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Folic acid is a critical supplement—for every woman of childbearing age...

By Michelle Koellermeier, MD
Obstetrician/Gynecologist

I have the great privilege of caring for women during their pregnancies and bringing new life into this world. Since January is National Birth Defects Prevention Month, I thought it would be good timing to highlight one thing I stress to all patients I see of childbearing age: make sure you are taking a prenatal supplement that contains folic acid.

Only 50% of pregnancies are planned, so any woman who could become pregnant should make sure she's getting enough folic acid.

This is something I emphasize with these patients because by getting enough folic acid every day, especially before conception and during early pregnancy, a woman can help prevent serious birth defects in her baby.

Folic acid, sometimes called folate, is a B vitamin (B9) found mostly in leafy green vegetables like kale and spinach, orange juice, and enriched grains. It helps the body to produce red blood cells, white blood cells, and platelets.

Repeated studies have shown that women who get 800 micrograms (0.8 milligrams) of folic acid daily prior to conception and during early pregnancy reduce the risk that their baby will be born with a serious neural tube defect (a birth defect involving incomplete development of the brain and spinal cord) by up to 70%.

The most common neural tube defects are:
• Spina bifida (an incomplete closure of the spinal cord and spinal column)
• Anencephaly (severe underdevelopment of the brain)
• Encephalocele (when brain tissue protrudes out to the skin from an abnormal opening in the skull)

All of these defects occur during the first 28 days of pregnancy—usually before a woman even knows she's pregnant.

Research has also found that, when taken before and during pregnancy, folic acid may also protect against other birth defects, including:
• Cleft lip and palate. In one study, women who took multivitamins, got at least 400 mcg of folic acid daily, and ate a healthy diet had the lowest risk of delivering a child with an opening in the lip (cleft lip).
• Pregnancy complications. One report found that women who took folic acid supplements during the second trimester had a reduced risk of pregnancy-induced high blood pressure—a serious condition known as preeclampsia.
• Premature birth. A study found that women who took folic acid for at least a year before getting pregnant cut their chances of delivering early by 50 percent or more.
• Low birth weight.
• Miscarriage.
• Poor growth in the womb.

Folic acid supplements are available at pharmacies and most drug stores. Folic acid is also contained within many vitamins such as One-a-Day Women’s multivitamins. Pay close attention to the dosage in each pill, however, as 800 micrograms (0.8 milligrams) of folic acid per day is recommended for women of childbearing age. It is best to talk to your doctor first about the appropriate dosage of folic acid for you, especially if you are taking other medications.

Dr. Michelle Koellermeier is an Obstetrician/Gynecologist at the Neenah location of Women’s Care of Wisconsin. Contact Dr. Koellermeier at 920-729-7105 or meet her here.

About Women’s Care of WisconsinThe providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, midwifery, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at www.womenscareofwi.com.
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Healthy babies begin with healthy mothers...

My pager goes off in the middle of the night. Sleep can be enjoyed another time. I am needed at the hospital reminding me of the important role the people of Women’s Care of Wisconsin play in the lives of other people, our patients. As obstetricians, we have the privilege of guiding new life into the world, addressing the fears of couples hoping to create families. We build lifelong relationships, sharing in tears of joy and tears of sadness. Being there for our patients and celebrating the birth of happy, healthy babies, is what motivates us to be exceptional physicians, recognizing there is an imperative to do everything possible to avoid a potentially devastating outcome for not only the child but also the family of the child.

The providers of Women’s Care believe having a healthy pregnancy starts before a woman is pregnant. Healthy babies begin with healthy mothers. We promote a well-balanced lifestyle to our patients, which means preconception care, proper nutrition, routine exercise, a healthy, safe environment, as well as a daily prenatal vitamin with folic acid. With good guidance, avoidable conditions that may have everlasting consequences may be prevented.

We are thankful to have the March of Dimes assist us in the adequacy of ensuring every baby has a healthy start. The significance of folic acid intake and the importance of a full term pregnancy are just two of the many beliefs Women’s Care of Wisconsin and the March of Dimes share and are working together to encourage. We are the willing front line advocates doing what we can to assure the people we bring into this world are not obliged to play catch-up from the start of their lives.

My colleagues and I are motivated chair people for the 2013 March for Babies. This is the largest annual fund raiser for the March of Dimes. We would be honored if you would join us in supporting this cause. After all, there simply is no other option than to try to achieve a perfectly healthy child, every time.

Sincerely,
Rami S. Kaldas, MD, Obstetrician/Gynecologist
CEO, Women’s Care of Wisconsin
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Dyspareunia, or painful intercourse, can be a medical condition – and women can do something about it...

By Michelle Landsverk, PT, DPT
Physical Therapist at PT Center for Women
View Michelle's Video Here


Have you ever gone to your doctor with an embarrassing problem? Like, one that you might not tell your mother about? But one that you might tell your girlfriends about? Like a problem that you think NOBODY else would have? Like a problem like painful sex?

As women, a lot of us have experienced it, but we tend not to talk about it. Many women who experience painful sex have thoughts like, This is SUPPOSED to feel good; what is the problem? Did I do something wrong? Is my partner too big? Is my uterus tipped? Is it our position during sex? Are my hormone levels the problem? Worse yet, they may ask the question, Is it my fault? because somehow they were made to feel that way by their partner or caregiver, or society at large.

The situation of pain with intercourse that many women harbor is called dyspareunia, which is the clinical term for experiencing pain with attempted vaginal penetration. For some women, that means that they cannot use a tampon, and for others, they have pain that either limits vaginal intercourse, or prevents it entirely.

In fact, pain with sexual intercourse is so common that:
• 40-50% of women in the United States have experienced dyspareunia for a period of time shortly after pregnancy
• Another third or so of women have experienced pain with attempted vaginal penetration not related to pregnancy
• And 5-10% of women have experienced dyspareunia ever since their first try at vaginal intercourse.

So now that we are finally talking, what are we going to do about it? And what does Physical Therapy have to do with dyspareunia? …Well… Lots!

First and foremost, you need to tell your doctor about it, in order to make sure that no disease process or hormone issue is the problem. Your doctor will perform a few tests in order to make sure that you don’t need medical treatment. And when your health checks out, your doctor will probably refer you to physical therapy, but if they don’t, it doesn’t hurt to inquire about it.

The reason is rather simple: our pelvic floor has muscles in it, just like any other region in our body. If you don’t have something that can be treated medically, then chances are, the problem lies within the pelvic floor musculature. The medical professional best equipped to help you rehabilitate an injured or dysfunctional muscle is a physical therapist.

There are plenty of women out there who experience pain with vaginal penetration, and they think if they just relax it’ll go away…only to feel extreme disappointment when sex hurts, again and again. And there is a vicious circle accompanying the problem, whereby the muscles of the pelvic floor tense up simply by ANTICIPATING the pain. This very real mind and body connection will lead to pain every time one tries to stretch an already tight muscle. The pelvic floor is meant to stretch, and when you think about it, you realize the functions of the pelvic floor muscles include allowing for intercourse and childbirth without catastrophic consequences, for example.

We do, in fact, have conscious control over most of the muscles in our body (except for muscles in the organs, like the heart muscle for example). But it’s easier said than done. One potential reason is that the muscle is in a state of chronic spasm, meaning, it’s not going to relax simply because you want it to. The cycle of spasm needs to be broken. And this is definitely possible.

So what are you going to do about all this? How are you going to climb this mountain to reach the summit of fulfilling, intimate vaginal sex?

Well, once you have been cleared of any medically treated problem, the next step is to become aware of your body, specifically the pelvic floor muscles. Through awareness exercises and muscle re-education, you will be able to sense when your muscles are in a relaxed state versus a tense state. You will learn how to relax a tense muscle, and even how to gently stretch a tense muscle. Your physical therapist can help you with this process.

The next step is to realize that first you will tolerate penetrative intercourse BEFORE it is actually a pleasurable experience. Meaning, you might achieve vaginal intercourse before it actually feels good. That is not to say that it should hurt, because it shouldn’t. And if it does hurt, then you are not quite ready to be back in the sack, so to speak.

Finally, realize that there is a solution. You don’t need to live with this. And fixing the problem can dramatically improve the quality of your sex life, and thereby the most important of your relationships.

Michelle Landsverk is a Doctor of Physical Therapy at Women’s Care of Wisconsin/PT Center for Women, 3913 W. Prospect Avenue, Suite LL2, Appleton, WI 54914. Contact Michelle at 920-729-2982 or meet her here.

About the PT Center for WomenAt PT Center for Women, our focus is on helping women incorporate lifestyle changes that will improve the quality of their lives. This includes gentle therapeutic exercise to both improve and maintain muscle tone, to rehabilitative exercise designed to get you back to your previous level of function and activities. From managing crippling abdominal and pelvic pain, to teaching proper sleeping postures and body mechanics at home and at work, we’re here for women. Learn more at www.ptcenterforwomen.com. - Comments

Learn more about treatment options for abnormal uterine bleeding...

By Marley Kercher, MD
Obstetrician/Gynecologist
View Dr. Kercher's Video


Abnormal uterine bleeding, in the form of heavy menstrual flow or irregular cycles, is one of the most common complaints that bring women in to see a gynecologist.

How to Treat Abnormal Uterine Bleeding
Option 1: Medication
Sometimes medications, usually in the form of birth control pills or other hormonal remedies, are prescribed to treat abnormal uterine bleeding. However, there are many women who either are unable to take these medications because of other underlying medical conditions, or who do not wish to be on long-term hormonal therapy.

Option 2: Surgery
For women who suffer from abnormal uterine bleeding and who are done with child bearing, surgical options are the next step. Traditionally, the only option for these women is a hysterectomy, which, although a reasonable choice for many, is a more radical step than some women wish to take, and it requires more recovery time than is sometimes feasible.

Option 3: Endometrial Ablation
There are now newer, less invasive options for the treatment of problematic uterine bleeding that can be performed right in your doctor’s office without the use of general anesthesia and with minimal down time.

Endometrial ablation in general refers to any procedure that destroys (i.e., ablates) the endometrium (uterine lining). When this technique was initially introduced, laser was used as the energy source. This limited the performance of endometrial ablation to operating rooms that were equipped with expensive and oftentimes cumbersome laser equipment.

More recently, newer ways of achieving quick, effective destruction of the uterine lining using other energy sources, such as heated fluid and radiofrequency electricity, have allowed physicians to offer endometrial ablation safely in an office setting.

There are various types of endometrial ablation. The most commonly performed is called a NovasureŽ procedure. This involves inserting a mesh electrode into the uterus through which radiofrequency energy (heat) is applied, thus cauterizing the uterine lining. This is typically achieved in about 90 seconds.

Success rates with NovasureŽ have been very favorable:
• approximately 90% of women report overall satisfaction; and
• about 30% report a complete cessation of menstrual flow 12 months after the procedure.

Endometrial ablation is not appropriate for every woman suffering from abnormal uterine bleeding. Premenopausal patients with a normal uterus, without evidence of cancer or pre-cancer and who have completed childbearing, are considered candidates for this procedure. Your physician will run tests, such as a pelvic ultrasound and a biopsy of the lining of the uterus, to determine the advisibility of ablation in your particular case.

Endometrial Ablation and Birth Control
Endometrial ablation itself does not provide effective contraception and any pregnancy that occurs after a woman has had an ablation is extremely dangerous. Therefore, your doctor will often recommend permanent sterilization as well if you have not already undergone tubal ligation, or your partner has not had vasectomy.

Permanent birth control can be accomplished in the office at a separate visit with something called the EssureŽ procedure. This involves inserting tiny coils into the fallopian tubes, which induces scarring in the tubes causing obstruction. If done in tandem with ablation, this portion is typically done first, and then followed by the ablation 3 months later after complete tubal blockage has been proven with a simple x-ray study.

Dr. Marley Kercher is an Obstetrician/Gynecologist at the Neenah location of Women’s Care of Wisconsin. Contact Dr. Kercher at 920-729-7105 or meet her here.

About Women’s Care of WisconsinThe physicians at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, midwifery services, infertility, procedures and surgery, incontinence, osteoporosis, menopause management and more at www.womenscareofwi.com. - Comments

Symptoms to recognize and when to see a physician to help ease your pain...

By Beth Helgerson, MD
Obstetrician/Gynecologist
View Beth's Video


Many women experience menstrual cycles that may not be “regular.” There are some reasons that can be pinpointed as to why this may occur.

What happens during the menstrual cycle?
Normal menstrual rhythm and cycling involves complex interactions between areas of the brain, the ovaries, and the uterus.

Regions of the brain stimulate the ovary to function. The ovary produces the hormone estrogen, which signals growth and thickening of the endometrium (the lining of the uterus). An egg is released from the ovary and moves into one of the fallopian tubes. The ovary also produces the hormone progesterone, which stops the growth of the endometrium. If the egg is not fertilized, the hormone levels decrease, resulting in the shedding of the uterine lining – which is the menstrual flow.

Many factors can interfere with the menstrual process, causing it to be “irregular:”
- The age of a woman can influence how the brain stimulates the ovary, and whether or not the ovary can respond.
- The ovary may not cycle properly. It is ovulation (which is the production of an egg) that results in the proper rhythm of production and secretion of these hormones.
- The uterus itself may have muscle growths, or changes in the glandular lining, which can alter regularity.
- Also, issues such as infection, pregnancy, blood clotting/bleeding abnormalities, and other illnesses can also interfere with menstrual rhythm.

Is it normal to have pain during menstruation?
Mild cramping in the lower abdomen or pain in the lower back is normal. Usually, exercising or placing a heating pad or hot water bottle on your stomach helps with mild cramping.

What is Dysmenorrhea?
If you suffer from severe cramps, nausea, or pain so intense that it keeps you from your usual daily activities, you may suffer from dysmenorrhea. Dysmenorrhea is defined as menstrual periods that are accompanied by severe pain in the lower abdomen or pelvis region that is either extremely sharp or dull, aching pain. This is not uncommon: painful menstruation affects approximately 50% of menstruating women, and 10% are incapacitated for up to 3 days. Menstrual cramps can dramatically improve with physical therapy.

What is Amenorrhea?
Amenorrhea is when a period never starts or a menstrual cycle stops completely. You should see your doctor if you have not started having periods by age 15 years or if you have not had a period for 3 months.

What can cause a missed period?
The most common reason is pregnancy. Other reasons you might miss your period include the following:
• Sudden change in weight
• Illness
• Stress
• Extreme exercise
• Hormone problems
• Taking certain medications

In summary, regular and predictable menstrual rhythm is a complicated process involving several factors. Problems in a number of possible areas that involve the reproductive system can all result in menstrual irregularities. Diagnosis can, at times, be complicated.

Your doctor may choose to use ultrasound evaluation, laboratory evaluation, and history with physical exam to fully evaluate your unique symptoms.

Dr. Beth Helgerson is an Obstetrician/Gynecologist at the Appleton and Waupaca locations of Women’s Care of Wisconsin. Contact Dr. Helgerson at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin
The physicians at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, midwifery services, infertility, procedures and surgery, incontinence, osteoporosis, menopause management and more at www.womenscareofwi.com.

 

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The symptoms and differences between the “baby blues,” postpartum depression and postpartum psychosis...

By Amber Post, MD
Obstetrician/Gynecologist
View Dr. Post's Video



Many women who have recently given birth experience feelings of sadness, irritability, and anxiety. There are three conditions postpartum women should be aware of, with different levels of severity.

The “Baby Blues”
The “baby blues” is a mild form of depression that occurs in 40% or more of new moms. The symptoms usually include rapid mood swings, irritability, anxiety, tearfulness, difficulty concentrating, and insomnia. Typically the symptoms start within 2 or 3 days of delivery and peak at 5 days.

We don’t know why these feelings happen, but perhaps hormonal changes or sleep deprivation play a role. Women are at a higher risk of developing baby blues if they have a history of depression or tend to have strong mood changes around the time of their period. Support, reassurance and rest are very helpful and typically women will notice an improvement within 2 weeks.

Postpartum Depression
Women with stronger symptoms that are not improving might be suffering from a more severe form of postpartum depression. Nearly 10% of women will experience postpartum depression. Symptoms include changes in sleep, energy level, appetite or weight, and sex drive. Other feelings can include anxiety, anger, guilt, being overwhelmed, feeling like a failure as a mother, or not bonding to the baby.

Symptoms usually start within the first month after giving birth but can be delayed. Risk factors for postpartum depression include previous depression, strained relationships with spouse or family, living without a partner, and unplanned pregnancy.

Postpartum Psychosis
The most severe form of postpartum depression is postpartum psychosis. These women have psychotic symptoms such as delusions or hallucination that usually start within a few weeks of delivery. This condition is considered an emergency because of the high risk of suicide or injury to the baby.

Women’s Care of Wisconsin has screening tools that can help distinguish whether these feelings are an appropriate response to the fatigue of child care and sleep deprivation, or if they are a more serious condition.

Increasing sleep and finding support and stress relief from family and friends will often help to improve the symptoms of baby blues. Do not try to do it all! Take special care of yourself; shower and dress each day and get out of the house. If your symptoms are worsening or persistent, talk to us about treatment options for postpartum depression. Counseling or medications may help to get you feeling like your normal self again. The most important thing to do is to seek help immediately if you have thoughts of harming yourself or your baby. The support you need is available and we are here to help you begin on the amazing journey of motherhood.

