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Endometriosis: Everything You Need to Know

Endometriosis is a common condition with plenty of misconceptions. The disease occurs when tissue called endometrium, similar to the tissue that normally lines the uterus, grows in other parts of the body. Endometriosis affects as many as one in 10 American women. It can cause pain, scarring, and even infertility.

Frequently Asked Questions


Why do I have to fill out paperwork at each visit when I have been seen by the same doctor for over 20 years?

We all know how frustrating it can be to fill out the mounds of paperwork given to us at a doctor’s visit. However, this paperwork is very important for you to receive quality care and to ensure your visits are filed properly with your insurance carrier. For some people, information such as phone numbers, address and insurance changes frequently. Likewise, health information may also change from visit to visit. Surgeries, family illnesses, and treatment received by other specialists will help your doctor diagnosis a problem more quickly. Accuracy is extremely important in healthcare.

How does exercise help me stay healthy?

Exercise helps both your body and your mind. It helps lower your risk or disease. It helps you feel better. When you exercise every day, you can lower your chances of having: a stroke, heart disease and diabetes. Exercise can lower your blood pressure, blood cholesterol and blood sugar. Exercise helps your mood. It changes how you feel and gives you more energy and helps you to sleep better.

How do I start to exercise?

Always check with your healthcare provider before you start an exercise program. If you have any health problems, talk to you provider about what exercises would be right for you. Choose exercises that: you enjoy, fit into your schedule, and that allow for any health problems. Do warm up exercises every time you exercise. Gently stretch your muscles for five to 10 minutes. When you stretch, you make your muscles less tight. You are less likely to hurt yourself. You can walk to warm up. It gets your blood flowing.

How can I prevent fatigue and exhaustion?

For many mothers the first weeks at home with a new baby are often the hardest in their lives. You will probably feel overworked, even overwhelmed. Inadequate sleep will leave you fatigued. Caring for a baby can be a lonely and stressful responsibility. You may wonder if you will ever catch up on your rest or work. The solution is asking for help. No one should be expected to care for a young baby alone. Every baby awakens one or more times a night. The way to avoid sleep deprivation is to know the total amount of sleep you need per day and to get that sleep in bits and pieces. Go to bed earlier in the evening after your baby’s final feeding of the day. When your baby naps you must also nap. Your baby doesn’t need you hovering while he or she sleeps. If sick, your baby will show symptoms. While you are napping take the telephone off the hook and put up a sign on the door saying “mother and baby sleeping”. If your total sleep remains inadequate, hire a babysitter or bring in a relative. If you don’t take care of yourself, you won’t be able to take care of your baby.

What can I do to prevent getting STDs?

The only sure way to prevent most STDs is not to have sex. If you do have sex, the following may help reduce your risk of getting an STD.

  • Know and limit partners – your partner’s history is just as important as your own.
  • Talk with your partner – shame and fear can hinder open and honest communication.
  • Know the symptoms and seek medical care if you develop a problem.
  • Use a latex condom and avoid use of oils or petroleum jelly.
  • Spermicides may help guard against some STDs.
  • Avoid risky sex practices.
Is urinary incontinence a natural consequence of aging?

Studies reveal that 30 percent of all women report episodes of urinary incontinence, which is the involuntary loss of urine from the bladder. However, only one half of these women report this condition to their physicians because it is either socially embarrassing or they believe that no treatment option is available. Urinary incontinence is not a natural consequence of aging. Pelvic exercise (for example, Kegels and biofeedback), medication, and outpatient minimally invasive surgical procedures offer excellent cure rates. If you have urinary incontinence, take charge of your health care and discuss it with your physician. Effective treatment options are now available for you.

I have a teenage daughter. When should she have her first Pap smear?

Since most abnormal Pap smears are attributed to human papilloma virus (HPV), which is predominantly transmitted through sexual activity, it is felt that Pap smears should begin when a young woman is involved in sexual activity. In addition, a young woman should be seen by a physician or other health care provider if she experiences other symptoms related to her female organs, such as irregular bleeding, pelvic or abdominal pain, or vaginal discharge. Certainly, most women should obtain a Pap smear by age 18 – 21 regardless of whether or not they have become sexually active.

