VPFW’s Dr. Allison Giles tackles the most burning women’s health questions submitted by RICToday readers. These are the first five in a series.
Questions about women’s health can sometimes be uncomfortable or even embarrassing to ask during your routine wellness exams… and the internet isn’t the most reliable place to turn to.
Let’s take a look at some commonly asked women’s health questions, such as “What should I do if I miss a birth control pill?” and “Is 30 too late to get the HPV vaccine?”
What should I do if I miss a birth control pill?
First, you should feel deep shame as you are undoubtedly the ONLY person in history to miss a birth control pill. Next, you should feel panic. Just kidding! It is very common for women to miss a pill and there are easy instructions to follow.
Let’s say you usually take your pill at 8am each day. You take your pill Monday 8am, fine. Tuesday goes by and then it’s Wednesday at 6am, and you realize you forgot Tuesday’s pill. Take your missed pill now AND your pill at 8am as usual. As long as it has been fewer than 48 hours from the time your pill should have been taken, take the pill you’ve missed AND your usual pill for the day. If it’s been more than 48 hours since you’ve missed a pill (meaning you’ve missed at least two pills), take the most recently missed pill and discard the others you’ve missed. Then continue taking the remainder of the pills left in the pack at the usual time. Use condoms until you’ve been back on the hormonal pills for at least 7 days in a row.
If you have missed more than 2 pills in the first week of a new pack of pills, and you’ve had unprotected intercourse in the past 5 days, you should use emergency contraception.
If it becomes a pattern that you are missing multiple pills per month, you will likely have irregular bleeding and find that the pills are not helping to prevent pregnancy. There are multiple alternative birth control options that do not require taking daily pills. Ask your gynecologist about them!
What kind of medication is out there to help me lose weight?
Wouldn’t it be great if there were a pill we could all take to help us lose weight? I would be first in line to buy it! Unfortunately, weight loss is one of the hardest goals to accomplish and medications are only a small component of the strategy. Candidates for weight loss medications are those who meet certain criteria based on height, weight, and presence of weight-related illnesses, such as hypertension. There are stimulant medications which help you eat less. There are medications that target hormones in the pancreas to help your stomach empty more slowly, so you feel full for longer with less food. There are also medications that target your brain to help you lessen food cravings. If you think you may meet criteria for a weight loss medication, you should talk to a primary care physician or endocrinologist.
For many women, the key to managing your weight lies with lifestyle changes rather than a magical pill. VPFW has doctors who specialize in nutrition and weight management and can give you personalized guidance and encouragement, if you’d like to schedule a consultation. You can also read about my personal struggle with weight loss and see how I found a winning combination of sustainable exercise and nutrition (and lost 70 pounds!).
What should I do to prepare for menopause?
Call your momma! While it’s not always true that you’ll experience menopause like your mom did, many patients find that their menopause experience is similar to their mother’s. Plus, it’s always a good idea to call her anyway. The key to preparing for menopause is to talk about it before it happens with people who’ve been through it. Talk to your gynecologist, your girlfriends, the random lady at the grocery store fanning herself in front of the open ice cream freezer door!
Common symptoms of menopause include the classic hot flashes and irritability, but there can also be more subtle signs. These include vaginal dryness, difficulty concentrating, and insomnia. The average age of menopause is 51, but many people experience the transition before or after that age. If you aren’t sure, come in for a visit and we will chat about your symptoms and check some labs that will take the guesswork out of it. In preparing for menopause, know that you do not have to suffer through your symptoms! There are multiple safe treatments that can target your worst symptom or treat the global process if you are experiencing multiple symptoms.
Dr. Ingrid Prosser has a great blog post about menopause and what you can do about it: Does Anyone Else Think It’s Hot in Here?
What are the chances of getting pregnant at age 40?
The age at which people are starting to have babies is going up. In your 20s, there is about a 1 in 4 chance of conceiving per cycle. By age 40, the possibility of conceiving per cycle goes down to about 1 in 20. If you’re not looking to become pregnant in your 40s, we recommend a reliable form of birth control until age 50 when the chance of becoming pregnant is less than 1%.
If you are hoping to become pregnant in your 40’s, you’ll face a higher likelihood that you will need the help of a reproductive endocrinologist/infertility specialist to achieve pregnancy. In fact, if you are 35 or older and have not conceived despite 6 months of trying, we recommend you see the specialist at that time. VPFW’s Dr. Shannon Brim has covered some frequently asked questions about getting pregnant at 40 and tips for optimizing your fertility health, if you’d like to learn more.
Pregnancies that are conceived at or after age 40 are at higher risk for complications. As our eggs age, they carry more genetic variations which can give rise to babies with chromosomal disorders such as trisomy 21 (Down syndrome), trisomy 18 (Edward syndrome), and Trisomy 13 (Patau syndrome). Because of the high rate of genetic abnormalities, these pregnancies are at higher risk of spontaneous miscarriage in the first trimester. If you have any illnesses that are more common as we age, such as obesity, hypertension, and/or diabetes, pregnancy may be ill-advised because it carries more risk for you. However, if you wish to pursue conceiving in your 40s, we recommend you schedule a visit with your OB to discuss what specific risks pregnancy may carry for you. Learn more in my blog post, Pregnancy After Age 40: The Odds, The Risks, and Whether to Try.
Is age 30 too late to get the HPV vaccine?
The HPV vaccine, which helps to prevent certain cancers caused by HPV, is now considered routine for boys and girls starting at age 11 (though it can be started as early as 9 years old). While it is most effective when it is given prior to sexual activity, it can still provide protection into adulthood against those strains an individual has never been exposed to.
HPV is very common – approximately 80% of the sexually active population will contract a variety of strains at one time or another. Since the vaccine is not effective against existing HPV infections, giving the vaccine prior to any sexual activity yields the greatest protective benefit.
For those who were not adequately vaccinated when they were younger, the CDC recommends the vaccine through age 26. HPV vaccination beyond age 26 is not universally recommended, again because exposure to multiple strains of the HPV virus through sexual activity has likely already happened, thus rendering the vaccine less effective. However, the HPV vaccine can still be considered beyond age 26, especially in cases where full vaccination did not happen at an earlier age. Talk to your GYN doctor about it!
For more information, check out Dr. Kristen Lewis’ blog post, FAQ’s about HPV and the HPV Vaccine as New Mandate Takes Effect.
Have a Question for Dr. Giles?
Submit your question below (anonymously) and stay tuned for more “Women’s Health Questions You’re Too Embarrassed to Ask” with Dr. Allison Giles on the VPFW blog.
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