Menopause is a pivotal point in a woman’s life and can take a significant toll on general health, mood, and lifestyle. Normally, your menstrual cycle is governed and regulated by your sex hormone cycle, or the regularly occurring estrogen and progesterone patterns. Perimenopause, the time in which your body begins to transition into menopause, begins when your normal, monthly estrogen and progesterone cycles begin to follow irregular patterns.

If you are around age 45, you may have already experienced some of the symptoms of perimenopause. Many of them overlap with menopause, but there are distinctions between the two, and some are more obvious than others. Signs of perimenopause may include one or a combination of the following symptoms:

• Heavy menstrual bleeding
• Bleeding that lasts longer than usual
• Bleeding that occurs more frequently (more than once within a 3-week span)
• Bleeding after sexual intercourse
• Hot flashes or unstable body temperature
• Sudden mood swings or emotional changes (depression, irritability, etc.)
• Incontinence or bladder/urinary issues
• Changes in fertility
• Insomnia or restless sleeping
• Vaginal or skin dryness
• Pain during intercourse
• Worsened PMS symptoms
• Joint and muscle pain
• Hair loss or thinning
• Weight changes
• Night sweats or cold flashes

The more ambiguous signs of perimenopause can be physically observed and identified by your obstetrician or gynecologist. Your doctor will examine the anatomy of your uterus and endometrium to diagnose your current symptoms. The less obvious signs of perimenopause may include:

• The presence of polyps and or other benign growths within the uterus or on the cervix
• A much thinner endometrium (endometrial atrophy), which is caused by low estrogen levels
• A much thicker endometrium (endometrial hyperplasia), which is caused by excess estrogen and very low progesterone levels
• Decreased bone density (osteopenia), or severe bone loss (osteoporosis)
• Fluctuating blood cholesterol levels
• It is best to consult with your obstetrician or gynecologist for screenings and exams. Screenings are critical toward identifying and managing potentially serious issues such as endometrial cancer or other gynecological illnesses.

When you’ve reached menopausal status, you may continue to experience symptoms that are similar to perimenopause. Shared symptoms between perimenopause and menopause may include:

• Insomnia or difficulty sleeping
• Vaginal or skin dryness
• Pain during intercourse
• Osteopenia or osteoporosis
• Hot flashes or unstable body temperature
• Joint and muscle pain
• Hair loss or thinning
• Weight changes
• Night sweats or cold flashes

The main symptom that differentiates perimenopause from menopause is the absence of your period for one year or longer.

It is important to know that the symptoms associated with perimenopause and menopause may differ among women depending on their diet, lifestyle, personal habits, medical history, genetics, family history, and environment. It is best to consult with your obstetrician or gynecologist either during or between your annual exams to learn more about how you can safely treat and manage your menopausal symptoms.

At Women’s Care, we believe it is essential to prepare you for the changes that accompany perimenopause and menopause. Explore our website, give us a call or visit one of our Eugene/Springfield offices to schedule an appointment with one of our physicians. Our team is here to help through all phases of women’s lives.

Fertility issues are fairly common and affect both men and women. The American Congress of Gynecologists and Obstetricians highlights the fact that infertility can be caused by a number of factors, but is most often associated with problems occurring within the reproductive system. More specifically, the most common infertility issues are the result of problems related to egg and sperm quality, sperm count, and hormone cycles. If you are a woman, you were born with a fixed number of eggs available for reproduction.

That number of available eggs steadily decreases as you age, as do your chances of conceiving. If you are a man, your fertility also declines as you age, however on less predictable terms. After ovulation, an egg can survive for up to 24 hours. Following sexual intercourse, viable sperm can survive inside a woman’s body for an average of three days and up to five. Thus, the greatest chance of conception lies between one and five days after ovulation. If conception does not occur after one year of regular, unprotected intercourse, there is a chance that either you or your partner may suffer from infertility.

