Trying to conceive is an exciting time and a little preparation can help improve your experience and the likelihood of a healthy child. Good health before and during pregnancy will ensure the safest environment for your baby to grow. Here are some tips that can help prevent problems that may affect you or your child’s future health:

Exercise

One of the best things you can do to help your long-term health, including during pregnancy, is to exercise. This decreases inflammation, reduces stress levels, and has been shown to decrease the risk of pregnancy complications, such as gestational diabetes or hypertension. Physical activity does not increase your risk of miscarriage, a low birth weight baby, or early delivery. If you have any medical problems, it is important to discuss with your provider what types of exercise may be suitable for you.

Balanced diet and vitamins

Eating a well-rounded diet including adequate fruits and vegetables will help prevent a nutrient-deficiency, such as iron or vitamin D, which can cause problems for you in pregnancy. Most women are able to get adequate nutrition in their diet. For women with a modified diet, like gluten-free or vegan, it may be beneficial to supplement other nutrients and should be discussed with your healthcare provider or a nutritionist. In the month prior to attempting pregnancy, regardless of diet, it is helpful to start supplementing 400 micrograms of folic acid daily, which has been shown to decrease the likelihood of neural tube defects in the baby.

Healthy weight

Maintaining a healthy weight is important to optimize your reproductive system. Obesity has been shown to decrease fertility and increase the risk of pregnancy complications for both mother and child. Underweight women also experience effects on fertility and increase the risk of a low birth weight baby, who is at risk for problems during labor and may have behavioral or health problems that last through childhood. Your provider can offer recommendations to help you reach a healthy weight range.

Control stress

Stress hormones can affect your menstrual cycle and have been shown to decrease fertility. In addition, studies have shown women in stressful jobs, have higher rates of preterm delivery and preeclampsia, a potentially dangerous complication of pregnancy. While it is impossible to remove all sources of stress, learning how to limit and physically handle stressors can decrease their impact.

Limiting caffeine

Significant caffeine intake can increase your heart rate, lead to dehydration, and increase stress hormone levels. In small doses, likely less than 200mg or 12oz of normal strength coffee, these changes are unlikely to affect your health or the pregnancy. Spacing out the caffeine intake and drinking enough water can help prevent issues.

Work to stop drinking, smoking or other drugs

Pregnancy can be a great motivator to decrease use of harmful substances, as many have been shown in studies to cause adverse outcomes in pregnancy. There is no level of alcohol use that has been proven to be safe in pregnancy so it is recommended to abstain. Alcohol use can also decrease both male and female fertility for some. Smoking cigarettes while pregnant can increase the likelihood of having a low birth weight baby and other adverse events.

See your healthcare provider

Most women would benefit from a preconception visit with a healthcare provider. This visit can help assess any medical problems, medications, personal or family history that could affect your pregnancy or your ability to get pregnant. Your provider will help to determine what testing, vaccinations, and medication changes may be recommended, as well as any other risk factors that require intervention. She can also review your menstrual cycle and determine the best time for you to discontinue your current contraception or time intercourse to promote fertilization.

Optimizing your health prior to trying to conceive will give you the best chance for a healthy mother and child, and our providers are here to help get you ready.

A woman’s sexuality is a complex mix of many physical and psychological responses, which can affect the way a woman thinks and feels about herself and her relationships. More than 40% of women in the United States report some kind of sexual dysfunction, according to a study published in the Journal of the American Medical Association (JAMA). While common, problems with sex often cause personal distress and can interfere in the relationship with a partner. Many women are hesitant to discuss these concerns with their providers and some women have had their concerns dismissed by healthcare providers in the past, left to suffer in silence.

Sexual Dysfunction

Women can experience problems in any of the stages of sexual activity, including desire, arousal, or orgasm. Psychological and intrapersonal issues can have a significant effect on all aspects of sexual function. It can be helpful to discuss your concerns with your partner and many couples benefit from individual or partnered counseling with a therapist trained in sexual dysfunction.

