Pregnancy, Menopause & More
Online Health Chat with Dr. Natalie Bowersox
July 30, 2010
Planning for your first pregnancy? Have questions about menopause symptoms? Wondering which vitamins and supplements are best for your body while pregnant? Let Natalie Bowersox, MD help get your questions answered about a variety of female health concerns. Take advantage of this opportunity to be a part of a live, private web chat with a gynecologist. Discuss your female health questions with Dr. Bowersox and let her identify your condition. She will be able to recommend the best treatment options available for you.
Natalie Bowersox, MD works in the Obstetrics and Gynecology Department of the Brunswick Family Health Center. She received her undergraduate degree from Baldwin-Wallace College, obtained her medical degree from the Medical College of Ohio at Toledo, and completed her residency at Albany Medical Center in Albany, NY.
To make an appointment with Dr. Natalie Bowersox or any of the other specialists in our Brunswick Family Health Center at Cleveland Clinic, please call 330.225.8886. You can also visit us online at clevelandclinic.org/fhc.
Cleveland_Clinic_Host: Welcome to our Online Health Chat with Dr..Natalie Bowersox. We are thrilled to have her here today for this chat. Let’s begin with the questions.
churchlady: My daughter is 15 and has very heavy periods. Is this normal?
Dr__Natalie_Bowersox: This can be normal. As long as the period is manageable, her cramping can be controlled with Advil or Motrin. If her cycles do not exceed 7 days, that can be normal.
jopat: I am in my early 40’s and have very heavy menstrual bleeding with a lot of clotting. Does this indicate a problem or does this mean I am getting close to menopause?
Dr__Natalie_Bowersox: This may mean that your periods are changing as you get older.
As long as your cycles occur regularly, the bleeding doesn't exceed 7-8 days and you can manage the cramping or clotting, than it does not generally indicate a problem. We do get concerned if your periods start to occur with more frequency and are associated with fewer period-free days.
sallyB: How young can a girl safely go on birth control pills, when being used to help regulate her period? How long can she stay on it?
Dr__Natalie_Bowersox: At the risk of sounding vague-that depends! I have had patients as young as 13 on a birth control pill to manage their periods. There is not a time limit of how long it is "safe" to be on birth control pills. I usually tell patients that they should stay on the pill until their symptoms are controlled or until they do not need it anymore.
stkinney: I am 42 and my husband and I are considering trying for another baby. I know there have been many medical advances, but what are the risk factors for someone my age having a baby, both to me and the baby?
Dr__Natalie_Bowersox: That really depends on you as an individual. When we address your individual risk, we look at your medical history, your partner's history, as well as your reproductive history.
With any pregnancy, regardless of age, there are risks. One thing to keep in mind though, is that your eggs are 42 years old as well, so getting pregnant and staying pregnant can be harder to do the closer you get to menopause, and the risks of chromosomal abnormalities increase too. That being said, women in their 40's do continue to get pregnant and have healthy babies.
lol5: What are some of the most common signs of pregnancy? How do I know I might be pregnant?
Dr__Natalie_Bowersox: Five very common signs of early pregnancy are as follows. You might experience all, some, or none of these symptoms, as pregnancy symptoms vary from woman to woman. A missed period — missing your period is the most clear-cut sign of pregnancy. But it is not definitive. Stress, excessive exercise, dieting, and other factors might cause irregular periods.
Frequent trips to the bathroom — even before missing a period, many pregnant women report having to urinate more often. You might even have to get up during the night. This occurs after the embryo has implanted in the uterus and begins producing the pregnancy hormone called human chorionic gonadotropin (hCG). This hormone triggers frequent urination.
Fatigue — utter exhaustion is a very early sign of pregnancy. Fatigue is a result of high levels of the hormone progesterone.
Morning (and noon and night.) sickness — Guess what? That queasy feeling isn’t limited to mornings. Most pregnant women who experience morning sickness — which can begin two weeks to two months after conception — feel slightly nauseated at other times during the day. About half have vomiting, but very few have severe enough morning sickness to develop dehydration and malnutrition.
Sore (and enlarging) breasts — If you’re pregnant, your breasts will probably become increasingly tender to the touch, similar to the way they feel before your period, only more so. Your nipples might also begin to darken and enlarge. Once your body grows accustomed to the increase in hormones, the pain will subside.
claraB: What are the risk factors to an obese women and pregnancy - for both the mother and child?
Dr__Natalie_Bowersox: Risk factors include increased risk of diabetes, hypertension, preterm labor, difficulty monitoring labor, increased risk of large fetus, and higher risk of cesarean section.
platty: What’s the best way to stay active during my pregnancy? Which exercises are safe to do while pregnant? Which exercises should be avoided?
