PCOS Symptoms

PCOS is the most common cause of female infertility. During each menstrual cycle, the ovaries release an egg into the womb. This ovulation process occurs once a month. But women with PCOS fail to ovulate or ovulate infrequently, which means absent or irregular periods and difficulty getting pregnant. In women with PCOS, the ovaries develop multiple small follicles that appear as cysts, hence the term “polycystic.”  These cysts are immature ovarian follicles that failed to ovulate. Thus, most women discover they have PCOS when they try to get pregnant unsuccessfully.PCOS requires immediate medical attention because, in the long-run, it could lead to health risks, such as depression, high blood pressure, lipid abnormalities, obstructive sleep apnea, and diabetes to name a few. Getting treatment at the right time can reduce or prevent these risks. So, it is important that you know some symptoms of PCOS.While irregular periods and pregnancy failure are the most common signs of PCOS, you may experience random, unrelated symptoms as well. Since it mainly affects your hormones, women with PCOS may experience all or some of the following symptoms:After puberty, if you experience heavy hair growth in uncommon body parts, including face, belly, chest, lower abdomen, and back, it could be a warning sign of PCOS. This condition is termed as Hirsutism. More than 70 percent of women with PCOS grow excessive hair on their body. Making the matter worse, excessive levels of male hormones have opposite effects on the scalp. That means it lleads to hair loss or thinning hair on the scalp, causing male-pattern baldness. When you have PCOS, our body has difficulty using the hormone insulin, causing insulin resistance. Insulin helps convert starches and sugars obtained from foods into energy. PCOS makes the body resistant to insulin. As a result, insulin, sugar, and glucose build up in the bloodstream.Combining this with high androgens levels leads to weight gain, especially around our abdomen and waist. That’s why women with PCOS have more of an apple body shape instead of peach shape. About 40% women, particularly young girls, with PCOS experience anxiety, depression, and other mental health conditions. Although there is less or no evidence supporting the direct connection between PCOS and depression, it could be due to the combination of several factors. For instance, one study shows that people with insulin resistance report frequent symptoms of depression, stress, and anxiety.PCOS patients with anxiety may have lower levels of neurotransmitters like serotonin, GABA and acetylcholine, thus worsening the situation.  Higher levels of androgens among women play an important role in acne development. It is because androgens cause sebaceous glands in the skin to produce an excessive oily substance called sebum. In order to produce the right amount of progesterone, testosterone, and oestrogen, our body depends on signals from the pituitary gland. PCOS interrupts these signals, leading to increased testosterone levels. It further enlarges sebaceous glands and the production of too much oily sebum. Blood clots during periods are normal. But, if you regularly and abnormally have blood clots the size of 10p piece or larger, it could be a warning sign of PCOS. PCOS also causes heavier blood flow during periods. It is because the uterine lining builds up for longer, causing periods heavier than normal. It can lead to other conditions, including anaemia, fatigue, and bleeding between periods.First of all, see a doctor as soon as possible, especially if you’ve had difficulty getting pregnant, excessive hair growth, and diabetes symptoms. Next, make the necessary diet and lifestyle changes and get regular exercise.  
4 min read

What Is an Ectopic Pregnancy?

Normally, pregnancy occurs when a fertilized egg implants and develops into an embryo inside the uterus. It attaches to the lining of the uterus. So what is an ectopic pregnancy then? An ectopic pregnancy occurs when a fertilized egg gets implanted outside the uterus, including fallopian tubes, cervix, and even within the abdomen. According to the data of the American Academy of Family Physicians, 1 out of every 50 pregnancies is ectopic.Ectopic pregnancies that occur in the fallopian tube are also known as "tubal pregnancies." The fallopian tubes are the tubes that connect the ovaries to the uterus. Sometimes an egg gets stuck in them and causes danger to a woman's health if the pregnancy continues. This is because the fallopian tubes do not have enough space for a pregnancy to develop and grow. As the fetus grows, the chances of tube being injured or bursting increases.Any woman of childbearing age can be at risk for an ectopic pregnancy. Sometimes, the reason for such pregnancies will never be determined. However, below are a few common causes of ectopic pregnancies.Symptoms and DiagnosisThe common symptoms of uterine pregnancy and ectopic pregnancies are nausea and breast soreness. However, abdominal pain, absence of menstrual periods, and vaginal bleeding raise the concern for a diagnosis of ectopic pregnancy. The doctor usually diagnoses it through a blood hormone test and by doing a pelvic ultrasound. Treatments for an Ectopic Pregnancy·         Medication – your gynecologist can give you an injection of powerful medicine to stop the growth of pregnancy out of the uterus.·         Surgery – the doctor can perform surgery like laparoscopy under the general anesthetic to remove the fetus or fertilized egg from the fallopian tube or other location. PreventionThere is no possible prediction and prevention in this type of pregnancies, but you can reduce it's risk. Follow a healthy diet and maintain good reproductive health to lower the risks of ectopic pregnancy. Also, try to visit your doctor for regular gynecological examinations, especially if you are trying to get pregnant. ConclusionRemember that ectopic pregnancy can happen in any woman and may pose a dangerous risk to her health.  So, if you have any unusual symptoms like abdominal pain and might be pregnant, be sure to see your doctor to rule this out.  
3 min read

Fertility by Age

 Fertility changes with age for both men and women. However, men’s fertility decreases to a lesser extent compared to women’s.  So, what is the change in fertility by age? For women, the peak reproductive period is between the late teens and late 20s. Fertility starts to decline as we reach 30, and it drops even faster once you reach your mid-30s.  After crossing 45 years of age, women’s reproductive potential has declined so much that getting pregnant can become difficult or lead to complications.   According to a PLoS One study, by age 35, women are only 12 percent likely to get pregnant within a specific three-month period, and by age 40, that number declines to 7 percent. Fertility decreases with age because both the quality and number of eggs gets lower. An egg is transferred from the ovaries to the womb every month after puberty to menopause. When sperms bind with the egg in the womb, you get pregnant.  A woman’s body does not make new eggs every month. Instead, women are born with all the eggs they ever have. As you age, eggs get older naturally and progressively. This decline is gradual until early 30 but accelerates after the mid-30s.  Older mothers often face difficulties like stillbirth, miscarriage, and babies with health issues. Such women are more likely to have a higher risk of complications, such as preeclampsia and gestational diabetes. Pregnant women aged 40+ years develop a higher risk of preeclampsia. It is because they tend to have more health issues before getting pregnant compared to younger women. Regardless of this, studies have shown that older women can still have complicated pregnancies solely due to the age factor even without any health conditions.  Late childbearing is troublesome not only for the mother, but for the baby also. It increases the risk of having a baby with damaged, missing, or extra chromosomes. Down syndrome is one common chromosome issue associated with later childbearing.   The success rate of infertility treatments like IVF, egg freezing, and other fertility treatments is lower among older women than in younger women. On top of that, these could impose the risk of mental and physical health problems, especially if you already have a medical disorder, like diabetes or high blood pressure. But, it does not mean you cannot get pregnant. Despite the challenges mentioned above, many women aged above 35 years and even 40 years have healthy pregnancies and babies. We just said that chances are less, but it’s not impossible.  Ideally, you should consult with a reputed gynecologist and fertility specialist and discuss your condition with them transparently. Seeing professional health care and receiving good prenatal care while you are pregnant can help a lot.   Women’s reproductive potential progressively declines as women get older. But, the time and rate of decline vary widely in women. If you age 35 or above and want to get pregnant, you should obtain information and appropriate treatment while being realistic about everything.  By learning about your options, you will be in a better position to make the right decision.
3 min read

Breast Lump Pregnancy - Should you worry?

Finding a breast lump in pregnancy can be very scary, and a lot of things may be in your head right now. BUT, don’t fill yourself with too much worry and anxiety.  Having breast cancer while pregnant is rare, even more so for women under 35 years old. Furthermore, you will experience a lot of changes in your breasts when expecting, so some changes can be normal.  But what exactly does a breast lump during pregnancy mean? Read on to learn more! Even during your second trimester, your breasts begin preparing to nurse your little one. Sometimes, a milk duct may get blocked, and even enlarged, during this process. You will know for sure as clogged milk ducts are typically hard and sometimes even reddened lumps, which feel tender or hot to the touch. Fortunately, they usually clear and feel better after a few days, or they sometimes continue clogging up and you may need antibiotics or surgical drainage. Other reasons your breasts would change during pregnancy is from the increase of hormones. You may feel tenderness or changes around your breasts and nipples from these hormones. You may also experience an increase in your breast size, changes of size and color of your nipples and areola, as well as bigger and noticeable Montgomery glands (the small bumps around your areola). Once you're in your fourth month and later, your breasts may produce colostrum and some people have small amounts of leakage or crusting of colostrum in the nipple area. Besides clogged milk ducts, the breast lumps during pregnancy may be due to many other things such as:             •           Cysts or fluid-filled sacs            •           Galactoceles or milk-filled cysts            •           Fibroadenomas, developing in your breasts’ lobules These are benign breast conditions, meaning they are NOT cancerous.  Also, the good news is that those pesky bumps show that your body is starting to prepare to nourish your little one! And when you choose to breastfeed, it can reduce the risk of breast cancer in the future. Furthermore, it's great that you are aware of the changes in your breasts during and after pregnancy. Since they change a lot, it's a great time to log in your breast shape and present feeling in a diary. If you do have a new breast lump or changes in the existing lump that has already been checked out, you should still have it checked with your doctor as any change could be a sign of an early or new cancer.  If your breast lumps are caused by clogged milk ducts, it can feel a bit uncomfortable from the tenderness.  Fortunately, you can help make your breasts feel a bit better by applying a warm compress to the affected area regularly. Or, you can run warm water on the lump while you shower. You can also try to massage the lump and clogged duct to unclog the milk buildup, eliminating or reducing the lump size.  Again, if the lump doesn’t get any better in a day or so, do check with your doctor as you might need antibiotics or surgery to relieve the issue.  If you’re worried that it’s breast cancer, your feelings are valid. It’s also best to know how to tell if your lumps are a sign of the condition. Breast cancer lumps aren’t usually red or painful when they appear, and they won’t clear up after hot water and/or a massage or antibiotics.  However, it can be difficult to distinguish the difference between benign and cancerous lumps, so if you feel anything suspicious in your breast, among any other new symptoms, then do get it checked immediately.  Wrapping It UpHopefully, our article on breast lumps during pregnancy informed you of the possible causes of a new lump during pregnancy. If you have a lump in your breast, make sure to get it checked out as soon as you can.
4 min read

