Dr. Victoria J. Mondloch, M.D.

Spotting and late for your cycle usually means late ovulation or a cycle where you didn’t ovulate at all so there is no typical rise and then fall in Progesterone to trigger your uterine lining to shed or to bleed. This usually will give patients a ‘bleed every 2wks x 3’, then the body resets, you will ovulate and then regular cycles resume. Things that cause the anovulatory bleed or missing your cycle are usually stress related, and EVERYONE has stress these days. So realize your next 4wks may have 3 separate spotting/bleeding episodes and then you will ‘reset’.

The first question to ask is did they tell you what organism was causing the UTI? Or did they say you had UTI sx’s because of the yeast infection? Or do you have both a UTI AND a yeast infection going on? You see, you need to know the answer to these questions to know how to best proceed. If all they did was a urine dip check, it only showed + WBC’s (White Blood Cells) which signal EITHER possible bladder infection or possible vaginal fall-out because of a vaginal reaction to the yeast infection. So the answer isn’t as simple as it sounds. Best thing to do is to drink 128oz or 1 gallon of oral liquids with 64oz being water and 16oz in electrolytes. Then to help answer the bladder infection question, check with the hospital to see if they actually ran a urine culture so they can tell you the offending bacteria that is causing the UTI, then you know what antibiotic is best to be treated with. If they didn’t do a urine culture, then I recommend taking either cranberry juice as part of your 128oz oral fluids daily or take cranberry pills with your 64oz of water daily. Then I also recommend cutting all simple sugars from your diet (simple sugars feed a yeast infection) and treat yourself with a vaginal Monistat cream daily for 1-3days based on symptoms; Monistat is perfectly safe in pregnancy. If Monistat is too costly, then it’s a messy alternative but some patients have success with plain yogurt placed vaginally (you’ll never think of yogurt the same again). Pregnancy can mimic symptoms of bladder and yeast infections without actually having either one; it’s always best to check in with a healthcare provider to be certain; Urgent Care’s are very expensive and won’t usually do the level of exam or lab that a doctor’s office will do for less money; but it’s ultimately your choice.

Yes, you will hear a pulse rate which should be YOUR pulse rate in your pelvis from either the lower aorta or the iliac arteries that come off of the aorta separating into Right and Left so that they can continue down to your legs and feet. An adult heart rate should be between 60-100 at rest; a fetal heart rate will usually require a Doppler ultrasonic heart tone detector using gel on your abdomen because picking up a fetal heart rate inside of a uterus, inside of a sac with fluid takes magnifying that signal and cutting out background noise to pick up. And a fetal heart rate will typically run between 120-160 or more so it is very different from an adult heart rate AT REST. Hope this helps.

You ask an age-old question: can an infectious virus that can spread via contagious serous fluid from a lesion that is acting up be a cause of spread to another person? Absolutely. However, even with herpes simplex virus or HSV, the prodrome or pre-lesion irritation or discomfort is a signal that you have active and contagious virus that you can spread via direct contact skin to skin, skin to vaginal mucosal tissue or even oral mucosal and skin tissue. The contagious nature of HSV is the same whether it is the cold sore HSV-1 or the genital HSV-2; but know that HSV 1 can occur in an HSV-2 area and vice versa. The best way to check for HSV in an asymptomatic patient is by HSV antibodies via blood test to HSV-1 and HSV-2; doing a culture has a very low yield and does not give reliable results. Hope this helps.

