Dr. Richard T. Burke, MD

Good Afternoon,
Good question. Ovarian cysts do not cause odors. A vaginal odor is usually the result of an infection. Your doctor will most likely take vaginal cultures during your visit.

Hello.
First off, great question. Second, do not listen to your pharmacist, please talk to you Ob/Gyn about this. If a patient needs to be on an anti-depressant and gets pregnant while on one, I usually do not stop it during pregnancy. Lexapro is quite safe during pregnancy, as is Zoloft. The one medication I would strictly avoid is Paxil, as we now know of its teratogenicity during pregnancy. Most anti-depressants are SSRIs (selective serotonin re-uptake inhibitors) and these are category C and considered safe after weighing the risks and benefits. I would certainly talk to your OB/Gyn and your psychiatrist about this decision (not your pharmacist). Good luck and start your prenatal vitamins!

Yes, it is completely safe to have intercourse during your entire pregnancy.

Richard T. Burke, MD

I am a huge proponent of massage and chiropractors after a delivery. Your entire body has just gone through a very dramatic change in a short time frame. Your muscles would certainly benefit from a massage.

Unfortunately there are no real great medications to shrink ovarian cysts. Certain birth control pills which contain drosperinone can help minimize cyst formation, but often times a large ovarian cyst has to be surgically removed

The current recommendations for a small cyst is to repeat an ultrasound in 6-8 weeks to assess for any change in size or complexity. With a history of endometriosis, it is most likely a benign hemorrhagic cyst and can resolve on its own. It does not indicate cancer, but the repeat ultrasound is done to make sure it does not change or appear cancerous. I agree with your current physician's recommendations.

Absolutely.. Many women suffer from the same issue called premenstrual dysphoric syndrome and can be treated with anti-depressant medications such as zoloft for the week or so before menses starts. You can also consider going on a continuous form of birth control pills that allow you to have only one or two periods a year, thus limiting the amount of times you experience the mood swings.

Fibroids can cause preterm labor, preterm birth, miscarriages and fetal malpresentation (breech or transverse as opposed to cephalic ((head down)). It depends on the size and the location of the fibroid. Your doctor is most likely referring to a surgery called a myomectomy which removes the fibroid while keeping the uterus in order to have a pregnancy. I would speak more with your physician about the size or consider a second opinion.

This can be normal due to scarring (adhesions) that form after surgery. Often times it will resolve over time but unfortunately can be a side effect of having abdominal surgery. Talk to your Obstetrician whom did the cesarean section about a possible ultrasound to look for ovarian cysts as well. Feel better

Most likely yes it will improve after delivery. Most women experience some incontinence, especially in the third trimester as the uterus enlarges and presses on the bladder, as these two organs are adjacent to one another. After you have the baby, this problem usually resolves quite quickly.

It would depend on which medications you are currently taking. Some are safe during pregnancy while others are not. I would schedule a preconception discussion with your obstetrician and bring the list of medications you are currently prescribed.

Having one abortion should not alter your ability to conceive or carry a pregnancy in the future. There is a rare condition called Ashermann's syndrome which can occur after a very aggressive dilation and curettage (D&C) but is very rare. I would make sure you use good contraception until you are ready to start a family, but most women have no issues having a child after an abortion.

That would depend if all the tissue came out after the medication was taken. I recommend a follow up ultrasound to ensure the uterus is empty. If it is, then you do not need a D&C.

Hello,

Great question to ask. Most patients whom are started on metformin are given it to control blood sugar levels in diabetes and also in patients with polycystic ovarian syndrome (PCOS). Determining if metformin is needed for your entire life is difficult to answer. Often times, patients are able to lose weight and eat a healthy diabetic diet and keep blood sugars in range without using any medications. However, the likelihood of needing metformin for a long period of time is quite common.

Richard T. Burke, MD

Good question,

A surrogate pregnancy is usually when a woman carries a child for another couple. The egg and the sperm are placed inside her in order to develop. Therefore, the surrogate's features should have no influence on the genetics of the fetus. If the surrogate was also an egg donor for that pregnancy, then the fetus would have her genetic composition.

Sincerely,

Richard T. Burke, MD

Hello,

Great question. This topic is extremely common. Most often, a white discharge is associated with either a yeast infection or bacterial vaginosis. Yeast infections are common after oral antibiotics are taken and can also occur randomly if the vaginal pH is altered even slightly. Bacterial vaginosis (BV) is an overgrowth of the normal vaginal flora (bacteria). This also can occur with even slight alterations in the vaginal pH. I recommend having a vaginal culture done at your GYN office and they can provide treatment options. If there is itching, you can also try an over-the-counter anti-fungal cream available at all pharmacies.

Sincerely,

Richard T. Burke, MD

Hello,

This is a great question. I manage a lot of couples that are trying to conceive and often the best thing is to be patient. We do not consider a couple infertile unless they have been attempting conception for 12 (yes, twelve) consecutive months. Using an ovulation calendar is a great idea, there are even multiple phone apps to help. The most important thing to know is what each day number means:

Day One: the day you start your menses, whether you menstruate for 3 day or 5 or 8, it does not matter. The first day is marked as Day 1 on your calendar. Most women will ovulate 14 days later. This makes day 14 very important as well. I counsel couples that some women may ovulate a bit sooner or a bit later than day 14 and I recommend unprotected intercourse on days 14, 16 and 18. Sperm is viable for 72 hours, so this gives you a total of 7 days in which viable sperm can reach the egg.

There are also ovulation kits available at any pharmacy which measure the LH (leutinizing hormone) in your blood and help predict when you are ovulating. If after 12 consecutive months, you are not pregnant, please consider discussing with your physician. Good luck and make sure you have already started a prenatal vitamin.

Sincerely,

Richard T. Burke, MD

Good afternoon,

You pose a great question! From a Western medicine approach, we do not truly know how this treatment works. However, it has been shown to increase multiple medical ailments. It is believed that by detoxifying and cleansing the body, many ailments can be improved, if not treated. I am a huge proponent of thinking outside the box when it comes to failed medical treatments and I encourage you to proceed. Please let me know if it is successful, as I will recommend it to my refractory patients.

Have a wonderful day,

Richard T. Burke, MD

Great question.

During your menstrual cycle, the blood can change the pH of the vagina and make yeast infections or bacterial vaginosis more prevalent. I would recommend having a vaginal culture near the tail end of your menses to check for these issues. Blood is an irritant and the vagina is very sensitive, and it can become worse after the birth of a child as well.

Sincerely,

Richard T. Burke, MD

Great question. Most over-the-counter meds are going to be safe in breastfeeding. Benadryl can be used, especially at night, because it may make you drowsy. Dayquil is also fine if only used for a day or two, it should not decrease the milk supply. Vitamin C and airborne are also good options.

Feel better,

Richard T. Burke, MD