Pregnancy Prep: Getting Your Body Bump Ready

Many women watch their belly grow and really let loose during pregnancy. Unfortunately, it’s no secret that excess weight gain during pregnancy can lead to gestational diabetes, elevated blood pressure, and skin changes that are difficult to reverse.  Here are some practical tips to avoid the bulge:

Get in shape before you get pregnant: Aim to reach an optimal weight for your height and body frame BEFORE you get pregnant. This will allow you to have more energy during and after pregnancy and help your body to bounce back faster.

Exercise regularly during pregnancy: Let’s be serious . Labor is no joke. That’s why it’s called “labor”, not “walk in the park”. If your body has the stamina to workout you will be ready for labor and can harness your energy and endorphins to push hard. Really hard.

Hydrate: Adequate hydration will boost circulation and prevent dehydration. Your skin can more easily stretch and will naturally bounce back without much damage. Dry skin, on the other hand is more prone to cracks and stretch marks leaving permanent scars and areas of sagging.

Strengthen your core: Focus part of your workout on your abdominal muscles. Later in pregnancy, back pain is extremely common as the body adapts to a growing bump. Strengthening the core muscles gives the lower back more support, while protecting against other injuries.

Infertility: Are Your Eggs Scrambled?

Many of you might remember looking up at the clock in school during exams and watching the long red second hand tick, tick, tick. As you tracked your time and filled in your scantron sheet (remember those!), your only worry was having a number 2 pencil. Unfortunately, sometimes the idea of your “biological” clock ticking is a lot more worrisome. Whether you would like to have children in the future, or you have struggled to get pregnant, infertility is an important topic for many women.

Typically, physicians classify infertility as either primary or secondary.

Primary Infertility: This is when a couple has not been able to conceive after a year of unprotected intercourse.

Secondary Infertility: This is the term used when a couple that has been pregnant before has not been able to conceive again.

Women are born with all the eggs they will have during their lifetime (typically this is about 1-2 million). Only about 400 of these eggs will actually mature. In men, on the other hand, new sperm are produced daily. The release of a viable egg and fertilization by sperm can be influenced by many factors.

When couples are faced with infertility, 50% of the time they may be attributed to female reproductive factors such as ovulatory dysfunction, polycystic ovarian syndrome, pelvic infections, or sexually transmitted infections. As women age, fertility also declines. Women are most fertile in their late teens and early twenties. Fertility begins to decline around age 35.

In about 30% of cases, the infertility may be attributed to the male partner. Common causes of decreased fertility in men are low sperm count, retrograde ejaculation, or hormone deficiency.

In about 20% of cases, the cause of infertility is unknown and is not clear even after medical examination.

Despite the multiple physical issues that can influence fertility, stress plays a large role. As the body becomes chronically stressed, the natural cycle of menstruation, ovulation, implantation and pregnancy is disturbed. Have you ever been under a significant amount of stress or pressure and missed a menstrual cycle? Not surprisingly, becoming pregnant under stress is also difficult. 

Worried there’s no “honey-boo-boo” in your future? (Or perhaps that’s what you want to avoid!). Don’t panic. Here are some simple guidelines to improve your fertility and health:

1) Take a Prenatal Vitamin: The modern American diet often lacks important nutrients and minerals that are needed for a healthy pregnancy and immune function. Taking a prenatal vitamin can help you prepare for pregnancy by supplementing nutrients your body may be lacking. Additionally, if you happen to get pregnant, prenatal vitamins include an adequate supply of folic acid, a vitamin that is vital to neonatal brain development. Aim to get 400 mcg-600mcg daily.

2) Track your cycle: Each woman’s menstrual cycle varies in length. Based on this fact, ovulation can also be variable. Generally, women ovulate about 12-14 days before the next period. Predicting this may be more difficult in women with irregular periods. At the time of ovulation, the egg can be fertilized for 12-24 hours. Male sperm remains viable for 2-3 days, so having intercourse 2 days before ovulation and on the day of ovulation may increase your chances of pregnancy.

