Women's Health Archive

Dysfunctional Uterine Bleeding

Questions to Discuss with Your Doctor:

• Do you have regular menstrual cycles?
• When was your last period?
• Is your bleeding always heavy or prolonged?
• How old were you when you started menstruating?
• How long ago did you develop abnormal bleeding?
• Are you sexually active?
• How many times have you been pregnant?
• What was the outcome of each pregnancy (live births, miscarriages, cesarean sections)?
• Have you ever had difficulty getting pregnant?
• What medications are you taking (including over-the-counter drugs and herbal remedies such as ginseng)?
• Are you taking hormone replacement therapy or birth control pills?
• Have you ever had medications injected (Depo-Provera or Norplant) for birth control?
• Have you ever taken estrogen or tamoxifen?
• Are you taking warfarin or other blood thinners?
• Have you ever had an abnormal Pap smear?

Your Doctor Might Examine the Following Body Structures or Functions:

• Blood pressure, heart rate, weight
• Abdominal examination
• Pelvic exam

Your Doctor Might Order the Following Lab Tests or Studies:

• Pregnancy test
• Blood tests such as complete blood count, coagulation (clotting) studies, and certain hormone tests (such as thyroid stimulating hormone, cortisol, prolactin, follicle stimulating hormone, testosterone)
• Pelvic ultrasound
• Pap smear
• Endometrial biopsy.

Irregular Menstrual Periods

Questions to Discuss with Your Doctor:

• Have you been experiencing high levels of stress?
• How much do you exercise?
• Have you ever had an eating disorder?
• Have you lost weight recently?
• Have you been intolerant of heat or cold.
• Have you had rapid heartbeats, dry skin, hair loss, constipation or diarrhea, or a change in weight (these are symptoms of thyroid abnormalities, which can cause irregular periods)?
• Do you have abnormal body hair?
• Have you gained weight?
• Do you have regular menstrual cycles?
• Is your bleeding always heavy or prolonged?
• How old were you when you started menstruating?
• How long ago did you develop irregular periods?
• When you do have your period, is it accompanied by symptoms such as abdominal cramping, mood changes, and bloating?
• Are you sexually active?
• When was your last period?
• How many times have you been pregnant?
• What was the outcome of each pregnancy (live births, miscarriages, cesarean sections)?
• Have you ever had difficulty getting pregnant?

Your Doctor Might Examine the Following Body Structures or Functions:

• Heart rate, blood pressure, and weight
• Heart and lungs
• Pelvic examination

Your Doctor Might Order the Following Lab Tests or Studies:

• Pregnancy test
• Blood tests for certain hormone levels (thyroid stimulating hormone, cortisol, prolactin, follicle stimulating hormone, 17-hydroxyprogesterone, testosterone, DHEA)
• 24-hour urine collection for free cortisol
• Pelvic ultrasound
• Pap smear (see p. 1066)

Pregnancy: 1st Trimester

Questions to Discuss with Your Doctor:

• Your age and how it will affect your pregnancy.
• Have you been pregnant before? If so, what was the outcome of each pregnancy. Did you have a full-term pregnancy (your baby was born close to your due date)? Did you give birth via a vaginal delivery or a cesarean section ("C-section") surgery? If you had a C-section, what type of C-section was it? Did any of your pregnancies end in miscarriage, voluntary abortion, or an ectopic (tubal) pregnancy?
• Does this pregnancy come at a good time for you?
• When was the first day of your last menstrual period?
• What is the usual length of your menstrual cycle?
• Do you have any medical problems such as diabetes, high blood pressure, thyroid problems, asthma, tuberculosis, epilepsy, or heart disease?
• Have you ever had any sexually transmitted infections such as gonorrhea, herpes, syphilis, or human papilloma virus (HPV)?
• Do any medical problems tend to run in your family such as sickle cell anemia, cystic fibrosis, Down syndrome, or hemophilia?
• Are you taking any medications (including over-the-counter medications)? If so, what are they?
• Do you smoke? If so, how many packs per day?
• In an average week, how many alcoholic beverages do you consume?
• Do you use any recreational drugs?
• Did you have any problems getting pregnant?
• Do you eat a well-balanced diet? Are you taking any vitamins, including folic acid (folate)?
• Do you exercise regularly?
• What is your home situation like? Who do you live with? Is your partner supportive of this pregnancy? If not, has your partner hit or threatened you?
• Are you having any problems with morning sickness (that is, nausea and vomiting)?
• Are you having any bleeding from your vagina?

