I am running low on my prescription – how do I obtain more medication? If it has been less than a year since your last annual exam your prescription can be obtained by e-mailing us ("Contact Us" on our website) or by calling any of our offices. A nurse will call in the refill to your pharmacy or send you a prescription in the mail at your request. If it has been more than a year since your last annual exam the nurse will notify you that you need to make your appointment before we can proceed with your refill.

When should I have my first pap smear? When you become sexually active or by age 21 if you are not sexually active

How often do I need a gyn exam and pap smear? If you are taking birth control pills, sexually active with more than one partner or having any gyn problems, you need an exam once a year. Pap smears may be recommended more frequently if they are abnormal. If you are postmenopausal but have a normal pap history, you may have pap screening every 2 to 3 years. However, you still need annual visits including a screening mammogram with a breast and pelvic examination.

What is a thin prep pap smear and why is it better? Thin prep is a liquid based pap test. The collection and processing method used in this test provides a better cell sample for analysis. Thin prep has become the preferred test over the conventional pap because it has been more effective in the detection of abnormal cells. Our office uses the thin prep pap test unless you specifically request the conventional test at the time of your visit.

What if my pap smear is abnormal? You will be notified by phone if your pap smear is abnormal by your provider or nurse. Our office automatically screens all paps with atypical squamous cells of undetermined significance (ASCUS) for the high risk human papilloma virus (HPV). This virus is the most common reason why abnormal cells are found with pap smears. You will be scheduled for an office procedure called a colposcopy to take a closer look at your cervix for abnormal cells. Follow-up may require only monitoring or may involve treatment if cell changes are significant. Click here for additional information on pap smears and abnormal results. For more information about HPV go to the American Social Health Association website at: http://www.ashastd.org/stdfaqs/hpv.html

Do I need to be screened for Sexually Transmitted Diseases (STDs)? We recommend screening for all women who have been sexually active with more than one partner. Tests may include Chlamydia, gonorrhea, HIV, Hepatitis C, Herpes Type 1 & 2 and syphilis. Consider screening on an annual basis if you have had unprotected intercourse with a new partner. Contact our office any time for STD screening if you are worried you may have been exposed or are showing symptoms of an STD.

What is Gardasil? Please click here for information about this vaccine.

What birth control method is best for me? There are many methods available depending on your interests and lifestyle. Most people are familiar with birth control pills that are taken on a daily basis. Click here for more information on the pill. Newer more convenient methods include the Nuva Ring or the Ortho Evra Patch. The Nuva Ring is inserted like a tampon and stays in the vagina for 3 weeks. It is very comfortable and very discrete. The Ortho Evra patch is worn like a bandaid and is changed once a week. Other options include the Depo provera shot, and Mirena IUD. The shot is given every 3 months and eventually makes your periods go away. The Mirena is available for women who have had children and want reversible contraception. This IUD is good for 5 years and helps to reduce heavy periods. Contact our office for an appointment to further discuss the best option for you.

Can I skip periods with my birth control pills? Yes, many women are taking continuous birth control pills and choosing to have a period every 3 months instead of every month. A new pill called “Seasonal” contains 84 active pills and one week of placebo pills in one pack. You can also do this with regular monophasic pills (skip the 4^th week of pills), the Ortho Evra Patch and the Nuva Ring. When you are ready to have a period, discontinue your contraception for 5-7 days, then restart it. Initially, you may experience occasional spotting, but this improves with time. It is not harmful to skip periods while taking birth control and many women with menstrual problems benefit from this type of schedule.

What is emergency contraception? Emergency contraception (EC) is a way to prevent pregnancy after a condom accident, unprotected intercourse or if you forget 2 or more days of birth control pills. EC must be taken within 72 hours of sexual activity in order to be effective. Our office prescribes “Plan B” which has fewer side effects. EC does not cause an abortion and will not harm a pregnancy if a woman is already pregnant. Contact our office if you need a prescription called in.

Is it normal to miss my period? It is not uncommon for women to have very light to non-existent periods on birth control pills. This is fine because the pill protects the uterus from abnormal cells. Missing periods when you are not on the pill can be a sign of menopause, perimenopause, pregnancy or a hormonal imbalance. If you miss 3 periods and are not pregnant, you should contact our office.