3) Watch out for Obesity and Diabetes: Diets rich in trans fat, simple carbohydrates, and preservatives can increase your body’s glucose load and create insulin resistance. Problems with glucose metabolism and obesity can affect hormones like estrogen and progesterone, and in turn affect ovulation. Attempt to eliminate refined sugars and add more fruits and vegetables to your diet. (Apple pie doesn’t usually count as a fruit!) Visit your physician for further testing for diabetes or hormone imbalance.

4) Dial Down Your Stress: Everyone says, “Duh”, to this one, yet stress is one of the most common symptoms cited by couples struggling with infertility. It turns out that as the body faces increased stress, a hormone called cortisol is released. Cortisol may decrease the formation of progesterone and impact ovulation. Consider focusing on another goal for a few weeks or months. This may ease your anxiety about fertility and improve your chances of getting pregnant sooner.

5) Visit your physician: If you have been trying to become pregnant for 6 to 8 months and have not been successful, speak to your doctor. He or she may recommend waiting a few more months without intervention, or check blood tests to evaluate your hormones and other causes of infertility.

Remember: Many couples that are faced with infertility often conceive naturally, or become pregnant after medical intervention. Try your best to have a positive outlook during this difficult time, and express your concerns to your physician. He or she can provide support and resources to help guide you in the right direction.

Premenstrual Syndrome: The Three Letter Word That Doesn’t Make You LOL

Before the iPhone, Twitter, and #FF, PMS was one of the best-known abbreviations amongst both men and women. Many women have suffered from fatigue, bloating and irritability before their period, but is this really Premenstrual Syndrome (PMS)? If you think you are suffering from PMS or PMDD (Premenstrual Dysphoric Disorder) but aren’t sure, we’ll help you learn about what symptoms to look out for.

The Nitty-Gritty: Your menstrual cycle is broken down into two phases: the follicular and the luteal phase. When your period starts, this is considered day 1. From day 1 until day 14 (approximately the time you ovulate) is considered the follicular phase.This phase also includes your menstruation days. From day 15 to 28 is the luteal phase. The symptoms of PMS occur in the luteal phase.

PMS: A true diagnosis of PMS requires you to have symptoms during the luteal phase of your cycle. This means the days leading up to your period are when you feel the worst. Many women feel bloating, irritability and fatigue. Generally, those who suffer from PMS are symptom free after they begin to menstruate.

PMS usually involves both physical and behavioral symptoms, so if you’ve been unusually upset for being interrupted during the Real Housewives reunion show, you may have a reason.

Common Physical symptoms include: 1) Breast tenderness 2) Bloating or weight gain 3) Diarrhea or constipation 4) Skin changes (including acne) 5) Fatigue or decreased energy 6) Insomnia 7) Headaches, back pain, or muscle cramping

Common Behavioral symptoms include: 1) Irritability 2) Sadness 3) Lack of Concentration 4) Anxiety or Depression 5) Feelings of Frustration or Anger

Bloating, fatigue, breast tenderness and headaches are the most common symptoms with greater than 50% of women experiencing at least one of these. Don’t be ashamed if you have designated “period pants”. Up to 90% of women experience bloating before their period, so many of your girlfriends are likely to have a pair too.

There are several theories on the mechanism of PMS, but the exact cause remains unclear. Some research suggests that although normal menstruation causes a shift in hormone levels (progesterone and estrogen), some women are more sensitive to these varying levels. Additionally, the variability in estrogen and progesterone is also thought to influence brain chemicals like serotonin and epinephrine, which are responsible for mood regulation and energy levels.

Your physician should make sure you do not have any other medical problem that could be causing your symptoms (thyroid disorder, underlying depression, anxiety, etc.), before diagnosing you with PMS.

If these symptoms sound familiar, you may have PMS. If, on the other hand, you feel like you’ve gotten a super-sized order, you may be suffering from PMDD.

PMDD: Premenstrual Dysphoric Disorder (PMDD) is a severe form of PMS. PMDD is similar to PMS in that it occurs during the days before your period begins, however women with PMDD generally have extremely severe symptoms that can affect multiple aspects of their life. In most cases, relationships with spouses, children, and friends are affected. Although women suffering from PMDD have physical symptoms, they are predominantly affected by mood symptoms. In order for a physician to diagnose someone with PMDD she must have at least five of the following symptoms: 1) depressed mood or feeling hopeless 2) anxiety 3) labile mood 4) anger or irritability 5) decreased interest in usual activities 6) difficulty concentrating 7) fatigue and lethargy 8) change in appetite or overeating 9) insomnia or sleep disturbance 10) feeling overwhelmed 11) bloating, breast tenderness, headaches or back pain.

