Dr. Chunjai P. Clarkson

I recommend seeing your doctor for a pregnancy test and examination. Irregular periods may be caused by a number of things, but the common things should be addressed first. If you have other serious signs or symptoms such as a fever, unusual vaginal discharge or abdominal pelvic pain you be seek care as soon as possible. Retained tampons can rarely cause toxic shock syndrome that may result in a rash. If you are not feeling ill, more likely the rash is not related to your periods and is a separate dermatologic or allergic condition such as urticaria (hives). Good luck with getting these issues addressed soon.

I usually recommend at least three cycles before trying to conceive again and that is a common standard among OBs There is not any data to support a specific time to wait of which I am aware. If this was her first miscarriage, I think it is fine to start trying. She should be taking a prenatal vitamin with folic acid to reduce the risk of birth defects. If she has had more than one miscarriage or there are any genetic diseases in either her or your families, it is advisable for her to have a preconception counseling appointment with her OB to see if any screening tests would be helpful or indicated. The ability to screen for genetic conditions has increased considerably in recent years. You can find more information at the ACOG FAQ site on prenatal genetic screening if you are interested.

Being a new mother is exhausting especially if you lack support at home or have other children to care for or you had any complications before or during delivery. Massages can be helpful for relaxation and treatment of specific problems. However, if you have recently delivered and are feeling very weak or tired you could be anemic. You should see your physician as soon as possible. A complete blood count can be checked to determine if you are anemic. You can also be screened for other issues such as elevated blood pressure and postpartum depression or occult infections such as mastitis.

There are several things this could be. Bladder infection or yeast infections are commonly seen. This should be evaluated by a healthcare provider as soon as possible as urinary tract infections untreated can lead to serious illness such as a kidney infection

This is most likely a benign cyst such as an endometrioma, but any cyst in a postmenopausal patient needs to be followed to ensure resolution. Size and complexity of the cyst on imaging are taken into account in determining management. A blood test can be done in conjunction with ultrasound, but it is more to guide the Obgyn in need for referral to a GynOncologist. There is not a reliable screening test for ovarian cancer yet so age of the patient, menopausal status, characteristics of the cyst, size of the cyst, change or growth noted on ultrasound or other imaging are criteria used to decide management. Family history such as breast or ovarian cancer, or known pathogenic mutations such as BRCA1/2 are also a factors to consider. A family history of ovarian cancer or multiple breast cancers, especially early/premenopausal cancers can be a reason to screen for hereditary cancer syndromes such as BRCA.

No, your chances of future pregnancy are very good if you ovulate normally, are otherwise healthy with no history or serious pelvic infections and have a partner who has normal fertility. Surgical abortions or dilatation and curettage or dilatation and evacuation which are done in the first and second trimesters respectively are very safe and rarely lead to complications. That is not to say that there is not a small risk of infection or injury to the cervix or uterus. Also having multiple abortions or D&Cs over time can lead to scarring within the uterus referred to as Asherman's syndrome. This is uncommon. It is important to see your Obgyn about a method of contraception that is best for you so you can avoid unplanned pregnancies in the future. You can also request preconception counseling to discuss any specific issues or concerns with the procedure you had and any other factors about your health that could impact future fertility. Once you have decided to try to conceive, make sure you take a prenatal vitamin as folic acid supplementation helps to reduce birth defects, specifically neural tube defects. Good Luck!

Ideally, you will not need a D and C. Most medical abortions are successful and the uterus completely evacuates the pregnancy tissue. However, there is a chance of an incomplete abortion or retained products and a D and C is needed in some cases. If there is persistent bleeding with clots and the pregnancy has not completely passed, then a D and C needs to be done. You should be seen for follow up to make sure the uterus has completely expelled the pregnancy. This can easily be done by checking an ultrasound and/or a urine pregnancy test or blood pregnancy hormone test. Sometimes a repeat dose of medication is given if clinically appropriate.

