Frequently Asked Gynecology Questions
1. “I have a Primary Care Physician (PCP) and an Obstetrician/Gynecologist (OB/GYN). When should I be seeing my PCP?”
Any symptoms not directly relating to your obstetrical/gynecological care should ideally be evaluated by your Primary Care Physician. Examples of what should be managed by your PCP include:
Urinary Tract Infections (in non-pregnant patients), cold/allergy/Upper Respiratory Infections, influenza, bone/joint pain, immunizations, headache evaluation and management, depression/anxiety, gastrointestinal disorders, and skin eruptions like poison ivy. If you do not have a PCP or Internal Medicine Physician we would be happy to provide you with some referrals. Please be aware that we are a Specialist office and we do not practice outside the scope of our care.
2. “I’m due for my GYN annual exam now, but just called to schedule my appointment and cannot be seen until after my prescription will expire and until after my annual mammogram is due. How can I extend my prescription and get a mammogram referral before my scheduled appointment?”
We request that you call our main number (703-717-4093) and leave a message on the nurse voicemail line. In your message, please let the nurse know the exact date of your upcoming scheduled appointment or the wait list month that you have been placed on. This way the appropriate refill quantity will be prescribed for you. Please follow all the instructions provided on the nurse voicemail recording. If you will be due for your mammogram before your GYN appointment, please provide the nurse with the name of the facility you usually go to for your mammogram. If your mammogram referral will need to be faxed for an immediate appointment, please so indicate.
3. “I believe I may have a urinary tract infection (UTI) and would like to get a prescription. How do I proceed?”
Symptoms of a urinary tract infection may include any or all of the following: Urgency, frequency, burning with urination, bladder spasms, urinary incontinence, bladder-pressure, dark or cloudy urine with strong odor despite increasing hydration, flank (side) pain, fever, and overall fatigue. We respectfully ask that you first seek management of your UTI with your PCP (Primary Care Provider), this is partly an insurance related issue. If you do not have a PCP, please let us know so that we will be able to help you select one for future reference. In this setting, a urine specimen will need to be collected, sampled for urinalysis and sent for culture. This is clinically necessary, but in certain situations, at the Physician’s discretion, an antibiotic may be called in without collecting a urine specimen. If no urine specimen is collected before treatment with an antibiotic, then a test of cure would be collected when the Rx has been completed. Some patients are symptomatic, but have negative cultures, indicating that further evaluation may be needed by a Urologist.
4. “I’m having symptoms of a vaginal yeast infection with itching, irritation and discharge after being on antibiotics for a sinus infection. What are my options?”
If your symptoms are mild, you can self-treat with an over-the-counter (OTC) Monistat Dual Pack. If you have been unsuccessful in the past with OTC creams, or have more substantial symptoms, then you may call to discuss a prescription strength treatment with: Terazol 7 Vaginal Cream or Diflucan Oral Tablets. Regardless of which medication you take for treatment, we advise that you abstain from intercourse during the week you are undergoing treatment. If self-treating with OTC meds and symptoms do not resolve, please call to speak with the nurse.
5. “I take Oral Contraceptive Pills (OCP’s) and occasionally forget to take one or two of my pills. What should I do when this happens and when do I need to consider ‘emergency contraception (EC)’ or use additional contraception, such as condoms?”
Missing pills or starting a pack late may make your OCP’s less effective. The chance of pregnancy after missing pills depends on how many pills are missed and when the pills are missed. A pill is late when you have forgotten to take it at the usual time. A pill is missed when it is more than 24 hours since the time you should have taken it.
If you miss one pill anywhere in your pack or start your new pack one day late, take the pill you missed as soon as you realize it, even if this means taking two pills in one day. Then continue taking the rest of the pack as usual. No additional contraception is needed.
If you miss two or more pills (i.e. more than 48 hours late), you should only take the last forgotten pill as soon as you realize it and the next pill should be taken at the usual time, even if this means taking two pills in one day. Additional contraception (i.e. condoms) is needed for at least the next 7 (seven) days, although a more conservative option would be to continue this back up method for the remainder of the pack. If there are fewer than 7 (seven) pills left in your pack, you should finish the rest of the pack, but you should start your next pack of pills without taking a placebo break.