Your Doctor Might Examine the Following Body Structures or Functions:

• Temperature, blood pressure, pulse, weight
• Chest exam
• Heart exam
• Abdominal exam
• Pelvic exam with Pap smear and cervical cultures
• Leg exam

Your Doctor Might Order the Following Lab Tests or Studies:

• Confirm pregnancy with blood or urine test
• Complete blood count and blood type
• Blood tests for syphilis, rubella antibodies, hepatitis B, HIV
• Urinalysis
• Portable Doppler instrument or stethoscope to measure fetal heart sounds
• Urine culture
• "Triple screen" (also known as "AFP-3" or "Enhanced AFP"
• Genetic testing

Pregnancy: 3rd Trimester

Questions to Discuss With Your Doctor:

• Do you have adequate support at home from family or friends?
• How do you feel? Have you had any problems since your last visit?
• Have you had any vaginal bleeding or spotting?
• Have you had any pain or uterine cramping?
• Have you had any discharge or leakage of fluid from your vagina?
• Have you noticed swelling of your face or ankles?
• Have you had any problems with your vision?
• Are you getting frequent headaches?
• Have you noticed a change in the frequency or intensity of fetal movement?
• Are you planning to breast-feed or bottle-feed?
• Have you selected a pediatrician for your baby?
• Are you taking classes on labor and delivery?
• Have you added health insurance coverage for your new baby?
• Have you purchased a special car seat to hold your baby when riding in your car?
• Have you decided on whether the baby will have a circumcision, if a boy?
• Have you talked with your doctor about the length of your stay in the hospital?
• Do you know the signs of going into labor so that you can call your doctor when labor begins? (These include uterine contractions and rupture of the membranes).

Your Doctor Might Examine the Following Body Structures or Functions:

• Breasts (to see if your nipples are inverted)
• Abdominal exam, including measurement of the height of your fundus (top of the uterus)

Your Doctor Might Order the Following Lab Tests or Studies:

• Culture of the vagina and rectum for Group B streptococcus bacteria
• Fetal ultrasound

Pregnancy: 2nd Trimester

Questions to Discuss with Your Doctor:

• How do you feel? Have you had any problems since your last visit?
• Have you had any vaginal bleeding or spotting?
• Have you had persistent vomiting?
• Have you had any pain or uterine cramping?
• Have you noticed swelling of your face or fingers?
• Have you had any problems with your vision?
• Are you getting frequent headaches?
• Have you had any vaginal discharge?
• Have you noticed fetal movement?
• Are you planning to breast-feed or bottle-feed?

Your Doctor Might Examine the Following Body Structures or Functions:

• Blood pressure, weight
• Abdominal exam including measurement of the height of your fundus (top of the uterus) and using a portable Doppler instrument or stethoscope to measure fetal heart sounds

Your Doctor Might Order the Following Lab Tests or Studies:

• Consider repeat complete blood count
• Fetal ultrasound
• Glucose tolerance test

Your Doctor Might Order the Following Treatment:

• Rhogam (Rh-Immunoglobulin), if your blood type is Rh negative (see p. 920)

Vaginitis

Questions to Discuss with Your Doctor:

• How long have you had this vaginal discomfort?
• Does it itch or burn?
• Do you have vaginal discharge? Does it have a bad odor? What is the consistency?
• Are you pregnant?
• Are you sexually active?
• Is sexual intercourse painful?
• Do you have pain or burning with urination?
• Are you urinating more frequently?
• Do you have urinary incontinence?
• Are you post-menopausal?
• Do you have vaginal dryness?
• Do you have diabetes?
• Have you recently taken antibiotics or corticosteroids?
• Is your immune system suppressed in any way?
• Do you take birth-control pills?
• Do you wear tight pants or synthetic fabrics (nylon)? (These are all predisposing factors for yeast infections).
• Have you or your partner ever had a sexually transmitted disease?
• Do you have fevers, chills, abdominal pain, joint pain, or a rash?

Your Doctor Might Examine the Following Body Structures or Functions:

• Abdominal examination
• Pelvic examination

Your Doctor Might Order the Following Lab Tests or Studies:

• Sample of the vaginal discharge to examine under a microscope (wet smear)
• Cultures of the vaginal discharge

With summer's approach come plans for travel, including flying long distances. But the prospect of a long flight often raises health concerns. Especially in passengers who are older or have certain conditions, air travel and the related stress can have an impact on health. Here are a few trouble areas and some precautions you can take.

Deep-vein thrombosis (DVT). Not all experts agree on an association between DVT (blood clots in the legs) and air travel. Symptoms may not occur for several days, so it's difficult to establish a cause-and-effect relationship. If there is one, it's likely due to prolonged inactivity. Limited airline space can discourage moving about. Dry cabin air may also increase the risk of DVT.

ITEMS TO GATHER:

• Towels, plastic sheet, and newspapers
• Soft blanket for the baby
• Gloves (ideally disposable surgical gloves), if available
• Thick string, clean shoelace, or sterile tape to tie off umbilical cord
• Plastic bag for placenta

REMEMBER TO…

• Note the time of birth.
• Congratulate the mother!

Birth of the Placenta

The placenta, which has provided the fetus with nourishment, is attached to the umbilical cord and is delivered about 20 minutes after the baby. Do not pull on the cord; delivery of the placenta occurs on its own. You can help by gently massaging the woman’s lower abdomen. The uterus will feel like a hard round mass.

Massaging the abdomen helps the uterus contract, which also helps stop bleeding. After the placenta is delivered, place it in a plastic bag to take with the woman and baby to the hospital. It is normal for more bleeding to occur after delivery of the placenta. Continue gently massaging the woman’s lower abdomen.

Butterfly Bandage