What is abnormal uterine bleeding? Bleeding that lasts longer than 7 days or comes more often than 21 days needs evaluation. Abnormal bleeding can be due to pregnancy, abnormal cells, mechanical problems (fibroids, polyps) or a hormonal imbalance. Abnormal bleeding after age 35 or any bleeding after menopause needs evaluation by your provider. Intermittent spotting on birth control pills is common in the 1^st three months or if a pill is taken late.

What can I do for menstrual cramps? You can try any over the counter product with Ibuprofen (Motrin) or naproxen (Aleve). Start taking this medicine when you first feel the first signs of your period beginning. For most women, 400-600 mg of Motrin or Aleve 1-2 tablets will relieve cramps. A warm heating pad over the abdomens is helpful too. Research shows menstrual cramps improve if you increase your daily calcium to 1500 mg a day. Birth control pills may provide additional relief. If you still have significant cramps after trying the above, please contact our office for an appointment.

What can I do about urinary leakage? This problem is more common than you think and can be helped. “Accidents” can occur with stress (coughing, exercise, etc.), or the urge to use the bathroom. Overuse of certain foods such as caffeine or citrus can add to the problem. Please contact our office for an evaluation. There are several treatment options available including our Pelvic Support Program to help meet your needs.

When should I begin getting mammograms? Routine mammograms should begin at age 40 unless specified otherwise by your physician or nurse practitioner. Talk with your provider if you have a family history of breast cancer especially under the age of 45. This would accelerate the start of mammogram screening for you. Many insurance companies will approve a one-time screening mammogram between the ages of 35-40. Check with your carrier to ensure it is a covered expense.

Can I have my mammogram done here if I had my last one at another facility? Absolutely. You just need to bring your prior films with you to your visit and we'll send them together with this exam for comparison. Our radiologist uses your prior films to ensure that nothing has changed in your breast tissue, so they are essential to get a final mammogram report.

Can I wear deodorant if I'm having a mammogram? Yes - we provide wipes for you to remove your deodorant prior to having your mammogram performed.

How do I treat hot flashes now that I’ve stopped my hormones or don’t want to start them? Hot flashes are mild for some women while other women are just plain miserable. We know estrogen works the best in relieving hot flashes during menopause, but hormone therapy may not be an option for everyone. Recent research on herbal remedies have mixed reviews as to whether they work and if they are safe. Some plant-based products have estrogen-like properties and very little is known about their relationship to the risk of breast cancer. Plants in this category include soy, black cohosh, and wild yam. Non hormonal medications that have shown to reduce hot flashes are in the class of anti-depressants. These include low doses of Effexor, Paxil, and Prozac, which can reduce hot flashes by 70%. Lifestyle changes that can reduce hot flashes include regular exercise, reducing your weight, avoiding spicy foods and caffeine, and staying hydrated. Talk to your provider on the best way to manage your symptoms.

What is a bone density scan? Women are especially at risk for osteopenia (bone thinning) and osteoporosis (bone loss). A way to evaluate bone density is with an easy, quick, painless x-ray of your spine and hip joints. The type of bone density test performed in our office is a DEXA test (the most accurate way to evaluate degree of osteoporosis).

Who needs bone density testing? Any estrogen-deficient woman felt by her provider to be at risk for osteoporosis is a candidate for bone density testing. This may include women on estrogen replacement. Other indications include x-rays of the vertebra showing osteopenia, osteoporosis, or vertebral fractures. If you have a history of steroid use of daily prednisone for 3 or more months or a history of primary hyperparathyroidism you may need a scan. A history of hyperthyroidism, smoking and regular alcohol use are also risk factors.

How do I prevent osteoporosis? Your skeleton continues to grow until you are almost 30. During this time calcium and exercise are your best bets for increasing the density of your bones. Calcium 1200 mg a day and regular weight bearing exercises 3-5 times a week is recommended. If your diet doesn’t include dairy or other calcium rich foods, taking a calcium supplement with 400 IU of vitamin D daily is needed. Stay away from too many carbonated drinks as it can remove calcium from your bones. The above holds true as a woman ages to prevent bone loss. After menopause, women need to increase their calcium to 1500 mg a day and continue with regular exercise.