Am I a candidate for Her Option®, in-office cryoablation for the treatment of heavy periods?
  • Do you suffer from heavy or long periods?
  • Are you past childbearing age?

If you answered “YES” to both of these questions, then you may be a candidate for a procedure known as cryoablation. Her Option cryoablation therapy from AMS is a treatment option for excessive menstrual bleeding (menorrhagia) that ablates endometrial tissue through subzero temperatures, using ultrasound guidance to monitor the safety and extent of treatment. Her Option is a comfortable treatment for menorrhagia because the natural anesthesia effects of cold eliminate the need for IV sedation in most cases, and allows the patient to be treated in the comfort of the office versus scheduling and waiting for an operating room.  This procedure significantly reduces and in some women, totally eliminates bleeding. The procedure takes less than 30 minutes and is performed in the Greenville OB/GYN surgical suite by the physicians of Greenville OB/GYN.  The patient is released to recover at home and able to resume normal activity the next day.  In-office cryoablation is covered by most major PPO insurance companies as well as Medicare. To learn more about this procedure and to establish if you would be a candidate, please speak with your physician.

What are the risk factors for breast cancer?

Several risk factors have been identified with the development of breast cancer. The incidence of breast cancer obviously increases with advanced age in women. In addition, hormone replacement, especially when it combines of estrogen and progesterone may increase the risk of cancer.

Other risk factors include:

  • Family history of breast cancer
  • An early age of menarche (when the period starts).
  • Late age of menopause
  • Later age of first live birth
  • Any history of benign breast disease which has been biopsied increases risk of breast cancer
What does smoking have to do with abnormal Pap test?

Women who smoke are more likely to have abnormal Pap tests. The Pap test detects cellular changes. Most abnormal cell changes are caused by infections with human papillomavirus. HPV infection is very common. Most of the time, the immune system gets rid of HPV before it can cause abnormal cell changes. In smokers, HPV infections are more likely to cause cell changes that can eventually become cancer. In addition, smoking lowers the ability of the immune system to get rid of HPV. Stopping smoking markedly improves the immune system, allowing the body to clear the virus naturally.

What changes should I expect with the onset of menopause?

Menopause is a natural part of aging. The lower amounts of estrogen that come with menopause will cause various changes in your body. These changes will occur slowly. It is important to remember that menopause is different for everyone. Some women notice little difference in their bodies or moods, while others report substantial changes. Possible changes include: hot flashes, sleep problems, vaginal and urinary tract changes, bone changes, emotional changes, and changes in sexuality. You should see your doctor if any of your symptoms become particularly bothersome.

What are hot flashes?

Hot flashes are sudden sensations of flushing and heat that some women feel when they are going through menopause. They are one of the most common and earliest signs of menopause. Hot flashes result from a decrease in the female hormone estrogen. Their exact cause is not completely understood, but it is believed that estrogen production affects the part of the brain that controls the body’s temperature. Blood vessels in the face, chest, and body widen and make you feel warmer. Hot flashes usually appear suddenly and without any warning but they may be triggered by emotional stress, excitement, anxiety, alcohol or some foods. Symptoms include redness and warmth on the skin of your face, neck, shoulders and upper chest, a pounding heartbeat and sweating followed by a slight chill. Hot flashes may last a few seconds or as long as 30 minutes. Most last no longer than two or three minutes. Hot flashes are most troublesome at night and interrupt your sleep.

What is the treatment for hot flashes?

