Women who are not on hormonal birth control will notice that their discharge changes in consistency and volume throughout the month as the cervix emits different secretions in an attempt to achieve or maintain pregnancy. It is an excellent way to determine when you are ovulating (i.e. most fertile) as you are considered most fertile when the mucus becomes clear, slippery, and stretchy. Many women compare their mucus at this time to the consistency of raw egg whites and are able to use this cervical mucus monitoring method coupled with the calendar method or basal body temperature as Fertility Awareness to avoid or accomplish pregnancy.

Some women using the NuvaRing® for contraception have also noticed an increase in normal vaginal discharge. This is likely due to the local presence of hormones that allows for optimal development of the good bacteria lactobacilli, which contributes to a healthy vaginal ecosystem by combating the overgrowth of yeast and offensive bacteria.

Yeast proliferate in a warm, wet and sweet environment. The vaginal area inherently has two of these components. The “sweet” is enhanced if you: have a high-carbohydrate diet, which raises your blood sugar and, therefore, the sugar content in your tissues; are taking in a large amount of sugar (juices, soda, added sugar, carbohydrates) which increases the sugar content of your urine; or are a diabetic (family history of diabetes makes you more prone) – especially an uncontrolled diabetic - which means your blood sugar tends to run high. This will cause the yeast, which normally live in a woman’s vagina, to overgrow and cause a white thick cottage cheese-like discharge, swelling, and itching.

You can treat this with an over-the-counter three-day or longer treatment for immediate relief. To prevent yeast infections, adjust your diet accordingly, wear cotton underwear and loose-fitting clothing to allow your vaginal area to get air, always change out of wet clothing/ swimsuits as soon as possible and do not douche as this washes out the “good bacteria” which prevent overgrowth of yeast.

What is the pain I have on the lower side of my abdomen? I’m sure it’s where my ovary is!
Sudden onset of pain in the general location of the ovary can be many things. Are your roughly halfway through your cycle? The most likely cause is mittelschmerz (pain in the middle) which is thought to be caused by the stretch on the surface of the ovary or the release of small amounts of blood or fluid into the cavity when you ovulate. This pain can be severe and lasts anywhere from a few minutes up to 48 hours. You may find the use of ibuprofen and heat application helpful.

The second most common cause of pain in this location is related to the passage of stool through the intestines. If you notice the pain alter with bowel movements, this is definitely the reason for the pain. If you find it troublesome or accompanied by other gastrointestinal complaints, see your primary care provider.

Finally, as with most pain, if the character of the pain is not persistent (i.e. “comes & goes”), it usually does not require treatment, but can be chalked up to “body maintenance”. However, if the pain continues and increases in intensity over a matter of days or weeks, you should have it evaluated.


I am on birth control and spotting between my periods. What should I do?
When you first start on a new type of birth control method it can take up to three months for your body to adjust to the new hormones. During this time, you may have unpleasant side effects such as breast tenderness, headache, mild nausea and spotting. Most of these disappear within two weeks. However, the spotting may continue irregularly for the remainder of the three months. Your birth control is still working even though you are having break-through-bleeding. Allow your body this entire adjustment period without stopping your new birth control. Usually, as with any period of change, the transition can be a bit rough, but if you wait it out, it is well worth it.

If you have been on birth control for a number of years and are habitually spotting, it may be time to change the combination of hormones you are currently taking.

I have been on the Depo-Provera® shot for almost 2 years and my health care provider said I have to find a new method. Why?
The current black box warning from Pfizer, the maker of Depo-Provera®, recommends the injection for no longer than two consecutive years due to accumulated loss of bone mineral density which may not be completely reversible. Research continues in this area and it is currently unknown if young women fail to reach full bone mineral density due to prolonged use of Depo-Provera® or if there is a recommended time period you can “take a break” from the medication and then return.

We currently recommend switching to one of the many other available methods of birth control after two years of Depo-Provera® use. If you decide to remain on Depo-Provera® for longer than two years, you may be asked to sign a statement acknowledging the risks and we will recommend you continue to take at least 1500 mg of calcium per day. Additionally, you should perform weight-bearing exercises (walking, running, weight-lifting) at least 3-4 times per week and have a DEXA bone density scan. The results of this test may indicate you could benefit from a low-dose estrogen patch, such as Menostar®, to help combat bone loss.

Am I supposed to worry if I am taking antibiotics while on birth control?
Although the incidence of contraceptive failure is low, birth control pills are less effective when combined with many types of antibiotics or St. John’s Wort herbal remedies. If you are using either of these medications while on birth control pills, you should use a back-up method of birth control during and for at least seven days after you finish your course of antibiotics.