If you have unprotected intercourse during the hormone-free interval (i.e. during the placebo pills) or in the first week of your pack AND have missed two or more pills in that first week, you may want to consider ‘emergency contraception.’
6. “I’m taking Oral Contraceptive Pills (OCP’s) and not due for my period for another two weeks, but having spotting. Why would this happen?”
This is commonly referred to as Breakthrough Bleeding (BTB) and can occur randomly, or due to inconsistent OCP timing. If you have missed any pills or were late taking them, this may occur. If you do continuous cycling with OCP’s and you have BTB after months of continuous cycling, you may be ready for a period. If you have been on the same OCP for years and have not been late/or missed any pills, nor taken any antibiotics that might interfere with the absorption of your OCP, and still having mid-cycle BTB, you may be due for a pill change. In this latter case, please call our triage nurse and request that your physician review your medical history and suggest another OCP.
7. “I’ve been taking an Oral Contraceptive Pill (OCP) for years with regular periods, but this month I skipped my period. Should I be concerned?”
To be on the safe side, we would recommend that you check a first morning Urine Pregnancy Test (UPT). If the UPT is negative and you have consistently taken your pills on time every day, there is no concern. It is not uncommon to skip a period or to develop short, light periods after acclimating to an OCP. If you miss your period again the following cycle, we would recommend you check another UPT. If it is still negative, you may continue taking the same pill, but if you are not reassured about not getting your period, you may call us and request that your physician change you to another OCP.
8. “My period is heavy with painful cramps this month, any suggestions?”
To help with your discomfort, we would recommend Non-Steroidal Anti-Inflammatory Drugs (NSAID’s) like over-the-counter Motrin, Advil or Aleve. If you cannot tolerate NSAID’s or Aspirin, then we would recommend Extra Strength Tylenol. A heating pad or Thermacare pad can also provide considerable relief. Following a nutritious diet with fiber-rich fruits and vegetables, iron-rich foods and plenty of hydration is helpful. As far as assessing the flow on very heavy days, using maxi-pads in lieu of tampons can be helpful. If you find that you are saturating a maxi-pad more than one per hour for greater than 2 to 3 hours, please notify us, as you might need immediate evaluation in the Emergency Room.
9. “We are considering starting a family soon. We would like to begin to try to conceive in the next 2-3 months. Are there certain vaccines, medications, or food that we should take or avoid?”
If this is your first time trying to conceive, you may benefit from a Pre-Conception Consultation with one of our physicians to better prepare you and to answer all of your questions.
A few guidelines:
- Take only pregnancy category safe medications. (Category A, B, or C- on an as needed basis only) Several safe over-the-counter medications are listed on our website. All prescription medications should be approved for pregnancy by the prescribing physician.
- Start a Prenatal Vitamin that has at least 800 mcg of Folic Acid. Over-the-counter Prenatal Vitamins have 800 mcg of Folic Acid. Prescription Prenatal Vitamins have 1000 mcg of Folic Acid. You are welcome to call and request a sample bag of prescription strength Prenatal Vitamins, which you may come by and pick up from our receptionist.
- While trying to conceive, it is safe to continue to exercise with an appropriate amount of hydration. Listen to your body and make adjustments in your routine as needed.
10. “I delivered my child vaginally last week and have a sore, irritated episiotomy site. What can I do to feel better?”
The most effective way to expedite the healing process is to soak in nice warm water. This is often referred to as a Sitz Bath. We recommend filling your tub as high as you want, with water as hot as you like, and soaking for 20-30 minutes at least twice a day. When you get out of the tub, you should gently pat the area dry, or dry the area with a hair dryer; wet skin will not heal. If you are breastfeeding, you may feel some prolonged discomfort in this area due to decreased estrogen levels. After your 6 week postpartum check-up, once you have been cleared by your physician to return to sexual activity, if you continue to be sore in the area of your episiotomy (or laceration), you may benefit from a vaginal lubricant.
11. “I’m having difficulty breastfeeding my child on my right side. He becomes fussy and pulls off the breast. The right breast aches, but otherwise I feel fine. What should I do?”