Dr__Natalie_Bowersox: The safest and most productive activities are swimming, brisk walking, indoor stationary cycling, step or elliptical machines, and low-impact aerobics (taught by a certified aerobics instructor). These activities carry little risk of injury, benefit your entire body, and can be continued until birth. Tennis and racquetball are generally safe activities, but changes in balance during pregnancy may affect rapid movements. Other activities such as jogging can be done in moderation, especially if you were doing them before your pregnancy. You may want to choose exercises or activities that do not require great balance or coordination, especially later in pregnancy.
Women should avoid the following during their pregnancy: holding your breath during any activity, activities where falling is likely (such as skiing and horseback riding), contact sports such as softball, football, basketball, and volleyball, any exercise that may cause even mild abdominal trauma such as activities that include jarring motions or rapid changes in direction, activities that require extensive jumping, hopping, skipping, bouncing, or running, deep knee bends, full sit-ups, double leg raises, and straight-leg toe touches, bouncing while stretching, waist-twisting movements while standing, and heavy exercise spurts followed by long periods of no activity, and exercises in hot, humid weather.
allie: Gestational diabetes runs in my family. I am now three months pregnant. Is there anything I can do to try and prevent this?
Dr__Natalie_Bowersox: Make sure that your physician is aware of your family history. The best thing you can do is practice good nutrition, limit pregnancy weight gain to the recommended amount, and get screened between 24-28 weeks by glucola testing.
campfun: How much weight gain is ‘recommended’ during pregnancy?
Dr__Natalie_Bowersox: That depends on what weight range you were prior to pregnancy.
Women who are in the recommended BMI range for their age should aim for 25-35 pounds during the pregnancy. Those that are overweight to begin with or obese will have different guidelines to follow.
bikini: My sister is eight months pregnant and has lost weight with her pregnancy. She was a little on the heavy side to begin with. Her doctor said that the baby is pressing against her stomach and that’s why she is not eating and thus losing weight. The baby is growing OK. Is this healthy for the baby? She barely eats anything. She does take her prenatal vitamins.
Dr__Natalie_Bowersox: Some women do note that their weight stabilizes or may fall off slightly at the end of pregnancy. As long as she and the baby continue to do well this is not something to be overly alarmed about.
punchy: What are some of the advantages of breastfeeding after my pregnancy?
Dr__Natalie_Bowersox: Breast milk is the best food for your baby and provides all the food and fluid your baby needs to grow. It is always available.
As soon as your baby is born, a hormone is released by your body that tells your breasts to produce milk. The more your baby feeds, the more milk your breasts make.
- Breast milk is convenient.
- It is always at the right temperature and does not require measuring or special preparation.
- Breast milk saves money.
- Breast milk is natural and free. Plus, you don't need to buy formula, extra bottles, or other feeding supplies for your baby.
- Breastfeeding is safe for the environment.
- Breast milk does not require packaging and doesn't waste paper, glass, tin, plastic, or rubber. Purchased milk substitute products do require packaging. Breastfeeding helps your baby's brain develop.
- Studies show that children who are breastfed have higher intelligence scores (by an average of 7 points) than those who are fed breast milk substitutes.
helen: When you get pregnant, even though you were on the pill, can this hurt the baby?
Dr__Natalie_Bowersox: Generally speaking, no!
nickS: Can you take inhaled steroids when you are pregnant?
Dr__Natalie_Bowersox: If you are taking an inhaled steroid to treat certain conditions like asthma, then the answer is yes.
EVM: Pre-menopause - will this cause an increase in migraines?
Dr__Natalie_Bowersox: That really depends on what triggers your migraines. Some women do report an association between their periods and migraines, and therefore may note some increase in headaches as they transition through to menopause. I would suggest keeping a headache calendar to see what times during the day/week/month seem to trigger the migraines. This may make it easier for you and your physician to figure out what triggers your migraines.
howcome: Are menopause symptoms hereditary? My mother went through menopause almost painlessly. Should that give me hope that I might do the same?
Dr__Natalie_Bowersox: We can always hope! There does seem to be some correlation for women when they compare themselves to their sisters or mom. I am not aware if there is any evidence-based studies to back this up though.
applepie: How long will my hot flashes occur and what can I do to prevent them?
Dr__Natalie_Bowersox: The severity and duration of hot flashes varies among women. Some women have hot flashes for a very short time during menopause. Other women may have hot flashes, at least to some degree, for life. Generally, hot flashes are usually less severe as time passes.