Dr. Amber Post is an Obstetrician/Gynecologist at the Neenah and Oshkosh locations of Women’s Care of Wisconsin. Contact Dr. Post at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin
The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, midwifery services, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at womenscareofwi.com.

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Women's Care now offers Certified Lactation Counselors to its patients.

Women’s Care of Wisconsin is proud to announce a new service we can offer to the Fox Valley – lactation and breastfeeding counseling!  There are three clinical employees who have completed an intense, up-to-date, research-based training course to become Certified Lactation Counselors.  These ladies, Brooke, Kristy and Heather, completed this course in May and are excited to be able to start putting all the knowledge they have learned into helping moms-to-be and current mothers with any breastfeeding topic. 

We often hear about how helpful the nurses and lactation consultants are while you’re still in the hospital after delivering your baby…but then after you go home, who do you call if you have questions or concerns?  Well, we would love to help!  If you have questions about how milk is produced, correct latch, feeding cues, positioning, milk supply, sore nipples, engorgement, pumping, returning to work…please call us.  Breastfeeding is the best choice for both you and your baby, and we would like to help make it a rewarding and successful experience for you. 

Although breastfeeding is a natural act, not all parts of it come easily to every mom.  Studies have shown that with good support systems, mothers are more likely to breastfeed their babies longer.  Maybe you haven’t had your first baby yet but would just like to ask some questions about what to expect.  Maybe this is your third child, and even though the first two breastfed without any problems, this new baby isn’t latching correctly.  Whatever the topic, our Certified Lactation Counselors can help you with issues over the phone or in person in the office.  Even if all you need is a little reassurance that you’re already doing everything correctly, we can provide that too!

Brooke, Kristy and Heather chose to take this course because helping moms be successful with breastfeeding is something they are all very interested in. Please don’t hesitate to call our office at 920-729-7105 if you have any questions or concerns.

About Brooke
Brooke is a Registered Nurse at Women's Care who graduated from UW-Oshkosh with a Bachelor's Degree in Nursing. She's always loved any nursing care that has to do with pregnancy, labor and babies. Brooke has two daughters, Allicyn and Whytni, who she nursed for a year each.  After having nursed her girls, she feels like she learned a lot “the hard way” and would love to pass on her knowledge so that no one else has to learn that way. She's very excited for this new opportunity of being a Certified Lactation Counselor and can’t wait to help!

About Kristy
Kristy is a Registered Nurse who has worked for Women's Care for over three years. She has over six years experience in labor and delivery. Kristy has three children who she breastfeed and enjoys helping and educating others on the benefits for mom and baby. She looks forward to working with patients so they can have a good breastfeeding experience as well.

About Heather
Heather is a Registered Medical Assistant who graduated from FVTC in 2006 and has been with WCOW for almost 6 years. She is so excited to be able to help other new moms with breastfeeding as she will be learning right along with them, experiencing hands on herself... Heather is currently six months pregnant with her first child! She's learned and gained so much knowledge of breastfeeding through her training to become a Certified Lactation Counselor and looks forward to her new teachings and experiences with our patients.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at womenscareofwi.com. - Comments

Helping patients make informed decisions regarding their preventive benefits...

By Jenny Hoier, CPC
Patient Advocate at Women's Care of Wisconsin


Healthcare reform was introduced over a year ago and we are still experiencing confusion on coverage for medical services, specifically preventive care. With the increase in coverage premiums, patient out-of-pocket expenses, and coverage limitations, patients and providers need to work together to maximize care, improve outcome, and contain costs to create a positive “healthcare experience.”

Preventive care is synonymous with routine, annual, check up, and yearly exam, to name a few. The definition of preventive care is “absence of a chief complaint.” The purpose of preventive care is to perform age appropriate risk assessment, update complete medical history, and provide counseling and recommendations based on risk and age.

Examples of preventive services would be the comprehensive exam from head-to-toe, where the provider is assessing numerous body systems. A flu shot and other vaccinations can be considered preventive. A pap smear is a preventive service. Mammograms, colonoscopies, osteoporosis screens can all be considered routine and preventive screenings when used to establish healthy baselines. The US Task Force publishes a list of covered preventive services. Additional questions regarding tests not listed should be directed to your insurance company.

Services that are not considered preventive would then be classified as diagnostic and include ultrasounds, biopsies, or any service that is being driven as a work up due to a patient’s symptom. The provider is performing these tests based on a condition that was brought forward to rule out underlying disease process and pathology. If the results return abnormal, future tests cannot be considered screenings as a diagnosis has been made. For example, a patient has a cholesterol screen, the results return high, and the patient then has to begin medication. Future cholesterol tests would then be diagnostic and not preventive/screening.

The point to remember is that preventive tests must be performed under the umbrella of appropriate age, frequency, and lack of symptoms. A common misconception that occurs is when a patient schedules their annual appointment and mentions a symptom they’re experiencing during that appointment. The provider orders additional testing to rule out disease. These tests are no longer considered screening despite occurring simultaneously with a preventive appointment. The symptom has now established medical necessity for the test to occur, or a “reason to perform.”

On the flip side, each insurance company is allowed to write their own benefit plan, so essentially, no two plans are the same. It is impossible for providers to be aware of every policy and the services covered and not covered.

At Women's Care, we strongly recommend a patient call their insurance company prior to receiving services to verify their individual benefit plan. Patients need to know frequency (once every 365 days or one visit per calendar year), preventive services covered (do they pay for TSH, lipid, and diabetes testing) and benefit maximum (payer allows only $300 per visit per year and the patient pays the difference).

We hope you find this helpful in explaining the guidelines we have to follow and the options patients have in making informed decisions regarding their preventive benefits. These recommendations apply to commercial insurance companies; Medicare has a unique set of coverage guidelines.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, midwifery services, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at womenscareofwi.com. - Comments

Is your family complete? Are you done having children? If so, you may want to consider Essure…

By Michelle Koellermeier, MD

Obstetrician/Gynecologist

View Michelle’s Video

Permanent birth control, also known as sterilization, refers to a number of medical techniques that intentionally leave a woman unable to reproduce. Sterilization options include both office-based procedures (in-office) and hospital-based procedures. Knowing the pros and cons of each option will help better inform your decision when the time is right.

Office-Based Permanent Birth ControlOffice-based sterilization options are performed within the comfort of a Women’s Care of Wisconsin clinic; not in a hospital. These in-office procedures offered through Women’s Care were designed with busy women like you in mind—women who don’t have a lot of extra time in their busy schedules to recover.

The benefits to having procedures performed within a Women’s Care clinic include:

-         no additional hospital fees

-         no incisions

-         no general anesthesia

-         no hormones

-         and best of all, virtually no recovery!

Many of our gynecologic procedures, not just permanent birth control, can be performed in the comfort of our office and are complete within minutes.

One Office-Based Sterilization Option: Essure
Essure is a permanent birth control procedure that works with your body to create a natural barrier to prevent pregnancy. Because there is no general anesthesia required, the Essure procedure can be performed comfortably and quickly (it usually takes about 10 minutes) in a Women’s Care clinic with no incisions and no hospital stay. Also, the Essure procedure is covered by most insurance providers. If the procedure is performed in our clinic, your payment may be as low as a simple co-pay, depending on your insurance plan.

During the procedure, your Women’s Care provider slides the small, soft inserts through the natural pathways of your vagina and cervix into your fallopian tubes. Over the next three months, your body works with the Essure inserts to form a natural barrier within each of your fallopian tubes. These barriers prevent sperm from reaching the eggs so that pregnancy cannot occur.

After three months, you will schedule an Essure Confirmation Test to verify you are protected. During this simple test, a special dye is introduced into your uterus and viewed on an x-ray, so your provider can confirm that your fallopian tubes are completely blocked and the inserts are in place.

Essure is proven to be the most effective permanent birth control available and more than half a million women have chosen Essure as their permanent birth control since 2002.

All permanent birth control procedures, including Essure, are associated with certain considerations. Some things to be aware of when considering the Essure procedure:

ˇ        no form of birth control should be considered 100 percent effective

ˇ        the Essure procedure does not protect against sexually transmitted diseases

ˇ        not all women will achieve successful placement of both inserts

ˇ        side effects during or immediately following the procedure may include mild-to-moderate cramping, nausea/vomiting, dizziness/light-headedness, bleeding and/or spotting

Hospital-Based Permanent Birth Control

Hospital-based sterilization options are performed either as an in-patient or out-patient procedure in a hospital. Hospital-based procedures will incur additional hospital fees. These methods include, but are not limited to:

- a tubal ligation, known popularly as "having one's tubes tied"
- a hysterectomy, in which the uterus is surgically removed, permanently preventing pregnancy

Women’s Care of Wisconsin is the number one provider for OB/GYN services at Theda Clark Medical Center and Appleton Medical Center, performing 55% of all out-patient procedures.

Learn MoreFor more information about Essure or any other in-office procedures offered by Women’s Care, please visit our website at www.womenscareofwi.com or check out www.essure.com. Women’s Care has the options you need to make healthy choices for your life!

Michelle Koellermeier is an Obstetrician and Gynecologist at the Neenah location of Women’s Care of Wisconsin. Contact her at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, midwifery services, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at womenscareofwi.com.

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Examining some of the causes of back pain after delivery for new mothers...

By Michelle Landsverk, DPT
PT Center for Women
View Michelle's Video


It seems like it’s a weekly occurrence in my practice to field this question: My back has been hurting ever since I had my baby. Did my delivery have something to do with it? Is it the way I hold my baby?

There is a little bit of a trick to answering this question: women want to know if any one of a number of variables surrounding the delivery has influenced how their back feels at this present moment. Problem is, variables happen every day, and so it is really hard to pinpoint any one of them and to say, “That’s it! That’s the root cause of the pain!”

Even so, women will ask me about a wide variety of potential factors that may or may not contribute to their back pain: epidurals, duration or intensity of pushing, C-sections, posture, rapid labors, perineal tears, and weight gain. They also ask me about the way in which they are breast or bottlefeeding their babies, how they hold and carry them, and sleep postures after baby arrives. Let’s take a look at several of these factors in order to either confirm or deny their impact on the health of our back.

Epidurals: Women will often come into the clinic and tell me that they had an epidural, and sometimes one of these questions will follow:
“I had an epidural when I delivered my baby three months ago. Could that be contributing to my back pain?” The short answer: Potentially, yes.
Or a woman might say: “I had an epidural when I delivered my baby 2 years ago. Could that be contributing to my back pain?” The short answer: not likely.

Let’s look at this on a large scale for just a moment. If epidurals used for pain relief during labor did in fact cause back pain, then thousands of new moms in the Fox Valley alone would be complaining of chronic backache every year. That simply doesn’t happen. Now, if we were to survey new moms who had an epidural (or even not) within twelve weeks of their delivery and ask if they had a backache, a significant percentage of them would say, “yes.”

So, it could just be the actual delivering of a baby that does it, and/or it could be the short-term effects from having an epidural placed that does it. Who is to say? And to complicate matters, there are a whole host of daily activities related to caring for an infant that could cause or aggravate a backache.

Rapid Labor or Back Labor: The amount of time spent pushing is more directly related to pelvic floor trauma than it is to back pain. Interestingly enough though, a strong and healthy pelvic floor is important in order to have a strong and healthy back.

There is a bit of physics in the explanation of this phenomenon, so I will give you the short version. There is a closed pressure system involving our diaphragm, abdominal musculature, intervertebral discs, and pelvic floor. If any one of those areas is compromised, then the other areas are stressed. If the stress is great enough, then signs and symptoms will follow. So, as far as the pelvic floor is concerned, if it is “bottoming out,” so to speak, then the other areas will have to work harder, and you may develop symptoms over time. Concerning the back, the symptom would be pain.

C-section: Having a C-section is definitely a potential risk factor for developing lower back pain, particularly in the short term. The surgery itself involves making an incision through the lower abdominal wall, thereby cutting the lower abdominal musculature. Now, if we take a step backward a moment, we may recall the saying, “strong abdominal muscles lead to a healthy back.” As we stated previously with the pelvic floor, the abdominal muscles are a part of a closed pressure system, thereby making the converse also true: weak abdominals can contribute to low back injury and pain.

There are solid reasons why your physician gives you lifting restrictions after you’ve undergone c-section, and one of those reasons is potential back injury. Your body needs that full six-week recovery in order for the abdominal muscles to heal enough to start working properly again.

Feeding: Whether you’re breastfeeding or bottle feeding, the way in which you are feeding your baby can most definitely contribute to both lower and upper back pain. The lower back pain component is related to sitting posture while you feed your baby. If your baby is like most babies, he or she tends to eat when you would rather be sleeping. And since you’d rather be sleeping, I am fairly certain that correct posture is not the thing that you are thinking about during a 3am feeding. Slouching into that glider rocker is more like it. Rounding out the lower back into the shape of a “C”—Yes! That is how the middle of the night feedings go. Usually to be followed by a, “Wow, it hurt to get out of that chair!” response.

A very similar circumstance precedes upper back and neck strain followings feedings. Typically, it’s due to the fact that we are looking down at our baby while he nurses. It’s natural, after all, to watch our baby eat; it’s part of the bonding process. Problem is, we end up with a terrible neck, shoulder, and upper back ache out of the deal. Bonded baby equals kinked neck. Ouch!

Holding Baby: If you are an experienced mom, did you hold your baby consistently on one side? And if you were good and switched back and forth between sides, are you constantly resting the baby on one hip? If you were standing in one place for prolonged periods of time, hip and lower back strain can occur. Likewise, if you were holding your baby when sitting, were you allowing your arms to rest on armrests of the chair, or a “Boppy” pillow, or were you making your shoulder and upper back muscles do all the work?

Weight Gain: Weight gain is another factor that can affect our spine health after baby arrives. It is totally normal to gain weight while you are pregnant. It most cases, it is preferred! The only exception to that rule is the case where a woman started out too heavy. So, the important thing to keep in mind is that making good food choices and maintaining an active lifestyle will help you lose that baby weight in a safe manner. It may not happen overnight, but certainly the weight will come off.

Sometimes finding the cause of your back ache is very clear, and sometimes it is not. If you can figure out some daily activity that causes your pain, try changing it and see what happens. If however you cannot figure it out, or self-modification doesn’t seem to be helping you, then you may need to be evaluated by your physician.

Michelle Landsverk is a Physical Therapist at PT Center for Women, 3913 W. Prospect Ave., Suite LL2, Appleton, WI 54914. Contact Michelle at 920-729-2982 or meet her here.

About the PT Center for WomenAt PT Center for Women, our focus is on helping women incorporate lifestyle changes that will improve the quality of their lives. This includes gentle therapeutic exercise to both improve and maintain muscle tone, to rehabilitative exercise designed to get you back to your previous level of function and activities. From managing crippling abdominal and pelvic pain, to teaching proper sleeping postures and body mechanics at home and at work, we’re here for women. Learn more at http://www.ptcenterforwomen.com/. - Comments

Women’s Care of Wisconsin now offers midwifery services in the Fox Valley...

By Becky Kahler-Thyssen, MSN, CNM, APNP
Nurse Midwife and Nurse Practitioner
View Becky's Video Here

I am very excited to be working with the team at Women’s Care of Wisconsin to now offer hospital-based midwifery services to the women of the Fox Cities community. I will help women through their pregnancies and births with midwifery care, and will be delivering babies at Appleton Medical Center.

What is a nurse midwife?
There is some confusion regarding the term "midwife" since there are differences in education and experience among those who practice midwifery. There are lay midwives, direct-entry midwives, licensed midwives, certified midwives and nurse midwives, and likely other terms that I might be unaware of.

A nurse midwife, like myself, has a Master's Degree, usually in nursing, and is board certified to practice as a nurse midwife by the American Midwifery Certification Board. I have a Master’s of Science Degree in Nursing with a specialty in Midwifery from the Frontier School of Midwifery and Family Nursing in Hyden, KY. My clinical preparation was at Gunderson Lutheran Medical Clinic in Lacrosse, WI, where I was certified by the American College of Nurse Midwives. I also have a Bachelor of Science in Nursing from Bellin College of Nursing in Green Bay.

Midwives are also primary care providers who specialize in the health needs of women throughout life. We listen to your concerns about your health and sexuality and can perform Pap tests and breast exams; provide birth control methods and family planning; HIV screenings and mammography referrals; and diagnose and treat vaginal and sexually transmitted infections. Midwives manage urinary tract infections, incontinence and many other gynecologic conditions.

Midwives offer:
• Cancer Screening and Mammography Referrals
• Childbirth Education & Preparation
• Comprehensive Gynecologic Care
• Family Planning and Contraception
• Infertility Counseling
• Osteoporosis Risk, Treatment and Reduction
• Sexual Health Management
• Menopause Management

What does a midwife do, and why should I chose a nurse midwife?
Midwife means "with woman." We approach women’s health with personalized care to empower women and their families.

A nurse midwife may do many different things. Besides the exceptional prenatal care a nurse midwife can offer, during labor a midwife (someone you personally know and trust) is present at your bedside nurturing, encouraging, and guiding you, all the way to when we deliver the baby into your arms. This can be very comforting and soothing for a woman and her family. Studies show that this can often shorten labor and decrease risk of cesarean birth and other interventions.