You are right in that every woman knows her body and knows her menstrual cycles. So when things change and either periods get lighter and out of routine, then we know something is off or out of balance. Especially when we’re trying for conception, we are sometimes very focused on trying and we tend to focus too much; this can actually raise our AM Cortisol, one of the foundational hormones that controls our wellness and that rise in Cortisol can actually upset our female hormone balance of Estradiol (E) and Progesterone (P4). If our E+P4 get so out of balance that we can actually impact ovulation; that means we continue to make E but no P4; then it’s not possible to get pregnant because you aren’t ovulating. If you can get your d21 labs drawn for E, P4 and AM Cortisol (draw before 9AM), then it confirms what you have going on. Sometimes taking Vitamin B Complex with methyl Folate/methyl B12 is enough to settle an AM Cortisol and get back to an ovulatory cycle; but sometimes you need to supplement the P4 with bio-identical P4 and sometimes you actually need to supplement with both E and P4. If you still are not ovulating, then you may actually need to work with your doctor as you may need some help pushing your ovary to make follicles by taking Clomid d5-9 of your cycle. You need to be carefully monitored for excess follicles or BP side effects or even ovarian hyperstimulation side effects.

Of course, sometimes every woman will just have an ‘off’ period and you don’t ovulate but then you DO ovulate the next month; so sometimes waiting it out, and doing an ovulation stick ($1 at the Dollar Store) can help you determine if you are indeed ovulating or not. If you are, then realize you don’t always get pregnant just because you have an ovulatory cycle; if may take a few cycles for everything to work; patience is a virtue. But if you have any questions, do not hesitate to contact your doctor; you may actually need no more than someone following your levels but you may need a little more medical help.

What you are describing is not unusual. In fact, the likely reason is that with menopause and lack of Estradiol that comes with menopause, the pH of the vaginal vault goes from it’s natural acid pH of approx. 4.5-5.0 to a more neutral or even slightly alkaline pH of 7.0-8.0. With this change in pH comes an imbalance in the approx. 30 bacteria that help maintain the healthy balance of a woman’s vaginal vault. And along with this change in bacterial balance, there are 2 ‘normal’ bacteria that can overgrow and cause problems: 1) Gardnerella which has a ‘rotten fish’ odor and this is called Bacterial vaginosis or BV; it is treated with an antibiotic gel called Flagyl placed directly in the vaginal vault. 2) Strep B which has no malodor at all but can cause itching, irritation and even bladder infection; it is treated with an antibiotic orally as the risk of strep getting into the bladder is a higher risk of that strep travelling from the bladder up into your kidneys. These patients are called strep carriers and once their bladder gets strep, it can be a regular trip to the doctor for antibiotics. The best treatment for both of these conditions is actually bio-identical hormone replacement orally or at least Estradiol vaginally as a cream or as a ring. Check in with your healthcare provider about how to best be certain that any vaginal infection or overgrowth is properly treated and then how to properly ‘reset’ the vaginal pH to prevent further issues.

I can sense your frustration; you are 33yo and your clock is ticking. But be reassured, your peak ovulation is only when the egg is actually released on d14-15 of a typical 28day cycle. The body’s ability to achieve conception is actually up to 6-7days pre-ovulatory and 36hours post-ovulatory. Sperm can live in the Fallopian tube up to 6-7days as they remain viable; the female sperm will last ‘longer’ as then swim slower and the male sperm swim faster and use up their food supply in the head of the sperm so they do not usually last the entire 6-7days pre-ovulation. So if you are able to use this information to help time your intimacy with your partner, then this should help.

Gambling on holding up ovulation is a little risky as it involves shutting down your cycles and hoping that they return on a schedule that may work for you; that could take 6-12months to actually achieve by using the pill to shut down your cycles and then allowing them to return. And NEVER let someone talk to you about using a synthetic Provera in oral or shot form as it causes infertility as well as it is the culprit for the rise in breast cancer, stroke and heart attack associated with the Women’s Health Initiative so synthetic Provera is essentially poison.

Talk to your healthcare provider/doctor and get a plan together to learn how to maximize your ovulation schedule.

Most women are well aware that they are likely to get pregnant around ovulation; however the timing of your cycle that is ‘most dangerous’ is actually 6-7days pre-ovulation and 36hours post ovulation. So if your periods are regular and predictable, count back from your cycle starting (day 1) and if your cycles are 28days and you had relations 10days before your cycle, it is a low likelihood you are pregnant. However, the best approach is always to do either a home urine pregnancy test (pee on a stick) or have your doctor do a blood quantitative HCG or blood pregnancy test to be certain. Why? Because one of the most dangerous options is an ectopic pregnancy where you may become pregnant and it’s in the tube; this type of pregnancy can cause abnormal bleeding and it can rupture your tube leading to internal bleeding and even hemorrhage/death.

