Dr. Cynthia S.b. Tucker, MD

The average age of menopause is 51, although some women can continue periods until a later age. I am assuming that you haven’t had bleeding for a while and this is new bleeding. The most worrisome causes of bleeding after menopause are cancer and pre-cancer of the lining of the uterus. It can also be cause by a very thin lining that is cracking. It is IMPORTANT that you see a physician for evaluation which should include a vaginal ultrasound to assess the thickness of the lining. If it is over a certain thickness, and endometrial biopsy (done in the office by sliding a thin tube through the cervix in to the uterus) or a D&C (dilation and curettage, usually done as an outpatient surgery) to get lining cells for a pathologist to look at to rule out cancer or pre-cancer. Once that is done, treatment varies depending on the circumstances.

AGAIN, IF THIS BLEEDING IS OCCURRING AFTER MENOPAUSE, IT IS ABSOLUTELY NECESSARY AND IMPORTANT TO SEE A PHYSICIAN FOR EVALUATION.

Hope this helps,

Cynthia Tucker, MD

The recommendation following a classical c-section is typically at least a year before conceiving. Even with a transverse cut on the uterus, it is recommended to wait at least a year. If you should get pregnant before that time, you run an increased risk of placenta previa or the placenta growing in to the scar on the uterus (acreta or increta). That risk is increased in classical c-sections. Placenta acreta/increta increases the risk of hemorrhage at delivery and increases the possibility that emergency hysterectomy may be needed.

Cynthia Tucker MD

While birth control pills work by adding hormones to stop the ovaries from ovulating, it is not “bad” for your hormones. It is a temporary effect while taking the pills and resolves without affecting the function of the ovaries after you stop taking the pills. If you have been “googling”, there may be information you find about the first pills to come out. These were extremely high doses (180/250 mcg of estradiol vs. 20/35 mcg estradiol in the current pills). The extremely high dose pills, if used for a long time, could affect the stimulation of the ovaries for an extended time after stopping them. With the strengths available today, the ovaries return to normal function (whatever your cycles were like prior to starting the pill) within 3 months and usually within a month after stopping the pill.
Make sure you follow the instructions you are given regarding starting the pill to know when the pill will be effective for you. Remember, pills do not prevent sexually transmitted diseases. Condoms are the only thing that reduces that risk.

Cynthia Tucker MD

Hi,

Unfortunately, nobody knows what actually causes fibroids (leiomyoma). These are fiber tumors that do not become cancer and they are pretty common (1/3 of women, higher rates in hispanics and blacks). Many times they do not cause problems. However, if they are located right under the uterine lining, even small fibroids can cause heavy bleeding. I know there are diets that are touted to reduce or prevent fibroids but these diets are not effective. It would be like saying a diet could prevent moles. Many times, fibroids are just observed depending on the severity of the symptoms and size. They typically will grow over time but how fast varies significantly from woman to woman.
Treatment options including – observation, removal of the fibroids, embolization (similar to a cardiac catheter but where they try to block blood vessels leading to the uterus) and the definitive treatment – hysterectomy. Since we don’t understand what causes them, new ones can appear and only hysterectomy would prevent these since there would no longer be a place for them to occur.

Hope this helps,

Cynthia Tucker, MD

Hi,

Not only does the flu shot not cause any defects or adversely affect a pregnancy, it is highly recommended by a number of medical groups. I urge my pregnant women to get one.

As far as the flu, the baby isn't directly affected but mom can be seriously affected. Because the immune system is depressed in pregnancy it is not only easier to get the flu, it is much more likely to be a severe form. If mom isn't eating, is running a high fever, or is getting very dehydrated, that will affect the pregnancy and baby, maybe even severely. Tamiflu is okay to take during pregnancy, but is not effective against all strains of influenza.

Hope this helps. I would highly encourage you to get the vaccine.

Cynthia Tucker, MD

Hi,
I am not sure what your doctor may mean. Fluid in the pelvis can only be detected on ultrasound or other imaging (CT, MRI). There are a variety of reasons that there can be fluid in the pelvic area. There is a normal amount of fluid present. You can see increased fluid for a short time following ovulation or rupture of an ovarian cyst. The fluid may be blood, which can be seen during the period. Fluid can also be present with some very serious problems, such as ovarian cancer or cirrhosis of the liver which would usually result in a large amount of fluid that is not just in the pelvis but throughout the abdomen. Typically with these issues, there are other things found in the imaging. There are a couple medical problems that can also lead to increased fluid, but again, that is typically not the only symptom.