What is Libido? A Quick Review

What is Libido?The term "Libido" simply means the desire for sex. In women and men, libido is linked to androgen hormones. As men have about 40 times as much androgen as women, they often have a more intense sexual drive. According to WHO (World Health Organization), sexual health is a state of physical, mental, social, and emotional well-being in sexuality. That's why libido is now considered a critical indicator of the quality of life and general health.   Undoubtedly, sexual health varies from person to person and may even fluctuate in the same person too. Everything from your lifestyle, personal preferences to health history, hormone levels, and medications can impact your libido. Familial responsibilities, job stress, and friend dynamics can also affect libido. While natural fluctuations of libido are normal in everyday life, abnormal libido levels can be a concern.  There are both physical and psychological causes of low libido. Physical causes include low testosterone, too much or too little workout, prescription medicines, and excessive substance abuse.  Psychological issues include relationship or social difficulties, depression, and stress. Other causes of low libido include aging, chronic illnesses, and dyspareunia. Nearly 4 in 10 men over age 45 experience low libido, while about one-third of women ages 18-59 suffer from the lost sex drive.  Clearly, there is no single reason behind the lost sexual desire. It is best to discuss the issue with your doctor for the best advice.   If sex is center in your mind every minute, then you probably have a high libido. Though having such a high libido may not be a bad thing, it becomes an issue if it causes problems with your sex life and life beyond sex. High libido can be termed as hypersexuality, sexual addiction, or compulsive sexual behavior. And, there could be some physical and even mental conditions behind hypersexuality.  Many people with anxiety can consider sex as a form of self-medication. Deeply entrenched feelings, like low confidence and unresolved embarrassment, can increase sex drive.  Moreover, certain drugs may also cause sky-high libido. Drugs like crystal meth, cocaine, caffeine, and ecstasy can jolt your brain like over-the-counter stimulants. Wellbutrin also causes increased libido as its side effect.  Treatment of Libido When it comes to low libido, testosterone replacement therapy is considered to be effective. In addition, depending on the actual cause, the following treatments could help: ●       Improve your diet●       Healthier lifestyle choices●       Regular exercise●       Proper sleep●       Reduce stress●       Quit smoking, alcohol, and substance abuse●       Change to a new medication●       Counseling If you experience high libido, you can try out things like interrupting your sexual urges, use your energy to other areas, find satisfying sex, or talk to someone about this.  Your physician may recommend mental therapies in case of a psychological cause. These sessions and therapies can sort out the issues and let you enjoy a happy and satisfactory sexual life.  The Bottom Line Understand the behavior of your body and discuss your feelings with your doctor transparently. That’s the only best way to know the root cause of the problem - physical, emotional, social, or if it’s something else.
3 min read

Life or Death: On Being Pregnant and Black

In 2018, tennis star Serena Williams, while recovering in the hospital from delivering her child via C-section, began to experience shortness of breath. Due to her history of pulmonary embolism, she explained to the nurse that she needed a CT scan and possibly IV anticoagulant medication.  The nurse dismissed her concerns, believing that the world class athlete’s pain medications were causing confusion.  Serena did not yield, and hours later, a CT scan revealed small blood clots in her lung, which could have easily ended the new mother’s life. My husband and I have been together for about 5 years and vacillate over whether we want children or not. We discuss the loss of our personal freedoms; the financial expense raising children entails in the United States and how parenthood alters a couple’s dynamic.  However, our worries oftentimes lean to the morbid, as we contemplate whether I would survive a pregnancy.  According to the CDC, Black women in the USA die at a rate of 41 per 100,000 live births.  When comparing maternal mortality rates across the world, the figures are alarming.  White women in the U.S. die at a rate of 13 per 100,000 live births, which is comparable to the maternal mortality rates in the former Soviet bloc countries like Latvia, Hungary and Romania.  Conversely, in Western European countries, the average rate of maternal deaths is between 1.9 to 5 deaths per 100,000 live births.   In other words, although Black women may experience more adverse outcomes during childbirth than White women in the U.S.; compared to women in other Western nations, American White women’s statistics are not good either.Data collected for over five years by the New York City Department of Health and Mental Hygiene highlighted that access to prenatal care, and being highly educated did not protect Black women from the inherent biases in the healthcare system.  In one study it revealed that “Black college-educated mothers who gave birth in local hospitals were still more likely to suffer serious pregnancy- or childbirth-related complications compared with women of other races or ethnicities who never graduated from high school.”In 2016, Dr. Shalon Irving, an epidemiologist at the CDC, died from hypertensive complications, three weeks after delivering her first child.  What could be regarded as more than a stroke of irony, Dr. Irving’s work focused on understanding how structural inequality, trauma and violence made people sick.   In a 2017 NPR article, it states that despite “...two master's degrees and dual-subject PhD., her gold-plated insurance and rock-solid support system...”; race alone was the main factor predicting Dr. Irving’s  fatal outcome.Although the majority of my African-American friends have had relatively easy pregnancies with uncomplicated deliveries, the fear that I’ll be the one to succumb to childbirth, remains constantly on my mind.  Despite being a healthy, young woman, I often wonder if bringing life into this world could result in my own physical demise.  Equipped with the frightening statistics and information about societal inequities, how does society begin to change a system that is disproportionately killing Black mothers?During slavery, Black women were likened to mares and expected to produce as many children as possible, to continue the slave based economy.  The denigration of the Black female body has been one of the legacies of slavery manifesting in the current Black maternal health crisis. As Black people continue to fight for basic human rights, it is not surprising that Black women experience increased health risks and negative outcomes, during such a vulnerable period like childbirth.There is a need for the federal and state governments to create public health initiatives that promote and improve the disparities in maternal care.  Practitioners must be educated during medical school and residency about their implicit and explicit biases that are resulting in the deaths of specific demographics.About 5 years ago, a friend who was in her second trimester asked me to accompany her to her prenatal appointment, as her husband was out of town. During the visit, the OB was emphatic as she instructed my friend to train for the delivery, likening labor to a triathlon.  My friend, a surgical resident living in a Miami high rise with amenities like a gym and pool; as well as a husband with above average cooking skills, could adhere to her OB’s recommendations. But what about other Black women, who aren’t as privileged?  Would they be able to prepare for the undue harm and stress pregnancy and delivery might put on their bodies? Due to structural racism, a large segment of women of color typically reside in food deserts without access to healthy fresh food, as well as few safe spaces to exercise.  With minimal activity and poor food options, Black women are often at greater risks of obesity and cardiovascular disease.  Bearing these inequities in mind, some individuals do not have the option of healthy food choices and remaining physically active, during pregnancy.  So, if a woman must train for pregnancy and the delivery like an upcoming sports event, then it must be imperative that all women have the access to resources that will allow them to maintain good health and decrease the risk of maternal mortality and morbidity.According to an article posted on LAIST, “What Pregnant Black Women Need To Know To Have A 'Safe And Sacred Birth', Black women have to be proactive  in their care.  They must:-Find a birth experience that works for their family-Advocate for themselves in the doctor’s office-Find providers who will work to improve birth outcomes-Have the wider Black community support pregnant women Last fall, I made an OB Gyn appointment for a problem visit. Over the past few years, I had noticed that my premenstrual mood swings were intensifying.  My mother told me that in her early 30s she had experienced a similar shift, so I decided to see a specialist. As I sat in the doctor’s office and relayed my symptoms, she barely made eye contact.  She dismissed my claims and seemed squeamish about performing a pelvic exam. I eventually dug in my heels, and pulled the ‘doctor card’. This garnered me a glance and a half smile. However, she quickly stated that I was exaggerating my PMS irritability, and as a psychiatrist, I was overanalyzing, looking for a problem. I left her office feeling gutted. I quickly went to Google reviews and discovered that other professional Black women had experienced similar treatment with this  practitioner.  After the encounter, I began to re-evaluate my already tenuous plans for motherhood.  If concerns about my period could be summarily discredited, then what might happen if I had any concerns during a pregnancy? A month after that experience, I journeyed several miles north to see a Black OB Gyn, who was recommended by a friend. She listened to all of my symptoms, as well as my unspoken concerns. She did a thorough examination and agreed that I was experiencing Premenstrual dysphoric disorder and offered me a variety of treatment options. After careful review, I decided on natural supplementation, which has made a difference in my monthly menses. But beyond that, I felt heard. I felt validated. I felt understood.  The stark difference in the two experiences has shown me that by using my network and seeking out the right practitioner, I can become a mother, without being fearful of death.Dr. Cisse is a board-certified psychiatrist, who provides care for adult patients. She is also passionate about exploring psychopathology at the intersections of race, gender and class, within the African Diaspora.
7 min read