Understand that immunizations help you to build a targeted immune response to that you are immunized against; in this case the HPV type 16 and 18 virus or the original HPV vaccine which is against the HPV types 4, 11, 16 and 18. There are literally over 100 HPV subtypes with another 13-15 subtypes that are also considered high risk but not as high risk as 16 and 18. So you are not even fully protected against all HPV even after receiving the HPV vaccine; so by this explanation, it is no guarantee at all that you can utilize the vaccine to protect against HPV infections. Topical HPV warts are usually types 4 and 11 but there are other subtypes that are responsible for the external warts as well. And you would have to be certain that your vaccine covered ALL of the external wart subtypes so again, there is no guarantee that the vaccine will protect you against these warts.

You are right to ask if all 3 of these issues/symptoms may be related; and they may. My first step would be to check your foundational hormone levels of 1) Estradiol, Progesterone, Total and Free Testosterone, 2) Full thyroid panel: TSH, Free T3, Free T4, thyroglobulin antibody and thyroid Peroxidase antibody, 3) AM Cortisol and Vitamin B12 and 4) Fasting blood glucose (FBS) and fasting insulin (4hr fast). Knowing the results of these tests and whether your hormone levels are in balance or out of balance is crucial to know; taking medication doesn’t help reset your body’s balance. Ask your healthcare provider to do these blood tests for you; if they are unwilling or unable to do this for you, then you need to find someone who will do these tests for you.

A vibrating sensation may represent a muscular twitching which can be a result of electrolyte shift (sodium/potassium), calcium metabolism (high or low) or you may have a stressed or pulled muscle from increased upper body physical activity; even putting away Christmas decorations if you over do your normal activity can cause an overstretch and possible microtear of the muscles between your ribs. As a wellness physician and OB-GYN, I would check these levels; I would also make sure your foundational hormones are balanced. My recommendation is to check with your chiropractor to be certain you haven’t displaced a rib which could stress your intercostal muscles (muscles between the ribs); also check with your healthcare provider and get your full thyroid panel, AM Cortisol, 4 hour fasting glucose + fasting insulin and complete metabolic panel (CMP). I also recommend female/male hormone balancing as the female hormones, Estradiol and Progesterone are research proven to decrease risk of ALL MORTALITY by 39%. This is US research done at USC in 2015 but not widely known or even promoted by doctors because of the prior controversy with artificial hormones studied in the Women’s Health Initiative that promoted artificial hormones and increased risk of cancer, heart disease and stroke whereas the USC research with human based bio-identical Estradiol showed a 32% reduction in cardiovascular disease (heart attack and stroke) and the previously mentioned 39% reduction in ALL MORTALITY, including CANCER! If you are intrigued by this answer, then I encourage you to get a copy of my book, Full Bloom: Perimenopause, Menopause, PostMenopause and Beyond as I outline more of the research that helps us debunk the myths and put forth the truths of bio-identical hormone replacement for women of ALL ages. Full Bloom is available as written and Kindle versions on Amazon.

Fetal movement is one of the best signs that a baby can show it’s mother; together with regular prenatal check-ups that keeps the mom’s health its best is one of the best ways to insure a healthy baby. Before a baby starts its process of dropping into the pelvis in preparation for labor, the fetus has an ability to move at will. So imagine that your baby’s head is dropping into a tight space with the uterus starting to cramp and push your baby’s head deeper into that tight space so fetal movement will react to that; movement is normal and lack of movement is concerning. It is always a good idea to ask how this process is affecting the health of your baby; so that is why your doctor or midwife will see you weekly toward the end of your pregnancy and check the progress of how well your baby’s head is dropping into the pelvis to be certain it is not too stressful or difficult for your baby’s head to fit. Decreased fetal movement can mean many things that could lead to your baby under stress which can advance to distress; this is why you are monitored for how your baby’s heart beat responds to contractions throughout labor. So here’s to a healthy end of your pregnancy, a normal labor and delivery process and a healthy mom and baby when labor is done! Congratulations in advance!