We are also there for you after delivery to help guide you on the best choices for your baby’s health, listening and helping you with your questions and concerns.

What if something goes wrong?
Electing to use a nurse midwife is appropriate for low risk pregnancies, which make up 60 to 80% of all pregnancies. Although we approach pregnancy and birth as a natural and normal process, we are always watchful for signs that may suggest otherwise. Women's Care of Wisconsin has a cohesive and supportive team of providers that are always available for consult, collaboration, and referral if the need arises. In these special cases, a woman may get the care of two professionals instead of one.

Why did I become a midwife?
When I was going to nursing school I loved learning about pregnancy, labor and birth. I was fascinated with a woman's ability to produce such a miracle! I cried like a baby when I watched my first birth. It was a very moving experience for me. I then started working on the labor and delivery floor and I absolutely loved it!

During this time, I had 3 beautiful children. With the experience of my own pregnancies and births, I realized I was really missing out on so much. I wanted to be with women and their families from the very beginning of their pregnancy as well as during the labor and birth. So I went back to school and graduated from Frontier Nursing University with my Master's Degree in Nursing and became board certified as a nurse midwife in 2003.

Learn moreFor more information on midwives, please go to myMidwife.org. This is a wonderful website that offers women and their families information regarding midwifery services.

Becky Kahler-Thyssen is a Midwife and Nurse Practitioner at the Neenah and Appleton locations of Women’s Care of Wisconsin. Contact her at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at womenscareofwi.com. - Comments

The importance of healthy sleep patterns to combat fatigue...

By Tracy Fritz, MS, RN, FNP-BC, APNP
Nurse Practitioner
View Tracy's Video Bio!


It’s 11pm on a Sunday. You are driving back to school after visiting your friends at a neighboring college. You’ve been up all day contemplating when to start writing that 6-page editorial for English but then remembered that you also have a quiz for another class bright and early at your 8am Monday class. How in the world are you going to get it all done? You could zip over to the 24-hour library at the school but, man; you are so tired you can barely keep your eyes open. You know! You’ll pick up some coffee or an energy drink and that will at least help you get through the first couple of hours. But when you can’t get to sleep and your heart is racing from all the caffeine…

Then what do you do?  You need to SLEEP!

Does this sound familiar?

I don’t miss the endless hours of sleep lost over big exams and major papers, then trying to pull working a job on top of it. As a nurse, I have experienced not only the fun and stress of college but also I was a night-shift worker for 8 years. Three of those years, I was doing both! How can a person survive? I can’t lie; I resorted to drinking as much caffeine as was humanly possible to drink. But at what cost to my health?

The use of supplements, whether that is in the form of caffeine in energy drinks, soda or coffee, or in the use of oral stimulants normally used for ADHD, is becoming a growing trend for college students. However, students don’t realize the health risks associated with overuse of caffeine.

Consuming a lot of caffeine not only leads to poor sleep habits and increases your risk for hypertension and heart arrhythmias, but it can lead to addiction. Using a roommate or friend’s oral stimulant is not only dangerous but VERY illegal, and if caught can hurt your chances of obtaining a job after college.

Lack of regular restful sleep can also cause major health concerns. Insufficient sleep is associated with a number of chronic diseases and conditions, such as:
• Diabetes
• Cardiovascular diseases
• Obesity
• Depression
It can also cause daytime sleepiness, sluggishness, and difficulty concentrating or making decisions. Teens and young adults who do not get enough sleep are at risk for additional problems, such as automobile crashes, poor grades and school performance, depressed moods, and problems with friends, fellow students, and adult relationships.

Quick Tips:
• Avoid stimulants like caffeine and nicotine. The stimulating effects of caffeine in coffee, colas, teas, and chocolate can take as long as 8 hours to wear off fully.
• Avoid pulling an all-nighter to study.
• Create a good sleeping environment. Make sure your bedroom is quiet, dark, relaxing, and not too hot or cold. Get rid of anything that might distract you from sleep, such as noises or bright lights.
• Make sure your bed is comfortable and use it only for sleeping – not for other activities such as reading, watching TV, listening to music or working on your computer.
• Stick to a sleep schedule. Go to bed and wake up at the same time each day, even on the weekends.
• Avoid large meals before bedtime.
• Be active for at least 2 ˝ hours every week. Regular physical activity helps improve your ability to sleep and your overall health. However, do not exercise within a few hours of bedtime.
• Eat a balanced diet. Regular healthy meals help you maintain your energy level without the necessity to add caffeine into the mix.
• Get routine health check-ups, which will help you stay healthy and help identify and correct any health concerns early.
• See your health provider at Women’s Care of Wisconsin if you have trouble sleeping or need additional advice on how to avoid caffeine and maintain regular sleeping patterns.

Tracy Fritz is a Nurse Practitioner at the Oshkosh location of Women’s Care of Wisconsin. Contact her at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/. - Comments

Tips to ensure a healthy lifestyle before pregnancy...

By Tracy Fritz, MS, RN, FNP-BC, APNP
Nurse Practitioner


Sometimes, pregnancy doesn’t give much warning before it’s already here. SURPRISE! Therefore, it’s important to recognize that a healthy lifestyle is not only important when you are thinking of becoming pregnant, but also for daily living.

Being healthy before a pregnancy, or “preconception health,” is very important in helping to give baby the best shot at a healthy start. It can also affect the health of the mother during and following pregnancy.

However, preconception health also applies to the partner, too. Issues like smoking, food choices, immunizations, drugs, and stress are just as important for the partner as the mother. These are all things that can affect a healthy pregnancy and can affect the child’s health after he or she is born. All of these things can and should be discussed with your provider before you are considering a pregnancy.

What are some things that can be done to plan for a healthy pregnancy?

1.  Make sure your weight is stable and healthy for your height. Now is the time if you are going to start a weight loss program, consider becoming a vegetarian or do anything that will improve your health but may stress out your body—because after you are actually pregnant, it is not recommended to dramatically change your eating or exercise habits.

2.  Get 0.8mg (or 800mcg) of Folic Acid for at least 3 months before a pregnancy. This can easily be obtained through a good prenatal vitamin (either over-the-counter or by prescription). Please check the label prior to purchase or consult your Women’s Care Provider. This can prevent neural tube defects in the first trimester of pregnancy.

3.  STOP unhealthy practices. This includes, but is not limited to, smoking, alcohol, and illicit drug use. If there is ever a time in your life that you have more motivation to quit, the time is now. It has never been shown in any literature that any amount of tobacco, drug or alcohol use is safe in pregnancy. In fact, the risk to the baby and your health during pregnancy are greatly affected, and this can lead to maternal and fetal complications and possibly death. There are also prescription medications that can be damaging to a developing fetus and should be discussed with your Women’s Care Provider prior to pregnancy.

4.  Avoid environmental teratogens. A teratogen is any agent that can disturb the development of an embryo or fetus. These harmful agents can be found in the home or at work, and include, but are not limited to, solvents, fumes, heavy metals (mercury or lead), and pesticides. Again, no recommended amount of exposure is okay during pregnancy and should be avoided. It is also noted that environmental exposures can also affect your body’s ability to get pregnant.

5.  Check for medical conditions and STDs. If you have any pre-existing medical conditions including diabetes, heart disease, high cholesterol, thyroid disease, etc, it is recommended to speak with your Women’s Care Provider prior to a pregnancy as well as your primary medical provider. It is also recommended to have sexually transmitted disease screening for you and your partner, and to get treatment if needed prior to a pregnancy. Some STDs can affect your body’s ability to become pregnant even if the symptoms were not noticeable during the infection.

6.  Get a genetic screening. Any genetic screening for Cystic Fibrosis, Tay Sachs, Sickle Cell Anemia, Thalessemia, etc, that can affect a pregnancy is also encouraged prior to getting pregnant, to ensure the best possible outcomes for you and your baby.

7.  Get up to date on vaccines. Please get your vaccines updated before considering a pregnancy, as there are some that can NOT be given during your pregnancy. It is always recommended to obtain an influenza vaccine before or during your pregnancy to avoid life-threatening complications of influenza and prevent your baby from infection. Babies are not able to get a flu shot until they reach at least 6 months of age. So to protect you and your family, get vaccinated. This goes for everyone in the household and those who will be taking care of your baby after he or she is born.

8.  Discuss concerns with your provider. If you had problems with past pregnancies, it is recommended to discuss these concerns with your Women’s Care Provider prior to attempting another pregnancy. Also, if you have had any lower abdominal surgeries or procedures that may have affected the uterus or cervix, those would also be important to discuss as well.
*(ACOG, 2011) (NIH, 2011) (NICHD, 2011)

Considering a pregnancy can be the most exciting and scary time of your life and you are NEVER going to be 100% prepared for that little bundle of joy—but as they say, “An ounce of prevention is worth a pound of cure,” and a healthy lifestyle paves the way for a healthy baby. The providers at Women’s Care are here for you to help you with all your questions about your health, your partner’s health and your unborn baby’s health. Happy planning!

Tracy Fritz is a Nurse Practitioner at the Oshkosh location of Women’s Care of Wisconsin. Contact her at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/.

* ACOG, 2011.  FAQ Good Health Before Pregnancy: Preconception Care. Internet search on December 7, 2011 at http://www.acog.org/~/media/For%20Patients/faq056.ashx

National Institutes of Health (NIH), 2011.  Preconception Care: MedlinePlus. Internet search on December 7, 2011 at http://www.acog.org/~/media/For%20Patients/faq056.ashx

National Institute of Child Health And Development (NICHD), 2011.  Preconception Care. Internet search on December 7, 2011 at http://www.acog.org/~/media/For%20Patients/faq056.ashx - Comments

Risk factors and what to look for to determine if an early delivery may occur...

By Kristin L. Clark, MD
Obstetrician/Gynecologist
View Kristin's Video


Patients often ask me, “How will I know when I go into labor?” If they have had a healthy pregnancy and are of a term gestation, I usually tell them not to worry; that signs and symptoms of labor aren’t subtle. Preterm labor, however, can be a little bit harder to detect. Fortunately, it’s not a common complication, but when it happens, early recognition and treatment are key in a successful outcome.

Risk Factors
There are some risk factors for preterm labor, the biggest of which is a prior history of preterm labor and delivery. Other risk factors include:
• previous cervical surgery
• multiple first or second trimester D&Cs (procedure to empty the uterus after a miscarriage)
• previous second trimester loss
• uterine infection
• premature rupture of membranes

Causes of Preterm Labor
Ultimately, we don’t really know what causes preterm labor. As I mentioned, the symptoms can be more subtle than labor at term. Some people will notice:
• an increase in pelvic pressure and spotting
• rhythmic tenable tightening
• cramping
• significant pain

It can also be very normal to have Braxton Hicks contractions during your second and third trimesters, so if you are having any of these symptoms, I would advise that you discuss them with your doctor so that he or she can help you sort through what’s normal and what needs to be addressed.

If your doctor is concerned that you might be in early labor, he or she will likely perform a cervical exam. Other tools that can be utilized include an ultrasound measurement of your cervical length and a fetal fibronectin swab. If this swab is negative, it gives us a 95% reassurance that you will not deliver in the next two weeks and a 99% reassurance that you will not deliver in the next week. If it’s positive, it doesn’t mean you are going to deliver, it just means that we need to watch you closer.

At times, I place my patients in the hospital for observation to see whether or not they are contracting regularly and to observe them for any change in cervical dilation. There are both oral and IV medications that can be used to treat preterm labor, and I use both differently in my practice.

Further, if your doctor feels that you are at risk for preterm delivery, he or she may advise two injections of a steroid called Betamethasone, 24 hours apart. This will help enhance your baby’s lung maturity so that if the baby did deliver before 34 weeks gestation, he or she has an easier time transitioning to breathing outside of the womb.

Ultimately, most people will not have to worry about preterm labor and delivery, but if it happens to you, we are lucky that we live in a day and age where we can treat it aggressively, and frequently help keep you pregnant until a term gestation.

I always tell my patients, “It’s your job to worry and it’s my job to make you feel better.” So keep this information in mind. If you have concerns, be sure to address them with your physician.

Dr. Kristin L. Clark is an Obstetrician/Gynecologist at the Neenah location of Women’s Care of Wisconsin. Contact Dr. Clark at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/. - Comments

Understanding the risks of delaying childbirth: what every woman should know...

By J. Elaine Larmon, MD
Perinatologist, Perinatal Consulting Group


Many women are faced with this difficult decision: have a baby, or focus on their career. There are many factors that contribute to their decision on what time is the best time to have a baby.

In the past 25 years, older women in the United States have accounted for an increasing proportion of total births (14%). The mean age at the birth of a woman’s first child (around 25) has increased by 4 years since 1970.

The increased occurrence of births at an older maternal age is due to several factors including:
   • Number of women aged 35-45
   • The availability of reliable contraception
   • Wider opportunities for further education and career advancement for women

Maternal education is one of the strongest predictors for the use of contraception, timing of childbearing and total number of children. College-educated women tend to have higher first birthrates in the thirties, illustrating the trend of delayed child-bearing being related to educational achievement and career opportunities.

The Risks
Although many older couples tend to be more mature and financially stable, women who delay childbearing are at increased risk of infertility and pregnancy complications. Facts that women should know when planning the timing of their childbearing include:
   • The probability of achieving pregnancy begins to decline significantly at the age of 32
   • The incidence of coexisting medical disease and pregnancy complications also increase with advancing maternal age
   • Pregnancy complications that are increased include chromosomal abnormalities, some congenital anomalies, placenta previa, gestational diabetes, preeclampsia, cesarean delivery, ectopic pregnancy, miscarriages and stillbirths

Fertility
Advancing age is also associated with prolongation in the average time for achieving pregnancy. The probability of achieving a pregnancy in one menstrual cycle (fecundability) begins to decline significantly at about the age 32 with a more rapid decline around the age of 37. Sub-fertility is primarily related to the poor quality of aging eggs, decreased ovarian reserve (fewer eggs), and an altered hormonal environment resulting in ovulatory dysfunction.

Older women also have had more time to acquire medical and surgical conditions such as endometriosis, pelvic infection, endometrial polyps and fibroids, which can impair fertility. Lifestyle factors may also play a role. Older women may have a decreased frequency of sexual intercourse and are more likely to be obese.

Pregnancy Complications

1. Pregnancy Loss
    a. Miscarriage: Older women experience an increased rate of spontaneous miscarriage. These losses are both chromosomally abnormal and normal and primarily result from a decline in egg quality. Changes in the uterine environment and hormonal function may also play at role.

In a large series of studies from Scandinavia, the overall rate of miscarriages treated in hospitals was 11%. Assuming that only 80% of women with miscarriages were treated in the hospital setting, the risk for miscarriage in various age groups was calculated. The risk of miscarriage in women less 30 years was 12%, between 30-34 years it was 15%, between 35-39 years it was 25%, between 40-44 years it was 51% and at ages 45 and greater it was 93%.

    b. Ectopic Pregnancy: A maternal age of 35 or older is associated with a 4- to 8-fold increase in ectopic pregnancies. This is likely due to an accumulation of risk factors over time, such as multiple sexual partners, pelvic infection and tubal pathology.

    c. Stillbirths: Women 35 years old and older have a higher risk for stillbirths compared to younger women. The risk of stillbirth also increases with advancing gestational age and is most notable after 37 weeks. The increase in mortality is largely unexplained. The absolute risk of stillbirths in developed countries such as the United States is still small.

2. Co-existing Medical Conditions: The prevalence of medical and surgical illnesses such as cancer, hypertension, diabetes, renal disease, and autoimmune disease increase with advancing age.
    a. Hypertension: This is the most common medical problem encountered in pregnancy and is more prevalent in older women. The incidence of chronic hypertension is 4-fold higher in women 35 years old and older than in women 30-34 years of age. The incidence of preeclampsia in the general population is 3-4%, which increases to 5-15% in women greater than 40, and to 35% in women older than 50.

    b. Diabetes: Prevalence of this condition also increases with age. The incidence of both pre-existing and gestational diabetes increases 3- to 6-fold in women older than 40, compared to those 20-29 years old. Gestational diabetes occurs in the general population at rate of 3%, rising to 7-12% in women greater than 40 years of age and to 20% in women over 50. Pre-existing diabetes is associated with increased risks of structural birth defects and pregnancy loss.

3. Fetal Abnormalities
    a. Chromosomal Abnormalities: Analysis from spontaneous miscarriages, terminations, genetic amniocentesis, stillborn and live born infants show a steady increase in the risk of chromosomal abnormalities as a woman ages.

    b. Congenital Birth Defects: The risk of having a child with a congenital malformation may increase with age. Several but not all reports suggest that as a woman ages, the risk of non-chromosomal anomalies increases. In particular, heart defects seem to increase with advancing maternal age.

4.  Placental Problems: The prevalence of placental abruption and placenta previa is higher among older women.

5.  Multiple Gestation: Advancing age is associated with an increased prevalence of twin pregnancy which is due to a higher incidence of naturally conceived twins along with a higher use of artificial reproductive technology in older women.

In summary, women who delay childbearing are at increased risk of infertility and certain pregnancy complications. Knowledge of these obstetrical risks associated with advanced maternal age can help a woman make an informed decision about timing of childbearing. These risks should be balanced against career and personal issues that might favor delaying childbearing.