Sleep and Weight Loss

Losing weight isn’t just about eating properly and working out more. It’s also about getting enough sleep!  Researchers report that women who sleep less than five hours a night weigh more compared to those who sleep for seven to nine hours a night.  Furthermore, those who sleep six hours a night are 12% more likely to experience weight gain, and 6% have a higher risk of obesity, compared to those sleeping seven hours a night.  These are such numbers we can’t ignore, showing how crucial sleep is for weight loss and overall health. But how does it work? Read on as we answer the question, “does sleeping more help you lose weight?”  While most people don’t know it, sleep is actually the foundation we need to help support our healthy eating and exercise habits. Here are some points you should consider when it comes to sleep and weight loss: When we don't get enough sleep, it will be challenging to control our behavior and energy levels. Lack of sleep would strengthen the want for rewards, leading to unhealthy eating and to replace exercise for quick fix rewards like watching television.  To be more specific, fewer hours of sleep can affect hormones that regulate your appetite. With less sleep, your hormones will stimulate cravings for high-carb food. Plus, the more time we are awake, the more waking time we have to eat! Our sleep would also affect our cortisol levels, which usually spike in the morning for better energy throughout the day. With poor sleeping habits, the cortisol levels are elevated, which negatively affects weight loss and disturbs your sleep cycle. This then makes it difficult to implement and act on a good weight loss program.  Furthermore, less sleep can also have us feel more stressed and exhausted, especially when we have to work while lacking sleep. This would have us stress eat or skip workouts from feeling too tired or tense! While lack of sleep can affect your weight, so can TOO MUCH sleep. Sleeping more can help you lose weight if you were previously lacking it. But if you are sleeping for over ten hours a day, this can be a problem. Just like sleeping for less than seven hours daily, it affects your hormone levels, having you crave for carb-rich food. Furthermore, it gives you less time to focus on your work for the day, resulting in skipped workouts and exercise.  Now that we know how too little or too much sleep leads to poor eating and exercise habits, how can you sleep well for better weight loss results? Here are some tips to follow to avoid poor sleep habits:             •           Keep a consistent sleep schedule that allows you at least seven hours of sleep a night            •           Prioritize relaxing and doing stress-free activities, especially during the evening, which can help wind you down for sleep            •           Do not perform any stimulating or exciting activities and avoid electronics an hour before bedtime            •           Reduce or eliminate alcohol and caffeine consumption. Also, consume your last meal two to three hours before bedtime  Wrapping It UpSleep affects many aspects of your lifestyle, from weight loss to health. With better sleeping habits, you are more inclined to eat healthier and exercise more, making you feel happy and reach your weight goals! So make sure that you learn more about how you can sleep better and create a consistent schedule to achieve more. Start now, we wish you the best of luck!
4 min read

Vaginal Atrophy Treatment: Different Remedies You Can Try

Vaginal atrophy, known as atrophic vaginitis, refers to the drying, inflammation of one’s vaginal walls. This may happen when a woman’s body has or produces less estrogen, occurring most often after going through menopause.  There many vaginal atrophy treatments, both medical and natural. So read on to learn more about this condition and how you can remedy its symptoms! Vaginal atrophy is caused by a decrease in estrogen production. With less estrogen, it makes the vaginal tissues more fragile and less elastic, feeling thinner and drier.  The drop in estrogen may happen due to the following:             •           Before or after menopause            •           After the surgical removal of both ovaries            •           During breastfeeding            •           Adjustments in medications that affect estrogen levels, like birth control            •           After chemotherapy or pelvic radiation therapy for cancer            •           A side effect of hormonal treatments for breast cancer There are also risk factors, such as smoking, having no sexual activity, or no vaginal births.               •           Vaginal dryness, burning, discharge, and/or itching            •           Burning urination, as well as frequent and urgency with urination            •           Urinary incontinence            •           Recurrent urinary tract infections            •           Discomfort and/or light bleeding during or after intercourse            •           Decreased vaginal lubrication during intercourse            •           Vaginal canal shortens and tightens Vaginal atrophy may increase your risk of urinary problems and vaginal infections, which is why it’s best to have it checked and diagnosed with your doctor if you feel any of the symptoms mentioned above.  Fortunately, there are ways to treat vaginal atrophy, such as: 1. Natural RemediesThere are a few lifestyle changes you can follow, which are:             •           Give up smoking            •           Staying sexually active can help to increase blood flow to your genitals            •           Avoid using perfumed products, including deodorants, douches, powders, soaps, and certain perfumed spermicides or lubricants            •           Keep hydrated and drink eight glasses of water a day to maintain your body’s moisture levels            •           Exercise regularly and maintain good physical activity to help with hormone balance 2. Your DietRight now, there is still little evidence to support claims about how dietary changes help with vaginal atrophy. However, it’s still best to maintain a healthier diet and if you choose to use herbal supplements and vitamins, check with your doctor beforehand.  Some have reported positive effects when consuming probiotics, which can help with urinary problems and vaginal dryness and infections. While further research needs to be done, you may try incorporating probiotics to your diet. 3. Using Moisturizers and LubricantsLubricants can soothe and lubricate your genitals safely. You can try using the following: 4. Medical Treatment Besides lifestyle changes and the mentioned remedies, some medications may help treat vaginal atrophy:                        •           Use topical estrogen cream to the vagina for symptom relief and to reduce exposure of bloodstream to estrogen            •           Oral estrogen or an estrogen-releasing ring to release hormones properly            •           Systemic estrogen therapy, which comes as a skin patch, tablets, topical gel, or as an implant under your skin. However, this may have side effects you’ll need to talk about with your doctor Make sure to check with your doctor before putting any products into your vagina or ingesting any supplements or medications.  Vaginal atrophy is uncomfortable but treatable and manageable. Try any of these safe treatments under the guidance of your doctor and see what works best for you now!
3 min read

What is Vaginismus - and Why Does it Occur?

Vaginismus occurs due to the spasm or squeezing of the muscles in a woman’s vagina. It typically occurs when something is inserted into the vagina such as the penis during intercourse or a tampon. Vaginismus can be mildly uncomfortable or extremely painful. [1]The most obvious sign of vaginismus is painful sex, also called dyspareunia. The pain occurs most commonly during penetration and usually goes away or reduces after withdrawal. However, in some cases, the pain may persist for a some time after the withdrawal of the penis or other object. [2]Dyspareunia is often described by women as a burning sensation or a feeling as if the penis is hitting a hard wall.It is also common for women with vaginismus to experience discomfort while inserting a tampon or having a pelvic examination at the doctor’s office.Some other common symptoms that can occur due to vaginismus include:·         Fear or anxiety of pain ·         Anxiety before sexual activity ·         Inability to have penetrative sex ·         Difficulty in inserting a tampon ·         Loss of sexual desireThese symptoms tend to be involuntary, which means a woman can not avoid them without proper treatment.While the exact cause of vaginismus is not known, it is believed that it might occur due to the fear and anxiety around sexual activity. However, in many cases, it becomes difficult to ascertain what came first: the anxiety or the vaginismus. [3]Some physical health problems such as infections and excessive dryness of the vagina or cervix can also lead to painful intercourse and cause vaginismus. [4]Physical therapy, sometimes called pelvic physical therapy, involves training the women to control the spams of the vaginal or pelvic floor muscles and it can be highly effective for the management of vaginismus. [5]Exercising at home can also help women to learn to control the contractions of the muscles in the vagina and pelvic floor. This is known as progressive desensitization that allows women to avoid anxiety and gradually feel more comfortable during activities requiring vaginal penetration.Progressive desensitization involves strengthening the pelvic floor muscles by practicing Kegel exercises. This is followed by the insertion of one finger into the vagina, up to the first knuckle, while doing Kegel exercises. Women may apply a lubricant on the fingers before insertion to avoid pain. Starting with inserting one finger, they can work their way up to inserting two and later, three fingers until they can feel comfortable.Once they find the insertion of 3 fingers to be comfortable, they can try putting specially designed inserts called vaginal dilators into the vagina to help the muscles get accustomed to pressure and size. This therapy can be helpful for women who suffer from vaginismus due to fear or anxiety. ConclusionIt is possible to treat vaginismus by identifying the possible causes such as anxiety, infections, or dryness and seeking appropriate treatment. Physical therapy or exercising the vaginal muscles can help to relieve the spasms and provide considerable amount of relief from vaginismus.References:1.      aafp.org/afp/2011/0915/p705.html2.      nhs.uk/Conditions/Vaginismus/Pages/Introduction.aspx3.      mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-203759674.      https://www.webmd.com/women/guide/vaginismus-causes-symptoms-treatments#15.      ncbi.nlm.nih.gov/pmc/articles/PMC5913379/
3 min read

How Early Can You Take a Pregnancy Test? The Real Answers Here!