The HPV vaccine has significantly reduced the incidence of HPV infections in teenagers and young adults. Most cervical cancer and cervical dysplasia are due to HPV infection. Your daughter can have the vaccine as early as age 12. The vaccine should be given before a girl or young woman becomes sexually active to be optimally effective at protecting her from HPV infection. Insurance will cover the vaccine up to age 26 in the US.
The vaccine works by providing immunity against certain types of the HPV virus that are most strongly associated with cervical cancer (types 16 and 18) and with precancer. The Gardasil 9 vaccine protects against the viral types that cause the majority of cervical cancer and dysplasia. The HPV vaccine is very safe, but as with all vaccines, some very small risk is present and information on vaccine complication rates for these vaccines is available on the CDC (Centers for Disease Control) site.

Most likely soon. The mean age of menopause is 51. However, there is a range at which clinical menopause occurs (defined as one year with no periods) and some people experience menopause later. Bleeding after menopause should be evaluated with an exam and in most cases endometrial biopsy. Evaluation by an Obgyn would be a good idea since endometrial cancer and hyperplasia (precancer), and benign conditions such as endometrial polyps, uterine fibroids are often seen in the perimenopausal and postmenopausal years. It is also the perfect time to go over menopausal symptoms, risks/benefits of hormonal therapy, cancer screening etc.

You may just need more time. If a year has passed and you still have not conceived, you should have a preliminary fertility evaluation. If there are other factors such as irregular cycles, or age over 35, prolonged infertility, history of tubal surgery, or male factor issues, then an earlier evaluation is advisable. Ovulation kits can be helpful for timing intercourse. Avoid using regular lubricants because some are toxic to sperm.

Start now. It's best to be on them as early as possible so that if you conceive unexpectedly, your developing embryo will have the benefit of folate, which helps prevent neural tube defects.

Intense pain should be evaluated by your Obgyn doctor or nurse practitioner.

Pregnancy is associated with dramatic physiologic changes including increased blood volume and cardiac output. Increased heart rate and fluctuations in heart rate are common and can be normal. However, persistent palpitations can indicate underlying disorders of the heart such as frequent pre ventricular contractions (PVCs). A baseline EKG, exam for abnormal heart sounds, lab studies, and sometimes a referral for Holter monitoring and echocardiogram might be ordered. Very severe or prolonged symptoms due to abnormalities of heart rhythm are treated with medication. Make sure you stay adequately hydrated, as this can affect heart rate as well.

Your risk for another ectopic is increased. It would be best to consult your Obgyn for a pre-conception discussion. Be sure to see your doctor early after a positive pregnancy test so that hormonal levels and ultrasounds can be done to determine whether you have a normal intrauterine pregnancy.

If there is itching or odor, it could be an infection. There is also an increase in whitish discharge in pregnancy due to high estrogen levels. This is called physiologic leukorrhea.

Herpes is usually a cluster of small blisters on a red base. Hpv lesions are more like little growths or genital warts. Have an experienced healthcare provider look at them.

You may have a urinary tract infection. Masturbation should not cause incontinence.

Yes

Oral contraceptive pills are useful for regulating menstrual cycles.

It is important to complete the course of antibiotics prescribed by your doctor. Chlamydia can cause longterm damage to your fallopian tubes or develop into a more serious pelvic infection referred to as PID (pelvic inflammatory disease) if untreated. Untreated infection can lead to fertility problems and pain. Treatment of your partner is necessary as well with re-testing in a month or two to make sure the infection has cleared. Unfortunately, our healthy gut flora also referred to as microbiome suffers when we take antibiotics. I recommend taking probiotics to offset this effect on the beneficial colon flora. There are many brands of probiotics available. Choose one with multiple bacterial strains of lactobacillus and bifidobacteria with at least 5 to 10 billion cells per dose. It’s also important to consume a diet that supports the growth of healthy colon flora, one that is rich in organic vegetables, and to avoid or limit the things that harm the microbiome such as soda and alcohol. Best of luck!