Dr. J. Elaine Larmon, MD is a Perinatologist at Perinatal Consulting Group, 3913 W. Prospect Avenue, Suite 102, Appleton, WI 54914. Contact Dr. Larmon at 920-729-7121 or meet her here.

About the Perinatal Consulting GroupThe caring team at the Perinatal Consulting Group provides specialty care to women with delicate pregnancies. We are focused on diagnosing, treating and caring for women and unborn babies who are at risk for complications or illness during pregnancy or who have been diagnosed with a disease or other medical problem. We work with your doctor to provide you and your baby with the special care you need. We are strictly a consultative practice, which means we do not perform primary care services. Patients receive a formal referral from their primary care provider and we work in conjunction with that provider (obstetrician, family practicioner or midwife) to ensure that you and your unborn baby get the best care possible. Learn more at www.perinatalconsultinggroup.com. - Comments

Even though there are still mysteries about conception, there is a 95% chance you will conceive...

By Rami Kaldas, MD
Obstetrician/Gynecologist
View Dr. Kaldas' Video Bio Here!


When I was doing my studies in gynecology and infertility in Palo Alto, California, there was a lab that was researching the biology of reproduction of the human cell. It was an illustrious group of scientists from Stanford. They were studying the fluid inside of unfertilized eggs. It was fascinating what they were discovering, but even more fascinating was what they didn’t discover and what they still do not understand – why it is when the sperm enters an egg and fertilization happens, the symphony of activity that ultimately develops into a baby occurs.

In the meantime, it has been discovered that about 4 out of 5 conceptions end up not progressing, that there is something not quite right about either the egg or the sperm or them getting together. It is, on a very microscopic scale, the workings as complicated as the biggest city in the world or more. It is a humbling thought. Nonetheless, humans have not gone extinct.

The point is, while the infinite number of details that go into making a human baby are mostly not understood, there are things that we do understand. Most of the time if a couple is unable to have a baby, we can figure out why and do something about it.

That is why I tell my patients with confidence when I see them that there is a 95% chance, knowing nothing about them, that they will have whatever children they want to have. It is a matter of simply, what is it going to take?
• After trying for about a year, 85% of couples are pregnant.
• After two years, that goes up to 93%.

That means that between the first and second year of trying, a complete half of the people who didn’t succeed the first year end up succeeding during the second year. In any given month, however, when someone times it just right, there is only about a 15-20% chance of achieving a pregnancy. After a year of trying, the chance of success in any given month goes down to about 4% and then after two years about 1%.

That is why, after a year of trying, it is reasonable to come see a fertility specialist at Women’s Care of Wisconsin.
• Half the time it has something to do with what is going on with the woman
• About 40% of the time it has something to do with what’s going on with the man
• 10-20% of the time, it is a combination of both.

The American Society for Reproductive Medicine (ASRM), also known as the American Fertility Society (AFS), sets out basic guidelines. For most people, it is pretty straightforward, figuring out why they are not getting pregnant. Steps you can take include:
• A simple semen analysis
• A tubal dye study to make sure the fallopian tubes are open
• Lab tests
• An ultrasound

Most of the time a combination of the above will yield an answer – but not all the time. That doesn’t mean that there is no hope certainly. Even when we can’t find anything wrong, treating with some tried and proven fertility drugs that have been around for decades will succeed for most people.

Frequently, a drug called Clomid is utilized to help a woman to ovulate better so she can become pregnant. Clomid has been around since the late 50’s. It was developed at the University of California as a contraceptive pill. Imagine the surprise they had when the people who were testing it were all getting pregnant instead of not getting pregnant!

The way Clomid works is that it binds estrogen receptors in the body and it fools the part of the brain that makes the hormone that stimulates the ovaries to make eggs into thinking that there is a low estrogen environment, or, in other words, that eggs are not being made. Therefore, the female brain, being the very smart entity that it is, makes more of that follicle-stimulating hormone that makes more eggs be produced and mature. However, since more eggs are made, you might end up with more than one baby… Clomid does cause a higher rate of multiple gestation, usually twins or triplets.

After several cycles of Clomid, which should not exceed six cycles because it is unlikely to work after that if it hasn’t yet, there are other stronger drugs that actually are the same thing that the female brain makes to make the eggs happen and mature in the ovaries. Those are given by injection through a very tiny needle that goes right under the skin. Those drugs, being more powerful and more direct, end up yielding twins or triplets or more about 25% of the time and are used usually in conjunction with intrauterine (artificial) insemination, or when the male partner agrees to donate a specimen for the sake of procreation and his progeny. We put the A+ scholars high up into the uterus, shortening the journey for the sperm. It isn’t always a slam dunk with an intrauterine insemination, but it typically does better than just medicine alone.

After a few months, if that doesn’t work, then it is reasonable to consider in vitro fertilization, where the egg is withdrawn from the ovary and put with the sperm in the lab. That involves a little more cost, inconvenience and discomfort, but if nothing else has worked it will usually achieve its goal.

That, in a nutshell, is Fertility 101. Most of the time, your hard work will pay off. Please remember that 85% of the time in the first year, your hard work at home will pay off with never seeing the doctor. But when you are facing infertility issues, realize that there are many options for you, and we are here to talk you through the options and help you achieve your family goals.

Dr. Rami Kaldas is an Obstetrician/Gynecologist at the Neenah and New London locations of Women’s Care of Wisconsin. Contact Dr. Kaldas at 920-729-7105 or meet him here.

About Women’s Care of Wisconsin
The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/. - Comments

What everyone needs to know about HPV...

By Hassan Shahbandar, MD
Gynecologist
View Dr. Shahbandar's Video Bio



What is HPV?
HPV is a virus that is responsible for cervical cancer, genital warts and other cancers, such as throat and penile cancers. There are over 120 different types of this virus. About 30 of these types are transmitted through human contact and most of these types are sexually transmitted.

How many people have HPV?
It is most common in teenagers who harbor it:
• 24% of 15 year olds
• 38% of 16 year olds
• 51% of 17 year olds
• 62% of 18 year olds

What is the difference between low-risk and high-risk types of HPV?
Of the over 120 different types of HPV, there are low-risk types that infect people without producing symptoms or with producing minor symptoms (skin warts), while the high-risk viruses are associated with potential causes of cancers.

How do women get HPV?
The virus is transmitted through skin-to-skin contact. It is not transmitted through ingesting contaminated food nor through breathing contaminated air.

Should I get the HPV vaccine?
Any female over the age of 10, who is not infected by HPV, is a candidate for the vaccine. If infected, then the vaccine is worthless. Insurance companies do not cover the cost for females over age 26 and do not approve the vaccine for males.

How do I know if I have an HPV infection?
Because most people who are exposed do not have symptoms, it is important to be tested by your health care provider, doing a pap smear, which shows if the virus has caused abnormality in the cells. If so, then a specific test to check for the virus is done. So far, the FDA does not recommend testing for the virus without a pap smear.

Do I still need a pap test if I got the HPV vaccine?
Yes, because the vaccine does not protect against 100% of the HPV types. It protects against the most common types: types 16 and 18 (causes of cervical cancer) and types 6 and 11 (genital warts). In all, the vaccine protects against 70% of cervical cancer but not 100%. It also prevents 90% of genital warts, but not all.

How often should I get a pap smear?
A pap test is used to detect the effect of HPV on the cervical cells and should be performed yearly between ages 21 and 30. After age 30, then it can be done every 2-3 years if you have had 3 previous normal pap tests without any abnormal ones, and if you do not practice risky sex. There is no need to test men, women who have had a hysterectomy for non-cancerous causes, or women after age 65 who are monogamous and have never had cancer or an abnormal pap in their past.

What happens if I have an abnormal pap?
You will need further testing called colposcopy, which allows your doctor to look at your cervix and vagina with a magnifying tool (colposcope) and perform a probable biopsy. Most of the time, the changes in your pap are not cancerous.

Could I have HPV even if my pap was normal?
Yes. If your immune system is good, then the virus fails to harm you, and usually you are not infectious.

Can HPV be cured?
Yes. Most people who do not develop cancer from HPV are cured by themselves without any use of medicine, but there is not an antibiotic available for HPV. The best cure is to prevent the spread of this virus by getting vaccinated and also avoiding risky sexual behavior.

Dr. Hassan Shahbandar is a Gynecologist at the Appleton and Waupaca locations of Women’s Care of Wisconsin. Contact Dr. Shahbandar at 920-729-7105 or meet him here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/. - Comments

Awareness of your posture can lead to increased musculoskeletal health and less chronic pain

By Michelle Landsverk, DPT
View Michelle's Video Bio Here!



Do you remember the words…“Sit up straight… pull your shoulders back… and for crying out loud, DON’T SLOUCH!”

Imagine your mother watching you doing any one of the following: Sitting in front of a computer monitor. Snuggling up with a favorite book. Playing video games. Sitting on the floor, in a chair, on bleachers, at church, or in a theatre. Standing in place. Waiting in line. Watching TV. Fishing. Driving a car.  Or…doing anything during your normal day that requires you to be in one place for a period of time.

Worse yet, imagine me watching you doing these things!

As a physical therapist, I talk about the importance of good posture as a way of maintaining good musculoskeletal health. This blog entry is to educate you on the relationship between good posture and good musculoskeletal health (I didn’t make this up; they are honestly interrelated). For, everything in our bodies is connected somehow, and at least philosophically speaking, one thing can have an effect on everything else.

To specifically address YOUR posture, is as individual as your day, but I can address global concepts here that are good for every woman to keep in mind. Words like: balance, tension, and harmony all come into play. Let’s take a look at them one at a time.

Balance – Think about your daily activities and habits. Are they “balanced”?  In other words, do you spend a measured amount of time standing in one place? Ask yourself these questions:

• Do you spend time standing at a checkout counter or standing in one position at an assembly line?
• Do you spend any time strolling or walking?
• Do you spend a measured amount of time in an office chair?
• How much time do you spend driving or riding in a car?

Furthermore, when you think about these daily activities and habits, does one in particular outweigh the others? If the answer is “Yes”, is there a way that you can find or make more balance between them?

You see, our bodies are not meant to be in one place for a lengthy period of time and our bodies were certainly not designed to be in one place or position for the majority of the day. Sometimes, it’s challenging to look for and find balance for our body positions during the day, but if you can achieve it, it’s well worth it!

Tension – Now let’s take our balance concept one step further. If you are balanced, then you are changing your position frequently throughout the day. If you are not changing your position at least once every 50 minutes, then you are NOT balanced, and therefore you are probably under some physical tension. Musculoskeletal tension to be exact; involving not only our muscles, bones and joints, but our connective tissues: like tendons, ligaments and fascias, and our nerves – right down to the cellular level.

This amounts to lots of layers of tension. This tension builds over time; hours upon hours, and sooner or later your body will retaliate. Usually that retaliation comes in the form of pain.

Some common types of pain that comes from chronic tension include:
• Headaches
• Neck pain
• Lower back aches
• Upper back pain
• TMJ pain
• Pinched nerves
• Intervertebral disc herniation
• There are also numerous medical conditions that are exacerbated by chronic musculoskeletal tension.

Harmony – How can we take our concepts of balance and tension in order to create harmony? We can actively work our bodies thru our awareness of what we are doing, and how we are doing them. In other words, if I am standing in line for an hour, I can be aware of my legs. Am I standing with all of my weight on one foot, or am I shifting my weight every few minutes? Am I locking my knees, or am I using my strong leg muscles to support me? Is my pelvis tilted way forward so that my butt sticks out, or am I using my powerful hip muscles to line up my spine with my pelvis? Where are my shoulders in relation to my head? Are they forward and rounded? Or are they comfortably lined up with my ears? Is my head forward in relation to my body? Or is it lined up, too?

You see, we can use our body awareness in order to create harmony and balanced tension in order to achieve the best posture for the current situation.  By doing so, we can reduce or completely eliminate pain resulting from chronic musculoskeletal tension.

Through this effort of creating harmony through balance and awareness of tension, we can optimize our posture, and therefore our musculoskeletal health, on a daily basis. Theoretically, this will lead to a reduction in any chronic pain we have as a result of the poor postures we used to maintain during the day. For everything in our body is connected, in some way.

Michelle Landsverk is a Doctor of Physical Therapy at Women’s Care of Wisconsin/PT Center for Women, 3913 W. Prospect Avenue, Suite LL2, Appleton, WI 54914. Contact Michelle at 920-729-2982 or meet her here.

About the PT Center for Women
At PT Center for Women, our focus is on helping women incorporate lifestyle changes that will improve the quality of their lives. This includes gentle therapeutic exercise to both improve and maintain muscle tone, to rehabilitative exercise designed to get you back to your previous level of function and activities. From managing crippling abdominal and pelvic pain, to teaching proper sleeping postures and body mechanics at home and at work, we’re here for women. Learn more at www.ptcenterforwomen.com. - Comments

Women need to know the risks and benefits of post-menopausal therapy

By Chris Danz, APNP
Nurse Practitioner


Despite the “information age” in which we live, confusion about post-menopausal hormone therapy persists. This is due to several factors.

In more than 60 years of research in menopausal medicine, studies have found both good and bad regarding hormone replacement therapy. The primary reasons for confusion regarding hormone therapy to treat the symptoms of menopause include:

• Menopause study results, which are fairly frequently changing, have not always been clearly communicated in an up-to-date manner
• Misrepresentation of study data by the media has at times resulted in further misinformation
• Outspoken celebrities, while making women aware of choices available to them, have provided information out of context at times, therefore contributing to misunderstanding of the risks and benefits of hormone therapy

In 2011, knowledge based on scientifically obtained information leads many menopausal experts to agree that hormone therapy for menopausal women can have a place in the management of symptoms of menopause.

Though not the only option, hormones are undoubtedly the most effective way to treat symptoms including:
• Hot flashes
• Night sweats
• Mood swings
• Cognitive changes (memory/focus)

Additionally, hormones are generally effective for treatment of vaginal dryness that results in pain with intercourse. Estrogen can also benefit fatigue, muscle and joint pain, and bone density. Although it continues to be debated, many physicians feel that if given early in menopause, estrogen can help minimize heart disease.

What about cancer risk with hormones?

In women who have a uterus, progesterone must be used in combination with estrogen to protect the lining of the uterus from becoming a cancer-prone environment.

Because estrogen and progestin used together appears to be the link between hormones and breast cancer, this is obviously of concern. However, newer ways of administering hormones using the lowest possible dose and cycling the progestin to limit exposure may decrease that probability.

Recent research has also found that numbers of years of use increases the risk most notably. Therefore, short-term use of hormones (less than 5 years) is generally recommended. Other risk factors such as age, weight and family history also indicate risk and need to be considered.

For every woman, both possible risks as well as potential benefits of hormone therapy need to be evaluated. Each woman has a unique health history and each patient’s symptoms, personal and family history, and long-term health goals need to be considered when making a decision to use or avoid hormone therapy.

If you do choose hormone therapy, here are some helpful hints to ensure you get the most benefit out of your menopause treatment plan:

• Work with your health care provider to individualize your menopause plan.
• Be comfortable with your health care provider and the information they are providing you.
• Request the lowest possible dose which allows you to be comfortable, and for the shortest duration of time, to get the greatest benefit while minimizing the risks.
• Request discussion about the safest possible way to deliver the hormones to your body.
• Follow up regularly with your hormone prescriber to be made aware of any changes in research or recommendations for hormone replacement. 
• Be aware that information in the media may be incorrectly represented. Find out the facts from your health care provider.

Stay tuned for more topics about menopause to be covered in upcoming blog posts!

Chris Danz is a Nurse Practitioner at the Appleton and Neenah locations of Women’s Care of Wisconsin. Contact Chris at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/. - Comments

What you can expect during the stages of menopause

By Chris Danz, APNP
Nurse Practitioner
View Chris' Video Bio!


Although every woman experiences menopause uniquely and with variable intensity, most women will experience some symptoms. This is because most of the body’s organs have estrogen receptors, which are affected in one way or another by the circulating hormones. As the hormone levels decline, the resulting estrogen deficiency results in symptoms.

Menopausal symptoms can be divided into three (3) time frames:
• Early menopausal changes
• Intermediate menopause
• Perimenopause (“late” menopause)

The “early” menopausal changes often overlap with the perimenopause time. In other words, some of the early symptoms are a continuation of those noted as hormonal changes of the late 30’s and 40’s.

The most common early menopause symptoms, one or more of which 85% of all women will experience, are:
• Changes in energy level (fatigue)
• Joint or muscle pain
• Sleep disturbance
• Hot flashes
• Night sweats

Other early symptoms can be vaginal changes, breast tenderness, decrease in sexual desire, weight gain and increased abdominal bloating. Many women will also notice cognitive changes, which include change in mental alertness, memory and ability to stay focused.

Altogether, these symptoms often result in a general decrease in well-being, which can further fuel or cause depression.

Some early symptoms do resolve after a time as the body adapts to lower hormone levels.  However, many persist and progress to the intermediate and late menopausal time, when the longer time of hormone deficiency results in further issues.