One of the most anxious moments women go through is taking the pregnancy test. It gets confusing as to when you should take it, and if you can get accurate results as soon as possible! So, how early can you take a pregnancy test, anyway? Read on to learn about the accuracy of pregnancy tests and how early you can take them. How Early Can You Take a Pregnancy Test? Unfortunately, you can’t take a pregnancy test and expect it to be accurate immediately after intercourse.  You are only able to take a pregnancy test and expect accurate results anytime after you experience a late period. This is when they work the best, which is why it’s recommended to take a pregnancy test if you experience a missed period and had sexual intercourse recently.   If you have an irregular period, or can't wait until your next period to find out, then the rule of thumb is to take a pregnancy test two to three weeks after your last sexual intercourse. This is the earliest time you can take a pregnancy test that shows accurate results. Pregnancy tests claim to work even before a missed period, though the results aren’t as accurate. If you come across “easy results” pregnancy tests, this may still be too early for you to get an accurate result, especially since all of our bodies are different and have different menstrual cycles and fertility phases.  If you take it too soon, such as a week after intercourse or before your period is due, then you may get a false negative. You will need to take another test after a week or two if so.  For those who are a bit confused about when to take pregnancy tests, there are online calculators that can help you. Simply put in the day your last period began and your average cycle length, and it will give you the earliest date you can take a pregnancy test. Another thing to take note of is the time of the day you should take the test for accuracy. It's much better to take it first thing in the morning, at least a day after your period is late. Your urine is more concentrated the moment you wake up, giving you more accurate results The Test AccuracyWhen you read and follow the instructions carefully, you get 99% accuracy when doing the pregnancy test on the day you miss your period. However, the 99% accuracy doesn't apply when doing the test early. Furthermore, some of these 99% accuracy claims may not even be true! Research studies have shown that the tests can be between 46-89% accurate. That’s why it’s best to take the pregnancy test when you miss your period and another test for confirmation.  For those who received a positive result, it’s best to check with your doctor for confirmation. This is when you can begin asking for advice and what steps to take. How About a Blood Test?Besides the usual over-the-counter pregnancy test, you can also go for a blood test. There are two types of blood tests to consider, which are: Qualitative tests measure if you have the minimum amount of pregnancy hormones in your blood to indicate you are pregnantQuantitative tests measure the exact amount of pregnancy hormone in the blood, which usually shows the progress of your pregnancy These also do not provide an accurate result when done too early. It is only best to take a blood test if you have gotten negative at-home pregnancy tests but still missed your period by a few days. As always, call your doctor if you are uncertain about any pregnancy test results or if you have any symptoms or issues.
4 min read

Hormone Imbalance: Causes, Symptoms, and More

 Hormonal imbalances occur if there are too much (or little) hormones in your bloodstream. Since they are a crucial part of your body, even the smallest changes and imbalances can cause discomfort and symptoms.  Read on to learn more about hormonal imbalance, from its causes and symptoms, down to what you can do to remedy it. Everyone experiences hormonal imbalance or fluctuations during various parts of their life.  There are cases unique to women, related to their reproductive hormones. Such causes include:             •           Pregnancy and breastfeeding            •           Menopause or premature menopause            •           Hormone drugs            •           Primary ovarian insufficiency            •           PCOS However, there are also other common causes, such as:             •           Diabetes            •           Underactive or overactive thyroid            •           Conditions affecting your hormones and glands            •           Hormone therapy            •           Tumors or certain cancer treatments            •           Medications            •           Eating disorders            •           Stress            •           Injury or trauma The symptoms of hormonal imbalance depend on the glands and hormones affected. The common symptoms include:             •           Unexplained weight loss or gain, sometimes bloating            •           Unexplained sweating and fatigue            •           Insomnia or difficult sleeping            •           Dry skin and/or skin rashes            •           Changes in blood pressure, blood sugar levels, and/or heart rate            •           Changes in appetite            •           Brittle or weaker bones and/or hair            •           Symptoms of depression, irritability, and/or anxiety            •           More or less sensitive to cold and/or heat            •           Increased thirst and needing to go to the toilet more or less than before            •           Reduced sex drive and/or infertility            •           A puffier face or hair growth on the face            •           Blurred vision            •           Deepening of voice in females            •           Breast tenderness and/or bulge in the neck If you experience any of these symptoms, it’s best to get checked with your doctor for a diagnosis.  There is no single test for medical professionals to diagnose hormonal imbalances. During your check-up, you will need to prepare a list of all your medications, vitamins, and supplements you currently take. Furthermore, you will need to describe your symptoms, as well as their timeline.  Your doctor will then suggest you take a few diagnostic tests:             •           A blood test            •           Pelvic exam and physical exam            •           Ultrasound            •           Other additional tests such as an MRI, biopsy, thyroid scan, X-ray There are also home testing kits that measure follicle-stimulating hormones in your urine. These levels would increase as you enter menopause, usually rising and falling during your normal menstrual cycle. This won’t be able to show if you have any serious hormonal imbalance issues, but it can tell whether or not menopause might have begun. Treatments for hormonal imbalance would depend on its cause. Here are some of the treatment options available:             •           Estrogen Therapy: Your doctor will give a small dose of estrogen, which is usually done for women who suffer from symptoms of menopause            •           Vaginal Estrogen: These can be in the form of estrogen cream, rings, or tablets. It’s helpful for those experiencing dryness and/or pain during intercourse            •           Hormonal birth control: This can help regulate your menstrual cycles, as well as improve your skin condition            •           Thyroid Hormone Therapy: These are for people who are diagnosed with hypothyroidism to balance their hormone levels  There are also various lifestyle changes and natural remedies you can try to treat hormone imbalance.   • Yoga is known to help regulate hormones while improving your overall balance, flexibility, and strength              •           If you are overweight, losing weight can improve your menstrual cycle and make your periods more regular            •           Have a balanced diet and exercise regime, which is crucial for overall health            •           Decrease the uncomfortable symptoms of hormonal imbalance by using targeted treatments like moisturizers and lubricants, removing unwanted new hair on the face and body, and to avoid any triggers of hot flashes You don’t need to suffer through the pain and discomfort of hormonal imbalance. For those who are experiencing any of these symptoms, do check yourself with a medical professional.
4 min read

Top 5 Causes of Vaginal Itching

 Vaginal itching is an uncomfortable and sometimes painful condition that mainly arises due to benign causes like yeast infections. But, there are many other potential causes of itching in the vaginal area. While itching in the vagina can often be treated with over-the-counter remedies, the condition can sometimes grow more serious if overlooked. So, it is important to be familiar with possible reasons for vaginal itching other than yeast infection: vaginal itching causes Genital itching is one common symptom of many STDs. STDs can occur due to sexual contact with a person who has an infection of some type. According to the Centers for Disease Control and Prevention (CDC), STDs occur at a very high rate, with millions of cases reported annually.  People can reduce the risk of suffering from STDs by: ●       Having safe sex (using barrier precautions) ●       Getting yourself tested for STDs before having sex●       Preventative measures like the HPV (human papillomavirus) vaccine BV is a common bacterial infection that often affects women after puberty. It occurs when the healthy bacteria in the genitals become unbalanced. Many times, BV does not show any symptoms. But, it can cause watery vaginal discharge with a bad odor and a burning sensation around the vagina.Some known causes of BV are:●       Smoking●       Douching (can upset the vagina’s natural bacteria)●       Bathing with antibacterial or antiseptic products●       Using scented products in the vagina or surrounding areas●       Using harsh clothing detergentsBV can be dangerous to pregnant women and their fetuses. So, pregnant women must see their gynecologist for any vaginal itching or discharge. The feeling of bugs crawling around any part of your body is really disturbing. This is sometimes caused by public lice, an easily transmittable infestation of tiny, crab-like creatures can make your vagina itch like crazy.  Public lice may attach to any body areas covered in hair. Bites or eggs from these bugs can cause vaginal itching and irritation in the surrounding areas. You can treat public lice using store-bought lice-killing lotions. In severe cases, you may need prescription medication.Hormones fluctuate during menstrual cycles and pregnancy. This can lead to drier vaginal tissue than normal, which can result in itching. Besides, perimenopause - the time period before menopause starts, causes a dropped level of estrogen. This can further lead to dryness and itching in the vagina. OTC moisturizers that are gentle and unscented can treat vaginal itching. Your physician may prescribe you an estrogen cream for external vaginal itching if they feel it is caused by your hormones or menopause. Women sometimes have procedures like waxing done to have less hair on their vulvar area. Due to these treatments, you can develop irritation, skin injury, rashes, and ingrown hairs which can all cause itching.If you are using any new treatment for hair removal, consider that they may be causing your itching. The Bottom LineOverlooking vaginal itching is never a good idea, as you may miss a serious cause. So, it is important to consult with your physician in a timely manner to get the appropriate diagnosis and treatment.   
3 min read

