Women’s Health Questions You’re Too Embarrassed To Ask: Part 3

From postpartum tips to sex before your annual exam to questions about being overweight, Dr. Allison Giles has you covered. You don’t even have to ask.

While you should never feel too embarrassed to ask questions at your OB/GYN appointment, we know it happens! We do our best to make you feel comfortable enough to ask away. But through my “Questions You’re Too Embarrassed to Ask” series, I love having the opportunity to tackle some of the topics patients are hesitant to bring up in person. Check out my third round of these questions and feel free to anonymously submit one you’d like to see covered in the future.

1. What can women do to ensure optimal postpartum health?
2. Do I need to avoid sex before my annual exam?
3. I’m afraid I’m addicted to my hormone replacement therapy! At what age should women stop this miraculous treatment?
4. I’m an adult woman, I don’t know what I should be eating, and I’m embarrassed to admit it.
5. Am I too overweight to get pregnant?

1. What can women do to ensure optimal postpartum health?

Social media would have us think that the postpartum period is when you and your partner have some sacred time off together to bask in the glow of your newborn. We’ve all seen the picture perfect family complete with smiles, makeup, and certainly no hint of exhaustion or exasperation. No filter needed!

I’m here to tell you that these sorts of images and ideas are generally not helpful because they usually do not reflect reality. Postpartum moms are in the unique position of trying to heal from delivery (vaginal or c-section), establish breastfeeding or bottlefeeding (whether that be formula or pumped breast milk), create a relationship with their new baby, and maintain the relationships she already has. All of this on 2-6 hours of interrupted sleep in a 24 hour time period. So how do we make sure that she is also taking care of herself? Here are a few ideas.

SLEEP!

We’ve all heard multiple times the saying “sleep when the baby sleeps!” It is true that sleep will help with emotional and physical recovery from delivery and is helpful in preventing postpartum depression but…good luck with that! As your little precious baby sleeps, you probably feel pressure to deal with the dishwasher, switch the laundry, pump, or make a meal. Maybe it’s even tempting to just sit on the couch and watch some TV by yourself without a newborn attached to your body (how dare you want some time to yourself!).

If you have family or friends that have been excited to meet the baby, this is your chance to lure them to your house to do so, but – when they get there and, shoot, the baby’s sleeping–put them to work while you go grab a nap! Many new moms feel hesitant to ask for help, but it’s so important to protect your ability to get some sleep.

Some families do not have the luxury of having anyone nearby. For those people there are doula groups in Richmond who offer postpartum services and can act as these helpful hands.

If you do decide to stay awake while your baby sleeps, do your best to make that time relaxing. Read to your other kid(s) (and reflect on the fact that you made it through the newborn phase with them and so you can probably do it again), watch Love is Blind, or sit outside. At night, if possible, enlist your partner to help with the feedings to see if you can squeeze in a 4-hour stretch of sleep.

Talk about a postpartum plan prior to delivery.

During the antepartum period, people tend to focus on the process of labor and delivery. This is natural – it’s exciting, daunting, and life-changing. There are so many birth plan templates out there. So. Many. I usually encourage shifting that energy and focus towards planning for the newborn phase around the 3rd trimester. Are you going to breastfeed? No? What type of formula will you use then? Pumping? What’s the tentative schedule for that look like?

Chores and errands do not evaporate when the baby arrives – bummer. So divvy up the tasks beforehand with your partner/help. People love to bring meals when the baby arrives, but make sure you also plan for some quick easy fixes (i.e. Papa John’s delivery), too. Look at some example “schedules” of the first few weeks with the baby. You can find many of these online. Understand that your baby may not fit the mold suggested by these plans, but it’s nice to have an idea of what it may be like.

The postpartum time wreaks havoc on your mental health. You aren’t sleeping. You’re trying to keep a newborn alive, which is stressful – the pressure is on in the most significant way. Perhaps you lack the support at home you need or thought you would have. Talking about your emotional state with your OB/GYN is critical. We usually initiate this conversation well before the birth of your baby, revisit it during your prenatal care, and broach the subject again shortly after delivery. There are many resources we can help you establish to ensure that the stress of having a newborn doesn’t rob you of the pure joy the experience can bring.

My colleague Dr. Jessica Ciaburri wrote a great blog post called What to Expect After Delivery that delves into the roller-coaster of physical and emotional changes of the postpartum period. She shares some more great tips for how to manage – all while taking care of your new baby.

2. Do I need to avoid sex before my annual exam?

Nope! During your annual pelvic exam, you may undergo a pap test (screening for cervical cancer) and vaginal STD testing. None of these tests are affected by having had intercourse before your annual exam.

However, if blood work STD testing is done shortly after unprotected intercourse, it may be too early to accurately predict if transmission of HIV, hepatitis B, or hepatitis C has occurred. Post-exposure medication to help prevent HIV should be initiated within 72 hours of the unprotected sex. Testing for HIV, Hepatitis B, and Hepatitis C will need to be repeated at certain intervals after the exposure.

We can also talk about emergency contraception at your annual visit if needed. Did you know that the copper IUD (Paragard) and two of the progesterone IUDs (Mirena and Liletta) can be inserted up to 5 days after unprotected intercourse and function as emergency contraception?

