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3. My first baby was born by Cesarean. Will I need to have another Cesarean? 4. I am 35 years old and hoping to become pregnant soon. What are my risks because of my age? 6. I have been told that my uterus in enlarged and that I have fibroids. What is this? 7. My periods used to be every 28 days, but now they come every 2 to 6 weeks. What is wrong? 10. I have a lot of pain with my periods and have been told I have endometriosis. What is this? 11. I have an abnormal Pap smear. What should I do?
If you have any medical problems now or in the past, you should be evaluated before conceiving. For example- if you have had high blood sugar (diabetes), your blood sugar needs to be in excellent control before you conceive, in order to prevent birth defects and lower the risk of miscarriage. It is also important to have good nutrition and consume folic acid daily at a dose of 0.4mg or 1mg if there is a family history of a specific type of birth defect. There are many other things that should be addressed before conception. This is a good reason to schedule a preconception visit with Dr. Randell. 2. I am pregnant and need to take medication prescribed by another doctor. Is this safe during pregnancy? Some medications for ongoing medical problems need to be taken throughout pregnancy in order to keep those problems under control. No one can guarantee the safety of any medication during pregnancy, so we have to weigh the risk of taking the medication against the benefit. In general, during the first three months, only medications essential for your health should be taken because this is when the babyís organ systems are forming and any birth defect potential would be maximal. After that there is less risk to the baby, except for a smaller group of drugs. This is a problem that should be discussed with Dr. Randell before conception. It is never a good idea to stop any prescribed medication without first discussing it with your doctor. 3. My first baby was born by Cesarean. Will I need to have another Cesarean? Assuming that the uterine incision was made low in the uterus (not the abdominal incision that you can see), most women may attempt a vaginal birth after Cesarean (called VBAC). Under these conditions we encourage an attempt to deliver vaginally. There is however a risk in this and that is the uterine scar can break down. This unfortunate event can occur in up to 1 percent of labors after C-section. The decision to attempt VBAC should be a mutual decision made by you and Dr. Randell. The literature suggests that successful VBAC occurs in 75% of attempts. 4. I am 35 years old and hoping to become pregnant soon. What are my risks because of my age? Older women appear to have an increased risk of several things when they become pregnant. Medical problems such as high blood pressure and diabetes are more common. Miscarriage rates increase and fertility rates decrease. However, one of the biggest concerns is that the older a woman is when she gets pregnant, the greater the risk of certain chromosomal abnormalities. The most commonly known one is Down's syndrome, however other syndromes caused by the same mechanism are also increased. Women who are 35 at the expected date of delivery are offered genetic testing. The final decision about getting tested however, is that of the patient, not the doctor. 5. I am 51 years old and having irregular periods and hot flashes. Is this menopause and how long will these symptoms last? The average age of menopause in the US is 52. The classic definition of menopause is one year without any periods, however, symptoms can occur much earlier. The classic symptom of menopause is the hot flush or flash. Problems that arise because of decreased estrogens at menopause are significant. The most worrisome is an increase in coronary heart disease and stroke, but there are other significant problems such as osteoporosis (thinning of the bones), urinary bladder and pelvic support problems, Alzheimer's disease, etc. We know that estrogen replacement therapy will markedly reduce or eliminate many of these problems. For this reason we offer estrogen replacement to all women at menopause unless there is a medical reason that precludes its use. The source of hormone replacement can be by pills or skin patches. 6. I have been told that my uterus in enlarged and that I have fibroids. What is this? The uterus is about 98% muscle. When tumors in this muscle develop we call them fibroids. Only rarely are they cancerous. These muscle tumors can distort to uterus and enlarge it sometimes leading to abnormal bleeding. They can also cause pressure symptoms and problems by pressing on adjacent structures in the pelvis. These can lead to bladder, kidney, bowel problems, pain, etc. The management of the fibroids depends upon their size and the symptoms they are causing. There are times when treatment is not necessary. Surgical treatment is also necessary in some cases. There are also techniques, currently considered experimental that cut off their blood supply and make them shrink. Each case needs to be individualized. 