While it may be impossible to completely avoid hot flashes during menopause, there are certain triggers that may bring them on more frequently or cause them to be more severe. To prevent hot flashes, avoid these triggers: stress, caffeine, alcohol, spicy foods, tight clothing, heat, and cigarette smoking.
sillytime: How long can symptoms of menopause last?
Dr__Natalie_Bowersox: Symptoms of menopause will vary for each individual. The time leading up to menopause, called the perimenopause, can last up to three years. However, menopause symptoms can occur from several months to several years, or in some cases, they never go away completely.
costalot: What can women take for hot flashes etc., if they had to stop estrogen due to breast cancer (hot flashes are increased due to taking Femora)?
Dr__Natalie_Bowersox: If your main concern is hot flashes, then there are several non-hormonal options that you can consider.
- First, remember to dress in layers so that you can adjust to whatever environment you are in.
- Keep your room cool at night and have a fan if possible.
- The Clonidine patch (which is a medication to treat hypertension) will often help lessen hot flashes.
- Another great option exists with certain antidepressants, like Lexapro and Effexor, which work well for some patients to lessen the flashes.
proudmary: Effexor® for hot flashes? I cannot take HRT. I’ve heard that it works – but that it is difficult to come off of and has unfavorable side effects. Is this correct? What about Celexa?
Dr__Natalie_Bowersox: Effexor does work well for hot flashes. Like any medication, when you are thinking about stopping this, you should do so under the care of your doctor. There can be some rebound nausea when you are trying to come off of this medication. Celexa has been used with some success as well.
maryh: What are the alternative therapies available to help with menopause symptoms?
Dr__Natalie_Bowersox: Complementary and alternative therapies are medical treatments that are considered nontraditional. They include dietary and herbal supplements, acupuncture, and chiropractic and massage therapy, biofeedback, homeopathy and eating certain foods that are thought to prevent disease or heal. Alternative treatments are often used alone, while complementary treatments are alternative treatments that are used in combination with traditional treatments, such as drug treatments or surgery. Women going through menopause may find relief from their symptoms from lifestyle changes. These lifestyle modifications may include avoidance of triggers such as caffeine, alcohol, spicy foods and cigarettes.
Some botanicals, such as phytoestrogens, may help relieve symptoms of hot flashes. Phytoestrogens, found in plant-based foods, are substances that are thought to have weak estrogen-like effects. They may work in the body like a weak form of estrogen. Some may lower cholesterol levels and have been suggested to relieve hot flashes and night sweats. Examples of plant estrogens include isoflavones. Isoflavones can be found in foods such as soy products, whole grains and beans. It is important to remember that not every woman is able to convert soy to equol (weak estrogen). Also, choose soy foods rather than supplements.
jules: Any other alternative TX besides estrogen if you are menopausal and have been diagnosed with Osteopenia?
Dr__Natalie_Bowersox: If you are a smoker, you should stop smoking.
- Adding weight-bearing exercise 3-5 times a week will help you preserve the bone you already have.
- Adding a calcium supplement with vitamin D twice daily will slow progression of bone loss.
- The bisphosphonates, like Boniva, Fosamax, and Actonel, which are non-hormonal, can be used to treat osteopenia as well.
- Check with your physician to see if you are a candidate for any or all of these options.
tracyols: How does the use of oral contraceptives compare to traditional hormone therapy for perimenopausal symptoms?
Dr__Natalie_Bowersox: I generally reserve hormone therapy for patients who are in menopause, meaning that they have not had a period for 12 months, ruling out other cause for this, and they are in their late 40's to early 50's.
Low-dose oral contraceptive pills, in a patient without contraindications, serve as a great bridge for the perimenopausal patient who needs control of symptoms, possible contraceptive benefits, and does not meet the criteria for menopause and hormone therapy.
jdr: Do you still prescribe HRT since studies show that women should stop HRT?
Dr__Natalie_Bowersox: I do prescribe hormone therapy to patients that meet the criteria for treatment.
sophiak: Can Premarin cause uterine cancer?
Dr__Natalie_Bowersox: Any kind of estrogen therapy can be associated with a slightly increased risk of certain female cancers.
chang: Has anyone done a study on hypertension based on menstrual period / Menopause and their influence? (Not based on age).
Dr__Natalie_Bowersox: I am not aware of any study looking at the link between your period or menopause and hypertension. However, many studies are done every year and that may be one worth looking into in greater depth.
loveya: What type of doctor should you see to manage your health care during menopause years?
Dr__Natalie_Bowersox: Your healthcare can be managed in combination by your Ob/Gyn and your primary care provider.
