Author Archives: vlm

If your periods are so heavy and or prolonged that they disrupt your normal daily activities, you may have excessive menstrual bleeding also known as menorrhagia. Symptoms of menorrhagia may also include cramping, pelvic pain and, in severe cases, anemia.

Excessive menstrual bleeding is a common condition that occurs for many of reasons. Two of the most common causes are a hormonal imbalance and uterine growths.

Hormonal Imbalances

Your menstrual cycle is controlled by hormones, including estrogen and progesterone. When these hormones are out of balance, they can cause heavy periods or bleeding between periods. Causes of hormonal imbalances may include:

• Hormonal changes in teens and in women nearing menopause
• Diabetes
• Thyroid disease
• Obesity
• Stress
• Strenuous exercise
• Anorexia (eating disorder)

Types of Uterine Growths

• Fibroids – benign (non-cancerous) growths in or near the uterus
• Polyps – growths that attach to the inner wall of the uterus and protrude into the uterine cavity

Treatment Options

There are medication and non-invasive treatment options available. Treatment options could include NSAIDs, oral contraceptives, oral hormones or a hormonal IUD.

You may need surgical treatment for menorrhagia if medical therapy is unsuccessful. Treatment options include:

Dilation and Curettage (D&C)

During this procedure, your doctor opens (dilates) your cervix and then scrapes or suctions tissue from the lining of your uterus to reduce excessive menstrual bleeding.

Uterine Artery Embolization

For women whose menorrhagia is caused by fibroids, the goal of this procedure is to shrink any fibroids in the uterus by blocking the uterine arteries and cutting off their blood supply.

Myomectomy

This procedure involves surgical removal of uterine fibroids.

Endometrial Ablation

This procedure involves destroying (ablating) the lining of your uterus (endometrium). The procedure uses a laser, radiofrequency or heat applied to the endometrium to destroy the tissue.

Endometrial Resection

We use the Myosure procedure to remove the growth on your uterus while preserving form and function of the uterus. Both endometrial ablation and endometrial resection benefit women who have very heavy menstrual bleeding.

Hysterectomy

This surgery to remove your uterus and cervix is a permanent procedure that causes sterility and ends menstrual periods. Hysterectomy is performed under anesthesia and requires hospitalization. Additional removal of the ovaries (bilateral oophorectomy) may cause premature menopause.

Many of these surgical procedures are done on an outpatient basis. Although you may need a general anesthetic, it’s likely that you can go home later on the same day. An abdominal myomectomy or a hysterectomy usually requires a hospital stay.

For those who require a surgical procedure, traditional open GYN surgery uses larger incisions for access to the uterus and surrounding anatomy which, ultimately, results in more pain, trauma and a longer recovery process.

Minimally Invasive Robotic-Assisted GYN Surgery

Drs. Pierce, Ung and Gamburg are the Princeton area’s most experienced GYN surgeons using the da Vinci® XiTM Surgical System for minimally invasive gynecologic surgeries.

Minimally invasive procedures like robotic-assisted GYN surgery are especially promising for women who would like to have children in the future. For instance, when removing fibroids – regardless of the size and location of the fibroid – the surgeon is able to better see where they are operating and to make precise movements to remove it, preserving the delicate structures of the pelvis and decreasing the chance of future complications.

The overall benefits of robotic-assisted GYN surgery include:

• Fewer complications
• Less blood loss and risk of infection
• Significantly less pain and scarring
• Shorter recovery time for a quicker return to normal activities
• A less invasive surgical option to get you back to your daily life

By operating with the da Vinci® XiTM Surgical System, our patients who suffer from excessive menstrual bleeding see noticeable benefits because incisions are smaller, pain is minimized and recovery time is reduced.

While clinical studies support the effectiveness of the da Vinci Xi Surgical System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Xi Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

You don’t have to suffer from excessive menstrual bleeding any longer. To learn more about your treatment options, Contact Us for an Appointment HERE.

You’re busy. You’re birth control is a priority but it’s not something you want to have think about constantly. Fortunately, at Delaware Valley ObGyn our providers can offer you a variety of contraception options that fit into your lifestyle and have pregnancy-prevention staying power. One of those options includes Intrauterine devices or IUDs.

What is an IUD?

IUDs are long-acting reversible contraceptives. This means they prevent pregnancy for years, but they can be removed to restore fertility.

IUDs are 99 percent effective in protecting against pregnancy compared to 85 percent for condoms and 91 percent for the pill. Basically, you benefit from having a highly effective form of birth control that you barely need to think about.