Intermediate menopausal symptoms can include:
• Vaginal dryness
• Pelvic tissue changes that often result in painful intercourse
• Further decline in sexual responsiveness
• Bladder changes

Late menopause symptoms can include:
• Bone density loss that can result in osteoporosis
• Changes in the heart that make women at greater risk for heart disease
• In general, more issues of aging are noted

As you work with your health care provider to identify a plan of care for your menopause, it can be most helpful to provide him or her with a list of symptoms you are experiencing, along with a “rating” of those which you are most affected by. It is also helpful to share possible long-term issues which are most worrisome to you. In this way, each of you will be able to focus on those options which will result in optimal improvement in your health and well-being.

Stay tuned for more topics about menopause to be covered in upcoming blog posts!

Chris Danz is a Nurse Practitioner at the Appleton and Neenah locations of Women’s Care of Wisconsin. Contact Chris at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/. - Comments

What to know and expect when entering the stages of menopause

By Chris Danz, APNP
Nurse Practitioner




Menopause is a time in a woman’s life where her body goes through many physical and physiologic changes, due to hormone changes. Providers specializing in menopausal medicine help women during this stage of life by educating them and advising them on treatment options for conditions that may arise.

What is menopause?
Menopause is generally considered the end of a woman’s reproductive life. The ovaries stop producing eggs and the hormones that bring about ovulation and the ability to get pregnant. The average age of menopause in the United States is about 51 years, though some women experience this change at 40, and almost all women will be menopausal by age 60. The average woman can anticipate spending one-third of her lifetime in menopause.

Estrogen is the most commonly discussed hormone of menopause. In fact, many of the changes which occur are directly related to estrogen decline. However, progesterone changes also contribute to the end of menstruation, and testosterone changes also occur, though generally more gradually.

How does menopause begin?
The first and most obvious change for a woman entering menopause is that menstrual cycles change and eventually, stop. By definition, a woman is considered menopausal if she has not had a period in one year.

Every woman will experience the hormone changes of menopause uniquely. For some, the onset may be very abrupt, quite intense, and difficult. For others, symptoms may be more subtle (or even absent). Most women will notice some symptoms, but these will vary from one woman to the next as to which ones are most bothersome to her.

What women need to know
However, whether symptomatic or not, women should understand the transition their bodies are undergoing, make choices and lifestyle changes to accommodate those changes, and embrace this new era in their female life-cycle.

Menopause is a relatively new phenomenon, as prior to 1900 many women did not live long enough to experience menopause. Because of this, the field of menopausal medicine is relatively new. There has been notable new knowledge and information in very recent years that affects choices available to women at this time in their life.

Despite the increase in available information, or perhaps because of it, many women are confused about menopause and treatment options they may have. Educating yourself is the first and most important step in managing your menopause. This blog will cover some of the issues related to menopause in the coming months. Topics will include:
* Symptoms of hormone decline
* Are hormones an option in 2011?
* Let’s talk about “bio-identical” hormones
* Non-prescription choices to manage symptoms
* Choosing a health care provider who will help meet your menopause treatment goals
* What about heart disease and menopause?
* Osteoporosis: am I at risk?
* Managing dryness - inside and out
* Menopausal weight gain
* Changes in sexuality
* Why am I not sleeping any more?

Stay tuned for these topics about menopause to be covered in upcoming blog posts!
Chris Danz is a Nurse Practitioner at the Appleton and Neenah locations of Women’s Care of Wisconsin. Contact Chris at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/. - Comments

Physical therapy and other lifestyle changes may improve the symptoms of IBS

By Connie Strey, Physical Therapist, PT, BCIA-PMDB
View Connie's Video Bio!




What is IBS?
Irritable Bowel Syndrome, or IBS, is defined as a non-inflammatory condition of the bowels that may cause cramping, diarrhea and/or constipation. Bowel control problems affect at least 1 million people in the United States. IBS mainly affects women and is most common between the ages of 30 and 50 years.

What Causes IBS?
It is not always clear what causes Irritable Bowel Syndrome, but experts feel that it may be caused by one or more of the following:
• Hypersensitivity with abnormal movement of the gut
• Disturbances in the gastrointestinal sensor and motor system
• Problems in the pathway of the central nervous system
• More sensitive colons than usual
• Visceral sensitivity (diffused pain in the low abdominal region)

What are the Symptoms of IBS?
IBS is usually very painful, is chronic, and is usually associated with flare-ups of both constipation and/or diarrhea. This gastrointestinal condition may present itself in three ways: diarrhea dominant, constipation dominant and/or both constipation and diarrhea.

Symptoms may include the following:
• Cramps / Abdominal Pain
• Gas
• Bloating
• Fatigue
• Changes in bowel habits—constipation, diarrhea or both
• An urge to have a bowel movement that does not happen
• Stools that have mucus in them

The symptoms can come and go over time. For some people, it is only mildly annoying. For others, it can be serious.

What Triggers IBS?
Triggers that result in the symptoms of IBS to flare up vary from individual to individual. Many patients report symptoms caused by:
• Psychological factors and stress
• Eating large meals
• Travel
• Certain foods
• Certain medications
• Women may have more symptoms during their menstrual periods

How Do You Treat IBS?
Irritable Bowel Syndrome cannot be cured, but it can be managed to reduce the symptoms.

Some options include:

Diet:
Keeping a record of foods you eat and symptoms you have. This can help you pinpoint which foods cause problems. Your doctor can suggest changes in your diet to help manage IBS. Eating frequent small meals, rather than two or three large meals a day can help. In some cases, adding fiber to your diet may help.

Exercise:
Exercise helps to increase bowel motility and reduce overall stress and anxiety.

Physical Therapy:
Physical therapy is an effective, non-surgical treatment choice for IBS. PT treatment such as progressive relaxation and diaphragmatic breathing are also beneficial. Light pressure techniques and visceral work have been known to help relieve pain.
The patient is always evaluated for pelvic floor dysfunction because of the tightening of the rectal region in order to decrease the urgency that may be present. Many times, tightness of the muscles in the pelvic floor and decreased sensation of the pelvic floor can be related to constipation. Soft tissue work will help resolve tightness of the hip and pelvis. Biofeedback is also used to decrease overall muscular tension.

Your physician also may suggest medications or lifestyle changes to relieve the symptoms.

IBS is not an easy condition to diagnose or treat, but with guidance from your doctor and/or physical therapist, you can identify some options that will help you find relief.

Connie Strey is a licensed Physical Therapist at Women’s Care of Wisconsin/PT Center for Women, 3913 W. Prospect Ave., Suite LL2, Appleton, WI 54914. Contact Connie at 920-729-2982 or meet her here.

About the PT Center for Women
At PT Center for Women, our focus is on helping women incorporate lifestyle changes that will improve the quality of their lives. This includes gentle therapeutic exercise to both improve and maintain muscle tone, to rehabilitative exercise designed to get you back to your previous level of function and activities. From managing crippling abdominal and pelvic pain, to teaching proper sleeping postures and body mechanics at home and at work, we’re here for women. - Comments

Critical reasons that women of all ages should schedule an annual gynecological exam

By Becky Thyssen, MSN, CNM, APNP
Nurse Practitioner



It’s that time again—time to schedule your annual gynecological exam. But then you stop dialing and you think, “Do I really need to have an annual exam?” Or, you may be the mom of a teenage daughter and you think, “Should I schedule one for her too?”

Annual gynecological exams are visits designed to screen a woman for certain conditions and give you and your provider the opportunity to discuss ways to help you prevent these conditions and lead a healthier life.

During your life span, you may be at more risk for certain conditions than at other times. For example, in your 20s, you may be more at risk for unwanted pregnancy; while in your 50s, you would be more at risk for breast cancer. Therefore, as you change, so does your annual exam and recommended screening tests.

TEENS:
If you are a teenager or a mom of a teenager, there is no set time to start seeing a provider for an annual gynecological screening. Sometimes your first visit is just sitting down and talking about your health and teaching you ways to be healthier.

Beyond establishing a regular health screening, teenagers should also be seen if:
• You are thinking about or already are sexually active
• You have a menstrual cycle that is irregular, heavy, or painful to the point that it interferes with your day-to-day activities
• You need the Gardasil vaccine, which is a vaccine that can help prevent cervical cancer
• You have vaginal discharge that causes an irritation or odor or any pelvic pain

20-39 YEARS:
Pap tests are recommended to start at 21 years of age. Therefore, if you are 21 and you have not had your pap test you should schedule yourself for a yearly gynecological exam. This is one screening tool that we use to make sure you continue to be healthy. In addition, clinical breast exams and pelvic exams are done at your annual exam. These two exams screen for breast lumps, ovarian masses or cysts, or any abnormalities of the uterus.

Young women should also be seen if:
• You are sexually active: for screening for sexually transmitted infections
• You are trying to prevent a pregnancy: for birth control options
• You are planning your first pregnancy: for preconception counseling

40-65 YEARS:
At age 40, your annual exam will include your first mammogram. Depending on your individual and family history you will need one every other year until age 50 when it is recommended yearly.

In addition, women over 40 should schedule exams for:
• Cholesterol, diabetic, or thyroid screening: this is done every 5 years if normal
• When you turn 50 years old, we recommend your first colon cancer screening
• When you begin menopause, we recommend screening for osteoporosis every 2-3 years

In summary, this is just a brief overview of what occurs at the annual gynecological exams over your lifespan. You can see the importance of getting expert gynecological care for you and your loved ones. By scheduling preventative annual exams, many conditions can be found and treated before they cause serious health concerns.

Becky Thyssen is a Nurse Practitioner at the Appleton and Neenah locations of Women’s Care of Wisconsin. Contact Becky at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/. - Comments

Compare the realities of laparoscopic surgery vs. robotic surgery

By Rami Kaldas, MD
Obstetrician/Gynecologist

Laparoscopic surgery, also known as minimally invasive surgery, has been around for a long time. However, it was only in the late 1980’s that someone connected a camera to the laparoscope. In gynecologic surgery, this is usually placed through the belly button through a 5-10 mm incision and usually there are anywhere between 1 and 3 other incisions depending on the surgery. That is very small! Therefore, major surgery can be done and the patient frequently will be going home feeling well the same day.

As of late, robotic surgery has been all the rage. Robotic surgery is simply laparoscopic surgery with a “robot,” or a computer/machine, helping in the surgery. Many of us see advertisements for it and think this is the ultimate in surgical intervention and that complication rates should be lower and recovery faster. Well, before jumping to conclusions, compare both types of surgery and decide for yourself.

Robotic Surgery vs. Laparoscopic Surgery:	Robotic Surgery	Laparoscopic Surgery
Surgery Set Up Times	The time to perform robotic surgery simply by virtue of turning on and setting up the robot/machine is much longer; sometimes hours.	With no machine to turn on and “warm up”, the set up time to perform surgery simply in the hands of a skilled laparoscopic surgeon is much shorter.
Incision Size	Two of the incisions are 1cm each and two or three more incisions are 8mm each.	Depending on the surgery, usually 1-3 incisions total and the incision size is anywhere from 5-10mm.
Surgeons at Bedside	Not necessarily; the surgeon could be elsewhere in the room or elsewhere in the world. The surgery is performed by the surgeon moving the hydraulic arms while sitting at the console away from the operating table. The surgery assistants are at the bedside.	Yes, both the surgeon and the assistants are at the bedside.
Cosmetic Results	With robotic surgery, the hydraulic arms are powerful and can sometimes pull on the skin, especially since once the robot is connected, the patient cannot be moved.	In the hands of an experienced laparoscopic surgeon, the cosmetic result can be more attractive due to the delicacy of movements.

That is not to say that robotic surgery does not have a role. The technology is getting ever better and it is enabling surgeons who would otherwise not have the skill to do minimally-invasive surgery to do it. Ultimately, the surgeon must know how to operate very well in whichever modality they are offering the patient to avoid serious complications.

At Women’s Care of Wisconsin, we have an exceptional collection of skilled laparoscopic surgeons. We have revolutionized surgery for women in Northeast Wisconsin. We insist that each surgeon who comes to us as a new associate becomes learned in advanced operative laparoscopy until they, too, are amongst the few exceptional laparoscopic surgeons in the country. We rarely have to leave longer incision scars, even though more than two-thirds of hysterectomies in this country still leave women with a big vertical incision or horizontal incision on their bellies.

Before you decide on a surgery option, consider all the facts about a laparoscopic surgery vs. a robotic surgery and talk to your physician about the best option for your situation.

Dr. Rami Kaldas is an Obstetrician/Gynecologist at the Neenah and New London locations of Women’s Care of Wisconsin. Contact Dr. Kaldas at 920-729-7105 or meet him here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/.

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What to expect and what to be concerned about during the first few weeks of pregnancy.

By Sreedevi Sreenarasimhaiah, MD
Obstetrician/Gynecologist


Congratulations! You’re pregnant. This is the start of a wonderful journey. However, your body is going through many changes and it may be hard to know what is to be expected and what are reasons for concern.





Nausea & Breast Tenderness
Nausea and breast tenderness are one of the first symptoms that women experience. This is because of the rise in hormone levels in the body.

Human chorionic gonadotropin, also known as HCG, is the pregnancy hormone responsible for the nauseated feeling. Some women are more sensitive to the hormone than others. Some women will have vomiting. Vomiting is not dangerous to the baby and does not mean that anything is wrong with the pregnancy. Sometimes, women can be miserable if it is severe.

There are many conservative remedies to help with nausea, but if your condition is severe, call or see your healthcare provider to discuss measures you can take. A warning sign for the need for medical attention is the inability to keep even liquids down, like water or juice. Dehydration can occur if it is not controlled quickly.

Typically, nausea and vomiting typically improves by the completion of the 3rd month of the pregnancy.

Vaginal Bleeding
Another symptom that is important to discuss with your doctor is any vaginal bleeding that may occur. Vaginal bleeding can vary from as much as some spotting or old brown discharge to bleeding that requires a pad or sanitary napkin. Your doctor will want to make sure that bleeding is not because of a threatened miscarriage and may need to do a pelvic exam.

Not all bleeding is bad and does not mean the pregnancy is at risk. Sometimes bleeding can be seen with implantation of the pregnancy or with sexual activity as the surface of the cervix is easily irritated in pregnant women. In such cases, the bleeding is usually very minimal. Bleeding of any amount, however, should be discussed with your doctor.

Vaginal Discharge
Women may notice changes in vaginal secretions during this time. A mucous-type discharge or white discharge may be present. This is normal as the body develops a natural barrier for protection of the cervix during pregnancy. However, signs of a discharge that is not normal is that which itches, has a foul odor, or may have a curd-like appearance. You are encouraged to report such discharge to your healthcare provider.

Fatigue
A feeling of fatigue is very common during the first few weeks. The need for more sleep is also common and normal. This again is hormone mediated and will improve as the pregnancy progresses.

Aches & Pains
Finally, some general aches and pains, specifically on both sides of the groin area, are to be expected. This is called “round ligament pain.” These are the ligaments that support the uterus that are being stretched as the uterus grows. This pain may be crampy, but should not be severe or constant.

If you have pain that is severe or is associated with any fevers or bleeding, this is not round ligament pain and could be something else that requires immediate attention. Notify your doctor.

Baby Movement
During the first few months, you will not be able to feel the baby move. Movement of the baby may not be felt until the fifth month. This is normal. Until then, reassurance can be provided by hearing the baby’s heart beat on monthly visits by a doppler exam.

The first few weeks are full of changes, but it is the road to an amazing journey! If you are being seen by a Women’s Care provider, we encourage you to make an appointment and be seen in our office between 8 and 10 weeks of pregnancy.

Dr. Sreedevi Sreenarasimhaiah (“Dr. Sree”) is an Obstetrician/Gynecologist at the Appleton and Neenah locations of Women’s Care of Wisconsin. Contact Dr. Sree at
920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/. - Comments

The facts about women’s most private parts and tips on how to keep them healthy.

By Tatyana Shereshevsky, MD
Obstetrician/Gynecologist


Vulvovaginal health is an important area of women’s health, yet is often overlooked or disregarded. Knowledge about and comfort with your body, including the genitalia, is vital to maintaining good health.




Introduction to female vulvar anatomy or the 3 V’s: vulva, vestibule and vagina.

1. The Vulva.

The vulva is outside the body. It includes all the outer genitalia you can see between your legs. The vulva protects the women’s sexual organs, urinary opening, vestibule and vagina.

The vulva begins at the top with the mons, made mainly of a fat pad and covered with pubic hair. All together, it provides a cushion during sexual intercourse. The mons leads down on each side to the labia majora, that are also covered with pubic hair. The labia contain a fair amount of fat to act as a cushion for sexual intercourse as well.

The outer lips, or labia majora, surround two smaller, thin flaps of skin without hair, the labia minora. These are part of the protective covering for the vestibule, urethra and vagina. The inner lips of the labia minora might be visible or not. Either appearance is normal anatomy. In cases of significant enlargement, it can cause sexual discomfort, hygiene problems and pain with physical activities. If so, it might require medical attention.

The main function of the labia minora is sexual. At the top, labia minora meet under the clitoris and above the clitoris to form a hood.

2. The Vestibule.

The area between the labia minora is the vestibule. The name fits. Like the lobby, the vestibule is the site of two doorways: the urinary opening (urethra) and vaginal opening (introitus) lower. There are a few sets of glands that open into the vestibule. The major ones are Bartholin’s glands, which reside on the either sides of the vaginal opening. Their role is to assist in lubrication.