If your hot flashes are mild and infrequent, use a fan or sip a glass of cool water or juice when a hot flash begins. Some natural remedies may help give some relief of hot flashes. For example, soybeans contain isoflavones, which are similar to the hormone estrogen. If your hot flashes are frequent and severe, and if you have night sweats severe enough to keep you from sleeping, your healthcare provider may suggest some hormone therapy. This treatment involves taking the two hormones estrogen and progesterone if you still have your uterus. You may take estrogen without progesterone if you no longer have your uterus. The hormones can be prescribed as pills that you swallow, skin patches, creams, vaginal suppositories, vaginal rings, shots, or pellets placed under the skin. Depending on your age, treatment with estrogen and progestin may increase the risk for heart disease. It may also increase your risk for stroke, breast cancer, blood clots, some gallbladder problems, and possibly dementia. Also, estrogen taken without progestin increases the risk of uterine cancer if you still have your uterus. Discuss the risks and benefits with your healthcare provider. Other medicines your provider may prescribe are Catapres (clonidine) or Bellergal, a medicine that contains Phenobarbital. Talk to your provider about what might be the best treatment for you.

My spouse and I are thinking about permanent sterilization. What should we know before making a decision?

Sterilization is a big decision and should not be done on a whim. While people choose sterilization for various reasons, you should be certain that you do not want children in the future, as attempts to reverse the procedure may not work and are very costly. In addition, many insurance carriers do not cover the reversal process. Take time to learn about your options. There are many short-term birth control methods on the market today, such as birth control pills, IUDs, injections and various barrier methods that are very effective, which you can use until you decide.

What is amenorrhea?

Amenorrhea is when a woman does not have her periods. There are two kinds of amenorrhea. The first kind is when you haven’t had your period at all by the time you are 16 years old. The second kind is when you are used to having periods and you stop having them for three months in a row. If you’ve never had periods you may have late puberty. This may happen if you are very thin or very athletic. Some other causes may be that you have a hormone problem or there may be problem with your uterus, vagina or ovaries. It’s a good idea to get a check-up. Your healthcare provider can make sure you do not have any of these problems.

What can be done to prevent missing a period?

To keep your periods normal, it is important to stay healthy. Eat and exercise to keep a healthy weight. Don’t use alcohol or street drugs. Medicines like sleeping pills can also make your periods stop. Don’t smoke. Get the help you need to lower stress and problems in your life. Talk to friends, family, or a counselor for support. Try to balance your work, play and rest.


What is prenatal care?

Prenatal care is the care you receive when you are pregnant. It includes care given by your healthcare provider, support from your family and an extra focus on giving yourself the care you need during this special time. Good prenatal care gives you the best chance for a healthy pregnancy and healthy baby.

What are prenatal exams, tests and procedures?

Various exams, tests, and procedures are a part of your checkups during pregnancy. Prenatal tests can help both the baby and the mother. Some tests check for diseases that the mother may have so she can be treated. Other tests look for birth defects. Still other tests are used to confirm the age, weight and health of the baby. Some tests are routine and usually done for all pregnant women. Other tests are optional and usually done only if concerns or problems arise and you agree to having them. At each visit your healthcare provider will discuss with you any problems you are having, such as headaches, swelling of your hands or feet, contractions, or bleeding. Keep all of your appointments. Regular checkups with your provider allow prevention and early detection of any problems. Your provider can then adjust the plan for your care as needed.

What are the routine tests and procedures?

The routine tests and procedures done during prenatal visits include: urine or blood test at your first visit, pelvic exam to determine the size of your pelvis and a Pap test of the cervix (usually done only very early in the pregnancy), physical exam including a breast exam, calculation of the gestational age of the baby, measurement of your height, weight and blood pressure, tests of a sample of your urine to look for bacteria, measurement of the height of the fundus (top of your uterus), determination of the size and position of your baby, test of a sample of your urine to look for bacteria in the urine, blood tests to check for anemia, blood tests to check for diabetes when you are 28 weeks pregnant, blood tests for blood type and RH antibodies and to see if you are immune to rubella (a type of measles), blood test for sexually transmitted infections, cultures of cells from your cervix to test for infection, blood test for hepatitis, skin test for tuberculosis, cultures of swabs of the vagina and rectum to test for Group B streptococcus in the 35th and 37th weeks of pregnancy, examination of your ankles and lower legs for swelling.

When should I see my healthcare provider?