One of the symptoms also must be a mood symptom from 1-4 (above). There are a few other criteria for PMDD that may be confusing. Speak with your physician to help get an accurate diagnosis. He or she may offer you several different treatment options to help you feel better.

So you’ve confirmed you feel miserable, and you may even know why. What can you do about it?

Exercise: Several studies have shown that daily exercise during the luteal phase improves both physical and mood symptoms of PMS and PMDD. Try to exercise for at least twenty to thirty minutes in the weeks before your period starts.

Healthy Diet: Maintaining a healthy diet can also help you feel more energetic. Avoiding foods high in salt and preservatives will reduce bloating. Swapping coffee and soda for water (try adding lemon) and decaffeinated tea may help improve some of the physical symptoms.

Treatment: In some cases your physician may recommend treatment with medication to help improve your symptoms. He or She will review the symptoms that are most debilitating for you and tailor the medication options based on this.

Now that you’ve learned the signs and symptoms of PMDD and PMS you can speak to your personal physician about the best treatment options for you. And hopefully PMS won’t be the week before your period when you say “Pass My Sweatpants” anymore!

Urinary Tract Infections: TMI on UTIs

If you’ve ever felt more than a sprinkle during your tinkle you may have had a urinary tract infection (UTI). Feelings of burning (not the good kind from pumping iron at the gym), deep pain, and a constant urge to go are all symptoms of a possible urinary tract infection.  Before you hit the grocery store and drive up the price of cranberry juice stock, learn about what causes infections, what to look for and warning signs to keep you from ending up extremely sick.

According to recent data, about half of all women will have a UTI in their lifetime. Women are more prone to getting urinary infections because anatomically they have a shorter urethra (the part of the urinary tract that connects the bladder to the outside) than men, which makes it easier for bacteria to gain access to the structures of the lower urinary tract.  Other risk factors that predispose women to urinary tract infections include more frequent intercourse, a new sexual partner, taking antibiotics, pregnancy, diabetes, and using contraception devices like diaphragms.

What symptoms should you look out for? Common urinary tract infection symptoms include needing to use the bathroom frequently with only small amounts of urine coming out (frequency), feeling a need to use the bathroom suddenly, despite recently using the restroom (urgency), abdominal pain or pain right above your pelvis or bladder, lower back pain, chills, and nausea.

It’s important to distinguish an uncomplicated urinary infection from a complicated one.  Uncomplicated UTIs are seen in healthy women who are not pregnant, and do not have other medical problems such as Diabetes, or HIV. Complicated UTIs are infections that may be ascending the urinary tract or involve more resistant bugs. This can be extremely dangerous as infections can continue to travel up the urinary tract and affect the bladder and kidneys causing severe fever, widespread infection in the blood, severe dehydration, and even shock. It’s important to also know that any urinary symptoms in pregnancy should ALWAYS be brought up with your doctor. Several studies have shown that untreated urinary tract infections in pregnancy can increase your risk of preterm labor.  UTI’s can also become complicated if simple or uncomplicated infections remain untreated for a prolonged period of time.  A woman can also develop a complicated UTI if she has had an infection within the last three months with the same bacteria.

A few ways to avoid urinary tract infections are to drink plenty of water throughout the day. This is not only good for your urinary tract but your whole body. Getting plenty of fluids can keep bacteria from proliferating throughout the urinary tract. It’s also important to void after intercourse. Although sleep often beats post coital voiding, failure to urinate after intercourse is one of the most common causes of UTIs in women.  Also avoid holding your urine in for lengthy periods of time by emptying your bladder as soon as you feel the need to go.

UTIs can be easily diagnosed and treated, so if you begin to feel symptoms get in touch with your physician ASAP. Early detection and treatment can avoid serious complications!

