using your right hand to feel your left breast and vice versa. Hold your hand in a flat position, using a firm and smooth touch. Cover your entire breast from the collarbone all the way to the abdomen, and also check from under your armpit to the center of your chest. Tip: follow a zigzag pattern to ensure you are covering the whole area. 
  4. Finally, feel your breasts using the same pattern as above whilst standing or sitting to feel if there are any changes.

You may notice some lumps and changes, but don’t panic - there are a number of reasons for non-cancerous breast lumps. However, it is important to still have any lumps or changes checked out with your doctor for peace of mind.


How often and what do I need to check? 

In your 20’s, it is recommended that women get a clinical breast examination every 3 years during their annual OBGYN visit, according to the American Cancer Society (ACS).

In your 30’s, continue to do clinical breast exams every 3 years. However, if you have a family history of breast cancer in a close relative like your mom or sibling, then you should talk to your doctor about starting to get more frequent mammograms. 

In your 40’s, clinical breast exams should be conducted every year to check for early signs of breast cancer; these are from the guidelines of the ACS

From your 50’s and up, it is advised by the ACS to continue with both a clinical breast exam and a mammogram yearly for the rest of your life.

Look after your breasts

Ensure that you are seeing your doctor annually for your health checks and get to know your breasts at different times of the month so that you can detect any unusual changes early.

All About Menopause

Menopause is the time of a woman’s life that marks the end of her menstrual and fertility cycles. The average age of menopause in the United States is 51, but it generally occurs between the ages of 40-59. Menopause will occur naturally with age, or it may sometimes be caused by surgical intervention of removing ovaries and fallopian tubes.

Menopause is diagnosed once a woman has gone 12 months without a menstrual period. It will often occur over a few years as the body is transitioning into menopause. Menopause occurs as the levels of estrogen and progesterone begin to change. This can result in symptoms that may be uncomfortable for some.  It is best to see your OBGYN, as they can help you through this time with advice and treatment.


Symptoms of Menopause

Some of the symptoms you may experience during menopause are:

  • Vaginal dryness
  • Painful sex
  • Hot flashes
  • Night sweats
  • Disturbed sleep
  • Irregular periods – either very heavy or not at routine intervals
  • Mood changes
  • Chills
  • Difficulty concentrating
  • Less full breasts
  • Hair thinning or loss

Due to the hormonal changes occurring in the body, some women may also develop depression.


Why Does Menopause Occur?

Menopause is a process that occurs when your ovaries age and produce less hormones. The body begins to change as you have lower levels of estrogen, progesterone, testosterone, luteinizing hormone and follicle-stimulating hormone. 

Initially, you may see the start of menopause with changes in your monthly menstrual cycle – the frequency may decrease, but the flow is heavier and lasts longer. 


Natural Remedies to Help with Symptoms

It is important to consult your OBGYN, as he/she may be able to prescribe medications or creams that help alleviate some of the symptoms of menopause.

However, you can seek relief at home too by following a few of these ideas:

  • Keep cool and comfortable – wearing loose, layered clothing can help you to cope with hot flashes. Also, try keep your bedroom cooler at night, and avoid heavy blankets if you are prone to night sweats. You can also carry around a small portable fan for those moments when you really need a breeze to cool off.
  • Exercise – adding 20-30 minutes of exercise a day, even walking, can help to increase your energy, promote better sleep at night and improve and stabilize your moods.
  • Vitamin supplements – taking additional vitamin D, calcium and magnesium can help to improve energy, mood and sleep as well as help to prevent osteoarthritis.
  • Communicating your needs – as your moods may be affected by menopause, it is important you have physical and emotional support around you.  Whether this is family, friends, or a professional therapist, it is important that you have someone to talk to.

There are many simple things you can do to help yourself, but seeing a health professional is important too. They will assist you and guide you towards the best treatment for you.

Nutrition During Pregnancy

You know you need to be looking after your body to help your baby to grow during pregnancy, but what should you eat?  What’s healthy, and what’s not? Are you eating for two, or is a small increase in calories “good enough”?


Nutrition during pregnancy

It is always important to eat a balanced diet, but even more so while you are pregnant.  The food you eat is the main source of nutrients for your growing baby. Many women don’t get enough iron, folate, calcium, vitamin D, vitamin Bs, or protein.  ACOG (American College of Obstetricians and Gynecologists) guidelines show that a balanced diet that includes fruits, vegetables, whole grains and proteins should provide enough nutrients and vitamins for

you and your baby. A diet of fresh foods, with less processed, sugary foods will help you and baby during your pregnancy.  Also, be sure to look into a multivitamin that is safe for you to take during your pregnancy to help supplement any of the vitamins and minerals you may be missing in your normal diet.  Your doctor may be able to assist with a prescription, or he/she may recommend a good OTC brand.