Good care during pregnancy includes regularly scheduled prenatal exams. You should schedule your first prenatal visit with your provider as soon as you think or know that you are pregnant. Depending on your health and health history, your provider will then schedule visits at least once a month for the first six months. During the seventh and eigth months you may see your provider every two weeks and during the last month once a week until your delivery date. If you are over 35 or your pregnancy is high risk because you have certain health problems, your provider will probably want to see you more often. In some cases your provider may refer you to a medical specialist for more help with special needs such as diabetes. Your healthcare provider will check at each visit to make sure that you and the baby are healthy. By seeing you regularly, your healthcare provider has the chance to find any problems early so that they can be treated as soon as possible. Other problems might be prevented. In addition to meeting your medical needs, your provider will help you know how to take care of yourself, including having a healthy diet, getting plenty of exercise and rest, and dealing with the emotional changes that can happen during pregnancy.

What will happen at the first prenatal visit?
Your first visit may be as long as an hour. Your provider will ask for history of your health, the father’s health, your family’s health, and the health of the father’s family. This information can help give your provider an idea of any problems you might have during your pregnancy. You will have a physical exam, including checks of your height, weight and blood pressure and a pelvic exam. You will have a Pap test, urine tests, blood tests, tuberculosis tests, and cultures of the cervix and vagina. Your provider will calculate your due date and the age of your baby. How the pregnancy is going can be judged as normal or abnormal only when the age of your baby is clearly known. If your periods were regular before you became pregnant, and you are sure of the first day of your last period, your due date will be estimated to be 40 weeks from the day you started your last period. Your provider will talk to you about how to stay healthy during your pregnancy.
What will happen at other prenatal visits?

Your provider will check how you are doing and how the baby is developing. He or she will discuss how you are feeling, ask if you have any problems, and answer your questions. During each prenatal visit your provider will weigh you, take your blood pressure, check your urine for sugar, protein, or bacteria, check your face, hands, ankles, and feet for swelling, listening to the baby’s heartbeat, measure the size of the uterus to be sure the baby is growing well. At different times during the pregnancy, additional exams and tests may be done. Some are routine and others are done only when a problem is suspected or you have a risk factor for a problem. Examples of other tests you might have are: chrionic villus sampling of cells from the placenta between the 10th and 12th weeks of pregnancy for information about your baby’s chromosomes and detection of some birth defects, amniocentesis between the 15th and 18th weeks for testing of the fluid around the baby for chromosome information and detection of some birth defects, blood tests, such as the triple or quad screen tests, to check for genetic problems or birth defects, ultrasound scans to check the baby’s growth and health and to look at your uterus, the amniotic sac, and the placenta, blood tests to check for diabetes, nonstress tests that use electronic monitoring to check the health of the baby, and other types of tests using electronic monitoring to check the baby.

What meds can I take in pregnancy?

It is best to not take any medications but acetaminophen (Tylenol) in the first 14 weeks of pregnancy. If you need symptom relief here are some medications that are safe to take when pregnant. For a stuffy, runny nose: Chlorpheniramine, Diphenhydramine (Benadryl). The side effects of those two medications include drowsiness and dry mouth. Pseudoephedrine HCL (Sudafed) which keeps you awake at night. Also, saline spray may help and is totally safe. For cough: cough medicine with the expectorant guaifensin. Other ingredients are not safe to use. If you cannot sleep due to your cough, consider calling for a prescription medicine with a narcotic cough suppressant. Cough drops with natural ingredients like menthol are safe. Also try half and half honey and lemon juice. For fever, headache, or muscle aches take acetaminophen (Tylenol). Do not take aspirin or ibuprofen. Do not let your fever go above 101 degrees. For sore throat: non-medicated throat lozenges are fine. Try acetaminophen for the pain and try gargling with salt water. For nausea: Vitamin B-6, Emetrol, Ginger, Seaband acupressure bands, Acupuncture, and take prenatal vitamins with dinner, not in the morning. It is important to avoid severe dehydration. For heartburn: Tums are safe to try. For diarrhea: Avoid dehydration by drinking plenty of fluids, eat easily digestible foods like white bread, bananas, applesauce and white rice. Also, Kaopectate is safe to use. Do not use Pepto-Bismol when pregnant.

