Does the thought of figuring out what supplements you should take make you feel like you are lost in the jungle? Well, don’t worry! I will be your guide and share some highlights about these mysterious nutrients, as well as point out ways to include these in your diet. So, without further ado, let’s get to it!

What are vitamins?

Wikipedia defines vitamins as molecules that are necessary for the body to function properly.^[1] Well, “How is this different from minerals and herbs,” you might ask? Vitamins are essential nutrients for the body that come from living things. They differ from minerals because although both are essential, minerals are found within the earth. Herbal products come from plants. But even though they come from living things, they are not necessarily essential for the body to function.^[2]

How many essential vitamins are there?

There are 13 essential vitamins. They include Vitamins A, C, D, E and K, as well as seven different B vitamins. Let’s talk more about each of these essential vitamins.

Vitamin A

Vitamin A is important for your vision and immune system. It is also critical for most of the major organ systems in your body to function properly. Worried that you are not getting enough Vitamin A? Have no fear. It is felt that the average person gets enough Vitamin A in their diet, regardless of their dietary preferences or restrictions. Preformed Vitamin A, known as retinol, is typically found in meats, eggs and dairy products. However, beta-carotene, which is the most common precursor to Vitamin A, can be found in all sorts of fruits and vegetables. Do you like cantaloupe, apricots, and mangos? If you do, you’re in luck! These are good sources of Vitamin A. According to the National Institutes of Health (NIH), carrots and spinach will score you about 50% of your daily requirement. But serve up a baked sweet potato and you will hit the motherload, a whopping 150% of your daily requirements!

For more information about Vitamin A, check out this link: https://ods.od.nih.gov/factsheets/VitaminA-Consumer/

Vitamin C

Vitamin C, also known as ascorbic acid, is an antioxidant. Antioxidants help to protect cells from damage due to free radicals. Our bodies are exposed to free radicals through the body breaking down food for energy and through the environment by pollution or cigarette smoke. In turn, free radicals can contribute to illnesses such as heart disease and cancer. So, Vitamin C is important to help your body deal with things that we either consciously or unknowingly expose our bodies to.

Vitamin C is probably most notable for being a booster for your immune system. According to the NIH, people receive the most benefit by getting enough Vitamin C daily as opposed to just taking it when cold symptoms begin. Your body also needs Vitamin C to make collagen, which helps with wound healing. But did you know that Vitamin C also helps your body to absorb iron? I would always encourage my anemic patients to take their iron with orange juice to help maximize their iron absorption. But you could also combine an iron rich food, such as spinach or legumes, with one of these foods that are full of Vitamin C. (More to come on iron in our mineral section.)

For most people, when we think about Vitamin C, oranges are the first thing that we think of. It is true that citrus fruits, such as oranges, lemons, and grapefruits, are a good source of Vitamin C. But other fruits, such as kiwi, cantaloupe, strawberries, and blueberries, contain Vitamin C as well. In the mood for veges? Red and green bell pepper, broccoli, and baked potatoes are delicious foods that can bring a little Vitamin C into your day.

For more information about Vitamin C, check out this link: https://ods.od.nih.gov/factsheets/VitaminC-Consumer/

Vitamin D

Vitamin D is critical for strong bones and absorbing calcium. Research has also shown that there are benefits in promoting heart health and reducing certain cancers. Vitamin D is found in fatty fish, such as salmon and tuna, as well as egg yolks. Do you follow a plant-based lifestyle? Fortified soy, almond, and rice milk; mushrooms; fortified cereals; and fortified orange juice are all vegan friendly sources.

Another way to get Vitamin D is through good old fashion sunshine. Vitamin D3, otherwise known as cholecalciferol, is absorbed from sunlight, and converted by the body to usable Vitamin D. So, enjoy a stroll in the park on a sunny day with an iced soy latte and get your Vitamin D!

It is possible to have your Vitamin D level checked by your doctor to see if supplementation would be beneficial. But be careful. Many insurance companies will not cover this as a routine screening test. There needs to be a justifiable medical reason for testing such as a concern for Vitamin D deficiency. Risk factors for Vitamin D deficiency can include getting limited sun exposure, poor dietary intake of Vitamin D, and problems with absorption.

For more information about Vitamin D, check out this link: https://ods.od.nih.gov/factsheets/VitaminD-Consumer/

Vitamin E

Vitamin E is a fat-soluble nutrient that is an antioxidant. It plays a vital role in the immune system. Vitamin E is also important for hair, skin, and nails, as well as vision.