Having cramping initially can be a symptom of the uterine muscle starting to stretch and the uterus trying to contract back. The cramping can also be the round ligament stretching but that is usually a sharper pulling pain that goes to your groin (the normal distribution of where your round ligament actually goes). If I understand your question correctly, a blood serum HCG of 9,000 was done; you are able to see a fetus with a beating heart at 5wk 2days so being told it’s too early at 9,000 is incorrect. The exception may be that you are pregnant with twins which would show 2 sacs by Ultrasound before it would show a fetus. However, you may have an empty sac or empty sacs or 1 sac with a fetus and 1 sac empty; in any of those cases, the placenta is what is registering the HCG test of 9,000. So if it is a singleton pregnancy with a single sac, your dates may actually be off; or you may also have a 2nd pregnancy sac in the tube or an ectopic; this can also give pelvic cramping with an empty uterus. And of course it’s possible to have a pregnancy in the uterus and in the tube at the same time; the ectopic pregnancy in the tube is a medical emergency that will grow and rupture the tube causing internal bleeding, possible hemorrhage and can be fatal so make certain you quiz your healthcare provider about all of these possibilities before settling on the explanation you are given.

You ask a great question; but a better question is are you perimenopausal with hormone swings that are leading toward menopause? When menstrual bleeding has dysfunctional bleeding or every 2wk bleeding, it usually means you missed ovulating the month before so you didn’t make Progesterone, giving you an unstable uterine lining that continues to grow so you bleed ‘on time’ at approx. 28days, but then you bleed again in 2wks to finish the lining that you didn’t bleed out at your ‘period’; then you ovulate that month so you bleed again 2wks later. So a true dysfunctional bleed is bleeding every 2 weeks x 3, then your body ‘resets’ and if you ovulate again, then you are back to a monthly bleeding cycle. This type of irregular bleeding happens more commonly with the hormone swings of perimenopause leading to menopause. If you would like a little more information about what else to expect from this time of your menstrual career, check out Full Bloom: Perimenopause, Menopause, PostMenopause and Beyond on Amazon by Dr. Victoria J Mondloch; it is an easy to read reference.

Primary amenorrhea is a very precise diagnosis and implies that you have already seen a GYN and perhaps even a specialist who has done some type of work-up. If I was running that type of work-up, it would include:

1. Hormone bloodwork to include ALL of your hormones that are governed by your pituitary gland
2. Pelvic US to understand if your female organs are intact and to rule out any congenital abnormality
3. Do your genetics to be certain that you are not missing an X chromosome; this is called Turner’s Syndrome and primary amenorrhea is associated with this
4. If you are very athletic or underweight for height, then you may have been improperly diagnosed primary amenorrhea as there is an etiology for your lack of periods.

If you have not had this level of medical investigation, then you need to advocate for your health and find a doctor who will run this level of work-up for you.

My first question is ‘what might you have inserted into your cervix and how far in do you think it went?’

The reason I ask this is to settle a few common misconceptions about the cervix. The cervix is quite protective; it is approx. 1.25inches or 2cm long in a woman who has never birthed a baby so that is quite a distance to pass something into and then through the cervix before entry into the uterus occurs. The cervix is also quite hard; if you tap on your forehead, that’s the relative hardness of your cervix so it doesn’t easily allow any foreign object to simply penetrate. As your cervix would prepare to have your menstrual period blood pass through, it will soften enough with a normal protein called prostaglandin; this happens with the drop in Progesterone at the end of your 28day cycle and triggers your uterus to let go of the lining that it build during your 24 days or so of not bleeding (whether you are on the pill and making very little lining or whether you are working with your own hormones).