What is all the hype about folic acid in pregnancy?
Folic acid can help reduce the risk of neural tube defects; including spina bifida, a birth defect in which the bones of the spine do not form properly around the spinal cord, and anencephaly, a disorder involving the incomplete development of major parts or all of the brain. Because of this, all women of childbearing age should take 0.4mg of folic acid daily. If you cannot consume enough folic acid through your diet, you should take supplements. Foods high in folic acid are: dark leafy greens/vegetables, whole grain bread/cereals, citrus fruits/juices, dried pea/beans and folic acid-fortified breakfast cereals.
What signs and symptoms of pregnancy will my healthcare provider check?

Your healthcare provider will look for various signs of pregnancy and ask about your symptoms at different stages of your pregnancy. These signs and symptoms include: nausea, fatigue, breast tenderness or enlargement, and urinary frequency in early pregnancy, an embryo that can be seen in an ultrasound scan as early as five to six weeks after your last period, enlarged uterus at about 6 to 8 weeks, enlarged abdomen at about 14 weeks, parts and movements of the baby that can be felt by your healthcare provider at about 18 weeks, the baby’s heartbeat heard by a Doppler fetoscope at 12 to 14 weeks, or by an ordinary fetoscope at about 19 weeks, movement by the baby felt by you at about 20 weeks if this is your first pregnancy, or as early as 16 weeks if you have been pregnant before, changes in the color of your vagina, cervix, and skin.

What is gestational age?

Gestational age is the age of an unborn baby, or fetus. It is measured in weeks and days and is based on the date of your last menstrual period. Your healthcare provider will talk about your pregnancy in terms of weeks, not months. There are three stages of each pregnancy, called trimesters. The first trimester is from the 1st week through the 13th week. The second trimester is from the 14th through the 27th week, and the third trimester is from the 28th week to delivery.

Why is it important to know the gestational age?

At specific stages of the pregnancy, certain things are expected. For example, first hearing the heartbeat, or feeling the baby move, is expected to happen at a certain time of the pregnancy. How the pregnancy is going can be judged as normal or abnormal only when the age of your baby is correctly known. It is very important to know your baby’s age if problems occur and the baby needs to be delivered early. It is also important to know when a baby is overdue so the health of the baby can be more carefully watched.

How is gestational age calculated?

The age of your baby and your due date may be calculated from the date of your last menstrual period. If your periods were regular before you got pregnant, and you are sure of the first day of your last period, your due date is estimated to be 40 weeks from the day you last started your period. An early exam of the uterus and an early positive pregnancy test also can help determine your baby’s age. Ultrasound can be used to confirm your baby’s age. The baby can be measured with ultrasound as early as 5 or 6 weeks after your last menstrual period. This method is most accurate in the first half of the pregnancy. The best time to date a pregnancy with ultrasound is between the 8th and 18th weeks of pregnancy. If you have had a special procedure to become pregnant, such as artificial insemination or in vitro fertilization, you will know when your baby was conceived. In these cases there is no doubt about the baby’s age. It can be hard to determine accurately a baby’s age and your due date if: your periods were irregular, you cannot remember your last period, the baby is unusually large or small, the due date based on the last menstrual period does not correspond with the size of the uterus early in pregnancy or with measurements of your uterus later in pregnancy.

What foods do I need to eat?

Eating regular, well-balanced meals is more important when you are pregnant than at any other time of your life. What you eat provides food for you baby as well as yourself. You need about 300 more food calories a day than when you were not pregnant. Most pregnant women need about 2200 to 2700 total calories each day. Your healthcare provider will suggest a range weight that you should gain. The usual recommended gain is about 20 to 25 pounds. Your need for protein increases to about 60 grams a day when you are pregnant. Many women already eat this amount of protein daily when they are not pregnant. However, if you are a vegetarian or eat little meat or dairy, you may not be getting enough protein in your diet. You may also need more vitamins and minerals, especially folic acid and iron. These nutrients are important for your baby’s growth and development. They give your baby strong bones and teeth, healthy skin, and a healthy body. Foods that are excellent sources of protein and vitamins are: beans and peas, nuts, peanut butter, eggs, meat, fish, poultry, cheese, milk and yogurt. Good sources of folic acid (also called folate) are: leafy green vegetables, broccoli, asparagus, fortified breakfast cereals and grains, beans, oranges and strawberries, yellow squash, tomato juice. Foods rich in iron are: lean red meat, pork, chicken and fish, fortified cereals, dried fruit, leafy green vegetables, beans, eggs, liver, kidneys, whole-grain or enriched bread.