Weight loss after Baby: When Postpartum feels like Postmortem

For all the new mom’s out there—we know you’re obsessed with that little bundle of joy! But if you’re not obsessed with how cute your butt is looking, you’re not alone. Most moms’ go through their baby’s first two months in a tired haze. The third month rolls around and you have decided to shed those extra pregnancy pounds. Somehow it’s your baby’s six month birthday and you’re still rocking sweats, wondering when you will slim down. Stop wondering and channel your inner Kourtney Kardashian-Or Kendra Baskett if you’re blonde! Here are some tips to get you on your way to the post baby body you want:

Track what you’re eating – Its amazing how many mothers come into the office with pages of notes (or excel spreadsheets for the more tech savvy) detailing how long their baby slept, how many ounces of milk their baby drank, and of course- how much their baby poops. You may laugh, but you know you did it! If you can record all that, you can certainly record what you’re eating. This is important even for non-postpartum patients trying to lose weight because it gives you a sense of where you are spending your calories. Eating a granola bar, a microwave meal, and an orange  for the whole day may have you looking like LeAnn Rimes very quickly, but it’s unsafe and never permanent. It is important for you to get carbohydrates, protein, fruits and vegetables during the day. If you’re finding yourself consuming a ton of one food group after reviewing your food diary you can make the necessary changes.

Breastfeeding- Like holiday shopping, it can be a great experience or the bane of your existence. No matter what, try several times before giving up, and then try again. If you are having difficulty with breastfeeding, ask your doctor to recommend a lactation specialist or give you some tips on how to make the experience go more smoothly. Several studies have shown that breastfeeding helps women lose more weight in their postpartum period. One study in particular demonstrated that women who exclusively breastfed for 6 months held on to an average of 1.1 lbs 3 years later, compared to women who never exclusively breastfed who held on to an average of 10.5 lbs after 3 years. 10lbs! That’s basically the weight of another baby! So if you can, really try to breastfeed. Not only does it increase bonding with your baby, but it’s also fewer bottles to wash and it may help you get back in your skinny jeans in no time.

Stay hydrated- Drinking plenty of water and fluids can help you slim down, and will also help with milk production. Having enough fluids on board will help keep you full, keep your skin looking great, and help your body process food efficiently. Water is necessary to help fiber get processed through your body and avoid constipation. If you are exercising you need to replete the water you are losing when you sweat. If you have trouble getting in enough water or don’t like drinking it, try different alternatives. Get a water bottle that you fill up in the morning and just aim to finish it by the end of the day (depending on how big it is of course, or you may need to fill up during the day). Go for other liquids like tea if you don’t like the taste of plain water. You are already going to be feeling exhausted while taking care of your new baby, but being dehydrated can make fatigue and exhaustion much worse, so really make it a priority to fuel your tank with fluid.

Sleep - We all know that getting a lot of sleep with a new baby is about as likely as an Hermés Birkin bag showing up at your doorstep.  Unfortunately, adequate rest is the key to keeping you sane, boosting your energy, and believe it or not-helping you lose weight. When you are continuously sleep deprived, your body’s metabolism can really take a beating. Some studies even suggest that one day of poor sleep can make your metabolism slower the next day, and increase your stress hormone and sugar levels. We all know you won’t get 8 hours of restful sleep at once, but trying to sleep when your baby is sleeping can really help you bounce back much quicker. So put your type A personality in a drawer and don’t pull it out until your baby is walking and you are chasing after them in your pre-pregnancy pants.

Set Realistic Goals- This is by far the most important tip you can take away. Be realistic, and go easy on yourself. Keep in mind that it took you about 9 months to put on the weight. Unless ABC called and asked you to be on Dancing with the Stars, 9 weeks is probably not so reasonable to take it off. It’s a good idea to aim for losing your postpartum weight by 6 months to 1 year. Most women who lose the weight by 6 months tend to keep the weight off long-term vs. those who don’t lose it by then. Aiming to lose about 1lb/week is generally safe and healthy. Try not to slash your calories too much because this can really take a toll on your energy levels and your milk production. Don’t obsessively weigh yourself either. If you find yourself doing this, put the scale away and bring it out only every few weeks. This will give you more incentive and help you to stop obsessing over numbers from day to day.