Sexual desire varies greatly from woman to woman, and can fluctuate from one time to another throughout a woman’s life. Lack of sexual desire is a common issue for women, with a national survey showing a third of women reporting this concern in the past year. When this causes personal distress, it is known as Hypoactive Sexual Desire Disorder (HSDD).

During the arousal stage of sexual activity, there is typically increased blood flow to the clitoris and vagina, increased lubrication and relaxation of vaginal muscles. An interruption in this can be caused by many factors, including medical illnesses, such as diabetes or thyroid disease. Medications also can affect the arousal response, and often there are alternative drug options that may have a less significant effect on libido. Along with your symptoms, it is important to inform your provider of any medications you are taking.

The absence or delay in orgasm can result from problems with desire or arousal, or from a variety of medical or physical factors. Issues with orgasm are most common in young women, but can occur at any stage of life.

Many women experience urinary incontinence (leaking urine) during intercourse, especially common in women after pregnancy and during menopause. For many, this can cause embarrassment and anxiety that prevents enjoyable sexual activity.

Painful Sex

Painful sex affects 2 out of 3 women at some time in their lives, according to the American College of Obstetricians and Gynecologists (ACOG). There are some causes that are temporary, such as a vaginal infection or changes in hormones or medications. But others causes can remain until addressed. Occasionally, pain with sex can be a sign of a more significant illness, infection, or tumor, a reason discussing your symptoms with a provider is important.

Vaginal dryness is a common cause of pain, which can result from taking birth control pills or other medications, or following cancer treatments or menopause. Pelvic floor spasms are also commonly found in women who experience painful sex. These spasms can result from previous painful experiences, such as a pelvic infection or sexual assault, or in some cases occur spontaneously. Once a woman experiences pain during sex, anxiety can arise with future activity that can interfere with other aspects of sexual function, creating a negative feedback cycle.

Research in sexual health has become more commonplace in modern medicine and new diagnoses and treatments are being discovered every year. The GYN providers at Rittenhouse Women’s are trained in assessing and treating many causes of sexual dysfunction. We offer several treatment options, procedures, and new technology to address painful sex and related issues in the office, including:

• Behavioral and medical treatments for decreased desire, dryness, and pain
• Pelvic floor injections for muscle spasms leading to painful sex or pelvic pain
• ThermiVa® for dryness, vaginal laxity, pain, incontinence, and decreased sexual function
• O-shot® (Plasma-rich protein injection) for decreased arousal, unsatisfactory orgasm frequency/intensity, and urinary incontinence

It is important to discuss symptoms with your provider, as sometimes they can be a sign of a more significant problem. Do not suffer in silence.

Why are we recommending “annual” dermatology skin checks? Well, because the most important strategy in combating skin cancer is early detection. By having a proper screening by a licensed dermatologist yearly, you significantly reduce the chance of developing skin cancer.

Skin cancer is the most common cancer that anyone will face and one of the only cancers that can be seen on the surface of your skin. Yet, one in five Americans will be diagnosed with skin cancer in their lifetime and one person dies from the deadliest form of skin cancer, melanoma every hour.

The most common cause of skin cancer is sun-damaged skin. It is also important to know, that this means all levels of damage; not just sunburn. No matter the season, any unprotected exposure can cause damage to the skin, because natural skin has no protection from UV rays of the sun.

Skin cancer can be broken up into two basic categories; melanoma and non-melanoma. Non-melanoma includes basal cell carcinoma and squamous cell carcinoma. When non-melanoma affects the head and neck, this will present as a sore or bump that does not disappear. On other parts of the body, non-melanoma can appear flesh colored or a brown tinted scar that often bleeds or releases a liquid substance. Generally, basal cell is characterized by a smooth, white appearance, while the squamous cell bumps are rough.

To spot melanoma, dermatologists suggest using the ABCDE rule. Even when doing your self-exams and using the ABCDE rule, remember that not all irregularities are problematic:

• Asymmetry – does one side have a different shape than the other
• Border- is it irregular, scalloped or poorly defined?
• Color- is the color varied from one area to another?
• Diameter- is it greater than the size of a pencil eraser?
• Evolving- is it changing from what it once looked like?