What Are Baby Sleep Regressions? What to Know and How to Handle Them

Is your little one waking up every 20 minutes and keeping you from having a good night’s sleep? He may be going through baby sleep regressions!After becoming a parent, you’ve probably heard about these sleep regressions without really knowing what to expect. To learn more about what they are and how to move past them, read on! Sleep regression is the time when your little one’s sleep patterns start to shift. They will wake up more throughout the night, having a difficult time sleeping again. Unfortunately, once they awake, so will you. It’s frustrating, but manageable, especially when you know how to handle it well and know why it happens. Baby sleep regressions are totally normal and fortunately, a temporary period. But why does it happen? Sleep regressions may mean that your little one is going through a growth spurt, and/or that his brain is going through some development. Since the brain is developing, your baby is starting to learn new skills and master existing skills, such as rolling over or sitting up. With every major milestone or development, a sleep regression usually is there to accompany it.  During this time of growth, development and learning, it might be tiring, stressful and frustrating for your little one. As a result, it impacts their sleep patterns. That is what is called a sleep regression. It’s not truly a regression in that is just means there is less regular sleep or a change in sleep to a pattern you may have seen more when they were infants.  Baby sleep regressions usually begin when your little one turns four months old. Note that there may be more regressions occurring in the future, usually every two to three months until they reach the toddler stage.  Usually, the first sleep regression at four months old is the hardest for parents, as it’s the first they’ll experience and they may have had better quality of sleep for a period before it.  This period can last between three to six weeks or longer, and it can catch you off guard! Your baby may have been sleeping well, only to begin waking up more at night, taking shorter naps, or even skipping them without an obvious reason. You will know when your baby is going through a sleep regression when you notice a sudden worsening of their sleep patterns.              •           Waking up multiple times at night            •           Less napping             •           More fussiness            •           Appetite changes  When it does happen, don’t worry! This usually doesn’t mean something is wrong. Reassure yourself that this is temporary and it means your little one is growing and learning new things as regressions occur, as they are engaging with their environment even more. But if your little one experiences other symptoms such as fever or other signs of illnesses, do consult their doctor. While baby sleep regressions are a technically sign of a good thing (development), I can’t deny that it’s frustrating for parents as well.              •           Give your little one time to practice throughout the day. He is working very hard mastering their new skills, and they may feel so eager to learn to the point they practice all night, which keeps them up! You can lessen the time he spends practicing at night by giving him uninterrupted time to practice various skills.            •           Feed your little one fully during the day and before bedtime to prevent them from getting hungry. This lessens any hunger cries and whines in the middle of the night. While you feed them, eliminate any distractions and feed in environments less likely to stimulate curiosity to ensure they are fed well.             •           Establish a healthy bedtime routine and create the optimum sleeping environment for your baby. Keep their room dark during nap times and let natural sunlight in when they are awake. Also, stick to a bedtime routine before it’s time to sleep, which can help them become drowsy and ready for bed. Baby sleep regressions don’t last forever. With the right knowledge, coping strategies, and tips, you can help them learn new skills as the entire family sleeps healthier. Good luck!
4 min read

What is Hormonal Acne? Everything You Need to Know

Acne is common, it occurs in most people to some degree at some point in their lives. However, you may notice that it happens mostly during puberty and times of stress or other changes, such as before periods, during pregnancy or during or after menopause. This is likely to be hormonal acne.  Hormonal acne happens because your hormone levels are rising or fluctuating, which affects your skin health and cell activity.  But what is hormonal acne and how can you treat it properly? Read on to find out! Hormonal acne is exactly what it sounds like, which is acne connected to hormone fluctuations. It’s usually associated with hormone fluctuations in puberty, though it can affect adults throughout any age, especially in women. Various factors contribute to hormonal acne, particularly menstruation, pregnancy, and menopause. There may also be underlying medical conditions that affect your hormone levels as well, thus causing acne. During puberty, hormonal acne might appear around your forehead, nose, and/or chin. In hormonal adult acne, it usually forms on the lower area of your face, such as around your jawline or cheeks.  The symptoms of hormonal acne include seeing whiteheads, blackheads, cysts, nodules, papule, or pustules around your face. There may also be lesions on your face other parts of your body, such as the neck, back, chest, and shoulders. The hormonal acne can be mild, moderate, or severe, with the intensity depending on various factors such as genetics, diet, environment, as well as the way you care for your skin.              •           Menstruation            •           Menopause            •           Increased androgen levels            •           Polycystic ovarian syndrome When hormone levels fluctuate, it aggravates acne issues as it increases skin inflammation, oil/sebum production in your pores, clog skin cells around the hair follicles and even increases the production of acne-causing bacteria. Hormonal acne IS treatable and can be prevented with the right tips and products. Here are some ways you can manage hormonal acne regardless of your age: Wrapping It UpHormonal acne is irritating, but treatable with the right knowledge and tips. The timeline differs from person to person, but if you use the right treatments, it can take 8-10 weeks to lessen acne and prevent it from coming back.If your hormonal acne persists and worsens, do talk with your doctor for a long-term treatment plan for better results.
4 min read

Does Insurance Cover Egg Freezing?

If you think you might want to delay pregnancy and may decide to have babies in your 40s or later, egg freezing can be a great option. But, the high cost of the procedure can make you think twice. So, Does Insurance Cover Egg Freezing? Though health insurance policies cover most of the infertility diagnosis and treatment costs, procedures like egg freezing are rarely covered. This is because egg-freezing is considered elective by insurance companies.  Let’s take a look at the cost of egg freezing and help you decide if it is worth it.   A single egg-freezing cycle costs between $6,000 and $10,000. This cycle takes about six weeks and includes initial tests, injections, and retrieval surgery, excluding the annual storage fee for frozen eggs. Egg storage fees start at $600 annually.  The total cost of egg-freezing can be broken down as follows:●     Treatment: $11,000●     Medication: $5,000●     Storage: $2,000 (For four years)The costs vary depending on your location. For instance, the cost of one cycle of egg-freezing ranges from $13,800 in Boston to $17,800 in New York City. And, since most women undergo the cycle twice, the total cost can reach up to $40,000. Although egg freezing is usually not covered by your health insurance, some plans cover it when done with medical reasons. In May 2018, the federal Access to Infertility Treatment and Care Act introduced a bill to mandate insurance coverage for fertility preservation. The bill aims to support patients who undergo fertility preservation procedures, such as egg freezing, due to medically necessary procedures such as cancer treatments. In addition, some parts of the process, such as a physician consultation, ultrasounds, bloodwork, and ovarian reserve testing, may be covered by several insurance companies. Only 16 states in the USA require insurance companies to offer coverage for infertility diagnosis and treatment. You’d be surprised to know that top companies, including Google, Facebook, and Apple offer egg freezing as a company benefit to their employees. You are advised to review your insurance plan or contact your insurance company to explain the coverage to you. A study conducted by Yale Medicine revealed that there is only a 3-5% chance to have a baby with egg freezing. However, doctors often collect multiple eggs, thus increasing the chance of late pregnancy. Women considering egg freezing should not rush with their decision. Choose this procedure without any pressure and after a long discussion with your doctor. In addition, you should carefully consider your reproductive goals, health, and overall costs involved. Success also depends on the age of the woman and overall health. The older you are, the lower are your chances of getting pregnant with a frozen egg. Does your insurance cover egg freezing? If not, don’t lose hope! You can consider other funding options. Talk to your financial advisor to find some alternatives. Many fertility clinics also offer payment options for egg freezing. You can even opt for crowdsourcing and borrow from someone close to you. Summing up all points, it is safe to say that egg freezing is worth considering if your health goals and budget allow.  
3 min read

Spotting in Pregnancy

While spotting is a relative common occurrence in early pregnancy, it can nevertheless be concerning. According to The American College of Obstetricians and Gynecologists, approximately 15-25 percent of women experience bleeding in early pregnancy. Spotting in first trimester pregnancies, or the first 12 weeks, is typically lighter in color than what one would experience with a regular menstrual flow. The color may also vary from a pinkish hue to red or even brown. Although it is easy to be worried when experiencing spotting during pregnancy, it’s important not to panic. Most women who experience spotting during pregnancy continue on to have a completely healthy pregnancy and deliver a healthy baby. If you’re wondering how common is bleeding during pregnancy 6 weeks, you should rest assured that it is relatively common. In fact, spotting or light bleeding can occur anytime between one and two weeks after fertilization occurs. This happens when the fertilized egg becomes implanted in the lining of the uterus. At this time, the cervix may be more prone to bleeding as a result of more blood vessels being present. Implantation bleeding may last for a few days and typically occurs before a woman even realizes she’s pregnant. In fact, this type of bleeding is sometimes mistaken for a regular period. There is no need to be worried about implantation bleeding. It should be kept in mind that any time bleeding or spotting occurs after a woman would have expected her period, it’s usually not implantation spotting, but is instead likely associated with early pregnancy instead. Understanding the Difference Between Bleeding and Spotting During PregnancyIn understanding whether to be concerned about spotting in first trimester pregnancies, it’s important to also understand the difference between actual bleeding and spotting. Vaginal bleeding that occurs during early pregnancy involves a discharge of blood that comes from the vagina. This type of bleeding can occur any time from the point of conception all the way through the end of the pregnancy.Spotting is relatively common during the first three months. There is usually no need to be alarmed. This is particularly true if you only notice a few drops of blood. As long as there is not enough blood to fill an entire panty liner, there is no need to be worried. By comparison, bleeding occurs when there is a much heavier blood flow. With actual bleeding, it will be necessary to wear a liner or even a pad in order to prevent blood from soaking through your clothing. Regardless of whether you are spotting or bleeding, it is typically best to get in touch with your healthcare provider and then describe to him or her the symptoms you are experiencing. It should be kept in mind that quite a few changes occur in the cervix during pregnancy. This is due to the high production of hormones that takes place during pregnancy. The presence of such hormones can cause the cervix to become softer. In addition to bleeding at the time of implantation, there can be many other causes for spotting to occur during pregnancy. Among those causes is a cervical polyp, which is a growth on the cervix. During periods of high estrogen levels, such polyps are more likely to bleed. This is particularly true during an exam or sexual intercourse. Cervical polyps are completely harmless. Other common causes of bleeding during early pregnancy include:In some cases, a vaginal infection can also lead to bleeding. When the cause of bleeding is a vaginal infection, it may also be accompanied by vaginal discharge. Certainly, no one ever wants to consider that bleeding might result in a loss of pregnancy, but miscarriage may also be a cause of bleeding that occurs during pregnancy. It’s certainly understandable that bleeding might trigger a concern regarding loss of pregnancy. According to a study; however, only 12 percent of the small number of women who experience bleeding in pregnancy actually had a loss of pregnancy. It should be noted that approximately two-thirds of women who do have a miscarriage experience bleeding. Given this; it’s important not to simply ignore bleeding during pregnancy. A healthcare professional can perform tests to determine a possible cause of bleeding in pregnancy. For instance, an ultrasound can determine whether bleeding stems from pelvic organs, such as an ovarian cyst. Blood tests may also be ordered to measure hCG, the pregnancy hormone. Low levels of this hormone might indicate that a pregnancy is not progressing properly. In some cases, progesterone levels may also be checked, as low levels of progesterone might result in bleeding or could indicate the presence of an abnormal pregnancy. Bleeding in Pregnancy as a Result of Abnormal PregnanciesWhen a pregnancy is not developing correctly, bleeding may be one of the first noticeable symptoms. For instance, if there is a genetic defect related to the embryo, bleeding could indicate an impending miscarriage. Once a miscarriage is in progress, it usually cannot be prevented. Molar pregnancies, also sometimes referred to as gestational trophoblastic disease, refers to a pregnancy in which there is something abnormal about the fertilization. This results in abnormal tissue growing in the uterus. Although the pregnancy is not normal, a woman may experience the same symptoms associated with early pregnancy. Depending on the type of molar pregnancy that has occurred, there may or may not be a fetus present in the uterus. In some cases, there is only tissue and no fetus at all. In other cases, there may be an abnormally formed fetus. When this is the case, the fetus typically has severe birth defects. Molar pregnancies are not able to progress toward the delivery of a normal fetus. One of the early symptoms of a molar pregnancy is bleeding or vaginal spotting. Molar pregnancies are diagnosed with an ultrasound or sonogram. When a fertilized egg does not implant in the uterus as it should, the result is an ectopic pregnancy. The egg may instead implant inside the Fallopian tubes. As the pregnancy progresses, there is a risk of the tube rupturing. Symptoms of an ectopic pregnancy may include vaginal bleeding and abdominal pain. A ruptured Fallopian tube can result in a significant amount of blood loss and could be potentially fatal. Emergency surgery and a blood transfusion may be necessary to resolve this life-threatening emergency.Anytime a pregnant woman experiences bleeding in pregnancy, it’s important to speak to a doctor. Although the bleeding or spotting could be completely harmless, it’s still important to determine the cause of the bleeding. While it’s quite likely that the cause of the bleeding is something relatively minor, other more serious causes of spotting or bleeding in pregnancy may include placental abruption, uterine rupture, placenta previa, or preterm labor. The best course of action is to see a healthcare professional as quickly as possible.In order to help manage spotting or bleeding in pregnancy and improve the chances of a healthy pregnancy continuing, a pregnant woman may be advised to stick to bed rest, stay well hydrated, spend time off her feet, limit physical activity, and elevate her feet.
7 min read