Vitamin E can be found in nuts and seeds as well as vegetable oils, like sunflower and corn. Prefer to go green? Spinach and broccoli are good sources of Vitamin E as well. You can also get your daily dose of Vitamin E through certain fortified foods. Be sure to check the label for d-alpha-tocopherol, which is natural Vitamin E, or dl-alpha-tocopherol, which is synthetic Vitamin E.

For more information about Vitamin E, check out this link: https://ods.od.nih.gov/factsheets/VitaminE-Consumer/

Vitamin K

Vitamin K is important for blood clotting and healthy bones. It can be found in vegetables, such as spinach, kale, and broccoli; vegetable oils; blueberries; and figs. Since Vitamin K does affect your blood clotting, check with your doctor before starting it if you are on blood thinners, such as Coumadin.  

For more information about Vitamin K, check out this link: https://ods.od.nih.gov/factsheets/VitaminK-Consumer/

B vitamins

There are seven B Vitamins. Here is a brief description of each and a link if you would like more information.

• B1 (Thiamin)- Thiamin helps your body to produce energy. It is also important for growth and development. It can be found in cereals, whole grains, rice, potatoes, and beans. https://ods.od.nih.gov/factsheets/Thiamin-Consumer/  
• B2 (Riboflavin)- Riboflavin also helps with energy production, growth, and development. It can be found in cereals, whole grains, and green vegetables such as asparagus and spinach. https://ods.od.nih.gov/factsheets/Riboflavin-Consumer/  
• B3 (Niacin)- Niacin is important for energy production and healthy skin. It also promotes proper functioning of the nervous system and digestive system. It can be found in nuts, whole grains, beans, and fortified foods. https://ods.od.nih.gov/factsheets/Niacin-Consumer/   
• B5 (Pantothenic acid)- Pantothenic acid serves an important role in energy, growth and development as well as breaking down fats. It is found in almost all foods. Some of my personal favorite sources are shitake mushrooms, avocados, potatoes, whole grains, peanuts, and sunflower seeds. https://ods.od.nih.gov/factsheets/Pantothenicacid-Consumer/
• B6 (Pyridoxine)- Pyridoxine is important for red blood cells, the immune system, and brain development during pregnancy. It can be found in potatoes, wheat germ, bananas, and dried beans. https://ods.od.nih.gov/factsheets/VitaminB6-Consumer/ 
• B7 (Biotin)- Biotin, like the other B Vitamins, is a key element in energy production. It has long been felt that biotin helps with hair, skin, and nail health. However, according to the NIH, scientists are still doing research to confirm this. Biotin can be found in peanuts, bananas, mushrooms, watermelon, and grapefruit. https://ods.od.nih.gov/factsheets/biotin-Consumer/
• B8 (Folic acid)- Folic acid is vital for the production of DNA and other genetic material. It is recommended that all women who could become pregnant take in at least 400 mcg of folic acid daily. If you are considering pregnancy, it is important to have folic acid in your system before getting pregnant. This helps to promote healthy development of the fetus and to reduce the risk of neural tube birth defects such as spina bifida. Sources of folic acid can include green leafy vegetables, citrus fruits, mushrooms, nuts, peas, and beans. https://ods.od.nih.gov/factsheets/Folate-Consumer/ 
  
  

Do I need a vitamin supplement?

It is possible to get all the essential vitamins that you need while eating through your diet. The key is to have a well-balanced diet that incorporates a wide range of foods. Eating some of your fruits and vegetables raw can help to maximize the vitamins you are ingesting by preventing important nutrients from being lost during the cooking process. But if you feel that you may be missing out on some of these key vitamins, a multivitamin can be an excellent way to get everything that you need in one pill. However, some people prefer to only supplement the individual vitamins that they may be lacking. That option is acceptable too. Just be careful not to overdo it. Although vitamins are important to help the body function properly, you do not need to excessively exceed the daily requirements. Too much of a good thing can also be harmful. If you are taking a supplement, look at the back of the bottle to see what percentage of your daily requirement is in the supplement. There are also resources online that can tell you how much of a particular vitamin is in a certain food.  

If you are considering adding a vitamin to your daily routine, check with your doctor first to see if the vitamin is right for you. You can also check with your pharmacist to ensure that the vitamin does not interact with any other medications that you are taking.