Always prepare for your annual dermatology skin check by doing a head to toe self-exam and note any concerns to take with you to your visit. You are primarily looking for spots or bumps that are new, that do not go away, and that change in color, size shape, or all three. At the time of your visit, point out any abnormalities to your dermatologist who will closely examine any moles, growths, or lesions you noted and may even take a biopsy if needed.

Remember, the two best ways to reduce your risk of skin cancer is to protect your skin from the sun and have your annual dermatologic skin checks!

Many women across the US suffer from heavy periods. For some it is only an inconvenience, but for other women it can interfere with their daily activities or lead to health issues like anemia. Heavy bleeding can be a sign of a benign growth in the uterus, such as a polyp or fibroid. While some women experience a normal increase in menstrual bleeding as they get older, heavy or increasing bleeding should be evaluated to rule out abnormal growth in the uterus that could lead to cancer over time.

There are several medical treatments that can help with heavy bleeding, but typically this response is temporary. Many women are looking for more definitive treatment to help control their cycles. In the past, women with heavy periods that have completed childbearing were often treated by a hysterectomy (surgical removal of the uterus), which has significant risk of complication and often requires a hospital stay. As a result, lower risk procedures have been created for women who wish to keep their uterus, avoid major surgery or who are not good surgical candidates.

The most effective of these procedures is called endometrial ablation, which is the destruction of the lining of the uterus. This procedure is minimally invasive and does not require an incision. Previous techniques involved using electric current with a rollerball or circulating hot water in a balloon to destroy the lining. These procedures were technically difficult to perform and limited in their success.

Current technology uses plasma or radiofrequency energy to more effectively target the uterine lining, increasing success rates and decreasing risk of complications. These procedures are performed without a hospital stay and can even be done in the office, avoiding the risk of intravenous anesthesia.

The Minerva device, the newest of the endometrial ablation technologies, has a soft conforming balloon, which increases comfort during the procedure. It also takes only 120 seconds to run, making it an ideal procedure to be performed in the office. Due to its design and energy source, it is the most effective of current ablation options, with 66% of women having no more periods after the procedure and a 98% satisfaction rate.

While endometrial ablation is not a form of contraception, it is not recommended that women get pregnant after it is performed, as there is an increased risk of serious complications. If desired, an additional procedure for sterilization can be performed at the time to address this concern.

Prior to endometrial ablation, evaluation of the uterine cavity and sampling of the uterine lining is performed to assess for abnormalities. This is done by hysteroscopy (camera in the uterus) with endometrial biopsy, which can also be performed in the office with minimal discomfort.

Most insurance companies currently cover hysteroscopy and endometrial ablation, making it an affordable and effective option for diagnosing and treating heavy periods.
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If you are experiencing increased or heavy bleeding, you should see your provider for evaluation and to discuss which treatment options are right for you.

Everyday I have patients ask me, “Why am I still breaking out? I thought acne was just for teenagers!”. Unfortunately, this is a myth and more and more women are dealing with acne into the 20s, 30s, and 40s. Skin specialists are not sure what is causing this increase in acne, but it is our new reality.

Why do we treat acne?

Acne can have a huge impact on a woman’s self esteem so early treatment is paramount. These days, almost all cases of acne can be treated successfully. The best results occur when treated early. If left untreated, scarring and hyperpigmentation can occur which can be permanent.

What treatments and solutions do we have for you?

Our DermaCenter medical spa can treat acne with chemical peels such as Environ’s Tca peel, which can combat acne by killing bacteria in the skin, controlling oil production and removing dead skin cells from the surface which will break up congestion allowing the skin to breath and products to penetrate more effectively. For best results Environ’s TCA peels should be done 3-4 weeks apart. We also have Environ’s Sebu line which includes various products specifically designed to treat acneic skin.

What can I do at home?

There are many over the counter products geared at treating acne. If you have mild-moderate acne, these over the counter regimens can be very helpful. Ingredients to look for include:

1. Benzoyl peroxide- kills the bacteria responsible for acne
2. Salicylic acid- helps breakdown blackheads and whiteheads. Also helps cut down the shedding of cells lining the hair follicl
3. Sulfur- helps breakdown blackheads and whitehead
4. Adapalene- new to the over the counter market, this is a vitamin A derivative (in the same class as Retin A). This medication regulates skin cell turnover to keep pores from clogging as well as reducing redness and inflammation.

