Coffee

Wake up, Stay Woke. The good, the bad, and the beans…

sokoloff-lingerie-146648I am tea drinker myself. A warm or cold cup of Chai is a daily ritual. I used to quietly, and sometimes publicly judge my husband for his desire for a cup of coffee, even on days that he didn’t have to work. Apart from the migraine prevention he reasoned, he actually liked it. Who likes black coffee? Well to, those of you who do, I have learned to admit when I’m wrong. If Mandy Moore’s character on This Is Us can do it, so can I (Rebecca was so wrong with Randall and William last season, but she admitted it). There are actually many health benefits of coffee, many that you may not know about. Every good has a bad though, every yin a yang, every Chance, a Mary Mitchell.

The Good

  1. Diabetes: “Coffee consumption was inversely associated with the risk of type 2 diabetes in a dose-response manner. Both caffeinated and decaffeinated coffee was associated with reduced diabetes risk.”  That means that the more coffee a person in this study drank, the lower their risk was of developing type 2 diabetes. They studied 1-6 cups and compared their outcomes with those who did not consume coffee. ¹
  2. Liver Cancer: Those who drank 2-3 and sometimes 4 cups of coffee per day had a statistically significant reduction in death from liver cancer and chronic liver disease. The reduction of death from both were anywhere from 40-70% depending on which disease and number of cups consumed.²
  3. Breast Cancer: Higher caffeinated coffee intake may be associated with lower risk of postmenopausal breast cancer. Decaffeinated coffee intake did not seem to have the same association.³
  4. Total Mortality: Higher consumption of total coffee, caffeinated coffee, and decaffeinated coffee was associated with lower risk of total mortality. To quote the study directly, “Regular consumption of coffee was inversely associated with risk of total mortality and mortality attributed to CVD [cardiovascular disease] and neurologic disease. Similar associations of caffeinated and decaffeinated coffee consumption with risk of total and cause-specific mortality were found. Results from this and previous studies indicate that coffee consumption can be incorporated into a healthy lifestyle.”ª
  5. Hypertension is not necessarily worsened by caffeine. This is a common misconception but the data shows “caffeinated coffee, decaffeinated coffee, and caffeine are not risk factors for hypertension in postmenopausal women.”†

And now to coffee’s down side:

  1. Pregnancy:  Less is more in pregnancy. 200 mg is max before known side effects can occur, but decreasing or eliminating caffeine is definitely the goal. 200 mg, by the way, translates to about two 8-ounce cups of regular coffee.
  2. Migraines- A two-edged sword. The breakdown is very clear from headaches.org. Before a headache or migraine, blood vessels tend to enlarge. Because it contains “vasoconstrictive” properties that cause the blood vessels to narrow and restrict blood flow, caffeine can aid in head pain relief. A caffeine rebound headache occurs from withdrawal of caffeine after a sufferer continually consumes too much of the substance. Talk about too much of a good thing…
  3. Breast tenderness: Caffeine consumption can contribute to painful breasts  in peri- and postmenopausal women. Decreased coffee, and chocolate (sorry) consumption can often help.
  4. Calories: So far, we have been talking about black coffee, but heavily sweetened lattes and that 500 calorie McDonald’s Frappe are not benefiting anyone’s health. That’s like eating celery dipped in a super fattening high-calorie cream cheese-based dip. Delicious? Yes. Healthy? No.
  5. Cost: You know your budget better than I. If you can afford 5 dollars a day, for a cup of Joe, do it. If you need to brew at home to make it affordable, do that. Remember, the environmental lover in me still wants you to bring your reusable cup to your coffee house of choice. Save a cup, save the earth.

OBG Management, a reputable medical journal, cited coffee post-surgery as beneficial. There is a good amount of fiber in coffee and intestinal stimulation related to its consumption. Following abdominal surgery, passing flatus (gas, farts, whatever you want to call it) is extremely important in the healing process. You know how you feel in that afternoon way-too-long meeting when you know you shouldn’t have had that black bean burrito for lunch no matter how delicious it was? Add the pain of abdominal surgery to that feeling and you’ll have an idea why passing gas is so important medically. Our intestines continue to make gas, but after surgery it is sometimes difficult and painful initially to get it out. A cup of Joe can help.

Cheers and top of the morning to you all!