In addition to reproductive issues, infertility may also occur as a result of age, genetics, environment, underlying medical conditions, or dietary and lifestyle habits. For example, if you are overweight or underweight, your fertility may suffer. Do you regularly engage in excessive or strenuous exercise? The energy demands placed on your body during your exercise routines may consequently affect your fertility. Furthermore, if you suffer from an underlying medical condition, such as high blood pressure or diabetes, the condition may affect your ability to conceive and carry a fetus beyond the first trimester.

If you suspect that either you or your spouse may be affected by infertility, consult with your obstetrician or gynecologist. Our team at The Fertility Center of Oregon is ready to help you with your fertility issues. Some common questions that may be asked at your fertility consultation may include:

• Your medical history of sexually transmitted and non-sexually transmitted diseases
• Your family history of fertility and infertility
• Past family planning methods, such as contraception and abortions
• Your current prescribed or over-the-counter medications and supplements
• Outcomes of your past pregnancies
• Use of illicit substances or drugs, tobacco, or alcohol

The Women’s Care and The Fertility Center of Oregon teams understand both the physical and emotional circumstances that revolve around issues of fertility. We are equipped to provide and discuss a number of treatment options that best suit you and your family’s needs. Visit The Fertility Center of Oregon website for additional information and to find the necessary forms to schedule an appointment. You may also contact either our Country Club or Riverbend offices today.

Pregnancy can be one of the most thrilling and transformative events in your life, and deciding on a nutritional regimen can become either overwhelming or unpalatable, depending on your cravings. As your baby develops, you may notice that your dietary needs change constantly or become very specific.

Pregnancy places a significant nutritional demand on your body, and this demand can be greater if you are pregnant with twins, triplets, or other multiples. As a result, your body will crave a diverse array of vitamins and minerals, such as vitamin A, calcium, and folic acid, all of which are essential to the health of you and your developing baby.

Health organizations such as the USDA, US Department of Health and Human Services, and American Congress of Obstetricians and Gynecologists recommend that expecting mothers maintain a well-balanced diet, rich in vitamins and minerals. Diets should include: leafy green vegetables, edible pulses such as beans and lentils, lean meats and vitamin-rich carbohydrates such as sweet potatoes, bananas, blueberries, and other starchy fruits and vegetables.

Here is a list of vitamin- and mineral-rich foods to consider during pregnancy:

• Strawberries
• Apples
• Oranges
• Beans and nuts
• Avocados
• Spinach
• Carrots
• Whole wheat pasta, bread, and crackers
• Oatmeal
• Lean, fully cooked meat or poultry
• Peanut butter
• Fresh cheeses
• Olives
• Broccoli

It is critical quit using alcohol and tobacco entirely, as alcohol consumption and smoking may cause your baby to suffer from serious health issues including, developmental delays, birth defects and/or low birth weight. It is also important to limit your consumption of unhealthy foods that contain high levels of refined sugars and saturated fats. Failing to do so may cause other health complications such as gestational diabetes and high cholesterol.

Here is a sample list of foods to avoid during your pregnancy:

• Raw or undercooked meat or poultry
• Unpasteurized milk and juice
• Raw shellfish
• Fish high in mercury (tuna)
• Uncleaned salads
• Raw or undercooked sprouts, such as radish and alfalfa

It is important to understand that vitamin and mineral supplements alone are not sufficient enough to replace a diet rich in healthy foods. Should you have food allergies or dietary restrictions, it is best to consult with your physician about viable food alternatives to ensure that you and your baby receive the proper amount of nutrients required to prevent pregnancy-related complications.

It is critical to maintain a balanced, nutritious and wholesome diet during pregnancy, and our team is here to help you along the way. If you have additional questions or prenatal-diet concerns please call one of our offices to schedule an appointment with a physician.

For the last four years, the physicians at Women’s Care have been screening before and after delivery for postpartum depression, postpartum blues and other mood disorders. We started the initiative due to our concern that postpartum depression was being underdiagnosed. We care about our mothers and families and wanted to make sure they were completely well, both physically and emotionally.

We routinely started screening with nationally recommended depression diagnosis tools and created electronic medical record forms to ensure patients follow up with counseling and other important treatment aids. We found that these tools drastically increased the detection of postpartum depression, allowing more women to receive treatment.