The condom broke/ fell off/ wasn’t used right during sex. What are my options?
There are a couple of emergency contraceptive methods available, but we typically prescribe Plan B® as it is one of the most convenient forms with minimal side effects. We usually advise anybody who regularly uses condoms as “Plan A” birth control to have a prescription for Plan B® contraceptive pills on hand as it is most effective when taken within 72 hours (although more recent studies have shown efficacy up to 120 hours) after unprotected intercourse.

Plan B® does not cause abortions, will not stop conception that has already occurred and will not harm a developing pregnancy. Emergency contraception will not prevent pregnancy if you have unprotected intercourse in the days or weeks following treatment unless you take it again. This type of frequent dosing is not recommended as Plan B® is intended as a back-up method of contraception ONLY (otherwise it would be called “Plan A”!).

For more information, click on Plan B® or call 1-888-NOT-2-LATE

My periods have been getting heavier and more painful. Does this mean that there is something wrong?
The pattern and flow of your periods will change throughout your life cycle and is usually normal. Most women find that heat application is comforting and Ibuprofen 800 mg (4 over-the-counter tablets) every 8 hours will help relieve cramping and decrease bleeding. If you are concerned, please keep a calendar of your periods with a 0-10 pain rating (“0” is no pain and “10” is the worst you can imagine) for at least three months and bring this with you for a physical exam to determine if further treatment is required.

When should I get my first mammogram?
Annual mammograms, when used as a screening tool, are able to detect pre-clinical breast cancers before they can be felt on exam. The current recommendation is no longer to have a “baseline” done between the age of 35 and 40, but that your first screening mammogram should be done at age 40. If you have a strong family history of breast cancer (your mother or sister) you should start your mammograms five years before she was diagnosed, if that is under the age of 40. Therefore, if your relative was diagnosed at the age of 42, you should start your mammograms at age 37. But if she was diagnosed at age 56, you would not wait until you turned 51 for your first mammogram, but start at the recommended age of 40.

I am starting to notice that I am getting “hot flashes”. What are these and how do I stop them?
Hot flashes are associated with the decline of a woman’s estrogen level and are the most common symptom associated with perimenopause and menopause. Regardless when they begin, hot flashes can be stressful or embarrassing. They may occur infrequently and briefly or they can cause significant discomfort and disruption to daily activities and sleep patterns.
It has been found that a gradual decline of estrogen correlates with less severe episodes.

Hot flashes can be relieved a variety of ways. Light layered clothing is an important option when hot flashes are disruptive. Some women have found that increasing certain foods or herbs in their diets will help relieve hot flashes, and some women rely on transitional hormone replacement therapy.

Are herbs safe during menopause?
Herbal remedies have not been adequately studied by the scientific community to determine common risks & benefits. However, consumers have long found that herbal remedies are effective in relieving symptoms about 50% of the time. In some circumstances, herbal remedies can interact with other medications that you may be taking, so be sure to check with your herbalist, compendium or health care provider before starting any treatment.

Since typical multivitamins contain 200-400 mg of calcium, you need to get the remainder of your recommended intake from either a calcium supplement or through your diet. Please follow the link here to WebMD’s advice about calcium and bone health.

I have noticed some lower abdominal pain and it burns when I urinate. What should I do?
From your symptoms it sounds like you may have a urinary tract infection (UTI). If you are under our care for your pregnancy, we will screen for UTIs at every visit and treat you if one develops at any other time during your pregnancy. However, if you are not pregnant, you will need to be seen by your primary care provider for diagnosis and treatment with a full course of prescribed antibiotics.

As soon as you suspect you may have a UTI, dramatically increase your intake of non-sugared beverages (WATER or real cranberry juice – not cranberry juice cocktail) to flush your bladder. If a UTI is caught early enough, this flushing may prove adequate treatment. If not, it will certainly offer some pain relief. You may also try an over-the-counter medication, like Uristat® to help with the discomfort until you can be seen by your health care provider. (Uristat® is only for temporary pain relief and is NOT a cure. Follow-up treatment by your provider is required.)

Prevention is ideal when it comes to urinary tract infections:
• Don't hold your urine for long periods of time - when it is time to go to the bathroom, go! Holding your urine allows bacteria in your urine to reproduce and can make you more susceptible to infections.
• Drink plenty of fluid all day long. Your urine should be light and clear by midday. Lighter than lemonade is a good color judge. If it is dark, you are dehydrated and should drink more water.
• Urinating after intercourse is also a good idea. The close proximity of the vagina and urethra allow rapid communication and transfer of bacteria from one to the other.
• Wipe from front to back after using the toilet.