There are two categories of IUDs: hormonal and non-hormonal. There is one non-hormonal IUD – the ParaGard. There are four hormonal IUDs. After a review of your health history and lifestyle, you and your provider will determine which IUD is the best type for you.

Those using IUDs should be conscious of the fact that IUD’s do not protect against HIV or other sexually transmitted infections (STIs).

Are IUDs painful?

All IUDs have the same basic look—plastic and T-shaped—and they’re all inserted through the cervix into your uterus. There are small strings on the end that let you know it is in place properly.

Insertion is different for everyone. For some women, especially those who’ve had children, it’s a minor annoyance. For others it can be painful, particularly if the doctor needs to open the cervix more for insertion.

The good news is that it is over in a few minutes and the whole appointment should not take more than 30-45 minutes. The bad news is that you might experience cramping or spotting for three to six months after insertion. Removing an IUD usually requires a short visit to our office.

Here’s what you need to know about the five different IUDs available right now:

ParaGard

How it works: Paragard is the only brand of non-hormonal IUD in the U.S. Wrapped in thin copper, it causes an inflammatory response in your body which prevents sperm from getting through your cervix.

You should consider this: If you want to avoid synthetic hormones, women who have normal to light flow and who want the longest option.

Side effects: Increased menstrual bleeding, increased cramps, random spotting and anemia.

How long it lasts: According to ParaGard’s website, the device lasts for 10 years.

Don’t Consider This: If your cramps and bleeding are already bad, then a non-hormonal IUD probably isn’t for you.

Mirena

How it works: Mirena releases a synthetic form of progesterone that thins out your uterine lining and can prevent your ovaries from releasing an egg. All of which prevents any rogue sperm from latching onto an egg and fertilizing it.

You should consider this: If you experience heavy menstrual periods.

Side effects: Significantly lighter period or no period at all, breakthrough bleeding, ovarian cysts, nausea and mood changes.

How long it lasts: According to Mirena’s website, the device lasts for five years.

Don’t consider This: If you’re prone to ovarian cysts, if react badly to progestin or if you’re hesitant about not having a period at all.

Liletta

How it works: Liletta works exactly like the Mirena, except it uses slightly less amounts of hormones and the amount decreases a little each year. However, this decrease does not hinder effectiveness.

You should consider this: If you’re shopping for an option that is lower in cost.

Side effects: Ovarian cysts, lighter period or no period at all, breakthrough bleeding, nausea and mood changes.

How long it lasts: Four years, according to the Food and Drug Administration (FDA).

Don’t consider this: If you react badly to synthetic progesterone or are prone to ovarian cysts.

Kyleena

How it works: Kyleena works just like Mirena and Liletta but contains slightly less of the hormone—the second lowest dose you can find in a hormonal IUD.

You should consider this: If you still want ample protection but also want a regular period.

Side effects: Nausea, breakthrough bleeding, mood changes, and ovarian cysts. It can also lessen or stop your period.

How long does it last: According to Kyleena’s website, five years.

Don’t consider this: If you react badly to synthetic hormones.

Skyla

How it works: Skyla works just like all four previously mentioned IUDs. It releases the smallest amount of hormones and is the smallest in size. This makes it easier to insert.

You should consider this: If you haven’t had children or have a tight cervix or those who want to keep getting periods while they’re protected

Side effects: Lighter bleeding, cysts, nausea and mood swings.

How long does it last: According to Skyla’s website; three years.

Don’t consider this: If you like protection for more than three years.

Interested in learning more about IUDs or other forms of contraception, schedule an appointment with one of our providers online HERE or call us at 609-896-0777.

Pregnancy is such an exciting time in your life. Yet it can be filled with questions and anxiety. The reality is your actions could affect your pregnancy and your fetus. Additionally, there’s advice everywhere from experts, friends and relatives as to what you should and shouldn’t do when you’re expecting.

Here are a few evidence-based recommendations from the American College of Obstetricians and Gynecologists.

Alcohol

High alcohol intake in pregnancy has been associated with fetal malformations and developmental delay. Although data suggests that consumption of small amounts of alcohol during pregnancy does not appear to be harmful to the fetus, the exact threshold from safe to unsafe is unknown, so alcohol should be avoided.

Artificial Sweeteners

Artificial sweeteners can be used in pregnancy. Data regarding saccharin is conflicting. Low consumption is likely safe.

Caffeine

When you’re pregnant you can safely drink an 8 oz. cup of coffee or 12 oz soda daily. Exact amounts of caffeine vary, but it should be kept low-to-moderate.