Important vitamins and minerals

Your body needs higher amounts of these important vitamins and minerals during pregnancy. The amounts below are taken from the ACOG guidelines around how much of each vitamin and mineral you and your baby need during pregnancy.

Calcium is important for strong bones and teeth. It can be found in dairy products, leafy green vegetables and fish. During pregnancy, you need 1000mg daily.

Folate, also known as folic acid, is very important during pregnancy as it helps with production of blood and protein. Folate can be found in leafy greens, legumes, liver and orange juice. Your daily intake should be 400 micrograms.

Vitamin B12 and B6 help form red blood cells, help to maintain your neural system. These can be found in animal products such as liver, meat, fish, poultry and milk. You need 2.6 micrograms of vitamin B6 and 2.6 micrograms of B12 daily.

Iron is important for red blood cells delivering oxygen to the baby. You will find this in lean meats, dried beans and peas. Daily, you will need 27mg.

Vitamin C is good for healthy gums, teeth and absorption of iron. Great sources are from citrus fruits, broccoli, tomatoes and strawberries. During pregnancy, you need 85mg daily.

Vitamin A is important for healthy eyesight and bone growth.  It is found commonly in carrots, leafy vegetables, and sweet potatoes. You will need 770 micrograms during pregnancy.


Weight gain is normal and important

It is normal to gain weight during pregnancy, and it is very important. If you gain too little or too much, this may impact the health of both you and your baby. Most women should only be eating about 300 calories extra per day, not eating for two and doubling your calories.

ACOG and The Institute of Medicine recommend if you are currently underweight to healthy weight, a gain of 20-35 lbs. is normal and within a good range. If you were overweight pre-pregnancy, a weight gain of 10-25 lbs. is within normal range. However, discuss this with your doctor to ensure you are gaining enough, but not too much weight to keep you and baby healthy.


Little changes can go a long way

It may seem overwhelming to try include all of these nutrients and minerals into your diet, but slowly look at each one and see how you can incorporate them into your daily diet. This will your baby to grow well ,and it will help you to have the right nutrients to look after your body.

Your doctor can help to give you more information on the right nutrition guidelines for you and your pregnancy.

Why is it important to get a pap smear?

The visit to your OB-GYN to get a pap smear is one that most women dread. However, this test is essential in helping to prevent more serious conditions.  It’s important to remember that just a few moments of discomfort can potentially save your life.


What is a pap smear?

A pap smear involves collecting cells from your cervix in order to check for pre-cancerous cells and for any traces of human papillomavirus (HPV). The presence of HPV is a risk factor for developing cervical cancer.

If there are abnormal/pre-cancerous changes present in the cervical cells, and they are detected early on, there are preventative treatments that may help to prevent them from developing into cancerous cells.


Who should have a pap smear and how often?

The American College of Obstetricians and Gynecologists (ACOG) recommends that women begin scheduling pap smears from the age of 21. You should have your test every 3 years until age 30. Thereafter, ACOG recommends a pap smear and an HPV test every 5 years. 

If there are any abnormal results, or if you have a history of cancer or a weakened immune system, your doctor may recommend more frequent screenings.


What does it involve?

You can have your pap smear done on your annual visit to your gynecologist, or you may schedule a separate appointment for this. 

During the procedure, you will lie on your back with your knees bent and heels together, or with your heels in stirrups. 

The pap smear is performed with a speculum, which is a special tool that allows your specialist to open your vaginal canal, in order that the cervix can be seen. A sample of cells are then collected from the cervix using a tool called a scraper.

Some women dread their pap smears due to the insertion of these instruments, but most only feel mild discomfort from these tools. The more relaxed you are, the more your vaginal muscles will relax and make the experience less uncomfortable. Taking deep breaths is helpful to relax yourself during the procedure.

After the cells are collected, they will be sent to a laboratory for analysis. Your doctor will contact you several days later with your results.


How do you prepare for your pap smear?

It is best to avoid intercourse, douching or using any vaginal medications up to two days before your pap smear. These may have an effect on the results found during your pap smear.

It is best not to schedule your pap smear during your menstrual cycle. If you are menstruating, your results may be less accurate.


Book your next checkup with Hart Fertility today!

Although it may be an uncomfortable experience for some, a pap smear is well worth your time as it can save your life and help with early detection of serious illness.