People also probably want to know if we can tell if you’ve had sex shortly before your annual exam. Of course! …Just kidding, we don’t know unless you tell us or we find a condom in there – which can also happen and please don’t be embarrassed about it!

Bottom line – please talk freely about sex and about how recently it happened, and don’t reschedule your annual just for that!

3. I’m afraid I’m addicted to my hormone replacement therapy! At what age should women stop this miraculous treatment?

I will talk specifically about the combination of estrogen and progesterone to help alleviate the symptoms of menopause. The textbook answer is age 60 because this is thought to be the age at which the risks of HRT outweigh the benefits. Oh, but the benefits! How to say goodbye to a treatment that, for many women, gives them their lives back from being ruled by insomnia, hot flashes, vaginal dryness, mood swings, and difficulty concentrating?

According to the American College of Obstetrics and Gynecology, hormone replacement therapy should be continued for the shortest duration possible at the lowest dose that achieves symptom relief. This, of course, looks different for every woman. Some women only need HRT for the first year or two of their transition to menopause (which tends to start between ages 48 and 50, by the way). Others will find relief for years. An easy way to tell is to take breaks from, or try to taper, the medication a few times throughout a given year. Some women will be pleasantly surprised that their symptoms are not as significant as they were, and others will know almost immediately that they need to get right back on the medication.

Discuss with your gynecology provider whether or not you’re a good candidate for HRT and, if so, how to safely plan for stopping it in the future. They can give you a personalized evaluation of the benefits and risks of hormone replacement therapy as well as of non-hormonal treatment options for menopause symptom management. Together you can create a treatment plan that works best for your lifestyle.

Two things I’d like to mention about HRT: It does NOT directly help with menopausal weight gain/difficulty losing weight. However, it may help with better sleep quality, which, in turn, may give you more energy to exercise. It does NOT help with libido, although it may help alleviate significant vaginal dryness, which may be a barrier to having more sex. Also, everyone should read the New York Times article, “Women Have Been Misled About Menopause.”

4. I’m an adult woman, I don’t know what I should be eating, and I’m embarrassed to admit it.

I wish more people would ask this question. Until I had worked with a nutritionist for about a year, I also had no idea what to be eating. There are two main reasons for this: in general, doctors in the US receive very little training about nutrition. Also, there are SO many things out there telling us what to do: keto, intermittent fasting, Whole30, paleo, and the Mediterranean diet, just to name a few. How is a person to actually know?

I believe that to truly learn about food and know what to eat, you have to track your food by using an app like MyFitnessPal and possibly involve a nutrition coach. Until you understand how much fat is in an avocado or how much sugar is in cereal, you may be eating these foods just because they align with a specific program rather than your personal goals.

Once you understand approximately how much protein, carbohydrates, and fat you should be eating, you can experiment with real foods you eat on a day-to-day basis to try and meet your health goals. This way, instead of being stuck with a program that doesn’t actually teach you anything about food but rather just prescribes what to eat (or not eat, in the case of intermittent fasting), you get to use your knowledge about food to actually participate in eating! How exciting!

For women in general, foods rich in protein and calcium should be prioritized – beyond that, I’m hesitant to prescribe specific foods. I am always happy to talk about what works for me (hint: I eat the same things every day), but I caution those who ask that because what works for me may not for you! If you’d like to read more about my personal weight management story, check out my blog post, “Sustainable Exercise And Nutrition: How I Finally Found A Winning Combination (And Lost 70 Pounds!).”

If your concern is weight management, you can schedule an appointment with a VPFW provider who will meet you wherever you are in your weight loss journey. They’ll help you formulate a plan for taking control of your health and wellness, monitor your progress, and provide additional counseling should you need it.

5. Am I too overweight to get pregnant?

In the USA from 1988 to 2018, the prevalence of obesity (which is body mass index > 30 kg/m2) has increased from 22% to 42%. Obesity has many implications in women’s health, and we encourage you to talk about it with us. My job is not to shame you or make you feel judged – my job is to help you understand what obesity means for your health and, in this case, your fertility and pregnancy.

Being overweight (BMI 25-29 kg/m2) or obese (>30 kg/m2) both decrease fertility by causing irregular periods, dysfunctional or absent ovulation, and changing hormones that are critical to becoming pregnant. There are many studies that demonstrate that weight loss for these patients can help increase the likelihood of becoming pregnant without the help of reproductive technology.

Becoming pregnant while overweight or obese has significant implications for pregnancy. The rates of miscarriage, fetal anomalies, and perinatal mortality are higher than for those women of normal BMI. Additionally, the risks of pregnancy-associated hypertension and gestational diabetes are higher. In short, it is more difficult to become pregnant–and pregnancy is more risky–if you are overweight or obese.

Please don’t be afraid to talk to us about it! We can help you find resources in the community to help your goals of a healthy weight and, therefore, an easier time conceiving and having a healthier, safer pregnancy. A preconception visit is a great time to ask questions like this. You might also check out Dr. Pound’s blog post, “Becoming Pregnant: 4 Keys To Mind And Body Prep,” for more tips on getting into physical and mental shape for conceiving.

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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