In our next segment, we will talk about some of the common mineral supplements.

-Dr. Kristin Williams

Medical Director of Women’s Health Specialists of North Texas

About the author: Dr. Kristin Williams is a board-certified OB/GYN. She graduated from Wayne State University School of Medicine in Detroit, Michigan. After completing one year of training at Tulane University in New Orleans, Louisiana, Dr. Williams moved to Dallas, Texas to complete her residency at Parkland Hospital. She worked in private practice with Women’s Health Specialists of North Texas for 16 years and now serves as the Medical Director.

This blog provides general information and discussions about health and related topics. The information and other content provided in this blog, or in any linked materials, are not intended and should not be construed as medical advice. This information is not a substitute for professional medical expertise or treatment.

^[1] https://en.wikipedia.org/wiki/Vitamin

^[2] https://www.pharmacytimes.com/view/vitamins-and-minerals-explained

In the first part of our series, we talked about Postpartum Care: Taking “You” Home from the Hospital. We then moved on to Postpartum Care: When Do I Need to Call My Doctor in part two. So what’s next in the final chapter of this three-part series?

Postpartum depression. This topic requires more than just a paragraph in a postpartum care blog post. To increase awareness around this topic, we will spend this post reviewing 4 Things You Should Know About Postpartum Depression.

1. Postpartum depression is NOT the baby blues.

While you were growing your “little nugget” inside of you, there were all sorts of hormones needed to support your body and your nugget’s growth. As nugget made his or her exit on the big day, the hormones purchased their one-way ticket and started making their exit as well. This sudden withdrawal of hormones can cause changes in emotions resulting in the baby blues or postpartum depression. How will you know the difference between the two?

Baby Blues: For most women, the baby blues are experienced 2-3 days after delivery. The symptoms typically go away in 3-5 days, but they can last up to two weeks. According to the Mayo Clinic, symptoms women can experience are:

• Mood swings
• Anxiety
• Sadness
• Irritability
• Feeling overwhelmed
• Crying
• Problems concentration
• Changes in appetite
• Difficulty sleeping

Postpartum Depression: Postpartum depression is NOT the baby blues. Some symptoms are similar, but postpartum depression symptoms are more intense, last longer than two weeks, and interfere with your ability to care for yourself and your baby. Symptoms of postpartum depression can even start up to one year after delivery. So don’t disregard these symptoms if they start later on. According to the Mayo Clinic, symptoms of postpartum depression include:

• Depressed mood
• Extreme mood swings
• Crying a lot
• Difficulty bonding with your baby
• Withdrawing from friends and family
• Change in appetite (eating too much or too little)
• Insomnia or sleeping too much
• Fatigue or loss of energy
• Loss of interest and pleasure in activities you enjoy
• Irritability and anger
• Feeling that you are not a good mother
• Hopelessness
• Feelings of worthlessness, shame, guilt, or inadequacy
• Difficulty thinking clearly, concentrating, or making decisions
• Restlessness
• Anxiety
• Panic attacks
• Thoughts of harming yourself or your baby
• Recurrent thoughts of death or suicide

2. It happens more than you think.

According to the American Psychological Association, 1 in 7 women experience symptoms of postpartum depression. More than likely, someone you know has experienced this. One of the reasons why we don’t realize it is so prevalent is that we, as a society, don’t talk about it enough. Unfortunately, there is a stigma that exists about mental health. However, the more we talk about it, write about it, and sing about it from the mountaintops, we start to break down the walls of shame surrounding this disorder. As we speak up and share our personal experiences, it might touch another woman and let her know she is not alone. There is light in the darkness, and there is hope.

3. and 4. “Postpartum depression is not your fault- it is a real, but treatable, psychological disorder.”

The above quote is from a brochure by The American Psychological Association. I could not have said it better myself, and it brings up two excellent points. That’s why I had to label the section 3 AND 4!

Let’s start at three. Postpartum depression is not your fault. It does not mean you are a “bad mother” or don’t love your baby. It is a medical disorder. It is no different than other medical disorders that can occur during pregnancy that are not a woman’s fault. No one blames a woman for having pre-eclampsia (high blood pressure in pregnancy) or gestational diabetes.

Therefore, you should not blame yourself for having postpartum depression. Postpartum depression is NOT YOUR FAULT.