What is VBAC? All About Vaginal Birth After C-Section

Are you considering having a VBAC? While it shows good rates of success, it may not be for everyone and you may have some concerns about it if you will want to go over with your doctor.  To help you decide, read on as we talk more about VBAC, from its pros and cons down to how you can prepare for it.  VBAC stands for Vaginal Birth After Cesarean. If you have delivered a baby via C-section and are pregnant again, you can choose between a repeat C-section or VBAC, if your obstetrician feels it is safe for you.  Many women have tried labor and a vaginal delivery after cesarean, which is possible and with a success rate of around 70%, in some studies. Many women choose a trial of labor after cesarean (TOLAC), because:             •           It can help prevent risks from multiple cesarean deliveries, like placenta accreta or placenta previa. This is beneficial for women who plan to have more children in the future            •           There are fewer and lower risks of any surgical complications that come with C-section delivery. Successful VBAC procedures are associated with lower rates of infection, blood clotting, and excessive bleeding. It may also decrease risks of requiring a hysterectomy and injury to one’s abdominal organs, like the bowel or bladder            •           There is a shorter recovery time when undergoing a VBAC versus a C-section, meaning a shorter hospital stay and shorter wait time before you can go back to your normal activities            •           It gives you the chance to experience a vaginal delivery  Those who are the best candidates for VBAC are the following:             •           Those pregnant with one baby and has had a history of 1-2 low transverse C-sections without problems that prevent VBAC            •           Those pregnant with one baby and have had a history of one C-section that underwent an unknown uterine incision type without problems that prevent VBAC. *This is unless your doctor suspects you have had a high vertical, or classical, uterine incision            •           Those pregnant with twins and have a history of one low transverse C-section and are a good candidate for twin vaginal delivery Prior vaginal delivery is also a great predictor of a successful VBAC procedure.  However, there are also those who are not candidates for VBAC, such as women having risk factors that decrease the chance of a successful VBAC. It’s best to check with your healthcare provider to see if you are an eligible candidate.  While there are numerous benefits from having a VBAC, there are also risk to consider.  If you experience a failed TOLAC, there may be more complications, such as uterine rupture. Though not to worry, as this is very rare and only happens to less than 1% of those who attempt a TOLAC. A uterine rupture occurs when the cesarean scar on your uterus opens. This risk is life-threatening for both you and the baby, and an emergency C-section is required to prevent any life-threatening complications if this happens. Your doctor may need to remove your uterus and perform a hysterectomy if this occurs. This is another reason why it’s important to weigh the pros and cons, as well as discuss the risks and success rates with your doctor, before choosing to do a VBAC. If you do choose to undergo a VBAC, you can prepare by talking about it with your healthcare provider. Discuss all your concerns and know what you can expect during VBAC. Submit your complete medical history, especially those that include records from your previous C-sections and other uterine procedures that may have been done. The healthcare provider will use your medical history to calculate the success rate of your expected VBAC. As long as you provide complete information and follow your doctors' advice, you can have a successful VBAC with no complications. Good luck!
4 min read

5 Sleep-Training Methods For Babies You Can Follow

As new parents, it may be difficult adjusting to your baby's sleeping habits, especially when they wake up crying in the middle of the night! Once they reach a few months old, it's time to begin training them to sleep peacefully on their own, and at the right time. How can you do it?Here are the 5 different sleep-training methods for babies you can consider trying: sleep training your babyAlso known as the Check-and-Console Method, there are different variations but a similar principle: Continue checking on your little one at preset intervals but you don't feet or lull them to sleep, as this would mean they won't sleep on their own. Once you go through the typical bedtime routine, put your little one in the crib and leave the room, waiting for a specific amount of time (a minute or two). Then go in and reassure your little one with a few words or a simple pat or rub. Do NOT pick the baby up and leave the room again, continuing to leave and check on them until they fall asleep.  While effective, some parents report that going into their room would aggravate their baby more. With that said, consider the next option, CIO. You do not respond to any crying as your baby tries to sleep. Go through the bedtime routine and put them in their crib and walk out.  This is a controversial sleep-training method that's still up for debate. What you do next is what works for you and your little one. Expect a lot of crying, though it's short-term and as long as you know they are safe (check through a baby monitor and camera), then it's worth a try. This is a gradual sleep-training method that needs a lot of patience and discipline.  Prep your little one for bed but instead of walking out, stay near the crib and sit down. Once they fall asleep, leave the room but once they wake up, sit back in the chair until they are asleep again. You should console them from your chair, if possible, and not closer. Every few nights, move your chair further away until you are outside the room.  If your baby is younger than seven months, then this is a suitable method where you’re staying in the room without having to provide too much help for your baby to fall asleep. Simply stand over your baby’s crib and start shushing him by patting his tummy for reassurance. You can also let your baby fuss over for a short while and pick him up, then put him in his crib before he falls asleep. These methods work well for younger babies but it may make some babies more upset because of overstimulation. With the Bedtime-Routine Fading technique, simply continue whichever sleep-training method works for you. But every few days, decrease the amount of time spent doing it until you won't have to do it anymore. As for the Bedtime-Hour Fading, you place your baby in the crib at the typical time they start dozing off, then make that their bedtime for a few nights. Then start to slowly move the bedtime at an earlier time, such as 20 minutes earlier until your little one nods off at the desired bedtime. Beyond these sleep-training methods for your baby, make sure that you do much more research and talk to your doctor for more advice. What can work for others may not work for you and your baby, so trial-and-error is needed here, as well as a lot of patience. The good news is that for most babies, sleep continues to improve over time regardless of which sleep training methods you use. Good luck!
4 min read