Just because these medications are over the counter does not mean they are free of side effects. Burning, dryness, and redness are common and will often go away with time. If you experience severe or prolonged side effects, stop the medication and come in to see us.

It is important to realize that any treatment regimen for acne takes time. The life cycle of a pimple can be up to 8 weeks, so patience is key. Before stopping any medication for lack of benefit, give it 8 weeks for the best chance of success.

OTC products didn’t work, now what?

If the over the counter products were not successful, it’s time to head into the office for more advanced treatments. There are many prescription options for treating acne these days. Depending on the history and severity of your acne, your provider may start with a topical medication. These include: antibiotics and vitamin A derivatives either alone or in combo with other medications.

Oral medications treat acne in a more systemic way. For individuals with moderate to severe acne on the chest, back and face, a course of oral antibiotics may be warranted to control acne. Some women may have hormonally influenced acne. Clues that this may be the case include: excessive hair growth, acne only on the jaw/lower face, premenstrual acne flares, or irregular menstrual cycles. In these cases different medications such as birth control pills or anti-androgen drugs (spironolactone) can be utilized.

For individuals with severe nodular or cystic acne, oral isotretinoin (Accutane) can be very effective. This is a Vitamin A derivative taken once or twice a day for 15-20 weeks. If reduces the size of oil glands leading to a reduction in oil production and decreased growth of bacteria. Though very effective, this medication certainly has its downside. Isotretinoin is known to cause birth defects, so it is imperative that women are not pregnant and do not get pregnant while taking this medication. Two forms of birth control are required when taking this drug and blood tests are often followed to monitor for any organ damage. Given the extensive monitoring required, this medication is generally only prescribed by dermatologists.

Is there anything else I can do?

Here are some basic tips from the American Academy of Dermatology to help you get the most out of your acne treatments:

1. Wash twice a day and after sweating
2. Use fingertips to apply a gentle, non-abrasive cleanser- washcloths/mesh sponges can irritate skin
3. Be gentle with your skin- use alcohol-free products and avoid astringents/toners and exfoliants if they irritate your skin.
4. Rinse with lukewarm water
5. Shampoo regularly- especially if you have oily hair
6. Let your skin heal naturally- no picking!
7. Keep your hands off your face throughout the day
8. Stay out of the sun and tanning beds

May is National Osteoporosis Month and we wanted to take the opportunity to share information on this condition which affects many women.

Osteoporosis is defined as a progressive loss in bone mass and density which can cause the bones to become thin and weak. When bones weaken, they can easily fracture, especially on the spine, hips, and forearms. Fractures caused by osteoporosis can lead to significant decrease in quality of life and increased risk of mortality.

Of the 10 million estimated Americans who have osteoporosis, about 80% of them are women. Women naturally have smaller and thinner bones than men, but are also at greater risk of bone loss after menopause due to lower levels of estrogen. This is because estrogen helps to protect and maintain bone density, so the decreasing levels of estrogen that occur in menopause lead to increased risk of osteoporosis.

Fortunately, there are plenty of preventative, diagnostic and treatment measures to help maintain, detect, and/or increase bone density. We will primarily discuss the preventative measures available to help maintain or increase your bone density.

The optimal diet for preventing and treating osteoporosis requires consuming adequate calories, as well as, appropriate amounts of Calcium and Vitamin D. The current nutritional recommendations for Calcium and Vitamin D are:

Calcium:

• Pre-menopausal women should consume at least 1,000 mg of Calcium per day, which includes foods, beverages, and supplements
• Post-menopausal women should consume 1,200 mg per day
• It is not recommended to take over 2,000 mg of Calcium per day due to risk of side effects
• The best sources of Calcium in our diet are: milk, yogurt, cottage cheese, hard cheeses, and green vegetables, like kale and broccoli

Vitamin D:

• Pre-menopausal women should consume about 600 International Units (IU) of Vitamin D each day
• Post-menopausal women should consume 800 IUs per day
• Milk supplemented with Vitamin D is one of the largest sources of dietary Vitamin D. Other good sources are salmon, cod liver oil, mackerel, and tuna fish

Another important preventative measure for bone health is exercise. Physical activity helps to increase bone mass, as well as increase muscle strength which reduces the chances of falling due to weakness. Most experts recommend exercising for at least 30 minutes three times per week for bone health.