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Couldn’t leave without the obligatory coffee art 😉

¹ Caffeinated and Decaffeinated Coffee Consumption and Risk of Type 2 Diabetes: A Systematic Review and a Dose-Response Meta-analysis. Diabetes Care 2014;37:569–586

²Association of Coffee Intake With Reduced Incidence of Liver Cancer and Death From Chronic Liver Disease in the US Multiethnic Cohort. Gastroenterology 2015;148:118–125

³Coffee and tea consumption and risk of pre- and postmenopausal breast cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort study. Bhoo-Pathy et al. Breast Cancer Research (2015) 17:15

ªAssociation of Coffee Consumption With Total and Cause-Specific Mortality in 3 Large Prospective Cohorts. Circulation 2015 Dec 15; 132 (24) : 2305-15.

†Coffee and caffeine consumption and the risk of hypertension in postmenopausal women. American Journal of Clinical Nutrition 2016 Jan; 103 (1) : 210-7.

Let’s Just Split The Bill: Reflections on being a woman today.

patryk-sobczak-162368It happens often. I’m having a great meal at a nice restaurant with some friends. We all order what we like and have some drinks. The check comes, placed politely face down on the table by the waiter who is likely ending his shift and just wants to close his register out. And inevitably, the person who ordered the rare filet and side of fois gras, with the taste for fine wine says, “Should we just split it?” More often than not, I mumble something along the lines of “oh yeah, seems fair, sure no problem, ok” while the mathematician in me (I’ve always liked numbers, fractions, percents #nerdalert) calculates just how much less I owe.

Then, despite how lovely the evening was, I will be sitting in my cab on the way home reviewing the bill, calculating again and again how much each of us should have paid, and ultimately thinking of ways I could have said something without sounding cheap or rude. Andfullsizerender-5 then this brings me to think, why can’t I just stand up for myself? It makes me wonder how many other women feel this way on a daily basis, in any aspect of their life. I understand the gravity of paying a bit extra for the bill is a first world problem, if you will. But it does beg the question, “How do we, as a gender, stand up for what we want and what we deserve, without coming across as rude, or aggressive.” It’s a fine line and balance. There have been moments when I have been assertive and said something, and I get labeled for that. Over the years we learn, and are conditioned to bite our tongue and go with the flow. We trivialize the grievances we have to keep the peace amongst family, friends, the work place. I once had a great conversation with a supervising physician at Rush University, where both Dr McDonald and I did our training. She said, “Shelly. You are a strong woman who knows the difference between right and wrong. The direction of your career will depend on how you convey that message. Either you will be a respected physician people look up to, or you will become the bitch no one likes to deal with.” As women, we have to be so conscious of our tone as well as how we are perceived. In the same breath, we cannot be afraid to be our very own and best advocate.oatyhejmm9e-jens-johnsson

There is a popular deodorant brand that has a line of commercials regarding this topic (I can’t tell you the name though, it’s a Secret…..). It shows girls and women changing the misconception that we have to be weak or quiet, paid less, employees and not employers, the notion that women should be seen and not heard. The message is one that I so strongly echo, especially in cases where there is abuse, neglect, unfair treatment, children being treated poorly. I also believe this can be done with the grace of the woman’s touch. We can be powerful and strong, without resorting to rudeness or aggression. To quote one of my dearest friends, “We’re smart enough to make these millions, strong enough to bear the children, then get back to business, see, you better not play me.” –Beyonce

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If I went to dinner with Bey, I think it would be her treat…

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The first trimester: Weeks 0-13

It’s a very exciting time! You are pregnant…. and huddled over the toilet, willing yourself not to revisit your breakfast. The first trimester of pregnancy is tough. The fetus and uterus are only about the size of a plum, but they can cause major drama. Your body is going through some crazy hormonal changes, you are taking what seems like horse vitamins that make you queasy, your normal diet, exercise, your whole routine has to adapt to this plum sized terror that is wreaking absolute havoc on you. The first trimester is especially challenging because most women don’t discuss their pregnancy until after 14 weeks, so there is hardly any company for your misery. I also believe second time moms do not get enough credit. Going through the first trimester can be extremely challenging enough, but now there’s a little mini-me who doesn’t get why you are sleeping/ passing gas/ cranky/ nauseous all the time.