Is it okay to eat fish during pregnancy

Fish and shellfish are an important part of a healthy diet. They contain high-quality nutrients. They are low in saturated fat and contain omega-3 fatty acids that can contribute to heart health. However, nearly all fish and shellfish contain traces of mercury. Some fish and shellfish contain higher levels of mercury that may harm an unborn baby’s developing brain and nerves. The Food and Drug Administration (FDA) advises women who may become pregnant, pregnant women, nursing mothers and young children to avoid some types of fish with high mercury levels. Instead, they should eat fish and shellfish that are lower in mercury. Here are some guidelines for eating fish and other types of seafood: Do not eat shark, swordfish, king mackerel, or tilefish (white snapper) because these fish contain high levels of mercury. Do not eat more than six ounces of canned white (albacore) tuna, tuna steak, or halibut each week. Do not eat more than two servings or a total of 12 ounces of fish each week. Choose shrimp, scallops, salmon, pollock, cod, catfish, or light canned tuna. These types of fish and seafood contain less mercury. Eating oysters and clams may increase your risk for infection. Do not refrigerate smoked seafood unless it is contained in a cooked dish, such as a casserole. Check local advisories about the safety of fish caught in local lakes, rivers and coastal areas.

What about heartburn during pregnancy?

For heartburn you should: eat five or six small meals a day. Avoid foods that commonly cause symptoms such as spicy and fried foods, orange and grapefruit juices. Cut down on soft drinks, chocolate, coffee and other drinks with caffeine. Instead, drink water, milk, and apple or cranberry juice. Don’t lie down for at least one to two hours after you eat. If heartburn gets worse when you lie down, raise the head of your bed four to six inches. Ask your healthcare provider which antacids you can take.

What is morning sickness?

Many women have morning sickness during the early months of pregnancy. In most cases, symptoms of nausea and vomiting are less common by the second trimester. In early pregnancy, the changes in your body can cause you to feel nauseated when you eat or smell certain foods or when you get tired or anxious. It may help if you eat crackers, pretzels or dry cereal before you get out of bed in the morning. Eat small meals often. Avoid greasy, fried or spicy foods that may upset your stomach. Drink plenty of liquids, but between meals rather than with them. Try crushed ice, fruit juice, or fruit-ice pops if water makes you feel nauseous. Avoid unpleasant odors and get enough rest. Ginger has been shown to help some women have less nausea, but you should talk to your healthcare provider about this before you add ginger to your diet.

Is it okay to exercise during pregnancy?

It is not only okay to exercise during pregnancy, but it is encouraged. The American College of Obstetrics and Gynecology recommends healthy pregnant women get 30 minutes of moderately vigorous activity most days of the week.

Exercise tips:

  • Increase your daily activities (walk more, use stairs)
  • The best exercise is the one you enjoy (sports, walking, running, swimming, aerobics, yoga, Pilates)
  • Use the talk test to gauge intensity. If you can talk during activity, it is not too intense
  • As your body changes, you may have to change activities
  • Have fun
Are there special instructions for the 18-week ultrasound?