It is also important to note things to avoid if you are at risk for Osteoporosis:

• Alcohol: Drinking alcohol excessively (average of more than 2 drinks per day) can increase the risk of fracture due to increased risk of falling and poor nutrition
• Smoking: Smoking cigarettes is known to speed bone loss. One study suggested that women who smoke one pack per day throughout adulthood have a 5 to 10 percent reduction in bone density by menopause, resulting in an increased risk of fracture

The risk of Osteoporosis is evident in women, especially in post-menopausal years. To further discuss prevention, detection, and treatment of this condition, please schedule an appointment with one of our medical providers today.

There’s no denying that gluten, a protein found in wheat and other related grains such as rye and barley, has gained a bad reputation in recent years. So much, it seems, that gluten-free food products are a fixture on many restaurant menus and grocery store shelves, and gluten-free diets and cleanses are now ingrained in popular culture. Despite its ubiquity, however, a gluten-free lifestyle is not necessarily warranted and may even be harmful for those without a known predisposition to gluten sensitivity, such as Celiac Disease. May is Celiac Disease Awareness Month, and now is a better time than ever to bring our attention to gluten and understand its activity in the digestive tract.

Celiac Disease is a chronic autoimmune medical condition that is triggered by the ingestion of gluten in those who are genetically predisposed. The presence of gluten in the small intestines of people with Celiac Disease induces an inflammatory response, which, over time can cause structural changes in the intestinal wall and lead to malabsorption of important dietary vitamins and minerals. Other possible manifestations of Celiac Disease are numerous and include gastrointestinal symptoms such as abdominal bloating and pain, chronic diarrhea, foul-smelling stool, and myriad possible extraintestinal symptoms such as chronic migraine, peripheral neuropathy, fatigue, mood changes, and rash. Celiac Disease can also be asymptomatic. In such cases, a diagnosis is made after patients who are at-risk are screened. Risk factors include having a first-degree relative with Celiac Disease or a personal history of other autoimmune disease such as Type 1 Diabetes or a thyroid disorder. Diagnostic testing consists of serum antibody measurement and/or genetic testing in addition to biopsy of the small intestine. Celiac Disease is somewhat rare in the general population, affecting approximately 1 in 100 people, and there are currently no recommendations that support universal screening for this disorder. The only treatment for Celiac Disease is strict adherence to a gluten-free diet.

A related condition that is still poorly understood, yet thought to be caused by an immune response to gluten is called Non-Celiac Gluten Sensitivity. People with Non-Celiac Gluten Sensitivity will exhibit similar symptoms as those with Celiac Disease, but will test negative for Celiac Disease on blood testing and biopsy. Furthermore, their symptoms will resolve after excluding gluten from their diet. The prevalence of Non-Celiac Gluten Sensitivity and the demographic characteristics of affected patients are currently unknown, but further investigations are underway to help better understand this clinical entity.

Despite the hype, gluten is innately harmless for those without a known history of Celiac Disease and those who do not have gastrointestinal or extraintestinal symptoms that resolve on a gluten-free diet. Further, gluten-free versions of common foods such as bread and other baked goods may actually be less nutritious than the original. Gluten-free foods often contain higher amounts of calories and might lack fortification with important micronutrients like folate, thiamine, and riboflavin when compared to their gluten-containing counterparts.

If you are concerned about the possibility of Celiac Disease or Non-Celiac Gluten Sensitivity, please talk to your healthcare provider about ways to diagnose and manage these conditions. If you are already adhering to a gluten-free diet for any reason, a Registered Dietician may help guide you towards full and well-balanced nutrition and a healthy life.