Here are some very frequently asked questions that might help ease you through this 12-14 week period. First of all, know that it does get better for the overwhelming majority of chris-rhoads-202247women. Most of the first trimester pregnancy symptoms happen because there is a sudden surge of estrogen and progesterone that helps to support the growing terror—er, I mean, fetus. By week 12 or so, they taper and plateau causing the symptoms to also subside.

What are some things that may help get through this first trimester?

Feeling nauseous: Some simple lifestyle modifications can really help with nausea. Small and frequent meals are best (think a handful of food every 2-2.5 hours). The reason it is called “morning sickness” is because commonly, waking up and having an empty stomach is going to trigger the waves of nausea. Ginger based products, as well as slightly salty foods (think of the pregnant woman drinking ginger ale and eating crackers for weeks) can also help reduce nausea. In general, it is best to maintain a diet that is slightly bland in consistency and taste to minimize gastrointestinal upset. If these do not help, chat with your doctor about medicinal therapy. Nausea and vomiting can become a serious health concern if a woman cannot stay hydrated, and this should definitely be addressed with your physician.

Getting a cold: Every single remedy says “If pregnant, discuss with your physician.” Medicines go through a rigorous evaluation before they are approved by the FDA and sold to the public. Because it is extremely unethical to perform experiments on pregnant women (Ma’am, we don’t know what side effects this medicine will caaleksandar-popovski-50818use on your unborn fetus, however, we appreciate you taking one for the team….), obstetricians don’t always have exact rules to follow. This is why we say things like “it is generally safe” or “the risks are almost nothing with this medication.” So what is safe to use in pr
egnancy if you don’t feel good? Acetaminophen, in the appropriate adult dosage is safe to use occasionally for pain, headaches, etc. You should never use Ibuprofen, or other anti-inflammatory
medications, ever, unless directly prescribed by your physician! Benadryl is also safe to help sleep at night for the occasional tossing and turning that may occur. For the women who complain of congestion at night, I am a huge fan of nasal strips to help open the nose. Of course, staying hydrated is also a great way to reduce congestion. I generally recommend that pregnant women give themselves about 5-6 days to notice an improvement. If they do not, they should see a primary care doctor for a course of antibiotics. Pregnancy makes it harder to fight infections, and you do not want to be miserable!

Exercise: I tend to be a bit conservative when it comes to exercise in the first trimester. The general rule of thumb is your heart rate should not exceed 160bpm for more than 20 bastien-jaillot-175465minutes. This means you may have to modify your normal routine. Fatigue and dehydration will be more severe in the first trimester, and it is important not to push yourself. Brisk walking is a great way to stay active, without putting extra stress on your body. If you experience any cramping or spotting, you should rest immediately.

The body and uterus are pretty amazing at nurturing a pregnancy. It can be nerve wracking and confusing with all the information out there. I always recommend discussing all questions and concerns with your physician, as everybody is different.

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Early pregnancy, early ultrasound, pregnancy confirmation

Pregnancy Confirmation Appointment: 5 Terms You Should Understand

This is one of the most exciting and anxiety provoking moments in a woman’s life.

Whether you were trying, timing your ovulation, it’s unplanned, whatever the circumstances may be surrounding it, a positive pregnancy test brings on a wave of emotions. What can be really frustrating though, is not knowing what this means. As an obstetrician, it can be extremely challenging to explain to women that we just have to wait and see. I want to be able to tell you everything is fine, the gender, what Ivy League school your fetus will attend, and how many grandkids to expectpexels-photo-27345.jpg. Obviously this doesn’t happen during your pregnancy confirmation appointment. I want to explain some of the things we worry about in an early pregnancy, and why it can be so hard to know exactly what is going on for a while.

Early pregnancy changes drastically from week to week. At 5 weeks, there’s a small gestational sac. At 6 weeks you can see a small fetal pole in that gestational sac. Between 6-7 weeks a heart beat develops. After about 8 weeks it should be fairly simple to see a fetus with a heartbeat, and from 8-14 weeks, the gestational age of the pregnancy is measured using the crown-rump length (top of the head to the lowest part of the spine). This measurement can be +/- 5 days from the dates given to you by your physician and still be considered accurate and within range.