The fourth item you should know about postpartum depression is that there are treatments available. Here are a few that your doctor might discuss with you:

Antidepressants. Antidepressants can be prescribed by your OB/GYN or your Primary Care doctor. They can help you feel a little more like yourself as your body transitions during this time. It doesn’t mean you will be on this medication for the rest of your life. But, when you and your doctor decide you are ready to be off them, it is important not to stop them abruptly. You will need to wean from them under the guidance of your physician. And yes, there are options that are safe to use while breastfeeding!

Therapy. Talking to a trained professional is another option. Not only does this provide a safe, judgement-free zone to express how you are feeling, but therapists can also provide you with coping techniques to navigate this tumultuous time.

Support groups. Speaking with others who are going through or have made it through postpartum depression can be therapeutic. There is just something comforting about being around others who have been where you have been. It can be a source of hope and encouragement. There are in-person and online groups available. Postpartum Support International is an organization that offers resources, including on-line support groups, to women and families affected by postpartum depression. For more information about the Texas Chapter, please visit https://psichapters.com/tx/.

Well, there you have it! Our journey through the postpartum period is complete. We reviewed what to expect after delivery, when to call your doctor, and what to know about postpartum depression. I hope this information answers some of your questions about the postpartum period. But if you have other questions, check out the Education tab on our website, www.WHSNT.com, to find out more about the postpartum period and other topics.

Until next time, be well, and be sure to show yourself grace and love.

-Dr. Kristin Williams

Medical Director of Women’s Health Specialists of North Texas

About the author: Dr. Kristin Williams is a board-certified OB/GYN. She graduated from Wayne State University School of Medicine in Detroit, Michigan. After completing one year of training at Tulane University in New Orleans, Louisiana, Dr. Williams moved to Dallas, Texas to complete her residency at Parkland Hospital. She worked in private practice with Women’s Health Specialists of North Texas for 16 years and now serves as the Medical Director.

If you or someone you know is in crisis, call or text 988 to reach the Suicide and Crisis Lifeline. All calls and texts are confidential, and help is available 24/7 for those experiencing suicidal thoughts or mental health-related distress.

This blog provides general information and discussions about health and related topics. The information and other content provided in this blog, or in any linked materials, are not intended and should not be construed as medical advice. This information is not a substitute for professional medical expertise or treatment.

If you or any other person has a medical concern, please consult with your healthcare provider, or seek other professional medical treatment. Never disregard professional medical advice or delay seeking care based on the information you have read on this blog or in any linked materials. If you think you may have a medical emergency, call or go to the Emergency Room or dial 9-1-1.

In our last blog post, we talked about what is normal in the postpartum period. But, what is NOT normal? In the second part of our 3-part series, we are going to look at five things you should let your doctor know about immediately.

• Heavy vaginal bleeding

Whether a woman has a vaginal delivery or a Cesarean section (aka C-section), some vaginal bleeding after delivery is normal. Typically, it is heavier in the first 24 hours after delivery. After that, the bleeding starts to decrease. First it will be like a normal period, then taper down to spotting, and  finally, it will stop. The amount of time that a woman bleeds after giving birth varies from a couple weeks to up to six weeks. The key is that the vaginal bleeding should gradually decrease overtime. If the bleeding suddenly increases — you begin to completely fill a pad in an hour for at least two hours — you should notify your doctor or seek medical attention.

• Foul-smelling vaginal discharge

Lochia, a mixture of blood and mucus, is the normal discharge that occurs after delivery. Normal lochia does not have a foul-smelling odor to it. If you notice a significant odor to your discharge, you should notify your doctor or seek medical attention.

• Pus from your C-section incision

If you have had a C-section, the hospital will let you know the best way to care for your incision at home. Some women have stitches, and some have staples. There could be little strips of adhesive tape, glue, or nothing at all. Regardless of how your doctor closes your incision, you might experience a few drops of blood or fluid on your dressing or underwear. This is ok. However, experiencing pus, large amounts of blood-tinged fluid, or heavy bleeding is not normal. Anything that is heavy enough to fill a thick pad or bandage with fluid or any amount of pus is a reason to notify your doctor or seek medical attention.

• Fever

A fever of 100.4 or greater is something that should be evaluated. There are many reasons that a woman could have a fever after giving birth. It could be related to the breasts, the uterus, your incision, or even a respiratory infection. No matter the reason, it is not normal to have a fever of 100.4 or greater and you should notify your doctor or seek medical attention.