To give you some perspective, one of the ways that a pregnant cervix is prepared to induce labor if it is still ‘hard’ is to use a prostaglandin suppository that is placed in the posterior vaginal fornix underneath the cervix to help soften it and start the natural process of labor. This may take 1 or sometimes more suppositories to get the cervix prepared and soft enough to then respond to the forces of contractions and labor in order to birth a baby but it’s a process.

To give you another perspective, when a cervix has an abnormal Pap smear and a LEEP procedure is done, approx. 10mm of abnormal cervix tissue is electrocautery removed with a hot wire loop and sent as a tissue biopsy to the lab to make certain all of the abnormal tissue has been removed and the margins are clear. The body will regenerate that missing cervical tissue but it may not be as strong as it originally was. That means that in many women, they are watched in pregnancy to be certain their cervix doesn’t prematurely dilate causing preterm labor.

This is a very involved timing question with regard to a very deadly disease. HIV is usually not a single exposure transmission risk but that is never a guarantee; this type of exposure needs professional follow-up to ensure that you are not the unlucky one in the minority who would have exposure and then positive testing.

The causes of fatigue is really the question that you are asking here: and the answer has multiple possibilities. The obvious answer that may not be the correct answer is lack of quality sleep or adequate sleep cycles while breast-feeding your 6month old. The 2nd most common cause of fatigue is low Ferritin/low iron. Ferritin is the protein that carries iron and is the best way to check for iron. Most breast-feeding moms have this cause overlooked as they are told ‘you’re not having periods so you shouldn’t be low in iron’ but it overlooks the loss of blood at time of delivery that you may not have adequately had time or nutrition to rebuild your iron stores. Simply checking an Hgb/Hct or CBC may not be good enough; checking a ferritin level is the most accurate. If you are unable to get this checked or cannot make it into a lab to get a blooddraw, then start liquid iron 1 teaspoon daily as it will not cause constipation and will more quickly raise the ferritin count.

If poor sleep quality is happening, then the question to ask is would you be comfortable taking a melatonin or 5-HTP supplement or do you feel it would prevent you from hearing your baby in the middle of the night? Only you can answer this question.

If low female hormone or low Estradiol is the reason for poor sleep quality, this will not recover until you decide to stop breast-feeding. Moms who have resumption of periods during breast-feeding will at least make SOME Estradiol but the amount that you will make is low and usually inadequate to cover for low Estradiol production.

Lastly, do not underestimate the psychological impact or your mental health on your physical health; take a walk daily or do something just for you everyday; your mental health depends on it.

The answer to your questions needs a little more background information to correctly address your issue. Any patient on the pill needs to address these few basic issues:

1. How long have you been on this pill? It can take up to 3-6months for your body to adjust to being overridden by artificial hormones of the pill.
2. Have you missed any pills in your pack? Missing even 1 pill can trigger breakthrough bleeding that can last
3. How much stress plays a part in potential break-through bleeding
4. If you had recent surgery as this type of physical stress can cause bleeding, even when patients are well established on their pill dose
5. If you were placed on antibiotics recently for ANY reason
6. If you are an undiagnosed polycystic ovary patient who would already have underlying hormone swings on their own with excess Testosterone production that could actually show as breakthrough bleeding
7. If you have undiagnosed uterine polyps or fibroids, you may bleed through artificial hormones due to the mechanical abnormality of the uterus

These are the most common reasons for breakthrough bleeding; if you have other potential circumstances, then please readdress this questions with more background information.

Your question is a good one: but I have a question for you, Why did they leave the Word catheter in for 6wks? That is much longer than usually recommended so your body was starting to not only consider the catheter a part of your labia but it started to build an epithelial or outside skin lining on the inside of your cyst based on the rubbing of the catheter inside of a mucosal cyst; epithelial tissues have their own gland openings and the tissue is like the back of your hand vs the inside of your mouth; it’s tougher so it will appear swollen. I would ask your doctor why the catheter was allowed to stay in place that long.