Remeber to enjoy your time with your baby. You deserve it! Every new mom has some body struggles, so you are definitely not alone. Trying your best and taking care of your health is the most important thing you can do for yourself and your baby. If you’re feeling extra stressed, or frustrated with weight loss, talk to your doctor about other options, he/she can hopefully give you more guidance and reassurance.

Irregular Periods: Is your Period a Question Mark?

There’s nothing worse than rocking out in your tan skin and white pants than to feel that horrible sensation that your period is here unexpected and unannounced—well, except maybe rocking your white pants well after labor day and then getting your period. For some women their period is no big deal, it comes and goes, on time- every time and it’s a no hassle few days of the month. For those 5 girls in America, you’re lucky because the rest of us millions have had a question about our period at some point during our life.

Having unpredictable, heavy, or abnormal periods can really make life stressful. If you have had any irregularities in your period it doesn’t mean YOU are abnormal- so come out of the mental rewind to that 8th grade video “Am I normal?” and get equipped with some of the facts to help you answer your period puzzle.

Abnormal bleeding can mean different things depending on your age. When you are first starting your period you may get periods on and off, or at irregular intervals because the hormonal feedback system in your body is still maturing. As you get older your periods should get more regular.

For women in their 20’s-40’s, the feedback system is mature so periods should be at regular intervals. Here are some reasons that periods may be abnormal in this age group:

Pregnancy- Now it doesn’t take a medical school degree, or even Britney’s 8 Grammy nominations to know that if you miss your period and you have been getting your swerve on, with or without protection- you might be pregnant. Pregnancy is an easy thing to test for, so don’t procrastinate. Get tested for pregnancy if you miss your period because if you are pregnant you have a lot of other potential life changes to deal with and giving yourself time to consider your options is very important.

Heavy but regular periods- If you get regular periods but they are very heavy this may be due to a fibroid. Fibroids are common, usually benign tumors that often grow in the uterus as extensions of the muscle and can cause heavy or painful periods. The best way to know if you have these is to see your doctor who will likely do a pelvic exam and/or send you for an ultrasound if he/she thinks this is medically necessary. Certain bleeding disorders can also cause women to get heavy periods, and usually this is noticed when people first start their period during puberty. Bring this concern up with your doctor because in addition to checking for bleeding disorders, patients can also become anemic after several cycles of heavy bleeding.

Spotting or bleeding between periods, also known as intermenstrual bleeding is the random bleeding you get at times other than when you expect your period. Intermenstrual bleeding can be caused by a number of factors- here are some common ones:

  • Birth Control Pills- Although designed to make your life easier, and regulate the hormone levels in your body , “the pill” can sometimes also cause spotting or breakthrough bleeding. This often happens when someone forgets to take their pill or when the pill isn’t taken around the same time everyday. Depending on the actual pill you are on, some may have varying amounts of hormones  which can lead to intermenstrual bleeding. Talk to your doctor about other pills or other options for birth control if this is significantly affecting your daily routine.
  • Cervicitis- This is inflammation of the cervix due to any number of causes. Most commonly infections with Gonorrhea or Chlamydia cause cervicitis, but bleeding can also be seen in some cases with Bacterial Vaginitis or other non-infectious causes. As you know- not everything that happens in Vegas stays in Vegas, so if you are worried about any of these diseases or you have abnormal vaginal discharge see your doctor as soon as possible for evaluation and treatment. This may also clear up your breakthrough bleeding.
  • Cervical or Endometrial Cancer- This cause is quite scary, but noteworthy. Getting regular PAP smears is the best way to keep surveillance on these two things. Either of these cancers may cause intermenstrual bleeding, but both have possibilities for treatment if caught early.
  • Stress, weight loss or gain, and exercise- can also affect your periods. All three of these things can cause changes in the hormonal feedback loop in your body and give you breakthrough bleeding, or even lack of periods. It is important to stay healthy and exercise but if you are exercising so much that your periods are affected you should see your doctor to discuss if this is the right routine for you and to rule out any other concerns that may be affecting your period.

That was a lot of period talk and you may be totally information overloaded! But before you drop down and get your Google on, be sure to bring up your concerns with your personal doctor. She/he can give you the best advice based on your personal health and history.