• Red, painful breasts

Whether you are breastfeeding or bottle feeding, your breasts can become engorged due to the increased blood flow to the breasts after delivery. The increased blood flow to your breasts encourages milk production. Breast engorgement can lead to discomfort. Warm compresses to the breasts, massaging the breasts before nursing, or pumping the breasts can help soothe discomfort. If you are not breastfeeding, it is no longer recommended that you bind your breasts. A good supporting bra is recommended. Acetaminophen, or Tylenol, can help ease discomfort. However, if your breasts become painful AND red, that could be a sign of an infection called mastitis. If one or both of your breasts become red and swollen, you should notify your doctor or seek medical attention.

In summary, here are five reasons to reach out to your doctor or seek immediate medical attention:

1. Vaginal bleeding that suddenly increases and is heavy enough to fill a pad in an hour for at least two consecutive hours.
2. A significant odor to your lochia, (aka vaginal discharge) after delivery.
3. Heavy drainage from your C-section incision — enough to fill a thick pad or bandage with fluid —or if any amount of pus is noted.
4. A fever of 100.4 or greater.
5. Red, painful breasts.

Well, there you have it! You are equipped with a few facts about what could require a call to your doctor after delivery. In our next discussion, we will talk about postpartum depression.

Until then, be well and make sure to show yourself love and grace.

Dr. Kristin Williams

Medical Director of Women’s Health Specialists of North Texas

This blog provides general information and discussions about health and related topics. The information and other content provided in this blog, or in any linked materials, are not intended and should not be construed as medical advice. This information is not a substitute for professional medical expertise or treatment.

If you or any other person has a medical concern, please consult with your healthcare provider, or seek other professional medical treatment. Never disregard professional medical advice or delay seeking care based on the information you have read on this blog or in any linked materials. If you think you may have a medical emergency, call or go to the Emergency Room or dial 9-1-1.

The big moment is finally here! You have waited nine months (by the way, it’s actually 10 months) for this big event! Your baby is about to enter the world. You have prepared diligently and meticulously for this exact moment. And, then it happens. The baby is here!

You’re ready to slay this thing called motherhood. Once your home, you start cramping. “Wait. Is that normal?” you think. Your significant other asks you if you want ketchup for your fries and you burst into tears. Is this normal?

“Is this normal?” is probably one of the most frequently asked questions by both new moms and seasoned moms alike. Women spend countless hours preparing to bring home the baby, but what about preparing for YOU? It is just as important to prepare for YOUR arrival home. In this 3-part series, we are going to focus on Postpartum Care for mom. That’s right! This is your ultimate guide to Bringing YOU Home. In today’s discussion, we are going to talk about what’s normal. But first, let’s talk about what the postpartum period is.

What is the Postpartum Period?

The postpartum period is defined as the time from delivery of the infant to the first six to eight weeks afterwards. Just as your body experienced all these miraculous changes during your pregnancy, your body will continue to go through changes after delivery in order to get back to its normal state; or more likely its “new” normal state. Remember, your body is recovering from 10 months of growing and nurturing another human being; not to mention the stress of that Iron Man triathlon you just completed, otherwise known as delivering a baby. So, this is an important time that you should be ready for.

So, what is normal?

This topic here could take up one of those ginormous 1000-page college textbooks you use to have. But let’s try to briefly summarize this.

• Cramping – Your uterus is a muscle. When the baby is full term, your uterus is about the size of a watermelon. After the baby is delivered, your uterus shrinks by approximately 50%. Even after its initial downsizing, it still has a long way to go before it is back to its normal size – around the size of a pear. Part of that shrinking process involves cramping. This can be normal for the first couple of weeks.

Typically, acetaminophen (Tylenol) and/or ibuprofen (Motrin), which are both available over-the -counter, can help. Be sure to check your discharge instructions from the hospital to see what your doctor recommends. A heating pad can also be soothing.

What to consider having at home: Acetaminophen, ibuprofen, a heating pad.

• Bleeding – The blood and discharge expelled from the uterus after delivery is called lochia. In the first 24 hours after delivery, the lochia may be heavier than a period. After that, the bleeding will gradually decrease to a flow similar to a period, then to spotting, and finally it will stop. This process can take anywhere from two to six weeks. Be sure to have both pads and panty liners at home to use. Avoid using tampons during this time.