7. My periods used to be every 28 days, but now they come every 2 to 6 weeks. What is wrong? There are several causes for abnormal uterine bleeding. Hormonal imbalance involving the thyroid gland, adrenal gland, pituitary gland, or ovaries may be the culprit. The other common cause involves structural abnormalities of the uterus, cervix, or vagina. These include polyps, uterine fibroids, precancerous changes or even cancer. It is obviously extremely important to be evaluated promptly when these problems occur. Many times these evaluations can be entirely performed in the office. Sometimes however, the evaluation requires surgery such as hysteroscopy usually done as an outpatient. 8. I am 60 years old and haven't had a period for 9 years. I have just started bleeding again. Is this a problem? Most bleeding after menopause is due to a benign condition, however cancer needs to be ruled out. All postmenopausal bleeding (defined as bleeding after a one year absence of periods) needs to be evaluated promptly. 9. We have been trying to get pregnant for the last year and a half and have been unsuccessful. What can be done? Fertility problems occur in about 15% of the population. Approximately 35% of couples with difficulty conceiving have more than one problem going on. A full evaluation is important to find out the exact cause of the fertility problem. Areas targeted for evaluation include the sperm count, ovulation, an analysis of the Fallopian tubes, various hormones, etc. After evaluation a treatment plan can be instituted. 10. I have a lot of pain with my periods and have been told I have endometriosis. What is this? The lining of the uterine cavity is called the endometrium. If this tissue gets outside of the uterus it can implant and grow is various areas of the pelvis and abdomen. This is called endometriosis. It is a common cause of pelvic pain and can cause infertility. The location and extent of the endometriosis as well as the degree of symptoms would determine the treatment necessary. Treatments that Dr. Randell uses range from observation to medical therapy, to minor and major operative procedures. Treatment must be individualized. 11. I have an abnormal Pap smear. What should I do? A Pap smear is a screening test for cancer, however; the vast majority of abnormal Pap smears are not due to cancer. Some abnormalities are due to inflammation or inadequate numbers of cells, and may be managed merely by repeating the Pap smear following treatment of the cause of the inflammation. Pap smears showing atypical or precancerous cells are best evaluated by a procedure called colposcopy. During this procedure, Dr. Randell examines the cervix, vagina, and vulva using magnification. Areas of abnormality are sampled and a management plan is developed. Many minor abnormalities are merely observed by means of frequent Paps combined with periodic colposcopy. Some abnormalities are treated using electrical, Laser, or infrequently cryosurgery. If cancer can't be ruled out by means of colposcopy, then a more extensive biopsy of the cervix called a conization needs to be performed. When you have a Pap smear done, be sure that you know the results and follow any instructions Dr. Randell gives you. Osteoporosis is a thinning of the bones and is most frequently seen in postmenopausal women. It is a silent process that makes the bones become weak and brittle. When the bones are affected by this disease, a minor fall can cause a fracture which sometimes requires major surgery (e.g. a broken hip). This disease has nothing to do with arthritis, which involves the joints. Hormone replacement therapy or other medications can minimize osteoporosis. Adequate calcium and vitamin D in addition to weight bearing exercise maximize the effects of medication. It is also important for teenagers and young women to maximize their bone mass (strength) by being sure their diets contain adequate calcium (1200 mg per day). Refraining from smoking and minimizing alcohol also helps. 13. I have a vaginal discharge and irritation that is not going away with the medicine I bought in the drug store. What should I do? There are many causes for these symptoms such as infections with viruses, Trichomonas, bacteria, yeast, etc. The only way to find out what is causing the problem is to have an examination with a microscopic evaluation of the discharge. Over the counter medication is all right to use for the symptoms listed on the label, but if the problem doesn't respond, an exam by Dr. Randell is necessary.
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