This week, the US Preventive Service Task Force released recommendations that women should be screened before and after childbirth for depression, anxiety and other emotional concerns. The doctors at Women’s Care feel this is vital, which is why we developed the same procedure years ago. Women’s Care is ahead of the times when it comes to your health!

Click here for more information about postpartum depression recommendations and screening.

In years past, a hysterectomy was viewed by many patients and physicians as a sort of “cure-all” for a range of disorders that affected the maturing woman. At the time, it surely was the most effective available treatment for a lot of these conditions. Even as non-surgical intervention and medical treatment advanced, however, many patients still held to the idea of receiving a hysterectomy once they reached a certain age. Early on in my medical training, for instance, I was routinely visited by women in their early to mid 40′s who came to see me because “it was time for [their] hysterectomy.” Their mothers, aunts, and grandmothers all had hysterectomies in their 40s and 50s, so they thought it was just something you did as you aged. Contrary to popular belief, we doctors aren’t anxious to take our patients into the operating room. In fact, that is often our last resort, when all other non-surgical treatments have failed. We spend quite a bit of time educating our patients regarding hysterectomies and the wide range of other options available to them that would let them avoid surgery.

Still, though, there are times when a surgical intervention is necessary. Other treatments may fail, and for some conditions, there may be no option other than surgery. Thankfully, though, surgical technology has advanced far beyond where it was back in the days of the ubiquitous hysterectomy. Traditionally, gynecologic surgeries were open affairs, meaning that they required a large abdominal incision. Now, for many surgical cases, laparoscopic alternatives are available. Laparoscopic surgery uses a tiny incision in the belly button through which a telescoping camera is placed. Then 1-3 more incisions are made usually near the hip bones. The uterus, ovaries or any other abnormal tissue can then be removed through the vagina or through these tiny incisions. Advanced laparoscopy affords patients the opportunity to achieve the same surgical goals with, on average, fewer complications than open surgery. With technology continuing to advance, we are now able to perform most major gynecologic procedures through a few tiny incisions – which means minimal pain, shorter hospital stays, and shorter recovery times. Patients are now able to return to work in 2-3 weeks, as opposed to two months if they were to have an open “traditional” procedure.

So if you have been “living with” a condition that just hasn’t been adequately treated with medication for fear of surgery, remember….this isn’t your mother’s hysterectomy. You very well might be able to have surgery, go home the next day, go back to work in a couple of weeks, and only have a few barely visible scars to show for it.

-Jennifer Freeman, MD

As women, pregnancy is a unique time in our lives, when we are not only responsible for our own bodies but the one growing inside us as well. Today, we are seeing many more obese women during pregnancy. Our wonderful, unborn babies are powerful motivators to improve ourselves and in the process improve the health of our children, both born and unborn!

http://childpack.com/pregnancy-exercises-is-a-must/

If you are a person who is very active and physically fit you can continue your current level of fitness well into the third trimester of pregnancy. If you have previously been inactive, this is a great time to start a simple exercise routine. Physicians know that women who keep up their exercise routine during pregnancy end up more fit than when they started. They also have a lower chance for heart disease and osteoporosis later in life than women who give up exercise during pregnancy. Your baby will also benefit from your exercise. Babies whose mothers exercise during pregnancy become accustomed to physical stress, and feel less stress during labor and birth. Babies born to mothers who exercise also have healthier birth weights and are less likely to become overweight or obese later in life.

The following list contains tips for establishing effective exercise routines during pregnancy:

• If you were not physically active prior to pregnancy, this is not the time to train for a marathon or start Cross Fit.  It would be better to just get out and walk at a brisk pace for the recommended time of 30-60min.
• Use “perceived exertion” as a way to monitor your intensity. This means that you should be working hard enough to raise your heart rate, and still be able to hold a conversation. 
• Pregnancy is a time for maintaining fitness, not high intensity work-outs.
• Avoid lying on your back for exercise after 16 weeks.
• Avoid sit-ups or crunches. For a strong core (important to support your growing uterus) do squats, lunges, or other stabilizing lower body movement.
• If you are participating in Cross Fit or similar work out type, you can continue to do these workouts with appropriate modifications. 
• http://crossfitmom.com/ is an excellent resource for work out modifications during pregnancy pertaining to Cross Fit. 
• http://fittobepregnant.com/is also an excellent site for nutrition and exercise information in pregnancy.
  