What to have at home: Maxi pads and panty liners

• Emotional Changes – A wide range of emotions can occur after having a baby. Of course, there can be plenty of bliss and joy, but there are many other emotions women experience such as anxiety, exhaustion, and frustration. Feeling overwhelmed in general or irritated by unsolicited advice from EVERYONE can also be normal emotions for moms. Typically, these changes in emotions can start around two to three days after delivery but last no longer than two weeks.

Why does this happen? After delivery, there is a sudden withdraw of the increased levels of hormones that were circulating in your body to support the pregnancy. With this withdraw, many women experience changes in emotions. All these things can be a part of what is called the “Baby Blues”. According to the March of Dimes, up to 80% of women can experience the “Baby Blues” after delivery.

If your symptoms are not getting better after two weeks OR your symptoms are getting worse, PLEASE speak with your provider. Sometimes there can be something more, such as Postpartum Depression. More on this in Part 3 of this series.

What to have at home:A support network, be it friends or family, that can lend a helping hand when needed. It is even better if they are also willing to give you a little space when needed but are honest enough to speak up if there is a concern. If there are certain ways you want things done, let them know that in advance BEFORE you and baby come home.

• Breast changes – Whether you breastfeed, bottle feed, or a little bit of both, your breasts will go through changes.
• If you are breastfeeding, you may get discomfort as your milk comes in and when your breasts get engorged. A nice warm shower can help to ease this discomfort. If you are engorged, breastfeeding your baby or pumping your breasts can help.

Nipple discomfort is also something women can face. Things that you can do for nipple discomfort are applying lanolin cream and cool compresses to the nipple. They sell creams and nipple cooling pads at your local store, or they are available online. You can also use a soaked tea bag that you put in the refrigerator. Another helpful tip that is quick and easy is expressing some of the milk after nursing, rubbing the milk into the nipple, and allowing the nipple to air dry.  Finally, avoid using soap on the nipple as this can be drying. If it is not getting better after a week, you may want to speak with a lactation consultant to help you with the baby latching on.

What to have at home: Lanolin cream, nipple cooling pads, nursing bra

• If you are bottle feeding, you can still get some breast discomfort. If your mom or grandmother tells you to bind your breasts, DON’T DO IT. Back in the day, that was a recommendation, but times have changed. Instead, experts recommend that you simply wear a good supporting bra. Cool compresses can also be comforting. Heat is not recommended as this stimulates the milk and that defeats the purpose if you don’t want to breastfeed.

What to have at home: Good supporting bra, ice pack

Other normal changes:

• Swelling of the hands and feet – Your body is starting to mobilize and get rid of the fluid it retained during pregnancy. Elevating your feet can help with this. If more support is needed, you can purchase compression stockings at your local pharmacy or online.

• Pain in the vaginal area – Even if you don’t have any tears, you can still get pain in the vaginal area. Ice packs to that area or cold maxi pads can help to relieve some of the discomfort. They do sell ice pack pads as well. Perineal bottles, which are often given to you at the hospital, can help flush water over the perineum – the area between the vagina and rectum – during and after urination, as urinating can be irritating. There are also numbing sprays with benzocaine in them, such as Dermoplast, that are available over-the-counter.

• Hemorrhoids  – Having hemorrhoid cream and witch hazel wipes, such as Tucks wipes, is always good to have on hand.

• Hair loss – It is normal to have thicker hair DURING pregnancy, but it is also normal to lose more hair than normal after you give birth. But don’t panic. It all evens out after a few months.

To sum it up, your “Bringing You Home” care package should include:

• Pads
• Maxi pads

You might also consider these items as well:

• Acetaminophen
• Ibuprofen
• Heating Pad
• Ice packs
• Lanolin cream
• Nipple cooling pads
• Nursing bra
• Good supporting bra
• Compression stockings
• Hemorrhoid cream
• Witch hazel wipes
• Benzocaine spray

These are some of the normal things that you may experience in the postpartum period. Of course, there are other things that you may notice that are completely normal as well. If ever in doubt, reach out to your doctor.

Next time, we will talk about some of the abnormal changes you want to watch out for.

Until then, be well and be sure to show yourself grace and love.