Because things change and develop relatively quickly in a short period of time, we are very dependent on an accurate last menstrual period. So for the woman with irregular cycles, or cycles that don’t subscribe to the 28 day rule, we have no basis for dating.

This is challenging in the first trimester. I have done ultrasounds on women that were supposed to be 8-9 weeks along, and see nothing but a small gestational sac.

Now what? Now I have to tell the patient, her husband, and whatever other family she has with her that I can’t give them the perfect social media worthy profile picture and they should cancel the announcement they had planned for that weekend. I also can’t reassure them that this is a normal pregnancy. Was she, in fact, close to 8 weeks and nothing ever developed? Did she just ovulate later than normal and we are all getting anxious because I did the ultrasound early? Can be very anxiety provoking for everyone.

As a provider, I hate not being able to give people answers. When this situation arises, another test we can look at it the HCG value (or the pregnancy hormone). If a woman’s HCG level is decreasing in a period of 48 hours, this is not a normal pregnancy. If the value is increasing, it can either be a normal pregnancy, or a miscarriage that didn’t “get the memo” yet. When this happens I recommend repeating the ultrasound in 5-7 days to check if there is any progress.

The Five Terms To Know For Your Pregnancy Confirmation Appointment

Let’s discuss some of the terms you may hear early in pregnancy when we don’t find what we expect.

  1. Miscarriage (abbreviated AB which stands for abortion, whether induced or spontaneous): essentially any pregnancy before 20 weeks gestation that does not result in a baby being born. This is a blanket term. The test was positive, but either no fetus developed, the fetus stopped growing, something basically halted the pregnancy from continuing. The majority of miscarriages can be attributed to a genetic mishap while the pregnancy is forming.
  2. Blighted ovum: If an ultrasound is done, and then repeated in 2-3 weeks and no fetal pole is ever seen, this is a blighted ovum. The egg and sperm fertilized and made their way into the uterus, but nothing grew in side. On ultrasound it looks like a thin walled cyst in the uterus.
  3. Threatened AB: This is when a woman has symptoms that could result in pregnancy, but no ultrasound or lab findings consistent with that. She may come in with bleeding, or cramping but still have a normal fetal pole and heart beat on ultrasound. We usually counsel these women to take it easy, avoid sex, tampons, pelvic exams and monitor their symptoms very closely.
  4. Incomplete AB: If, unfortunately, a woman comes in with bleeding and cramping, and there is no evidence of a fetal heartbeat, and her cervix is already open, this is an incomplete AB. The process has already naturally started to take place in the body. These women have the option to undergo a surgical procedure (D&C) to clean the uterus out, or monitor the bleeding and symptoms at home.
  5. Ectopic Pregnancy: This is a scary one. The fertilized embryo doesn’t make the total journey to the uterus, and gets stuck in the tube. It decides to stay, implant itself into the tube, and start growing. This can be extremely dangerous because the tube has the approximate diameter of a pinky finger, and can rupture once the pregnancy grows too large (usually around 6-8 weeks). This is not a normal pregnancy and needs to be terminated with either medication or surgery as soon as possible. Delay of treatment can result in dangerous bleeding in the abdomen and even death.

Going to the doctor and not getting the answers you’re hoping for can be extremely hard. Miscarriage is extremely common, 33% of pregnancies do end in miscarriage.  It is often a test of patience to have to wait 2-4 weeks to figure out what is going on. Especially difficult is that discussing miscarriage isn’t very common and women often feel isolated in their pain. Although it is not very consoling, the majority of women do go on to have normal pregnancies after a loss. Remember to follow up with your physician if your pregnancy test is positive, and you have any symptoms of heavy bleeding, intense pain or cramping, or severe nausea.

Check back in the next few days for some tips and tricks on surviving the first trimester!

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Your dentist vs your gynecologist: Myths dispelled and terms explained

pexels-photo-298611Who makes you the most uncomfortable? I was sitting in my dentist’s chair, getting my teeth cleaned, and thinking Is dentistry like what I do every day? I mean my workplace is not the mouth, but the necessary evil theme applies. Like in gynecology, if you don’t to see your dentist at regular intervals, you will find yourself with plaque that turns to cavities that turns to YUCK MOUTH. Be glad YUCK VAGINA isn’t a term (it is a thing, just not a term. Please do not hashtag that).