Constipation in Pregnancy

Expecting a baby is a joyful occurrence in life. Constipation in pregnancy is not. Recent statistics as many as half of all pregnant women may suffer from constipation at some point during pregnancy.Other sources report that bowel disorders during pregnancy are so common they may affect up to three-quarters of women.While it may be reassuring to know constipation is a fairly normal experience to have when you are pregnant, it doesn't answer the question of how best to find relief. Treating constipation in pregnancy looks different than it does when you are not pregnant. Find out what is and isn't recommended to find constipation relief in pregnancy.The American College of Obstetrics and Gynecology (ACOG) defines constipation as follows:According to the American Pregnancy Association, there are a number of factors that can cause constipation during pregnancy.Changing hormone levels, and in particular a spike in progesterone, can contribute to a sluggish gut. Progesterone is so important for helping your muscles to relax and expand as your baby gets bigger.But progesterone also has this effect on the gut muscles, which has an unintended side effect: constipation. To make matters even more uncomfortable, as one research study explains, when progesterone levels increase, this inhibits motilin, a hormone that stimulates the smooth muscles of the gut to contract. For many pregnant women, morning sickness symptoms and food cravings or aversions can throw off their usual dietary routine. The gastrointestinal system does not like change and may react with constipation and other unpleasant side effects like gas, bloating, cramping and pain.In general, eating a diet low in fiber is one of the main dietary causes of constipation in pregnancy as well as in other times of life. Another main cause is poor hydration.Inadequate intake of dietary fiber combined with too-low intake of water is a reliable recipe for constipation in pregnancy.For some women, pregnancy can cause nausea, vomiting, fatigue and other physical symptoms that may lead to inactivity. Inactivity can in turn lean to sluggish gut motility that causes constipation.While learning you are pregnant is exciting, it can also be stressful. In fact, all types of stress, both "bad" (distress) and "good" (eustress) impact your body in essentially the same way.Stress, worry and anxiety is normal and natural during pregnancy but it can also send your body into fight-or-flight mode. The American Psychological Association (APA) notes that stress of any kind can affect how and how rapidly food matter moves through your gut, which can lead to constipation.As the Mayo Clinic points out, one of the pregnancy supplements most frequently implicated in constipation is iron.Other medications may also contribute to constipation - always talk with your healthcare provider if you suspect constipation in pregnancy is linked to any medications or supplements you are taking. Always talk with your doctor before adding any new supplements.Pregnancy constipation can and does change as pregnancy itself progresses. This is due both to ongoing hormonal fluctuations at different stages of pregnancy and also because of physical changes.For example, the entire abdominal structure stretches and widens as your baby grows. This can put pressure on existing structures and internal organs, including the intestines, colon, rectum and bladder.The first trimester is when most women experience the set of symptoms commonly referred to as "morning sickness."In this first stage of pregnancy, constipation is more likely to arise because of sheer upset to your system as hormone levels spike and fall and your diet tries to adjust to symptoms like nausea and fatigueAs mentioned here earlier, progesterone spikes reduce gut motility and slow the progress of waste matter through and out of your body.As well, as John Hopkins Medicine explains, constipation naturally arises as your uterus begins to change shape and exert pressure on the intestines and rectum.During the second trimester, your baby really starts to grow. While the majority of morning sickness symptoms will begin to disappear, your growing baby will actually push your uterus up and out of the pelvic cavity, in part relieving the pressure on your intestines and rectum.However, for many women, the second trimester is the time when appetite increases. Increased food intake combined with back aches, body aches and pains and disrupted sleep can in turn cause constipation in the second trimester, according to John Hopkins Medicine.After experiencing constipation in the second trimester, you may feel quite hopeful that it will finally ease up in the third trimester.Unfortunately, according to John Hopkins Medicine, this is unlikely to be the case. The reason is because your baby is now large enough to once again put pressure on both your bladder and bowel, causing leaking in the former and constipation in the latter.The onset of hemorrhoids, another common pregnancy complication, may make constipation symptoms feel more intense.Treating constipation in pregnancy correctly is important both for your baby's health and safety and for your own.First step: try to resolve constipation naturally.The best first step is always to try to resolve the constipation symptoms naturally, as the American Pregnancy Association (APA) explains.As best you are able, try to increase fiber and water intake and daily exercise. The APA recommends aiming for 20 to 30 minutes of moderate exercise at least three times per week. Swimming and walking are excellent choicesHowever, always talk with your doctor before adding anything new to your daily diet or exercise routine.In some cases, it may be possible to switch to a different type of iron supplement or take smaller doses more frequently to ease constipation symptoms.Separating out iron supplements from your other prenatal vitamins can also help ensure you keep taking in appropriate levels of all.If possible, you may be able to work with your provider to take in more dietary iron instead of taking it in supplement form.Here again, never make any changes without talking with your doctor first.There are three general categories of medical remedies that your doctor may recommend for pregnancy constipation that does not respond to other things you have tried: stool softeners, laxatives and bulk-producing agents. The Mayo Clinic states that stool softeners are generally considered to be safe for use during pregnancy.The Cleveland Clinic also publishes a list of constipation remedies considered safe for use while you are pregnant.The American Pregnancy Association reports that Milk of Magnesia is one remedy that is also considered to be safe for use during pregnancy.Thankfully, constipation during pregnancy is considered a highly treatable symptom. Now you know you have multiple options to help your gut acclimate to the widespread changes occurring throughout your body.Always seek a doctor's guidance before treating constipation in pregnancy that does not respond to other natural lifestyle modifications. This is for your baby's safety.
6 min read

What is Egg Freezing?

Freezing eggs is a decision that some women may want to explore based on their lifestyle or health. There are many questions that surround the process of egg freezing and it can leave many feeling overwhelmed. Today we answer the most common questions asked and we also go into detail on how the procedure is completed. If you or someone you know is interested in freezing eggs for future use, then read ahead. Freezing your eggs can be done for a number of reasons ranging from wanting to get pregnant later in life to having certain medical conditions. Egg freezing doesn’t require sperm, unlike embryo cryopreservation. However, it will require you to take fertility drugs to start the ovulation process so that your body will produce multiple eggs. Those that might want to consider egg freezing are:Egg freezing is not something you want to take lightly. The first step you want to do is find a fertility clinic that has experts in this matter. These experts are commonly referred to as a reproductive endocrinologist. Each clinic you look into should list their data of live births, pregnancies, and some will even include the ages of the women they treat. This information can be found on a clinic’s website, an in-person consultation, and the Society for Assisted Reproductive Technology has more information on the data surrounding US fertility clinics. Before you begin the freezing process, you will have to undergo various testing. These tests include:There are 3 steps to completing the egg freezing process. The first is ovarian stimulation, the second is the egg retrieval, and the third is freezing.Egg freezing doesn’t happen without any risks. There can be complications due to the procedure or fertility drugs. Some of these risks include:This will depend on your insurance company. Some will pay for medication but not the procedure or the testing. Others will pay for testing only. Overall, egg freezing isn’t covered by most insurances, but some will cover partial or full coverage if you suffer from a special circumstance such as cancer or early menopause. Those that don’t have insurance that covers this procedure or any insurance at all may find a fertility clinic that can help finance you, you can fundraise money, look into getting personal loans, or even some government and state grants can be applied for. The cost of egg freezing varies depending on a few factors. One factor is the clinic you choose. Each one charges their own prices for the services they offer, usually between $7,000 and $12,000 and that cost includes the medication, procedure, and testing. The storage fees will vary based on the clinic as well, but many charges somewhere between $500 to $1,000 a year. There is also no time limit on when you have to unfreeze your eggs, but keep in mind that if you intend to get pregnant, many clinics have cut off ages unless you plan to use a surrogate. It’s best to check with the clinic on their policies first.Another factor is how many rounds you may need to undergo. As you age, your body will naturally make fewer eggs so while someone in their early 20s or 30s may need 1 cycle, mid-30s and late 30s may need 2 or 3 cycles to get the necessary amount of eggs needed for freezing. This also can be affected by your egg quality as well. If you have poorer egg quality, you may need to do several cycles. Unfreezing your eggs when you feel it’s time to try for pregnancy can cost around $5,000 to $7,000.
7 min read

What causes breast pain?

The real answer is . . . We don’t know. But we do know there’s a 99% chance it’s NOT cancer (Kushwaha et al.). Breast pain is extremely common and as many as 70% of women will experience it at some point in their lifetime (Kataria et al.). Sometimes it is a dull ache, like increased heaviness and sensitivity that corresponds with the menstrual cycle. Sometimes it’s in both breasts, sometimes only one. Pain which fluctuates with the cycle is called “cyclical pain”. What scares women is when it’s a sudden, sharp pain in one area in one breast. That is referred to as “focal pain”. Focal pain is more likely than cyclical pain in women in their 40s and 50s. In multiple studies conducted among women with focal breast pain and no other symptoms, 1% were found to have breast cancer. Breast cancer is far more likely to present with an abnormal finding on a mammogram or a lump in the breast, Regardless, we ALWAYS double check with imaging tests. The best test is an ultrasound to check the area(s) of pain and sometimes a mammogram as well. Occasionally the ultrasound will show a cyst in the area which is causing the pain, but most of the time, there’s nothing there.most commonly what’s seen is normal, healthy breast tissue and nothing which looks abnormal on the imaging tests. “So what’s causing my pain then, Doc? Can you fix it??” is the conversation which starts as soon as I tell someone we didn’t find any cause for the pain. The truth is hormonal changes in the breast are complicated and we don’t know the exact cause or the best treatment for breast pain. There are ongoing studies and theories, but we are still working on understanding the interactions between breast tissue and the rest of the body. Additionally there are other disorders which can cause referred breast pain, such as inflammation of the cartilage of the ribs. Even if the cause or an easy fix for breast pain has not been identified, there are treatment options available. Studies have shown that over 70% of women wear improperly fitting bras and switching to a more supportive bra or a sports bra will help. Non steroidal anti-inflammatories like Ibuprofen have also been shown to be effective in 80% of women (Kataria et al). For focal pain, there is a topical version of Ibuprofen which works better than other treatments. Relaxation techniques such as meditation and acupuncture which work for other forms of pain may also help. But as you probably noticed, none of these are treatments designed to treat only breast pain specifically. Studies on breast specific pills such as evening primrose oil and danazol have not had convincing enough results to recommend them for everyone. Additionally, they can have serious side effects such as diarrhea or facial hair growth. Most of the time breast pain goes away on its own, especially as we get older and our breast tissue becomes less active. Studies have shown that non cyclical breast pain may resolve on its own in up to 50% of patients (Kataria et al.). If not, changing bras and/or taking Ibuprofen may help. If none of the above works, there are other medications which are worth trying. Before taking anything, please discuss the risks and benefits with your doctor and decide on a plan that works for you. After reading this if you develop breast pain, what should you do? If it’s new and doesn’t go away in a day or two, see your primary care doctor or Ob Gyn. Make sure your care plan includes an ultrasound and/or mammogram and not just a physical exam. If your doctor doesn’t order an imaging test - don’t be afraid to ask about it. Your care plan is always something you should fully understand. If you’re worried about insurance coverage, new breast pain is a clear indication for an imaging test, even if you’ve had a normal mammogram recently. You should not have to pay out of pocket, provided your insurance covers imaging studies at baseline. Once you get the ultrasound +/- mammogram, be prepared for the results. Most of the time there won’t be a cause for your pain and sometimes that’s hard to hear. The most important thing is that cancer has been ruled out.Even if we don’t know the cause we do have treatment options. You will expand on your care plan with your doctor - you do not have to keep living with breast pain! In most situations, one of the above mentioned treatments works well, or in some women, the pain gets better on its own. It may take some trial and error to figure out the best combination of therapies for your pain. Rest assured, you will not need another doctor’s visit or repeat imaging.However, if the pain is persistent despite treatment or you develop new breast pain, have it checked out. Don’t assume it’s nothing because you’ve had negative imaging tests recently. You should feel empowered to consult your physician with ANY new breast symptoms, not just breast pain. And of course, if you’re over 40 or have a strong family history, make sure you get yearly mammograms and take control of your breast health!Dr. Amani Jambhekar MDBoard Certified in General SurgeryFellowship Trained in Breast Surgical OncologyKataria, et al. “A Systematic Review of Current Understanding and Management of Mastalgia.” Indian J Surg. 2014 Jun; 76(3): 217–222.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4141056/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4960349/https://www.ajronline.org/doi/full/10.2214/AJR.17.18879
5 min read