  http://gymflow100.com/baby-friendly-workouts-mom-sweats-and-baby-is-happy/

Exercise is such an important part of my life now. I am active in running, hiking, biking and Cross Fit training. I cannot imagine not getting up to exercise. I do have to go to bed early and get up at the crack of dawn, but it is worth it. My children are observing me and learning that being active is important for healthy bodies. 

We are our children’s role models and if we want them to be healthy, we need to model healthy behavior for them.

-Kimberly Bock, MD

No one is free of stress. Many of us handle it well, most of the time, but there are still life events that can “tip us over.” Perhaps our teenager is acting out, our partner has cheated on us, or we are facing a major life-threatening medical event. In those times, it is a great idea to find a certified counselor you can trust.

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So what is counseling like? The first session, called “intake,”involves information gathering. What is the presenting concern? Who is involved in the concern? Is there violence? Is excessive drug or alcohol use part of the problem? Sometimes we construct a “genogram” –a multi-generational family tree. Who taught you what you know? Are you simply repeating a family pattern? Are there behaviors we identify that you would be willing to change?

In family counseling, no one person is the “identified problem.” You are part of a family unit and the unit is the patient. You and your partner are together for a reason. You and your partner might decide to strengthen your relationship and remain together, or one or both of you may abandon the relationship. Often practical people want me to “tell them what to do,” but I cannot. I do not live in your skin.

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There are no guarantees with counseling. Change is painful and people do not seek out counseling when they are comfortable. Sometimes couples come to counseling with one foot out the door already. A clear contract of purpose is important – are we here to work on the marriage or has one person already decided the marriage is over? It is not ethical to assist a couple with their marriage if one or both had an outside partner.

A counselor cannot tell you what to do, but they can help you evaluate options you may not see. As a licensed marriage and family therapist for 20 years, I see individuals, couples, and family units of all varieties. Many times these visits, usually an hour in length, are covered by insurance.

Most people are afraid someone will see their record or learn of their problems. In our office, counseling records are locked, visible only to me. Absolute confidentiality is the hallmark of counseling, and in fact the ethics of releasing records are even tighter than those in medicine in general. If you move, your counseling records will not go with your general medical chart without a special release specifically for counseling. One person in a family cannot release records of family counseling to someone else without the permission of all parties.

If you think counseling might be helpful to you as an individual or as part of a fa mily unit, it might be worthwhile considering it. People are capable of amazing change if the see an advantage in changing. Your life could be better.

–Gary J. LeClair, MD, LMFT

I would like to take a moment to help empower you to consider using your pregnancy as a time for lifestyle change. This is definitely not an easy challenge, but one that will have great rewards if met. Effective change needs to focus on nutrition and exercise. It is a two- step process and both steps go together. In a healthy pregnancy, weight gain is not nearly as important as the nutrition and exercise that goes into the pregnancy. The right amount of weight gain will vary from pregnancy to pregnancy, with a range from 0-30 pounds. It is important to give your body and baby the nutrition they need. Avoid foods that can be harmful, such as processed foods and low-nutrient, high-calorie foods. So what does this look like? The following is a list of guidelines for healthy nutrition during pregnancy:

• 80-100 grams of protein daily from meat, legumes, nuts, whole grains and yogurt. Chicken, pork, fish, beans, and Greek style yogurt are some examples (grill, bake or broil)
• 5 or more servings of vegetables daily. At least 2-3 of those servings should be leafy greens (such as spinach, kale, collard greens)
• 2-3 servings of fruit daily. The following link is provided to review serving sizes for fruits and vegetables:
  •  http://www.choosemyplate.gov/printpages/MyPlateFoodGroups/Fruits/food-groups.fruits-counts.pdf
• 2-3 servings (the equivalent of 1-2 Tbsp.) of healthy fat daily
• 2-3 liters of water

The following is a list of the top 10 foods you should be eating in pregnancy. For more detailed information visit the following link: http://fittobepregnant.com/

• Spinach, Eggs, plain Greek Yogurt, Berries, Brightly Colored Vegetables, Salmon or Fish Oil, Sweet Potatoes, Lean Meat, Walnuts or Flaxseed, Beans and Lentils.