The thin membrane with one or more tiny openings in the middle of it that surrounds the vaginal opening is called the hymen. The hymen is a membrane of tissue at the opening of the vagina. It covers the opening of the vagina from birth until it is ruptured vaginal penetration, delivery, a pelvic examination, injury or sports. It has no known biological function.

3. The Vagina.

The vagina is truly inside the body. The vagina is a tube-like passage from the vulva to the cervix, which is the portion of the uterus that projects into the vagina. It is through a tiny hole in the cervix that sperm make their way toward the internal reproductive organs. The vagina is usually six to seven inches in length, and its walls are lined with mucus membrane and numerous tiny glands that make vaginal secretions.

The stretch of skin between the vagina and anus is called the perineum. Its skin covers a muscle called the perineal body. Providing resistance, it plays an important role in delivering babies.

Everyday Habits to Maintain Good Vulvovaginal Health.

1. It is so worth repeating: eat well, get adequate sleep, and exercise 2-3 times a week. Good general health is the best defense against infection and diseases.

2. Have smart sex. That means have one partner and use a condom.

3. Douching might destroy the normal bacteria in the vagina.

4. Avoid scented deodorant tampons or pads and spraying perfumes in the vaginal area.

5. Use tampons wisely. Choose the right absorbency tampon and change it regularly every 2-6 hours. A menstrual period usually produces around 4 to 12 teaspoons of menstrual fluid, about 20-60 gm.

6. Rethink powders. Corn starch is safer than talcum.

7. Loosen up. Thongs, bodysuits or tight spandex garments can trap sweat and feel abrasive.

8. Bathe right. Limit your time in hot showers or baths to 3 minutes. Mild soaps such as Dove, Basic, or Neutrogena are advisable. Never scrub the vulva. Occasional soaks in not-too-hot bubbles are fine. Lavender, rosemary, and clove oils should be diluted.

9. Wash diaphragms, cervical caps, spermicidal applicators and sex toys periodically.

10. Do not wear a pad or panty liner every day. It can be abrasive and irritating.

By educating yourself and being proactive about your feminine health, you can avoid discomfort, infections and diseases and ensure that you and your body are happy and healthy.
  
Dr. Tatyana Shereshevsky is an Obstetrician/Gynecologist at the Neenah and Oshkosh locations of Women’s Care of Wisconsin. Contact Dr. Shereshevsky at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/. - Comments

What you need to know about bacterial and viral STDs

By Kirsten Wengeler MS, APNP
Nurse Practitioner

Sexually transmitted infections (referred to as STIs or STDs), are a group of infections that are transmitted through sexual contact. This sexual contact can be vaginal, oral, or anal and in some cases through intimate skin to skin contact. A person with an STI can pass it to others by contact with the skin, the genitals, the mouth, the rectum or through body fluids. In many cases this person may not even be aware that they have one of these infections and could pass it along.

Some quick facts on STIs include:

• STIs affect people in all age groups, races, and backgrounds
• Centers for Disease Control (CDC) estimates that there are approximately 19 million new STI infections each year
• They cost the U.S. healthcare system $16.4 billion annually
• They cost individuals even more in terms of acute and long-term health consequences

STIs can be broken down into two categories, bacterial and viral.

Bacterial STIs:
• Often has no symptoms, especially in early phases
• Can be treated and cured with antibiotic therapy
• If not found and treated early enough their consequences can be permanent, including infertility
• Examples of bacterial STIs are chlamydia, gonorrhea and syphilis

Viral STIs:
• Often has no symptoms, especially in early phases
• There is presently no cure
• Can cause life-long symptoms and in some cases even death
• Examples of viral STIs include herpes, HPV (Human Papilloma Virus), HIV (Human Immunodeficiency Virus) and Hepatitis B

Limiting Your Risk

There is really no way to have a sexual relationship with another person that does not put you at risk for STIs, unless you are both tested prior to being intimate. However, limiting the number of sexual partners you have in your lifetime reduces your risk of acquiring an STI, and the correct and consistent use of condoms has been shown to decrease one’s risk of acquiring an STI (but does not entirely prevent the transmission of STIs).

The only sure way to protect yourself from an STI is abstinence. This is avoidance of all types of sexual activity. Someone who practices sexual abstinence does not run any risk of contracting an STI or having an unwanted pregnancy.

Ideally you should wait to have sex until you are ready for a long-term relationship with just one person. This person should be equally committed to this relationship and to only having sex with you. Even in this situation, there is a risk of STDs if you or your partner has had other sexual relationships prior to this relationship.

If you are or have been sexually active it is important that you see your healthcare provider for STI testing. Your healthcare provider will also be able to help you assess your risk and provide you with information to reduce your likelihood of acquiring an STI.

Kirsten Wengeler is a Nurse Practitioner at the Neenah location of Women’s Care of Wisconsin. Contact Kirsten at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/.

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Reliable, safe exercise tips for after baby is born

By Michelle Landsverk, DPT

So congratulations! You’ve had your baby, and now you’re excited to get back into those favorite clothes that you haven’t worn in quite awhile. You feel like they should fit, because after all, your baby is five weeks old already. But, your jeans are still two sizes too small.

So, what do you do? You promptly jump onto the treadmill, turn up the incline, and start jogging. Fast. For like, two minutes. And then something happens. You notice that you’re wet. Not wet with sweat, just wet. In the saddle region, and at that moment you realize that your body is not quite like it used to be prior to that beautiful baby you now have. The very next thing you do is call your girlfriend, mom, sister, or all three and shout, “DID THIS HAPPEN TO YOU!?” 

It’s true, and it happens all the time. Women have a baby, and then they want to pick up their life where it left off prior to pregnancy. The little story I just told you about is only one of several potential hiccups that new moms experience when they are ready to resume their pre-pregnancy workouts, or simply start exercising altogether.

So, let’s take a step back together and figure out a safe, effective, and successful way to get back into a healthy and active lifestyle once your baby is born. After all, a “simple” thing like going for a jog may not be all that simple. 

The first thing you need to do is take into account exactly how the delivery of your baby went:
• Did you have him or her vaginally, or via c-section?
• If you had the baby vaginally, did you push forever and a day, or was the delivery very fast?
• Did your perineum tear, or did you have an episiotomy?
• If you had a c-section, did your incision heal properly in a timely manner?

These factors may influence how quickly you will feel ready to start a post-pregnancy exercise program.

You also need to think about what exercises you have available to you. For example, many women will begin a running program either because they own a treadmill, or running is easy because all you need to do is step outside. Problem is, when running, each time your foot strikes the ground, there is considerable force on your pelvic floor, like, seven-times your body weight. Think about that for a second. A 150-lb woman running strikes the ground with 1,050 lbs of force with each stride! In my opinion, that’s way too much for any woman until she’s closer to twelve weeks post-partum (I know there are plenty of moms out there who disagree with me, but for the vast majority of American women, twelve weeks is a better guideline).

Many women go to the library and check out exercise DVD’s of various sorts. Often times the most popular DVD’s are those that correspond with the latest exercise fad, or reality TV show. The latest exercise class crazes are definitely zumba and kettlebells, and Jillian Michaels is the most popular exercise guru right now, bar none. Interestingly her video, “30 Day Shred” is one of the most sought after DVD’s for those people interested in weight loss. Now, I don’t want to pick on Jillian too much, after all, she has been and continues to be an incredible vehicle for change. However, one of her promises is “killer exercises.”

Well, I’m here to tell you, as a physical therapist, the number one reason for a failed exercise program is burnout or injury from choosing exercises that are simply too tough for a de-conditioned body. I do in fact see plenty of patients in the clinic who have injured themselves doing a new exercise program. So please, if you do choose to do a DVD work-out, avoid any exercise that doesn’t feel right, or stop doing any exercise that hurts to do.   

Finally, I do need to make one point about working out those abdominal muscles. Oh, our poor abs! First we stretch them beyond recognition, and then we expect them to bounce back with vigor. Second, there’s exercising abdominal muscles in order to get them stronger or more toned…which is the more correct mindset for exercising them. And there’s exercising the abs in order to shed excess fat around the waistline, which is a less healthy to approach exercising them.

Let me explain why: despite the claims of popular infomercials, you cannot spot-train any particular area of the body, especially the middle! In other words, you cannot achieve a smaller waist by simply exercising your abdominals. There are other factors involved. You need to increase your aerobic (cardio aerobic) exercise, AND decrease your caloric intake in order to decrease the size of your midline. This is a very hard concept to grasp for a lot of frustrated women out there, but once you embrace it, you will find that your clothes fit better and you will feel better about your body!

There are some wonderful exercise options out there for women. If you have access to a full-service gym, you can get your cardio aerobic exercise by swimming, and by using various pieces of exercise equipment like the elliptical trainer, recumbent or upright bikes, and rowing machines. Treadmills are excellent, but again, I recommend only walking for the first 12 weeks after your baby is born.

If you don’t have access to the gym, and the weather is agreeable, taking your baby for a walk in the stroller is wonderful for you and him or her. Fresh air is great for the two of you, and the resistance of the stroller will help increase your heart rate for the cardio aerobic workout your body needs.

Resistance exercise, or weight training, is also great. Although I do recommend that you use weights for toning and light strengthening, versus heavy resistance training. Working out with heavy weights, particularly if you are doing standing-type exercises, is not good for your pelvic floor muscles for the first 12 weeks after the baby is born.

And finally, exercise classes, like zumba and yoga will help you with balance, coordination, flexiblity and strength. Plus, exercise classes give you the camaraderie that you might need to draw upon on those days that it is hard to motivate yourself to get going.

My point is really this: there are healthy ways to view exercise, and I’m here to help you pick out good, safe options to lose that baby weight. The healthiest way is to set realistic goals for yourself, and to stick with the basics of diet (i.e. portion control) and exercise. Please realize that your weight wasn’t put on in a few short weeks, and it will not come off in a few short weeks. Eat right, and get your sleep, and pick some exercises that feel right to do. In addition, check out these online resources for post pregnancy exercise tips:

• Post Pregnancy Exercise: Getting Back in Shape
• Post Pregnancy Fitness

Michelle Landsverk is a Doctor of Physical Therapy at Women’s Care of Wisconsin/PT Center for Women, 3913 W Prospect Ave, Suite LL2, Appleton, WI 54914. Contact Michelle at 920-729-2982 or meet her here.

About the PT Center for WomenAt PT Center for Women, our focus is on helping women incorporate lifestyle changes that will improve the quality of their lives. This includes gentle therapeutic exercise to both improve and maintain muscle tone, to rehabilitative exercise designed to get you back to your previous level of function and activities. From managing crippling abdominal and pelvic pain, to teaching proper sleeping postures and body mechanics at home and at work, we’re here for women. Learn more at www.ptcenterforwomen.com.

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Women who have migraines during their cycles should consult a physician

By Beth Helgerson, MD
Obstetrician/Gynecologist

Migraine headaches are a very common ailment. In fact, it’s believed that 12% of the population suffers from chronic headaches. Migraine headaches are more common in women, and although the mechanisms are not fully understood, oftentimes migraine headaches can be associated with the menstrual cycle.

Migraine headaches do not have specific diagnostic imaging studies that are recommended, but rather diagnosis is made based on history and physical exam.  Usually, migraine headaches are recurrent, and consist of:

• A prodrome, or “pre-headache,” which can consist of food cravings, mood changes, muscle stiffness, fatigue and other symptoms;
• An aura, which can consist of visual disruptions, tingling, numbness, confusion and other symptoms;
• The headache, which can be debilitating and can affect the entire body;
• The postdrome, or “post-headache,” which can include lower or higher mood levels, fatigue, poor concentration and other symptoms.

Not all migraine episodes include all phases. You can read more about the anatomy of a migraine headache here.

For many women, declining estrogen levels can be a trigger for migraine headache.

Examples of this would include:

 • The beginning of a menstrual cycle – the beginning of the bleeding phase of a menstrual cycle is a low estrogen timeframe compared to the rest of the cycle. 
• During postpartum, which is associated with diminished estrogen levels.
• During perimenopause, when there are wide fluctuations of estrogen levels from day to day in many women, and this can be a trigger for migraine.
• Women taking combination birth control pills will also have decreased estrogen levels during the placebo pills. 

There are three primary treatment options for migraines:

1. Medications. Migraine headaches can be treated with rapid onset triptan medications such as Imitrex. These are medications that are felt to promote vasoconstriction, and also block pain pathways within the brain. When given early in the headache sequence, they can prevent the headache. 

2. Prevention. If triptan medicines are inadequate, patients and their physicians should consider prevention. Prevention options may include extended regimen, combination contraceptive options, and also the possibility of supplemental estrogen during the menstrual cycle. Certainly risks of estrogen have to be considered. Some women are at increased risk of side effects that can be serious, and this should be discussed with a physician. 

3. Transdermal or transvaginal delivery of estrogen. Some women will find that transdermal or transvaginal delivery of estrogen may be more effective than oral medications.  Oral medications are more fluctuant than the transdermal or transvaginal approach, and this can also be considered with one’s physician. 

In summary, menstrual migraines can very much impact the quality of life of women and those they care for. There are options for treatment, and prevention should also be considered. Talk with your physician about the most appropriate treatment options for you.

Dr. Beth Helgerson is an Obstetrician/Gynecologist at the Appleton and Waupaca locations of Women’s Care of Wisconsin. Contact Dr. Helgerson at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin
The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at www.womenscareofwi.com.

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There are safe alternatives to hysterectomies and tubal ligations to avoid pregnancies

By Marley Kercher, MD
Obstetrician/Gynecologist

I have the privilege of taking care of women throughout every stage of their lives. This means annual exams, prenatal/pregnancy care, birth control, menopause management and elimination of incontinence issues. A satisfying part of my job is empowering women by helping them prevent unwanted pregnancies when their families are complete.

Some women think the only permanent options to avoiding pregnancies are hysterectomies, tubal ligations and vasectomies. Within the last five years, there have been two different in-office procedures created that provide permanent birth control and do not include any of the above. These procedures are called Essure and Adiana.

In addition to these procedures, an ablation procedure called NovaSure can be done, also in the office, to significantly reduce or completely eliminate menstrual cycles, adding to the quality of life for women.

Essure & Adiana
Essure and Adiana are permanent birth control procedures that work with your body to create a natural barrier against pregnancy.

They offer women what no birth control ever has:
• No surgery, burning or anesthesia
• No hormones
• No slowing down to recover
• Performed in less than 30 minutes
• Trusted by hundreds of thousands of women and doctors for over five years

Both procedures are permanent and are NOT reversible. Therefore, you should be sure you do not want children in the future.

Unlike other permanent birth control, these procedures do not require cutting into the body or the use of radiofrequency energy to burn the fallopian tubes.

Instead, in the case of Essure, I insert a soft, flexible coil through the body’s natural pathways (vagina, cervix, and uterus) and into your fallopian tubes. The very tip of the device remains outside the fallopian tube, which provides us with immediate visual confirmation of placement.

With Adiana, a tube is also inserted into the fallopian tubes and a small amount of radiofrequency energy is applied to the lining of the tubes. Then, a biocompatible silicon matrix material is inserted at this site.

During the three months following the procedure, your body and the inserts work together to form a natural barrier that prevents sperm from reaching the egg. During this period, you must continue using another form of birth control (other than an IUD).

After three months, we have you come back into the office to verify you’re protected.  The test uses a dye and special type of x-ray to ensure both that the inserts are in place and that the fallopian tubes are completely blocked.

NovaSure
The NovaSure procedure is a quick, safe, simple, one-time endometrial ablation treatment. This minimally invasive procedure controls heavy bleeding by using energy to remove the lining of the uterus. The average treatment time is about 90 seconds and only needs to be performed once to lighten or stop your periods.

Without the side effects of hormones or the risks of hysterectomy, NovaSure has a quick recovery time so you can get back to your life sooner. Most women experience no pain after the procedure, and can return to work and regular activities the next day.

If you are considering permanent birth control, please consult with your physician on the best solution for your needs.

Dr. Marley Kercher is an Obstetrician/Gynecologist at the Neenah location of Women’s Care of Wisconsin. Contact Dr. Kercher at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin
The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at www.womenscareofwi.com.

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Young women should see their doctors to discuss pap smears, STDs and birth control methods

By Amber Post, MD
Obstetrician/Gynecologist

Many teens and parents wonder what an appropriate age is to start seeing a gynecologist.  There is not one correct answer for everyone, however there are many reasons why now might be the right time! Young women should consider making an appointment if they have heavy or painful periods, want to prevent pregnancy, are worried they are pregnant, are sexually active, or if they have reached age 21.

What can I expect at my first visit?
The first visit begins with discussing your health history. The physical exam will include a breast exam and a pelvic exam. The pelvic exam may include a pap smear or STD testing if necessary.  We will then discuss the results.