So, ultimately it depends on what else is going on. Good luck,
Dr. Tucker

Hi.
It depends on what the heart condition is, what the underlying heart function is and what is being used to control it.
This would be an excellent question for your cardiologist.
Most likely, you would need to see a Maternal-Fetal specialist (perinatologist) for a consult and for the management of your pregnancy.
Like most chronic problems, many cardiac problems get worse as you age, so if you are considering pregnancy, the earlier you have it, the better the outcome is likely to be.

Good luck,
Cynthia Tucker MD

Hi,
No imaging study is perfect. Ultrasounds may not detect fibroids if they are small or if the sound doesn’t ‘bounce’ off differently than the surrounding muscle of the uterus.
Sometimes there may be other clues to the presence of a fibroid such as the change in shape of the tissue around it (for example, a bulge in the surface of the uterus or a dent in the lining).
Ultrasound is the best imaging study for the uterus/pelvis, so a CT would not be helpful.

You don’t give your symptoms, but it is likely that any fibroid too small to be detected would not have symptoms associated with it.

Hope that helps.
Cynthia Tucker MD

There are many potential reasons. The most common reason is that you are building lean muscle mass which weighs more per volume than fat. If you are noticing your clothing is fitting better, this is probably the case. Eventually, you will start seeing changes in the scale. The second is that your food calorie intake has increased at the same time. It usually requires a combination of activity and low calorie diet to lose weight, especially as we get older.

Hang in there. Even if the scale isn't changing, you are doing good things for yourself. Remember, you don't see the weight you would have gained if you weren't exercising.

Cynthia Tucker, MD

Hi, bloating and gas are a common experience in pregnancy. The hormones effect the intestines, usually by slowing them down which gives the intestinal bacteria more time to create gas, which then causes bloating. It is safe to take GasX and Digel during pregnancy. Other than increasing fiber intake (I would avoid Metamucil as some bacteria will process that type of fiber but other fiber products without that type of fiber can help) and avoiding foods that make you gassy. If you have a food/drink which 'makes you go', that might help as well.

There should be no problem going for a massage 3 months after a c-section. Activity restrictions are usually for 6 weeks.

It depends on how long the bleeding lasts and how heavy it is. Depending on how far along the pregnancy is, she may see the pregnancy pass. Usually when that is happening, bleeding will be heavy and there will be bad cramping.
If she is having bleeding where she is soaking through a regular menstrual pad in an hour and it goes on for more than 2 hours, she needs to be seen and evaluated. If the bleeding continues for more than 1 week without decreasing, then she needs to be evaluated.

There is no question it will affect the menstrual cycle, typically causing bleeding a few days after taking and shifting the hormonal cycle as well. Using the I-pill as a routine method of birth control is not recommended for a variety of reasons and will not be effective every time. If you are not using a method, even condoms, you should seriously consider using another method and saving the I-pill for emergency situations - like the condom broke.

Fat converts some hormones into other hormones. This includes estrogen and progesterone which are part of the menstrual cycle. Increased production of these hormones can result in the ovary not producing eggs regularly. Some women can develop PCOS as a result of the hormone shifts. Fortunately, losing weight can reverse this situation.
If you are having regular predictable periods, that usually means you are ovulating. You can check this with over the counter ovulation tests (but don't use those to decide when to have sex - the egg is only viable for 12-18 hours and you may miss your window). If your periods are more than 32-34 days from start to start, you may also have difficulty conceiving.
Remember that the connection of ovulation to period is not from the start. Once ovulation occurs, the ovary produces progesterone for 12-14 days and then stops if there is no pregnancy. The drop is progesterone is what triggers the period. You can estimate when you are likely to ovulate if you are having regular periods. Back up 2 weeks from when you expect your next period, that is likely when you will ovulate. You want to spread your focus time at least 5 days before and after. During that time you want to have unprotected sex at least every other day but not more than once a day. If your periods are unpredictable, this is hard to do.
If you have been trying actively to have sex during your fertile time and have not conceived, it may be time to see a gynecologist who has experience in treating infertility or a reproductive endocrinologist (a specialist in fertility treatments). There are pills that can help some women ovulate before having to look at IVF.

Even the most regular woman can experience weird cycles from time to time for a variety of reasons. I wouldn't worry about it unless it becomes a frequent thing.