This sounds like a blocked milk duct. It can easily be cleared with the application of 10-15 minutes of moist heat, followed by massage, then followed by breastfeeding or pumping. This regimen should be carried out prior to every feeding until the clogged duct resolves. Sometimes a small pimple or blister on the nipple may first need to be cleared in order for the milk to flow. In some cases, a clogged duct may quickly progress to mastitis (breast infection) and give symptoms of red patches or streaking on the breast, fever, chills or increased breast pain. Mastitis requires immediate antibiotics. You should follow the regimen outlined above, start Ibuprofen and call your physician for a prescription for antibiotics.
12. “What are some of the classic symptoms of Peri-Menopause and Menopause?”
Classic symptoms of Peri-Menopause and Menopause are irregular periods, hot flashes, night sweats, mood irritability, insomnia, vaginal dryness / irritation (due to decreased estrogen levels) and weight gain. You may not experience all of these symptoms, or you may experience some to a lesser degree than others.
13. “I’m menopausal and experiencing extreme hot flashes during the day and night sweats every evening. My appointment for my annual exam is not for another eight weeks. Is there anything I can do for relief?”
- You may wish to try an over-the-counter supplement known as Black Cohash. It is commonly sold as “Estroven” or Remifemin. You should anticipate 6-8 weeks before you may notice any benefit.
- You should hydrate well, try soy products and avoid spicy foods.
- You should wear layered clothes for easy / modest removal.
- You should layer bed sheets and blankets and sleep with a room fan.
14. “I entered menopause a few years ago and did not suffer any immediate symptoms so I opted to hold off on starting hormone replacement therapy. Now I’m experiencing vaginal dryness and pain with intercourse. I’d still like to avoid hormone replacement therapy, but can you suggest any products that might help?”
There are plenty of over-the-counter lubricants to choose from these days, many with different textures and additives, only adding to the confusion. We recommend a few that our patients have used with success:
*Astroglide
*K-Y Warming Liquid
*K-Y Liquibeads (Individually wrapped)
If the above products do not seem to be providing enough relief and you would like to discuss whether you are a candidate for a prescription strength vaginal estrogen tablet called Vagifem, please call to speak with the nurse.
15. “I have Osteoporosis. In order to prevent further bone loss, I take a calcium supplement fortified with Vitamin D and do weight bearing exercise. I have also been taking generic Fosamax, an oral bisphosphonate, for a little over five years now. I have heard that after five years, drugs like Fosamax, Actonel, or Boniva don’t do any good and may even cause harm by increasing the risk of atypical femoral fractures and osteonecrosis of the jaw. Should I stop taking my generic Fosamax?”
Unfortunately, there is almost no literature available to guide decision-making about the optimal duration of bisphosphonate therapy. What we do know is that millions of women have been treated successfully with these agents and thousands of hip, spinal, and other nonvertebral fractures have been prevented. Osteonecrosis, or bone death, of the jaw is extremely rare and mostly occurs in cancer patients. Only approximately 250 cases of atypical femoral fracture have been reported worldwide. Atypical femoral fracture can occur in patients who have NOT been treated with bisphosphonates, and its true incidence is unknown. Research is clearly needed in this area and continues to be done. For now, the risk-benefit ratio greatly favors the use of these medications in properly selected patients at heightened risk for osteoporotic fractures.
16. “I am menopausal and recently had a DEXA scan done whereby I learned that I am osteopenic. I would like to avoid further bone loss, but would also like to avoid taking any medication for this condition. I know I need to do weight bearing exercise and should take Calcium fortified with Vitamin D, but how much Calcium and Vitamin D do I really need and is safe for me to take?”
Osteopenia is defined as a bone density “T-score” between -1.0 and -2.5, the lower number being the cutoff for osteoporosis. Osteopenia is analogous to prediabetes or prehypertension. Many cases of osteopenia are best treated with lifestyle changes, not drugs. When you have osteopenia, further bone loss can be prevented with regular weight-bearing (i.e. walking, running, aerobics) and strength-training exercise, adequate intake of calcium and vitamin D, not smoking and limiting alcohol consumption to one drink a day. Despite a recent study linking calcium supplements to an increased risk of heart attack and stroke, it is clear that 1,200 mg a day of calcium from diet alone, or a combination of diet and supplement, is optimal. Each serving of dairy (a cup of milk or yogurt or chunk of cheese) provides about 300 mg, and most people get another 200 or 300 mg from nondairy sources. Vitamin D, about 1,000 to 2,000 international units a day, is also important to assure adequate calcium absorption.