The Pap Smear
A pap smear is a brushing of cells from the cervix to detect cervical cancer.  Your pap result will be one of the following:

• Normal
• ASCUS (atypical squamous cells of unknown significance)
• LGSIL (low-grade squamous intraepithelial lesion)
• HGSIL (high-grade squamous intraepithelial lesion
• AGC (atypical glandular cells)
• Cancer

If your pap was abnormal, the most likely next step is colposcopy. With colposcopy we visualize the cervix through a magnifier to identify the abnormal area. If necessary we also do a biopsy. Abnormal cervical cells are graded on a scale from CIN-I to CIN-III. Low-grade lesions such as CIN-I often will heal on their own. Your follow-up will depend on your age and the severity of the lesion. Typically this means repeating your pap and possibly colposcopy every 6-12 months. Most CIN II and all CIN III lesions should be excised. Most commonly this is done by a LEEP.  With LEEP we remove the entire abnormal area.

Abnormal pap smears are caused by the HPV virus. The type of HPV that affects the cervix is sexually transmitted. There are many types of HPV, but there are a few types that cause the majority of cervical cancers. We will often test for these “high-risk HPV” during your pap. You can protect yourself from HPV by practicing safe sex and getting vaccinated.

STD
Another common concern for adolescents is sexually transmitted disease (STD). There are many different types of sexually transmitted disease, some of which can cause long-term problems such as pelvic inflammatory disease and infertility. An exam is recommended if you have any of the following symptoms:

• Burning
• Sores
• Bumps
• Rash
• Blister
• Discharge
• Itching
• Pain
• Redness
• Swelling

The most common STDs are gonorrhea, chlamydia, and trichomonas. These STDs may cause an increase in vaginal discharge. If not treated early they can cause PID. Herpes tends to cause painful blisters or ulcers. More serious STDs include HIV, syphilis and hepatitis, which may be asymptomatic at first. Your best protection from STDs is to use a condom every time you have sex.

Birth Control
There are several safe and effective ways to prevent pregnancy, including barrier methods, hormonal methods and sterilization. Only abstinence is 100% effective.

Barrier methods include the male and female condom, diaphragm, cervical cap, sponge and spermicide. Overall these are the least effective at preventing pregnancy.

Hormonal methods include birth control pills, NuvaRing, contraceptive patch, Depo Provera, Implanon and IUD. Often they make your period more predictable, lighter, and less painful.

 - Birth control pills are taken once a day, preferably around the same time each day. They contain estrogen and progesterone.
- The NuvaRing is inserted vaginally by you and is worn for 3 weeks. It is then removed for one week, which is when you will get your period.
- The contraceptive patch is applied for one week at a time for three consecutive weeks, then left off the week you will get your period. The dosing is less predictable, therefore it is not recommended if you weigh more than 175 pounds. There is also a possible increased risk of blood clots with this method.
 - Depo Provera is an injection given in the clinic every 3 months. Most women stop getting their period, though some will have irregular bleeding. Another potential side effect is weight gain.
- Implanon is a rod is inserted under the skin of your arm that lasts for 3 years. This has also been associated with irregular bleeding. 
- The Mirena IUD is inserted into your uterus and lasts for 5 years. Insertion can be more difficult prior to having children. Most women have very light or no menstrual bleeding. 
- The copper IUD lasts for 10 years but may increase your menstrual bleeding.

Emergency Contraception 
If you fear your birth control may have failed, such as missed pills or a broken condom, emergency contraception is available. It is now approved to be used as late as 5 days after unprotected sex. The sooner you take it, the better it works. It is taken in two doses and is 75-89% effective. Nausea is a common side effect.

Whatever your concerns are for yourself or your child, younger women should definitely consider seeing a gynecologist as soon as they have issues or questions. Education and preventive care is the best way to ensure a healthy body now and in the future.

Dr. Amber Post is an Obstetrician/Gynecologist at the Neenah and Oshkosh locations of Women’s Care of Wisconsin. Contact Dr. Post at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin
The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at www.womenscareofwi.com.

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During pregnancy, that is the question…

By Michelle Landsverk, DPT

Frequently I get the following question from my pregnant patients: “I’ve never really exercised before, but I need to. Is it okay to start now?”

I always greet this query with a degree of both enthusiasm and caution. A couple of months ago, I wrote about the benefits to both pregnant Mother and baby, of exercising through a pregnancy. At that time, my focus was on preventing gestational diabetes, and fighting childhood obesity. In other words, I highlighted two major benefits to exercise during pregnancy. 

This month, I will look at the risks of exercise during pregnancy. “Risks!” you say, “What risks?” Now, before you stop reading this and come to the conclusion that you should not exercise during your pregnancy, I urge you to look at this through my eyes. 

As a physical therapist, I am specially trained in exercise prescription. In other words, I teach people how to exercise. Sometimes that involves rehabilitative exercise in order to heal from an injury or surgery, occasionally it includes performance coaching for seasoned athletes, and sometimes it involves teaching someone who has never exercised before how to start. If you fall into the third category of people, this blog is for you! 

First of all, let me state the few reasons why women would absolutely not be allowed to exercise during a pregnancy. These are set by the American College of Obstetrics and Gynecology. They include: 

  • Significant heart or lung disease
  • An incompetent cervix
  • Multiple gestation at risk for premature labor
  • Persistent second or third trimester bleeding
  • Placenta rupture during pregnancy
  • Ruptured membranes
  • Preeclampsia

There are also several reasons why pregnant women would have to be closely monitored if exercising during a pregnancy. These include:

  • Severe anemia
  • Chronic bronchitis
  • Poorly controlled type I diabetes
  • Extreme morbid obesity
  • History of extremely sedentary lifestyle
  • A fetus that is not growing as it should
  • Poorly controlled high blood pressure
  • Poorly controlled seizure disorder
  • Poorly controlled hyperthyroidism
  • Smoking heavily during a pregnancy

Now, you may or may not feel like diving right into an exercise program right now. And if you’re feeling that way, it’s okay. My point here is really to say, if you’ve had an active lifestyle prior to your pregnancy, please continue on.

There are, of course, precautions and no-no’s to adhere to like: no cliff-diving or sporting activity that would put you at risk for sustaining any type of injury or trauma directly to your abdomen. But things like pre-natal yoga and aerobics class, walking and swimming are all really good.

You do need to be mindful of your level of exertion; because you do not want to compete with your baby for oxygen, and you do not want to expose your baby to prolonged thermal stresses (you do not want your baby to get abnormally hot or cold).

My favorite way to have pregnant women monitor themselves for safety is by a simple little test called, “the talk test.” The talk test is a measure of the oxygen demands of your heart and lungs as you exercise. It has actually been tested scientifically, and it has been found to be both reliable and valid (medical terms for consistent and correct). The test is performed while you exercise.

All you need to do to complete a talk test is see if you can hold a casual conversation while you are exercising. If you are able to talk and hold a conversation, then you are doing fine. However, if your breathing is too intense, and your heart rate is too rapid, then you would not be able to talk effectively and you are exercising too hard. 

If you have never exercised before, and you want to start now, that’s awesome! Please talk to your doctor first for any safety issues you might need to pay special attention to. Then take a girlfriend with you, get out and exercise and talk away!

Michelle Landsverk is a Doctor of Physical Therapy at Women’s Care of Wisconsin/PT Center for Women, 3913 W Prospect Ave, Suite LL2, Appleton, WI 54914. Contact Michelle at 920-729-2982 or meet her here.

About the PT Center for Women 
At PT Center for Women, our focus is on helping women incorporate lifestyle changes that will improve the quality of their lives. This includes gentle therapeutic exercise to both improve and maintain muscle tone, to rehabilitative exercise designed to get you back to your previous level of function and activities. From managing crippling abdominal and pelvic pain, to teaching proper sleeping postures and body mechanics at home and at work, we’re here for women. Learn more at www.ptcenterforwomen.com.

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Don’t suffer in silence, talk to your doctor about available treatments

By Connie Strey, Physical Therapist, PT, BCIA-PMDB

As seen on a recent episode of True Life on MTV, pelvic pain dysfunctions are a silent disease. Many young women (as well as older women) suffer from pain in the pelvic region causing pain with intercourse, tampon insertion and sometimes light touch. 

Most of the women that come to see me about their pelvic pain have seen at least five doctors prior to physical therapy. The majority of them have been told somewhere within their search for treatment that they should just relax and have a glass of wine.

This is very upsetting to a physical therapist, knowing that this type of pain and dysfunction is musculoskeletal and it can be treated as a musculoskeletal dysfunction with traditional PT techniques. It just happens to be in a very delicate area of the body. This area has muscles that are similar to other areas of our body. They can become very tight, and this tightness can be treated with appropriate techniques.

The reasons patients have pelvic pain can include:
• A gynecological problem
• Painful periods
• Muscle spasms
• Injury to the area

No matter what the cause is, the muscles will reactively tighten and spasm to protect the pelvic floor region. This tightening and spasming can cause difficulty with penetration including intercourse and tampon use.

Dyspareunia is the medical terminology for pain with intercourse. Dyspareunia can be caused by muscle spasming. The muscle spasm of the pelvic floor around the vaginal opening which causes dyspareunia is called vaginismus. 

Vaginismus, which is one of the common diagnoses of pelvic pain, is a muscle spasm of the muscle that surrounds the vagina. This muscle can clamp down and cause difficulty with penetration and pain with intercourse. Throughout my 23 years as a physical therapist in treating pelvic dysfunction, the most common comment that is made to me from women who have vaginismus is that they have pain with intercourse. 

There is help for patients with muscle tightness in the pelvic region. Treatment options include physical therapy and on some occasions, surgical intervention.

Treatment options in physical therapy include:

• Stretching the pelvic muscle with a dilator. A dilator is a 6” long cylinder piece of plastic which is inserted into the vagina to stretch both the outside muscle of the pelvic floor and the inside muscle in the vagina. Dilators come in many sizes, starting with extra small all the way to large. Stretching the muscles will help decrease the tightness so intercourse is less painful. Using a dilator will also decrease the hypersensitivity of the vaginal opening. The vaginal opening can become very hypersensitive to light touch, causing pain. This in turn will cause more muscle spasming, which causes more tightness, which causes more frustration. 

• Myofascial release and trigger point release can be performed by a physical therapist to the tight muscles of the pelvic floor. These techniques help with relaxation of tight muscles.

• Ultrasound is a modality that can be used in tight muscles to help increase circulation and decrease tightness throughout the muscles in the vaginal area.

• Retraining the muscles of the pelvic floor and teaching them to relax can also be a treatment option.

• Internal vaginal biofeedback can be used to teach the muscles of the pelvic floor to “let go” and relax so muscles can restore their flexibility and pain with intercourse can decrease.

• Electrical stimulation can also be used with internal or external electrodes. This is used to decrease overall pain and muscle tension and increase circulation of the pelvic floor, which in turn also will decrease the tightness of the muscle and decrease pain with intercourse. 

• Other treatment options in physical therapy include postural reeducation and visceral mobilization.
Most importantly, education about pelvic floor irritants and “dos and don’ts” of the pelvic floor is always beneficial. Many times we are using or doing things to the pelvic floor that can be irritating, causing the pelvic floor to tighten in response to the irritation, causing muscle tightness and pain with intercourse.

If you have pelvic pain and are living with it, please consider talking to your doctor about your treatment options. You do not have to suffer in silence—there are many options to help you.

Connie Strey is a licensed Physical Therapist who specializes in pelvic pain and biofeedback at Women’s Care of Wisconsin/PT Center for Women, 3913 W Prospect Ave, Suite LL2, Appleton, WI 54914. Contact Connie at 920-729-2982, or meet her here.

About the PT Center for Women  At PT Center for Women, our focus is on helping women incorporate lifestyle changes that will improve the quality of their lives. This includes gentle therapeutic exercise to both improve and maintain muscle tone, to rehabilitative exercise designed to get you back to your previous level of function and activities. From managing crippling abdominal and pelvic pain, to teaching proper sleeping postures and body mechanics at home and at work, we’re here for women. Learn more at www.ptcenterforwomen.com.

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It’s more common than you think—here’s what you need to know

By Hassan Shahbandar, MD
Gynecologist

HPV, or Human Papilloma Virus, is responsible for cervical cancer, genital warts and other cancers, such as throat, anal and penile cancers. There are about 120 different types of this virus. About 30 of these types are transmitted through human contact, of which most are sexually transmitted.

Anyone who has unprotected sexual intercourse is at risk for contracting the virus. It is unusually common in teenagers. 24% of 15 year olds, 38% of 16 year olds, 51% of 17 year olds and 62% of 18 year olds harbor this common virus.

Most people who are exposed or harbor this virus have no symptoms nor have any sign of a disease. The body’s immune system will usually destroy the virus, especially in young people, so the majority of people exposed do not get genital warts nor cancer. But some do, and some might also have symptoms such as irritation, burning or a raw feeling in their genital tracts. These symptoms are much more common in women than men.

How to find out if you have HPV
A pap smear is used to detect the presence of this annoying and sometimes risky virus. Testing is recommended for females after age 21 every one to two years; then after age 30 testing can be stretched to every two years, and if the patient has three negative pap smears and does not practice risky sexual behavior, the test can be extended to every three years. There is no need to test men, women who have had a hysterectomy for a noncancerous cause, or monogamous women living with monogamous men after age 65.

Vaccines available
HPV vaccines are 100% effective against the types of virus that they are made for, which include types 16 and 18 (the causes of cervical cancer), and also types 6 and 11 (the causes of genital warts). An HPV vaccine will prevent 70% of cervical cancer and up to 90% of genital warts (depending on what vaccine is being used).

The vaccine is recommended for girls over age 10. It is not recommended for boys or pregnant women. The risks associated with an HPV vaccine are like the typical risks of any other vaccine; there is no reason to hesitate to get this vaccine.

To prevent the spread of this virus, it is recommended to use condoms properly or abstain from sexual activity.

Dr. Hassan Shahbandar is a Gynecologist at the Appleton and Waupaca locations of Women’s Care of Wisconsin. Contact Dr. Shahbandar at 920-729-7105 or meet him here.

About Women’s Care of Wisconsin
The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at www.womenscareofwi.com.

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If you are suffering from pelvic pain, there are many treatment options available to you

By Connie Strey, Physical Therapist, PT, BCIA-PMDB

Pelvic pain is a symptom that can affect both men and women. Treating pelvic pain has taught me that every pain syndrome is unique. The more I would treat pelvic pain, the more I realize it is very complicated. Because of that, I continued my education to be certified in the treatment of pelvic pain, thinking I would have all of the answers. Becoming certified has opened my eyes to the fact that it is more complicated that I would have ever thought.

There are two types of pelvic pain, acute and chronic.

Acute pelvic pain:
• Starts over a short period of time, anywhere from a few minutes to a few days
• Many times is experienced after surgery or with soft tissue injury
• Is often short-lived but may be severe
• Is often a warning sign that something else is wrong and should be evaluated promptly

Chronic pelvic pain:
• Severe and steady pain, dull aching or sharp pains with cramping, pressure or heaviness with the pelvis
• Pain with intercourse, having a bowel movement or sitting
• Persists for a period of three months or longer
• May be intermittent or constant; intermittent chronic pain will usually have a cause while constant pelvic pain may be the result of more than one problem

The cause of chronic pelvic pain is often hard to find. Because specific diagnosis is difficult and finding the problem that explains your pain is not clear, that does not mean your pain isn’t real or is not treatable.

Pelvic pain can be caused by endometriosis, pelvic adhesions, vulvodynia, irritable bowel syndrome (IBS), interstitial cystitis (IC), diverticulitis, kidney stones, pelvic inflammatory disease, vaginal infection, vaginitis, STDs, ovarian cysts, an ectopic pregnancy, tension in the pelvic floor muscles, chronic pelvic inflammatory disease, pelvic congestion syndrome, ovarian remnant, fibroids, disease of the reproductive system, scar tissue, urinary tract and bowel dysfunction, physical and sexual abuse, depression, anxiety or musculoskeletal problems of the pelvic floor.

Here is some further explanation on some of these gynecological causes for pelvic pain:
 • Endometriosis: a condition where the lining of the uterus grows outside the uterus. This tissue can attach itself to the ovaries, fallopian tube and intestines. Endometriosis can cause pelvic pain during menstruation and can result in the formation of pelvic adhesions.

• Pelvic adhesions: bands of scar tissue that bind organs together. They can be caused by infections or pelvic inflammatory disease, by pelvic or abdominal surgeries or endometriosis, and cause generalized pelvic discomfort or localized pain. The diagnosis of pelvic adhesions can be very difficult and many times are diagnosed through laparoscopic surgery. 

• Vulvodynia: pain around the opening of the vagina and around the surrounding lips (vulva). The cause of vulvodynia is unknown. Women with vulvodynia may have pain with intercourse, wearing tight pants or insertion of a tampon. They describe their pain sometimes as burning, stinging, stabbing and rawness.

• Irritable bowel syndrome (IBS): can cause constipation, diarrhea or a combination of both. The patient many times will feel pelvic pain described as bloating, which can be aggravated with stress and diet. This pain may be relieved with a bowel movement.

• Interstitial cystitis (IC): pain in the bladder. Symptoms may include urinary urgency, frequency, and pain with urination. Many times this has Hunner’s patches associated with the diagnosis. These are thin patches in the bladder wall which can be irritated by the urine itself. 