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All I can say is #ouch

We are both needed in the world. You may not await seeing your dentist or gynecologist with excited anticipation, but without us, you can find yourself in trouble (flash to the scene in Cast Away when Tom Hank’s character had to hit his own rotten tooth out of his mouth with an old Ice Skate).

I have asked my dentist, the amazing Dr. Ozzie Smith, III, to share a blog post he wrote years ago but that is still relevant today. Take it away, Dr. Ozzie:

Dental Myth #1:  I have TMJ

This is actually true, and so does everyone.  The acronym TMJ stands for temporomandibular joint.  This is the joint in the mandible (lower jaw) that articulates with the temporal bone in the maxilla (upper jaw).  TMJ is often confused with the term TMD, which stands for temporomandibular joint disorder.  Whenever someone says, “I have TMJ,” it’s the equivalent of saying “I have knee.”

Dental Myth #2:  Getting a denture is a rite of passage

yingpis-kalayom-133680I see patients all the time who feel it’s only a matter of time before they have to get dentures.  This is only partially true.  If you do not take care of your teeth and gums, allowing them to deteriorate–then yes, a denture is in your future.  However, if you take care of your teeth and gums, and address any health issues in your mouth as they arise–there is no reason that you should ever have to wear a denture later in life.

Dental Myth #3:  They’re just baby teeth 

frank-mckenna-127295Your child’s teeth, called primary teeth, serve a purpose.  As your child grows, primary teeth create proper spacing and room for permanent teeth to erupt later on.  Poor dental hygiene can cause these tooth to decay early.  If the primary teeth start to decay, it’s not okay to pull them or let them fall out just because “they are baby teeth.”  Prematurely removing a primary tooth can cause the space it was holding to begin closing–not allowing sufficient room for the permanent tooth to come in.  This is why it is important to care for and keep primary teeth in the mouth for their normal life span (anywhere from 4 years to 10 years).  Additionally, there are even some instances where the baby tooth is also the permanent tooth.  Some people never develop a permanent successor to some of their primary teeth due to their individual genetics.  In this case, their baby tooth will be their permanent tooth until they are old enough to consider other options. Should a child be diagnosed with a cavity at an early age, and that tooth or teeth are not treated, this cavity will progress and can cause larger issues like pain, infection and, in a worst case scenario,even death.

Dental Myth #4:  Dentists use Novocaine

metal-drill-carbide-drill-bit-milling-47729I personally have never used Novocaine; very few dentists do.  Its widespread use was probably stopped more than 30 years ago.  The local anesthetics that we use today are still in the -caine family, but are much more efficient and decrease the likelihood of allergic reactions.

Dental Myth #5:  Bad Breath = Halitosis

Ok, so this one is actually true.  Where the myth lies is in the fact that the halitosis is not the cause of the bad breath.  More often than not, bad breath is the result of untreated periodontal disease.  The bacteria associated with periodontal disease does have a very distinguishable odor, and if it’s allowed to fester and grow, the results can be… wait for it…breathtaking!  Periodontal disease is treatable.  Patients with a history of periodontal disease, AND have gone through the treatment for periodontal disease, should have their teeth cleaned initially 4 times a year, as opposed to the standard twice a year.  Other causes of bad breath include:  dental infections, not brushing the tongue, and sinus problems.

pexels-photo-305568Bonus Myth, from my brother-in-law, Robert “Bobby” McDonald D.D.S.

Every tooth ache is an abscess requiring antibiotics or crushed pain medications: False! Tooth pain can be due to nerve inflammation or a cavity, which does not necessarily require antibiotics. Also, over-use of antibiotics leads to resistance. Can you imagine having a bacterial infection that won’t die with antibiotics? That is a thing. Don’t be that person. From the CDC:

Antibiotics and similar drugs, together called antimicrobial agents, have been used for the last 70 years to treat patients who have infectious diseases. Since the 1940s, these drugs have greatly reduced illness and death from infectious diseases. However, these drugs have been used so widely and for so long that the infectious organisms the antibiotics are designed to kill have adapted to them, making the drugs less effective.

Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections.

xvfzo6lmb0-maria-victoria-heredia-reyesCrushed pain medication (like aspirin or ibuprofen) applied to the painful tooth area will cause gum damage and essentially chemical burns to the delicate mucosa of the mouth. This can be painful and take days or weeks to heal. The solution? Go see your dentist if you have tooth pain. The price of your dental work will likely be substantially less than that of your general health if you are mistreated or end up with resistance to certain antibiotics.

Special thanks to Dr. Ozzie and Dr. Bobby. I’ve seen Dr. Ozzie for years at both his Hyde Park and West Loop locations. My husband, father and children are all patients of Dr. Ozzie. I also have seen his partner Dr. Bianca Clark. She’s awesome too. Click here for more information about their practice.

Take home points: Go see your dentist. Go see your gynecologist (if you are a woman). A pregnancy shout out: Periodontal disease in pregnancy is linked to severe bacterial infections, and can even lead to preterm labor or delivery. It is extremely important to make sure your dental hygiene is checked if you are considering pregnancy, and that you definitely do not ignore tooth pain while pregnant. Don’t ask me for any more antibiotics for your painful mouth (the question is posed periodically). Not my orifice. I call “not it”. Be safe out there. Oh, and brush two minute twice per day and use floss daily. Don’t let this be your mouth…

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Brush two minute twice per day and use floss daily, please!

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Irregular Periods: Polycystic Ovarian Syndrome May Be To Blame

For some, irregular periods are a struggle. You never know when you are going to get your cycle. When it does come it is usually heavy, with clots or cramps, and it can last 2-4 weeks. A large proportion of women with irregular menses (medical term for periods) have a disease process called polycystic ovarian syndrome (PCOS). “Poly what now?” you may say… Let’s break it down.

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Imaginary Stop Period Button: If I could make this real, I’d be a rich woman

In a regular menstruating woman, the brain, ovaries, and uterus have a synchronous relationship. Hormones are secreted from the brain, causing the ovaries to release estrogen and progesterone (by way of a normal ovarian cyst), which in turn create a plush uterine lining. If there is no pregnancy, this lining is then shed, which is your period, triggered by an abrupt drop in the ovarian hormones. The cycle then starts again. In PCOS, however, this communication is disrupted. There is an abundance of testosterone and estrogen, and this throws off the brain- ovarian- uterine cycle, which in term leads to irregular periods. Essentially, there is an unopposed exposure to estrogen, and this leads to continuous stimulation on the uterine lining. The ovaries secrete low levels of estrogen but never cycle, and the cysts that form never rupture- leading to the name “polycystic ovarian syndrome.” The once plush lining becomes overgrown and irregular. This leads to the irregular and heavy bleeding.

What time is it? Infographic time!

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Women who struggle with PCOS also are at risk for other things. You could be overweight, have increased hair growth, and may be at risk for something called “metabolic syndrome”. The weight contributes to the abnormal hormonal balance, and the hormonal imbalance contributes to the weight. Fat cells, or “adipose” contribute to estrogen and testosterone production (hence the hair growth). Also, women with PCOS (even the 20% who are normal body weight) tend to be prone to diabetes, heart disease and cholesterol abnormalities.

john-towner-188594Don’t lose hope. First and foremost, exercise and diet are key. Women who lose only 5% of their weight notice considerable improvement in their symptoms. That means if someone clocks in at 250 pounds, they only have to lose about 12 pounds to help drastically improve their quality of life. That being said, it can be challenging to change your lifestyle, diet and habits. During this transition, there are options to help regulate your cycle and help protect against heart disease/ diabetes. If fertility isn’t an imminent concern, birth control is one of the best options to regulate your cycle. It controls the excess hormones and regulates your cycle. Metformin (a drug used for diabetes) can also help control insulin resistance caused by PCOS.

If a woman is ready for child bearing, the biggest challenge is timing ovulation (egg release). Because the cycles are irregular, usual ovulation predictor apps or symptom trackers are hard to rely on. The most common medication to help stimulate ovulation is a pill named Clomid. As with anything, there are risks involved, and not everyone is a good candidate for this medication.

If your cycles are wildly irregular or unpredictable, or your symptoms correlate with some of those discussed here, it is a good idea to discuss the evaluation for PCOS with your physician. There are significant health consequences if this is left untreated. Keep in mind though, that this is a very manageable and treatable disease.

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She must be smelling flowers because her cycles are no longer irregular. She looks happy. That has to be the reason…

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