As a general OBGYN for years, and who has a strong interest in fertility, I often ask about family-building at your annual wellness visit. I get common questions such as "Can I get pregnant?" or "How will I know everything is okay for me to conceive?" or "When should I start trying?" It is well-known that egg quality and quantity decline with age, naturally.
We spend most of our teens and adult life, listening to information about how NOT to get pregnant. So, now, you’ve made the decision to try to conceive. You’ve heard time and age reduces your fertility. That part you can’t control. Here’s what you can control, to hopefully promote a health pregnancy.Healthy lifestyle choices are a modifiable thing you can do, starting now. I don’t recommend you do them all at once, but take it day by day, week by week, and slowly but surely, you’ll have modified everything within your reach.Preconception visits are great because we can go through the following in detail, and understand where you need improvement, with your specific medical history.Stop smoking, and/or any drugs. Smoking causes the placenta to not function well. It can cause growth problems with your baby. It also decreases your egg quality and quantity, negatively affecting fertility. Ilicit drugs can cause even worse consequences, like neonatal withdrawal from the substance after birth, placental dysfunction, and even stillbirth.Achieve a healthy weight. Nutrition should focus on whole fruits, vegetables, lean proteins. A Plant-based diet is preferable, but not required and if you eat in this way, there is even some data that suggests elimination of red meat can increase your fertility. Decrease sweets, sugary sodas, desserts, chips, and keep to minimum.Exercising is a great way to increase metabolism, calorie burn, increase lean muscle mass and reduce stress. Moving your body intentionally for 55 minutes, at least 3 times per week sets you up for success prior to and during pregnancy. Clinical research has shown that women who exercise during pregnancy and start pregnancy at an optimal weight, have improved pregnancy outcomes, including for both baby and mom. They also do better in labor.Make a preconception consult 2-3 months prior to trying to conceive, with your OBGYN. In some cases, discussion is needed with a high risk OB specialist, or Maternal Fetal Medicine specialist. Any history of previous adverse pregnancy outcomes, and health history in either yourself or a previous child should be discussed to modify and optimize health where possible.Start prenatal vitamins with DHA. Start 3 months before stopping birth control, or trying to conceive. If you do not use birth control, it is not a bad idea to just use prenatal vitamins in the case of an unexpected pregnancy to prevent birth defects. DHA is great for mom, but is also beneficial to baby’s brain health.Decrease alcohol intake. An occasional glass of wine or drink, is okay while trying to conceive, but excessive binge-drinking has adverse health effects and does need to stop while trying and altogether while pregnant.Preconception labs can also be done, not to check fertility necessarily, but to test for and identify modifiable issues with your health that deserve optimization prior to pregnancy.Preparing for conception can be a little bit scary, but with a visit to discuss it ahead of time, it can really ease your concerns and your mind. So, bring your questions!**None of the above is to be taken as personal medical device. Book a consult with Dr. Reyes to establish a patient-physician relationship.
Your period should still allow you to go about your life. If you are… Missing school or work, vomiting, having such severe pain that you can’t alleviate with usual over the counter medications, going to the emergency room for pain or heavy flow, having deep penetrative pain with sex, painful bowel movements, pelvic pain between your periods, you may have endometriosis. The above are how many endometriosis patients present. Some have suffered for years. Some have found great relief with oral contraceptives or other medication. Some have surgery. Some suffer from infertility. The best thing to do is to keep looking for answers, finding a gynecologist who can diagnose and treat you. THE ABOVE IS NOT NORMAL. Be patient, as endometriosis patients go to several doctors sometimes before finding the answer. Stick with your doctor once you find her, and sometimes it takes more than one treatment to find it. Endometriosis is hereditary. If your sister or mom has it, it is high likelihood that you could too. It is suspected when patients have painful periods, painful intercourse with deep penetration, and painful bowel movements. This is what we call clinical endometriosis, or endometriosis that has not been proven surgically. To be sure, although not always necessary, laparoscopy is done for surgical diagnosis. This means a camera or laparoscope is inserted at the belly button, and the pelvis and abdomen is surveyed to determine the cause of pelvic pain for the patient. It is a disease where endometrium (the lining that sheds with your period) which should live inside the uterus, is also outside of the uterus, in the pelvis. Laparoscopy is the only way to see INSIDE the pelvis. The goals of surgery are to diagnose and, if present, treat endometriosis. It is a chronic condition that until menopause can continue to cause pain. This is because until the natural decline in hormones (menopause), it is fed by our natural hormones. Generally, medication to block those hormones are needed, or even used without or prior to surgery, if not conceiving. Hormonal contraceptives, or other types of hormone blocking medications such as Lupron or Orilissa are often used. If you have been suffering, it is time to see us. Find answers. What questions do you have about endometriosis ?