Ultrasound technology has been available since the 1970’s. Ultrasound is a safe procedure that has been used to diagnose and detect fetal problems, allowing for prompt treatment to be available at the time of delivery if needed. Advances in ultrasound technology have revolutionized modern obstetics. At Greenville OB/GYN we have excellent ultrasound capability, allowing us to diagnose many (not all) conditions as well as provide your baby’s first picture. It is recommended that all moms have an ultrasound exam between 16-18 weeks of pregnancy. At this time, measurements will be made of your baby’s head, abdomen and legs. We will also look at the brain, heart, spine, kidneys, and bladder. Measurements can allow us to confirm your due date with the one given to you at the beginning of the pregnancy. Many times we can also see the sex of the baby so let us know if you do or do not want to know. To prepare for your ultrasound, please start one hour and fifteen minutes before your appointment by empting your bladder. Then drink 16 ounces of water or another beverage. Make sure you finish this amount at least one hour before the appointment. Your bladder will be quite full and may be uncomfortable, but it really helps us to see the baby. We try to run on time for all OB ultrasounds, but please let us know if you can’t hold it anymore. Partners and other family members are welcome to come in for the ultrasound. Finally, ultrasound pictures will yellow and fade with time. To have long-term copies, bring them to Kinko’s and have color copies made, they come out great and last for a long time.

Are there risks with 3D or 4D?

No. 3D and 4D Ultrasound utilize sound waves to look inside the body, technology similar to radar.  A probe placed on the body emits sound waves into the body, listens for the return echo and then generates an image.

What is 4D ultrasound?

4D means 4-Dimensional–the fourth dimension being time.  4D Ultrasound, the latest in ultrasound technology, combines 3D picture with time, resulting in “live action” images of the unborn child.

When is the best time to have a 4D?

This optional service is best performed around 27 to 30 weeks gestation and affords an opportunity to obtain three and four dimensional images of your baby, particularly of it’s face and heart.  The study provides an opportunity for you to see your child’s growth and development early in the third trimester and to look for heart and facial defects that might not be apparent in the routine ultrasound offered at 18 weeks of gestation.

How long is a 4D ultrasound?

There are many factors that impact the length of an ultrasound, including the position of the baby in the womb.  A typical ultrasound exam for an expectant mother will last approximately 20-40 minutes.

What are the advantages of a 4D ultrasound?

In contrast to 3D imaging diagnostic processes, 4D imaging affords your doctor the ability to visualize internal anatomy as it is moving in “real-time.”  The movement patterns of fetuses help physicians to draw conclusions about the fetal development.  Also, 4D imaging increases the accuracy of ultrasound-guided biopsies thanks to the visualization of the needle movements in “real-time” in three planes.  With 4D imaging, physicians and sonographers can now detect or rule out issues, such as anomalies and genetic syndromes.

What about the postpartum blues?

More than 50 percent of women experience postpartum blues on the third or fourth day after delivery. The symptoms include tearfulness, tiredness, sadness and difficulty in thinking clearly. The main cause of this temporary reaction is probably the sudden decrease of maternal hormones. Since the symptoms commonly begin the day the mother comes home from the hospital, the full impact of being totally responsible for a dependent newborn may also be a contributing factor. Many mothers feel let down and guilty about these symptoms because they have been led to believe they should be overjoyed about caring for their newborn. In any event, these symptoms usually clear in one to three weeks as the hormone levels return to normal and the mother develops routines and a sense of control over her life. There are several ways to cope with the postpartum blues. First, acknowledge your feelings. Discuss them with your husband or a close friend as well as your sense of being trapped and that these new responsibilities seem insurmountable. Don’t feel that you need to suppress crying or put on a “supermom show” for everyone. Second, get adequate rest. Third, get help with all of your work. Fourth, renew contact with other people; don’t become isolated. If you don’t feel better by the time your baby is one month old, see your healthcare provider about the possibility of counseling for depression. If the blues are making it impossible for you to care for yourself and your baby, get help as soon as possible.

What is postpartum depression?

After childbirth, many mothers feel more emotional. They may feel sad, afraid, or angry. This is called postpartum blues or the baby blues. For most women these postpartum blues are mild and go away within a week. Postpartum depression lasts longer and is more severe. About 10 to 20 percent of women, especially very young mothers, have the more severe form. Postpartum may develop within a few days to a few weeks after giving birth or having a miscarriage. For about 60 percent of women, it is your first episode of depression. While hormone changes after giving birth seem to play a part, the full causes are not known. Risk factors that increase your chances of getting postpartum depression are: having been depressed sometime before you got pregnant, having been depressed after the previous pregnancy, having family members who were depressed, especially after pregnancy, returning home with your baby to a very stressful home or relationship, having a baby with health problems or who cries often, having a miscarriage late in pregnancy or a stillbirth. If your pregnancy was unwanted you are also at risk for post partum depression. Besides feeling sad and uninterested in activities, you may also: feel unable or unwilling to care for you baby.