What is Dyspareunia: Causes, Symptoms, and Treatments

Dyspareunia is the recurring genital or pelvic pain that occurs when sexual intercourse or other related activities are attempted. Women with dyspareunia may feel a sharp or intense pain in the vagina, labia, or clitoris. The pain can occur during, before or after sexual intercourse. Though both men and women can experience dyspareunia, women are more likely to suffer from it. According to the American College of Obstetricians and Gynecologists, up to 75 percent of women experience it during intercourse at some point.  In this post, we will briefly discuss the common causes, symptoms, and treatment of dyspareunia.  The intensity of dyspareunia pain varies among women, depending on various factors. Women with this condition may feel superficial pain at the vagina’s entrance, or deeper pain when penis penetrates or thrusts.  Pain may occur: ●       in the urethra, bladder, or vagina.●       during or after intercourse●       during penetration●       in the pelvis during sex●       only during specific circumstances or with specific partners●       when using tampon ●       feelings of burning, aching, or itching●       stabbing pain, or pain like menstrual cramps  For some women, dyspareunia can be a sign of a serious health problem. That’s why it is important to understand the underlying causes of dyspareunia. Causes vary based on whether the pain is deep or superficial.  The Vagina feels dry when it secretes less fluids and this can cause pain. Also, as women grow older, the vagina’s lining becomes thinner and dry due to decreased estrogen levels.  Other causes of superficial pain may include: ●       Increased genital sensitivity to pain ●       Genital inflammation or infection ●       Inflammation of the urinary tract●       Genital injuries ●       Radiation therapy can cause changes in the vagina that can cause pain●       Involuntary contractions of the vagina called vaginismus●       Congenital abnormality or a hymen being present●       Narrowed vagina due to surgery or injury  Deep pain occurs during or after sexual intercourse and can be due to: ●       Infection or inflammation of the uterus, cervix, ovaries or fallopian tubes ●       Endometriosis●       Pelvis tumors and ovarian cysts●       Scar tissue between organs in the pelvis  Besides these, emotions can also affect sexual activity and pain. Emotional factors of dyspareunia include psychological issues, such as anxiety, depression, and relationship problems. Stress and history of sexual abuse can also cause this pain.   There are several ways to treat dyspareunia. Pain caused by underlying infection or conditions can be treated with things like moisturizers, antibiotics, antifungal medicines, and topical corticosteroids.  There are several home remedies you can try out: ●     Use water-soluble lubricants.●     Empty your bladder before sex.●     Have sex when both of you are relaxed.●     Calm burning after sex by applying an ice pack to the vulva. ●     Take a store-bought pain reliever before sex.  Make sure you consult with your physician if you feel intense pain. In more severe cases, doctors may recommend therapies, such as sex therapy, vaginal dilation, or desensitization therapy.   Though there is no particular prevention of dyspareunia, you can make some changes to try to reduce the pain. After childbirth, do not perform sexual intercourse for at least six weeks to avoid any injury or infection. Use proper hygiene and get adequate medical care. Use condoms to prevent sexually transmitted diseases, and use vaginal lubrication. If required, seek medical care before the issue begins to affect your life and relationship.    
3 min read

How to know if you have PCOS or Polycystic Ovarian Syndrome?

PCOS is also known as Polycystic Ovarian Syndrome. It is a hormonal imbalance that occurs in some women and adolescent girls. The condition is so common, up to 10% of all women may have PCOS. (Dumesic, Daniel A et al. )That means that one in every 10 girls or women have PCOS. So for example, if there is a room of 100 girls, 10 of them will have PCOS. Girls with PCOS have problems with their period. Some girls have no periods, whereas others can have very frequent periods. If your period happens more often than every 21 days or less often than every 45 days you should see your doctor as this can be a sign of PCOS. Some girls can go a year or more with no periods. It is important to understand, however, that menstrual periods can be irregular for up to two to three years after a girl starts having her period. Most physicians will wait to diagnose PCOS until a girl hs had her period for at least 2 years before saying it is irregular. (Legro, Richard S et al. Girls with PCOS can also have increased hair on their bodies in places that girls and women do not like to have hair such as their face, stomach, chest and lower back. Some girls with PCOS can also have severe acne. Girls with PCOS can also have a harder time losing weight or can gain weight more easily. Girls and women with PCOS also can have a higher risk of developing high blood sugars or a condition like Type 2 diabetes. Some girls with PCOS can also have feelings of sadness, anxiety or depression. If you are diagnosed with PCOS, this does not mean that you have “cysts” on your ovaries. Girls with PCOS usually have normal looking ovaries but they may look slightly bigger than normal. The enlarged ovaries usually do not cause any pain.Doctors don’t know the exact cause of PCOS but it is thought to be genetic, meaning that someone in the girl’s family most likely has PCOS as well but this is not always the case. In PCOS, there are specific hormones called androgen hormones that are higher than normal. One of these androgens is called testosterone and it is higher than normal. This imbalance in androgen hormones can cause the periods to be irregular because these hormones can prevent an egg from being released from the ovary every month. The higher testosterone level can also cause girls to have an increase in facial and body hair and can cause acne.
Usually your doctor will talk to you first about your symptoms and family history. Then they will want to do a physical exam. They will usually want to order some blood tests to help figure out if you have PCOS. Sometimes, an ultrasound of the ovaries is done to help understand if you truly have PCOS.The treatment of PCOS is geared towards what specific symptoms you have and what is bothering you the most. If you have irregular periods, usually the first line treatment is birth control pills. Many of the symptoms of PCOS like irregular periods, acne and frequency of growth of hair on the face and body can be controlled with birth control pills. You may also need to be treated by a dermatologist or laser specialist for acne and hair growth.For girls that are overweight, doctors will recommend weight loss with diet changes and exercise to prevent further weight gain or to start a weight loss program.Exercise and weight loss sometimes can help periods become more regular and they can help prevent diabetes. Exercise is also help with mood symptoms including anxiety and depression. Another commonly prescribed medication is metformin which is a medicine used to treat diabetes. Sometimes at higher doses of this medication, menstrual periods can return to normal.( Legro, Richard S, et al).Once girls are treated for PCOS, they generally are very well controlled. Girls and women with PCOS may be an increased risk of developing type 2 diabetes in the future. They may have a hard time getting pregnant in the future but this is not always the case. Girls and women should still use birth control pills to help prevent unwanted pregnancies if they are sexually active.Your doctor is always a good resource if you have other questions.Dumesic, Daniel A et al. “Scientific Statement on the Diagnostic Criteria, Epidemiology, Pathophysiology, and Molecular Genetics of Polycystic Ovary Syndrome.” Endocrine reviews vol. 36,5 (2015): 487-525. doi:10.1210/er.2015-1018Legro, Richard S et al. “Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline.” The Journal of clinical endocrinology and metabolism vol. 98,12 (2013): 4565-92. doi:10.1210/jc.2013-2350Witchel SF, Oberfield SE, Peña AS. “Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls. J Endocr Soc. 2019 Aug 1;3(8):1545-1573. doi: 10.1210/js.2019-00078. eCollection 2019 Aug 1. Review. PubMed PMID: 31384717; PubMed Central PMCID: PMC6676075.Carmina E, Oberfield SE, Lobo RA. The diagnosis of polycystic ovary syndrome in adolescents. Am J Obstet Gynecol. 2010 Sep;203(3):201.e1-5. doi: 10.1016/j.ajog.2010.03.008. Epub 2010 May 1. Review. PubMed PMID: 20435290.
5 min read
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