Hot flashes, night sweats, vaginal dryness. Fatigue, irritability, lack of sleep, low libido. Ugghhh. These symptoms start for many women in their 40s and beyond the natural age of menopause at approximately age 51-52 on average. Lets break down this commonly requested bioidentical hormone therapy and find out what it really is and what it is for. Basically — that catchy word “BIOIDENTICAL” means any hormones that are like the ones your ovaries produce – estradiol, natural progesterone, and testosterone. This type of hormone therapy is the safest for cardiovascular risk, especially when estradiol is given in non-oral form such as gel or patch — and even breast cancer risk over time may be lower with natural progesterone compared to synthetic counterparts. Synthetics = Premarin (conjugated equine estrogens — yes from horses) and progestins such as norethindrone or medroxyprogesterone. Natural/bioidentical = estradiol and micronized progesterone (plant and non-animal sources) Bioidentical hormones (BHRT) can include compounded hormone creams, troches (oral lozenge), and pellets which are non-FDA approved and rely upon the pharmacy compounding the products. The quality of your compounding pharmacy matters. There are other brands available which are bioidentical and FDA approved and so therefore the safety is more well-known. These come in commonly known brands such as Estrogel, Divigel, Minivelle, Elestrin. This doesn’t mean the non-FDA approved options cannot be used, but should be used with caution. The risks and benefits of whichever method you use should be fully explained and understood. Hormones are not required for every patient. Understand long term goals and purpose. It’s an individualized approach. I have seen many patients inappropriately given hormones through the years — there are reasons they should NOT be used, even if BIOIDENTICAL. Talk to your physician. Make sure you know the credentials of the person doing your hormone therapy and the goals of treatment. Have an evaluation to find out what your options really are. A board-certified gynecologist should be your go-to for management of hormone replacement therapy.
Weight gain happens, especially in the menopause transition. Even if you have not changed your diet or exercise habits. Frustrating. Normal hormonal changes in women over 40, and then more so over 50, encourage a decrease in our usual metabolism, and many times a shift in the fat stores to the mid-section. Not to anyone’s surprise, exercise and nutrition remain the mainstays of weight maintenance. It just become a little bit harder over age 40. Exercise Maintaining muscle mass through menopause is important to reduce weight gain. This is best achieved with weight bearing exercise. Incorporating weight or bodyweight training (so often skipped by women!), or even just walking, swimming, yoga, and pilates can maintain muscle mass, and enhance your metabolism. So, don’t just do “cardio” alone, looking for calories burn. Nutrition The other big factor in weight maintenance, is nutrition. Take a good look at your plate. Half of your plate needs to be filled with lean sources of protein, and green, leafy vegetables. While we all love a plate of spaghetti or basket of bread now and again, make sure to consume nutrient-dense complex carbohydrates in moderation, while limiting the simple ones such as white flour, sugar, pasta, etc. Also, watch the wine and other alcoholic drinks, because empty calories add up quickly. A mindset switch to eating for health, and viewing food as fuel for your body, as opposed to a restriction mindset to achieve less pounds on the scale, is imperative. You can actually “think” yourself to weight loss if needed, improved energy and overall health, if you start truly believing in this mindset switch. What about stress? Is it my thyroid? Additionally, other factors such as stress levels, medications, and health concerns like insulin resistance and hypothyroidism can also contribute to the “why” of your menopausal weight gain. Stress is often underestimated, but must be managed – with exercise, and mental health optimization with either a psychiatrist, and/or a counselor. Mental health is so important to overall health. Consulting with your physician about your overall health is important before just assuming it is your hormones that need treating. Will hormone therapy help me achieve weight loss? The short answer is - no. Studies on a variety of hormone therapy options have not been shown to achieve weight loss. It is more common that we regard them as “weight neutral” – not causing substantial weight gain or loss. It really is a combination of factors as above, but an individualized consult with your gynecologist will help determine if hormones are indicated, or not in the menopause transition. An ounce of prevention Making small adjustments to what you eat, and increasing the amount that you move, may be what your menopausal body needs to regulate its weight throughout the change. It is important to remember to not be harsh on yourself if you’ve gained weight. With self-care, time, and patience, you can lose the weight no matter your age or life stage.