My husband and I have been trying to get pregnant for the past six months without luck. When should we seek medical help for infertility?

Approximately fifteen percent of couples in the United States struggle with infertility and are unable to get pregnant. Typically, infertility is diagnosed after twelve months of trying to conceive without the use of birth control. I would encourage you and your spouse to keep trying. If you aren’t pregnant after six more months, you may want to see a doctor and have an infertility evaluation. Tests can be done to find the cause of Infertility after which you can discuss treatment options if necessary.

What is infertility?

Infertility is usually defined as not being able to get pregnant after trying for at least one year. Women who are able to get pregnant but then have repeat miscarriages are also said to be infertile. Infertility is a problem for one of every six couples. It can be caused by problems in a man’s or woman’s reproductive system. Problems in the woman’s body are responsible for about half of the cases of infertility. Often the reason for infertility in a woman is that her ovaries are not releasing eggs. For example, when a woman gets older, the ability of the ovaries to release healthy eggs declines, especially after the age of 35. Other things that may affect the eggs and the release of eggs (ovulation) are: hormone problems, overweight or underweight, smoking, too much stress, unhealthy diet, ovarian tumors or cysts, intense exercise, abuse of alcohol or drugs, tumors in the pituitary gland, chronic illness, such as diabetes and some medicines. A woman who is not ovulating normally may have irregular or missed menstrual periods. An abnormal or damaged fallopian tube or uterus can be another cause of infertility. When an egg is released, it must pass through a fallopian tube to the uterus. A man’s sperm must join with (fertilize) the egg along the way. The fertilized egg must then attach to the inside of the uterus. A fallopian tube or uterus may be damaged by an infection, such as a sexually transmitted disease, a birth defect in the female organs, growths in the uterus, such as polyps or fibroids, scar tissue from surgery (called adhesions), endometriosis which is tissue from the uterus growing outside the uterus, DES syndrome, which you may have if your mother took the medicine DES when she was pregnant with you. You may have problems with your cervix that make it hard for the sperm to reach and fertilize the egg, such as cervical stenosis (a cervix that is very narrow or closed), abnormal cervical mucous, cervicitis, which is inflammation or infection of the cervix. In rare cases, a woman’s body is allergic to sperm and destroys it. Some rare genetic problems also cause infertility. Thirty percent of infertility cases have no known cause.

How is infertility diagnosed?

You and your partner will have thorough exams. You will be asked about: your sexual history, including previous pregnancy, miscarriage, or abortion, your medical and family history, your diet and exercise habits, stress, your use of drugs, alcohol and tobacco, your sexual intercourse practices, such as how often you have sex and whether you use lubricants. You may need to find out if you are ovulating each month. Your healthcare provider can tell you how to take and chart your body temperature each morning. Your temperature will rise after ovulation. You can buy kits at the drugstore that can help predict ovulation. Blood test and an ultrasound of the ovaries can also be used to see if you are ovulating. Other tests that may be done are: urine and blood test to check for infections and a hormone imbalance, test of samples of cervical mucus and tissue from the lining of your uterus, tests of your partner’s semen to check the number and quality of sperm in the semen. You may have the following procedures to check for a blockage in your tubes or uterus, scar tissue, or endometriosis: hysteroscopy, laparoscopy, hysterosalpingogram.

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Endometriosis: Everything You Need to Know

Endometriosis is a common condition with plenty of misconceptions. The disease occurs when tissue called endometrium, similar to the tissue that normally lines the uterus, grows in other parts of the body. Endometriosis affects as many as one in 10 American women. It can cause pain, scarring, and even infertility.