• Musculoskeletal problems of the pelvic floor: Many times the muscles of the pelvic floor are over-stretched, torn, cut during childbirth or weakened from disuse or injury. There may be movements and postures that compress nerves and structures of the pelvis that can lead to pain and dysfunction. Spasming of the muscles of the pelvic floor can cause dyspareunia, which is pain with intercourse. Many times the deep pelvic pain can be caused from the deep pelvic floor musculature. These muscles, the levator ani muscle group, form a sling from the pubic bone to the coccyx. These muscles lift and support the pelvic organs – bladder, uterus and rectum.  When there is a spasm of the levator ani muscle group, it can cause pelvic floor tension, myalgia or levator ani syndrome. Many times these muscles of the pelvic floor will have trigger points that are tender to touch. They can also refer pain to the pelvis, lower back and abdominal region.

• Physical or sexual abuse, depression and anxiety: can also contribute to chronic pelvic pain. It is estimated that half the women with chronic pelvic pain have a history of abuse. It is essential to address abuse, depression and/or anxiety with medications or with therapy as needed.

Tests and diagnosis:
• Pelvic examination will reveal abnormal growths, tension in the pelvic floor and infection.
• Samples of the cervix and vagina to look for infection and sexually transmitted disease may also be obtained.
• Another exam may be laparoscopic surgery. Using a thin tube with a small camera, the gynecologist can look for abnormal tissue or signs of infection. 
• Other tests that may be performed include imaging studies – vaginal ultrasound, abdominal x-ray, CT scan or MRI. These may all be tests the doctor may prescribe.

Treatment:
If the underlying cause of the pain is found, the doctor will focus on eliminating the particular cause. If no cause can be found, the physician will focus on managing the pain. Possible treatments for chronic pelvic pain includes:
• Antidepressants
• Antibiotics
• Hormone treatments
• Pain relievers
• Physical therapy
• Trigger point injections
• Nerve separation
• Counseling
• Surgery as the last resort

Physical therapy is prescribed when there is a Musculoskeletal or visceral component to the pain. Physical therapists that specialize in pelvic pain have one or both of the following:
• Certification Achievement in Pelvic Pain (CAPP) certified
• Biofeedback Certification Institute of America – Pelvic Muscle Dysfunction Biofeedback (BCIA-PMDB) pelvic biofeedback certified for this specialty

Pelvic physical therapy may include:
• An application of heat or cold to the pelvic floor, abdominal area, or both
• Stretching exercises or strengthening exercises
• Manual therapy techniques for soft tissue mobilization and myofascial release
• Relaxation techniques
• Transcutaneous electrical nerve stimulation (TENS)
• Modalities such as ultrasound or electrical stimulation
• Acupressure—inserting needles into the skin in precise areas which will induce endorphins and enkephalins (natural pain killers that reduce pain)

Biofeedback:
• Is used to control the pelvic floor musculature and decrease the reponse to pain
• Uses special monitoring equipment that picks up the EMG activity of the pelvic floor musculature
• Teaches the patient to relax Spasming pelvic floor musculature
• Retrains muscles to begin strengthening
• Can be performed externally, vaginally or rectally

Chronic pelvic pain accounts for 20 to 30 percent of all laparoscopies in adults and 10 percent involve gynecological visits. Be assured, with the proper medical treatment, your pain can go away and you can resume normal activities. Please, if you are suffering from pelvic pain, do not hesitate to consult with your doctor.

Connie Strey is a licensed Physical Therapist at Women’s Care of Wisconsin/PT Center for Women, 3913 W Prospect Ave, Suite LL2, Appleton, WI 54914. Contact Connie at 920-729-2982, e-mail her at e-mail here or meet her here.

About the PT Center for Women

At PT Center for Women, our focus is on helping women incorporate lifestyle changes that will improve the quality of their lives. This includes gentle therapeutic exercise to both improve and maintain muscle tone, to rehabilitative exercise designed to get you back to your previous level of function and activities. From managing crippling abdominal and pelvic pain, to teaching proper sleeping postures and body mechanics at home and at work, we’re here for women.

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Did you know that 40% of women have incontinence at some point in their life? Here’s what you can do to take control.

By Eric Eberts, MD
Obstetrician/Gynecologist

Incontinence is the loss of urine in an uncontrollable fashion. There are many reasons as to why people have it. Some of them are very easy to treat successfully and are easily cured, and some of them are very challenging to cure. But we can usually get significant improvement with treatment. Incontinence is one of my favorite conditions to see a new patient with; I can often cure them outright and almost always make a big improvement for them with fairly little intervention.

Most people put up with it and hope that it’s going to get better, or put if off until tomorrow, only to realize that several years have passed and it’s only gotten worse.

In generations past, people have looked at the loss of urine as a normal part of aging or normal consequences of childbearing, both of which I think are mistakes. What I would encourage people to think about is the fact that although incontinence is not painful, it’s not normal. People really don’t like to deal with it because it’s embarrassing. But they should realize, it’s very common, and often very easy to treat.

However, correctly treating incontinence means also that you have an understanding of what the true diagnosis is, very much like a headache. There are many different causes for it and the headache itself is usually a symptom of an underlying abnormality of some type, just as incontinence can be caused by many different things. 

Relief for women dealing with bladder control issues typically takes one of three routes:
• It can be as simple as a 10-minute outpatient procedure or a prescription for  medication.
• It may require a combination of therapies to get someone to a much better function.
• Sometimes we need to treat an underlying, undiagnosed urinary tract infection, which should be evaluated further, as it could possibly be a sign of other diseases such as MS or diabetes. 

There are varying levels of incontinence, all of which can be diagnosed and treated to help you return to a normal, active lifestyle.

Spasm and bladder irritability:
  • Conditions where a person is urinating frequently and up a lot at night with a sudden 
  sense of urgency (similar to the television commercials you see)
  • Tends to be a neurologic, irritational aspect to the bladder
  • There are a handful of different medications that are typically used to treat this
Stress incontinence:
• People leak a small amount of predictable urine every time they cough, sneeze, lift or 
jump
 • Will not get better with time
 • Often times this can be treated effectively with proper Kegel exercises, but a lot of times that treatment requires ongoing and continuous exercise by the person, and sometimes even then it won’t hold up over time
• Should that fail, we can proceed with a small, 15-minute, outpatient procedure that is very successful such as some type of sling procedure, which in the past was a very big surgery and nowadays really can be done quickly with a very fast return to full function status

For more challenging cases, treatment options are available and include:
  • Physical therapy and E-Stim or other pelvic floor strengthening
  • Relaxation techniques that need to be taught correctly and practiced by the patient
  • Periurethral bulking, which is an injection in the bladder neck to help strengthen the 
   closure ability of the bladder or injections into the bladder wall that keep the muscles  
   from contracting involuntarily and spasming, thus making the bladder leak when the
  patient doesn’t want to

When incontinence affects how you function, what you’re doing, your clothing choices or travel plans, it’s just a shame not to get an evaluation and treatment—because so often, it is actually fairly easy to fix with many different treatment modalities. 

Suffice it to say, there are many treatments for many different causes in the many unique types of patients out there. But I would encourage readers to not for a minute think that this is a normal part of aging and something they simply have to “put up with.”  I would encourage them to seek medical evaluation and intervention, because if you’re thinking about the fact that you’re leaking urine, then it is probably affecting you on a daily basis.

Join me at a talk I’m giving tonight, Fixing the Leak, at 6:30 in the Ironwood Conference Room at Appleton Medical Center. Hope to see you there!

Dr. Eric Eberts is an Obstetrician/Gynecologist at the Appleton and Oshkosh locations of Women’s Care of Wisconsin. Contact Dr. Eberts at 920-729-7105 or meet him here.

About Women’s Care of Wisconsin
The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at www.womenscareofwi.com.

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Women’s Care employees’ dedication to caring extends to entire community

By Katie Sharratt, Marketing Coordinator and Employee Committee Member

At Women’s Care of Wisconsin, we feel it is very important to support our community. Through our Women’s Care Employee Committee, we have been able to support many worthy causes that help women and their families. We’d like to highlight some of the organizations we’re involved with on this blog, and encourage you to join us in supporting them as well.

Heart Walk
Did you know the number one killer of women is heart disease? This year’s Heart Walk, benefitting the American Heart Association, was held on Saturday, Oct. 2 at Fox Valley Technical College in Appleton. Despite a very brisk and chilly morning, Women’s Care had a great team of employees who came out to support a fellow coworker, who happens to be a five-year survivor of Sudden Death Cardiac Arrest.

Save 2nd Base

As part of Breast Cancer Awareness Month, The Bar held a fundraising walk on Oct. 2 at multiple locations across the Fox Valley. The turnout was phenomenal and we were proud to be part of this event to raise money to fund breast cancer research and help save 2nd base!

Women’s Care Cookbook for Causes
Women’s Care employees have been busy this summer putting together their favorite recipes into a cookbook containing 290 recipes. If you are a devoted cook/baker or are looking for the perfect Christmas gift, please consider purchasing a Women’s Care Cookbook. All cookbooks are $10; proceeds will be donated to the various local charities we contribute to throughout the year. Cookbooks are on sale in our Appleton and Neenah offices or by e-mailing us at wcwi@womenscareofwi.com.

About the Women’s Care Employee Committee
Founded in 2009, the Women’s Care Employee Committee strives to make community a major focus of its employees’ passions by participating in and donating to charities, fundraisers and sponsorships throughout the Fox Cities and surrounding areas.

Meet our providers and learn more about women’s health, gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at www.womenscareofwi.com.

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The most important things you need to do to make sure you and your baby are healthy and happy

By Kristin Clark, MD
Obstetrician/Gynecologist

Patients frequently ask me “What can I do to ensure a healthy pregnancy and baby?” While there are multiple precautions one should take while pregnant, I will discuss five of the most important topics below. As always, if you have specific questions or concerns, it’s best to address these with your doctor. Keeping open lines of communication will be key to a healthy pregnancy and a healthy baby.

1. Get Prenatal Care.

This may seem basic, but getting regular, prenatal care is going to be the best way to detect any potential problems with your pregnancy or with your baby.

Prenatal care will allow you and your doctor to:
• Assess your vital signs including blood pressure and evaluate for any signs of toxemia or preeclampsia

• Measure your baby on a regular basis to assess whether he or she is growing too fast or too slow

• Discuss medications, answer specific questions or concerns about labor and delivery, and develop a birth plan

There are many “right ways” to have a baby, and ultimately your doctor wants you to have the safest experience possible for both you and your child.

2. Avoid Alcohol and Tobacco.

Patients frequently ask me if it is okay to have a glass of wine now and then. Whenever advising patients on the safety of certain substances in pregnancy, I always look to the American College of OB/GYN (ACOG) for recommendations. This governing body is the gold standard for recommendations on care during pregnancy.

• ACOG states that no amount of alcohol is considered safe while you are pregnant. While I have had patients who have had a glass of wine now and then and it has not been harmful, I cannot advise them that it is a safe practice, and therefore I tell my patients not to drink alcohol while they are pregnant.

• Further, tobacco use can be very detrimental to both you and your baby. There are over 100 different toxins in tobacco smoke, and most of these toxins will pass the placenta. This can put your child at risk for oxygen deprivation, growth restriction and possible long-term issues with asthma. It can also lead to pre-term birth, which in and of itself has many potential long-term consequences.

So bottom line, don’t drink or smoke while you are pregnant.

3. Make Sure You Are Up to Date on All Vaccines.

Pregnant women are often hesitant to take a medication or get a vaccine if it is not absolutely necessary for fear of harming the baby. I try to reassure my patients that vaccines, especially the flu vaccine, are of vital importance while you are pregnant because:

• Your immune system does not function like normal when you are pregnant, therefore you are more susceptible to infections.

• If you get an infection while pregnant, it is usually more severe and can last longer. This is especially true for influenza and H1N1 flu.

The CDC has confirmed that the flu vaccine (both containing thimerosal and the mercury flu vaccine) is safe for pregnant women to receive at any point in their pregnancy. It is also recommended for anyone who is going to be caring for an infant or around an infant less than 6 months of age. Therefore, I tell all my patients that they should get the flu vaccine while they are pregnant and if they are going to have a child during flu season, all of their family members should be vaccinated as well. 

Other vaccines that are not as routine are tetanus boosters (especially with any kind of puncture injury) if one has not been given in the last 5 years, pertussis vaccine following delivery (this should NOT be administered during pregnancy) in order to help prevent transmission of whooping cough to your newborn, and the rubella vaccine if you are not already immune (also given postpartum).

4. Make Sure You Are Taking a Prenatal Vitamin and Folic Acid. 

Some of my patients do have difficulty tolerating prenatal vitamins, especially in the first trimester, but I try to encourage at least a multivitamin supplement with at least 400 mcg of folic acid. In actuality, 800 mcg of folic acid is better in that it does definitely help prevent neural tube defects.

If possible, a prenatal vitamin with folic acid supplement should be started at least 1 month before trying to become pregnant in order to build up certain vitamins and minerals in your body before conception. For example, the fetal neural tube or spine forms completely by 6 weeks gestation. Some patients do not even know that they are pregnant at this time, and could have a developmental problem before they even get a positive pregnancy test.

Taking a prenatal vitamin and folic acid supplement will also help prevent anemia, a common complication in pregnancy.

5. Eat Healthy and Exercise. 
Of course, pregnant women are entitled to dessert! That being said, try to avoid the mantra “I’m eating for two.” You really only need to add an extra 300 calories in your diet per day in order to ensure that you are getting enough calories to your developing baby.  

Try to eat a healthy diet balanced with whole grains, lean protein, fruits and vegetables. In the first trimester this can be difficult, especially if you are nauseated. I usually tell my patients not to worry too much about eating healthy in the first trimester if you are feeling sick; just eat what stays down and what tastes good. Once the nausea resolves, you can focus more on a balanced diet.

Also, I do encourage exercise in pregnancy in that it will increase endorphins, minimize nausea and make physical discomfort such as back pain less prominent. In general, you should not start a new type of exercise while you are pregnant, but you may continue to exercise and perform activities that you normally do in moderation.

I usually tell patients that they should not exercise beyond a level where they could have a conversation with someone and become breathless. I also tell them to try and keep their sustained heart rate less than 150.  It is okay to let a heart rate spike above 150 during exercise with interval work, but again, moderation is key with any type of activity while you are pregnant.

Above all, enjoy this time – this is one of the most exciting, wondrous, and fulfilling times of your life! Please make sure you are focusing on taking good care of yourself and getting the best care possible for a healthy pregnancy.

Dr. Kristin Clark is an Obstetrician/Gynecologist at the Neenah location of Women’s Care of Wisconsin, 200 Theda Clark Medical Plaza, Suite 130, Neenah, WI 54956. Contact Dr. Clark at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin
The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at our website by clicking here.

  

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Talk to your provider about how exercise can help ensure healthy conception and pregnancy

By Michelle Landsverk, DPT

It’s October. Families are enjoying apple picking in the crisp, fresh fall air. Fall TV is going full speed ahead. Friday night lights bring cheers and football wins. The leaves are changing. It’s Healthy Babies Month and National Breast Cancer Awareness Month. And, did you know?  It’s National Physical Therapy Month.

This year physical therapists and physical therapist assistants are educating the general public on the dangers of obesity. The statistics on rising obesity rates, especially among children, are staggering.  Various health conditions arise directly as a result of obesity, namely:
            • Type II diabetes
            • Cardiovascular disease
            • Osteoarthritis
            • Many forms of cancer
            • The list goes on and on…

Why does this matter to us at Women’s Care of Wisconsin/PT Center for Women? Two critical reasons:

            1) infertility rates rise with obesity
            2) pregnancy is generally riskier in the overweight population

Early last month, a new Johns Hopkins Children’s Center study found a missing link from obesity to infertility, clarifying the relationship between being overweight and the inability to conceive.

Earlier in 2010, lead researchers at the Harvard School of Public Health conducted a study designed to look at the relationship between exercise both before and during pregnancy, and the onset of Gestational Diabetes Mellitus. The rationale behind the study was the fact that obesity and inactivity are related, and that obesity is a major risk factor for gestational diabetes. 

The results of this study are certainly encouraging. A positive relationship has been established between exercise both pre-pregnancy and during early pregnancy with a significantly lower risk of developing gestational diabetes, and thus hopefully breaking the cycle between gestational diabetes, childhood obesity, adult obesity and type II diabetes.

Both of these important recent studies confirm the importance of incorporating exercise into your daily routine and maintaining a healthy weight. Your provider can help advise you on the most appropriate diet and exercise regime to help you achieve a healthy conception and pregnancy.

>>Read more about the Johns Hopkins Children’s Center research linking obesity and infertility here

>>Read more about the Harvard School of Public Health’s research indicating obesity as a risk factor for gestational diabetes here

Michelle Landsverk is a Doctor of Physical Therapy at Women’s Care of Wisconsin/PT Center for Women, 3913 W Prospect Ave, Suite LL2, Appleton, WI 54914. Contact Michelle at 920-729-2982 or e-mail here.

About the PT Center for Women  At PT Center for Women, our focus is on helping women incorporate lifestyle changes that will improve the quality of their lives. This includes gentle therapeutic exercise to both improve and maintain muscle tone, to rehabilitative exercise designed to get you back to your previous level of function and activities. From managing crippling abdominal and pelvic pain, to teaching proper sleeping postures and body mechanics at home and at work, we’re here for women. Visit our web site here.

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