Exercise and Bedrest

We encourage you to exercise regularly. If you are experiencing an uncomplicated pregnancy, we recommend that you try to achieve an average of 20–30 minutes of moderate-intensity exercise 4-5 times per week.

Fish Consumption

You should try to consume 2-3 servings of low-mercury and high-DHA fish a week. Sushi that is prepared in a clean and reputable establishment is unlikely to pose a risk.

Hair Dyes

Although data is limited on the topic, hair dye absorption is minimal and presumed to be safe during pregnancy.

Hot Tubs and Swimming

Studies show that increasing your body temperature increases your risk for miscarriage and birth defects. You should probably avoid hot tub use in the first trimester of your pregnancy. Swimming pool use is fine throughout your pregnancy.

Insect Repellents

Topical insect repellents (including DEET) can be used in pregnancy and should be used in areas with high risk for insect-borne illnesses. As a result of the risk of mosquito-borne illnesses, including West Nile and Zika virus, these insect repellents are recommended in high-risk areas. In regard to travel destinations, you should be aware of the potential infection exposures (including Zika virus) as well as available medical care at each destination.

Marijuana

Marijuana use is not known to be associated with any adverse outcomes in pregnancy. However, data regarding long-term neurodevelopmental outcomes are lacking; therefore, we recommend against marijuana usage during your pregnancy.

Nutrition and Weight Gain

The National Academy of Medicine recommends that you eat a healthy, well-balanced diet, and that you increase your caloric intake by a small amount (350-450 calories / day). However, these recommendations as well as the baseline caloric requirements are highly dependent on your activity level, height, weight, and metabolism history.

Generally, your diet should include plenty of fruits and vegetables, whole grains, dairy, and a variety of proteins. A good nutrition resource for pregnant women is this website run by the U.S. Department of Agriculture: www.choosemyplate.gov.

Oral Health

You should continue good oral health and routine dental procedures including cleanings, fillings, extractions, root canals, etc.

Other Foods

• Avoid raw and undercooked or uncooked meat.
• Wash vegetables and fruit before eating them.
• Avoid unpasteurized dairy products.
• Unheated deli meats could also potentially increase the risk of Listeria, but the risk in recent years is uncertain. Avoid foods that are being recalled for possible Listeria contamination.

Prenatal Vitamins

Prenatal vitamins are designed to meet the daily mineral and vitamin (micronutrient) requirements of most pregnant women. However, except for folic acid and possibly vitamin D and iron, it is unknown whether meeting recommended dietary allowances improves outcomes or that failing to meet these recommended allowances worsens outcomes. Additionally, for women with well-balanced, nutritious diets that meet the recommended allowances, supplementation is likely not required. If supplementation is required, there is no known best formulation. A simple multivitamin will normally suffice, including nonprescription vitamins.

Seat Belts

You should continue to use three-point seatbelts when you travel in an automobile. The lap belt should be placed across the hips and below the uterus. Although there is potential for injury from a seatbelt, the risk is low and, because seatbelts significantly reduce the risk of major injuries from collisions, the overall effect is beneficial. Do not disable the airbags.

Sexual Intercourse

If you’re not experiencing bleeding, placenta previa at greater than 20 weeks of gestation, or ruptured membranes, you should be able to enjoy intimacy with your partner.

Sleeping Position

There is conflicting data about sleeping on your back and stillbirth. You can sleep on your side but know that side-sleeping does not prevent stillbirth.

Smoking, Nicotine, and Vaping

You should not smoke cigarettes during pregnancy. If you are unable to quit entirely, you should reduce it as much as possible. Since vaping devices still contain nicotine, the harm to pregnancy and baby is still possible, even beyond addiction. Consequences include but are not limited to preterm birth and low birth weight, common causes for infant death. Nicotine replacement (with patches or gum) is appropriate as part of a smoking cessation strategy.

Travel

Airline travel is safe in pregnancy. Pregnant women should be familiar with the infection exposures and available medical care for each specific destination. We won’t tell you not to travel, but you should weigh the balance of the benefit of the trip with the potential of a complication during travel.

Join Dr. Pierce and Ursula Miguel, CNM

Delaware Valley OB/GYN and Infertility Group

Refreshments will be served!

Dr. Pierce and Ursula Miguel will host a FREE, informal discussion on preconception and parental issues.

WHEN: April 15, 2019 6-7pm
WHERE: Del Val OB/GYN
300B Princeton-Hightstown Rd
Princeton, NJ

RSVP: UMIGUEL@LMA-LLC.COM