I have had three pregnancies. During my first pregnancy I was not very active and did not pay attention to what I was eating. I had too many treats. As a result, I gained 55 pounds and had a very difficult birth and a big baby. During my second pregnancy, I was more active and paid more attention to what I ate. I gained only 30 pounds and had a very easy birth. During my third pregnancy, I was again very active and even more attuned to what I was eating. My final weight gain was 25 pounds and again I had an easy birth.

These changes in nutrition and exercise habits are not easy and will require some effort, but the rewards are significant for both you and your baby!

–Dr. Kimberly Bock, MD

The idea of starting or expanding your family is exciting but can also be nerve-racking. In order to have an easy pregnancy and a healthy baby, you want to be as healthy as possible before you begin your pregnancy. There is a lot of information out there about the best exercises, vitamins, and foods; it can be overwhelming. Luckily, it’s really not that complicated.

If possible, you can make several changes 3-6 months before you get pregnant. First, setting a goal for a healthy body weight is ideal. A normal BMI, or body mass index, is between 19 and 26. BMI can be calculated by knowing your height and weight and using a simple formula. Many BMI calculators are also available online. Try http://www.bmi-calculator.net/. Second, starting an exercise program that involves cardiovascular and weight training is also recommended. If you currently exercise regularly, you should continue your typical level of fitness.

Vitamins are everywhere and usually occupy an entire section at the drugstore. I am often asked, “Which one is the best?”  In reality, the best vitamins come from our food. A diet that contains vegetables, fruits, and good sources of protein should provide you with a healthy balance of vitamins. Pregnancy is a special time however, and a few vitamins in higher dosages are advised. Folic acid is a B vitamin and is important in the development of a babies’ spinal cord. Most cereals and breads are supplemented with folic acid. However, taking additional folic acid is important prior to pregnancy to make sure your baby will be healthy. Folic acid is available as a stand-alone vitamin and is also an ingredient in prenatal vitamins. Folic acid tablets come in 400 microgram tablets and it is recommended that you should take two daily.  Women who are pregnant also need calcium in higher amounts–generally 1,000 to 1,200mg daily. Only take calcium supplements if you cannot get this amount in your diet. Iron is also important in your diet during pregnancy, but is not usually needed prior to pregnancy.

Once you are pregnant, there are a few types of foods you should avoid. When trying to get pregnant, the most important restriction involves fish that are high in mercury. Mercury is an element that can build up in our bodies and negatively affect the development of a baby’s brain. High mercury levels occur in larger fish such as tuna, mackerel, marlin, orange roughy, shark, swordfish, and tilefish. An extensive list can be found at www.nrdc.org/health/effects/mercury/guide.asp . However, you shouldn’t avoid fish altogether. Fish that are low in mercury contain healthy omega three fatty acids and should be eaten a few times weekly.

Now it’s time to skip that cocktail with the girls. When actively trying for pregnancy, it is recommended not to drink alcohol or smoke. Alcohol can cause birth defects and no amount is currently known to be safe. Quitting the habit of smoking often takes several months and many tries. Your Women’s Care physician or primary care provider can offer you support to quit.

Remember that itchy rash you had as a kid? Hopefully it was chicken pox (varicella) and you are immune. Testing for immunity to several infections is available and should be done if you are considering pregnancy. Both chicken pox and measles (rubella) are highly infectious viruses that can cause birth defects during pregnancy. Do not worry; there are vaccinations to both of these infections that can be completed prior to pregnancy if you are not immune.

Having a pre-conceptual consult with your Women’s Care provider is a great way to start getting prepared. A personalized approach can be developed to assist you with having a healthy pregnancy and baby.

And lastly for the cat lovers, due to a parasite found in cat feces, you are off litter box duty!

Tina Schnapper, MD

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