MS821: What are the latest recommended amounts of calcium citrate & calcium carbonate products to take daily? Which is better? How much Vitamin D do need to take daily with the calcium? Do you take these all at once, or divide it throughout the day?
Dr__Natalie_Bowersox: Great question! The recommendation for calcium is approximately 1200mg/day. I tell patients that whichever calcium supplement with vitamin D that they can tolerate and remember to take every day, is the best one for them. Neither is better. I would take the supplement in divided doses, so twice a day. Most calcium supplements contain Vitamin D which aids in absorption of the calcium.
The vitamin D amount you need daily depends on you and your individual needs. Typically, this level can be checked in the office with a blood test, but I will tell you that most people in Ohio are deficient in Vitamin D. Check with your physician to see what amount of supplement is right for you.
mememe: What foods have vitamin D in them?
Dr__Natalie_Bowersox: This is the time that you need to read your labels. Add more vegetables to your diet. Dairy products, like milk, are enriched in Vitamin D as well.
imgame: Heard you need magnesium when taking calcium – yes or no?
Dr__Natalie_Bowersox: If you are taking a multivitamin or eating balanced meals then the answer is no.
jax: Can you over take meds for building bones? (i.e., Fosamax)
Dr__Natalie_Bowersox: As long as you are taking the medication as it is prescribed the answer is no. However, if you are concerned about the length of time you have been on the Fosamax, then the answer is that it depends.
It is a good idea to revisit why you are on medications. The length of time you have been on that particular medication, etc. when you meet with your physician at your yearly exam. It is important to take an active role in your healthcare and ask questions!
momma: I’ve been taking Forteo for 1 ½ years, How can I tell if my bone mass is normal or increasing?
Dr__Natalie_Bowersox: The best way to tell would be when you return for your follow up bone density scan. These are generally done every 2 years. This will allow your physician to evaluate any progression of bone breakdown and evaluate your response to treatment.
mich: Are more women getting osteoporosis since the number taking HRT has decreased due to last study?
Dr__Natalie_Bowersox: No, the numbers appear to be increasing because we are doing a better job of screening and early intervention for osteoporosis and osteopenia (thinning of the bones).
madhatter: How strong is family history in regards to osteoporosis?
Dr__Natalie_Bowersox: Family history does play a significant role in your risk for osteoporosis.
kissmekate: What can I do to get a full night sleep? I am up 4 or more times going to the bathroom every night.
Dr__Natalie_Bowersox: I would make an appointment to see your physician. Getting up that many times during the night can be due to many reasons ranging from pregnancy to drinking too much fluid in the evening, to issues with bladder control.
callhome: After my third child, I now have issues with urinary incontinence. More so, I have to go to the bathroom all the time. I will go, and then ten to twenty minutes later I have to go again. When I do go, there is not a lot of volume, which I would expect the opposite to be true? I have tried doing the Kegel exercises, but they don’t seem to work. What else can I do?
Dr__Natalie_Bowersox: I think this would be a great time to discuss this with your gyn. Some of us do treat incontinence or they may refer you to a urogynecologist (a GYN with additional training in urologic problems) to evaluate your concerns.
Sometimes medications can help treat the symptoms that you are experiencing and can make a big difference.
BerthaB: What can we do early on to lessen or prevent Osteoarthritis?
Dr__Natalie_Bowersox: I do not generally see patients with osteoarthritis. If you have questions regarding that I would recommend you touch base with your primary care physician.
liss: What does it mean if you have high testosterone levels as a women? What are the risks?
Dr__Natalie_Bowersox: That would depend on the symptoms that you are experiencing and why those levels were checked to begin with.
hibi: What can women do about unwanted facial hair? What causes this?
Dr__Natalie_Bowersox: Unwanted facial hair can be due to heredity, certain medical conditions, and may increase as you age. You can try plucking or laser treatments. You may want to see your primary care physician for this or a dermatologist.
hello: I have had a hysterectomy with ovaries removed. Sometimes I still feel like I have the bloating, crampy feeling. Is this normal?
Dr__Natalie_Bowersox: You may continue to have some cramping occasionally from post-surgical changes or scar tissue.
Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Natalie Bowersox is now over. Thank you again Dr. Bowersox for taking the time to answer our questions today about Pregnancy, Menopause, and More!
Dr__Natalie_Bowersox: Thank you for all your great questions!
- To make an appointment with Dr. Natalie Bowersox or any of the other specialists in our Brunswick Family Health Center at Cleveland Clinic, please call 330.225.8886. You can also visit us online at clevelandclinic.org/fhc.
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