Dr. Kristin Williams

Medical Director of Women’s Health Specialists of North Texas

About the author: Dr. Kristin Williams is a board-certified Ob/Gyn. She graduated from Wayne State University School of Medicine in Detroit, Michigan. After completing one year of training at Tulane University in New Orleans, Louisiana, Dr. Williams moved to Dallas, Texas to complete her residency at Parkland Hospital. She worked in private practice with Women’s Health Specialists of North Texas for 16 years and now works with the office as the office Medical Director.

This blog provides general information and discussions about health and related topics. The information and other content provided in this blog, or in any linked materials, are not intended and should not be construed as medical advice. This information is not a substitute for professional medical expertise or treatment.

If you or any other person has a medical concern, please consult with your healthcare provider, or seek other professional medical treatment. Never disregard professional medical advice or delay seeking care based on the information you have read on this blog or in any linked materials. If you think you may have a medical emergency, call or go to the Emergency Room or dial 9-1-1.

Can you guess one of the most frequently asked questions I received when I was in private practice? No matter their age, nationality, or education level, women wanted to know – Do I need a pap smear?

Who can blame them? Recommendations have changed throughout the years, and once you think you’ve got it all figured out, it changes again. So, what’s the answer?  In this blog, you will finally know the answer to a question that has bewildered women for ages. But first, let’s talk about what a pap smear is.

What is a pap smear?

A Papanicolaou test, affectionately known as the pap smear, is a test that looks for abnormal cells on the cervix that can lead to cervical cancer. But did you know that now experts say that looking for abnormal cells of the cervix is not the only way to screen for cervical cancer? Let’s take a closer look at this.

What are the tests for cervical cancer screening?

There are three basic types of tests for cervical cancer screening – Cytology, HPV testing, and Cytology with HPV testing. While all these tests are performed the same way in the doctor’s office, they are tested differently in the lab.

• Cytology only (also known as the Pap smear) – Looks for abnormal cells on the cervix but does not screen for HPV. This type of cervical cancer screening is recommended for women 21-29 y/o.
• HPV testing only – Looks for high-risk strains of the Human Papilloma Virus (HPV). There are well over 100 different strains of HPV. But not all strains of HPV cause abnormalities that could potentially lead to cervical cancer. Therefore, screening only for high-risk strains of HPV, not for abnormal cells of the cervix itself, is one option for cervical cancer screening. This test can be performed on women 30–64 years old.
• Cytology with HPV testing (also known as the Pap smear with co-testing) – Combines the two methods described above. This test can be performed on women 30–64 years old as well. It basically combines the two methods mentioned above.

Therefore, in this blog, we will not use the term pap smear but instead cervical cancer screening. Now, let’s debunk five of the most common myths about cervical cancer screening.

Does age matter?

Myth #1:  You should have cervical cancer screening when you turn 18 years old.

Fact:  Women should start having cervical cancer screening at 21 years old. Even if someone becomes sexually active before then, screening for cervical cancer is not necessary until age 21.

How often do I really need to be screened for cervical cancer?

Myth #2:  Even if your cervical cancer screening is normal, you should still have to repeat your screening every single year.

Fact:  Women who have normal screenings of their cervix do not need to have yearly cervical cancer screening. I know some of you are saying, “Are you sure about that? Is that safe?” Yes, I am and yes it is!

Women who have normal screenings of their cervix may space out their screenings between 3 -5 years, depending on your age and what type of screening you had. I continue to stress normal because these guidelines do not necessarily apply to women who have had an abnormal result on their cervical cancer screening.

Let’s break this down further

• Cytology only (the pap smear) – This type of cervical cancer screening is recommended for women 21-29 y/o and is performed every 3 years if normal.
• HPV testing only – This type of cervical cancer screening only looks for high-risk strains of HPV, not abnormal cells from the cervix. It can be performed on women 30–64-year-old and is performed every 3 years if normal.
• Cytology with HPV testing (the pap smear with co-testing) – This test screens for both abnormal cells of the cervix and high-risk strains of HPV. It can be performed on women 30–64-year-old and can be performed every 5 years, instead of every 3 years.

The good thing is that you do not have to remember all of this. Your doctor will keep track of when you are due for your cervical cancer screening. The takeaway from this myth is that not every person needs a cervical cancer screening every year. This takes us into Myth #3.

How often should I see my Gynecologist?

Myth #3:  My doctor says that I do not need to have cervical cancer screening every year. Therefore, I do not need to see my gynecologist every year.

Fact:  You need to see your gynecologist every year. YOU NEED TO SEE YOUR GYNECOLOGIST EVERY YEAR. One more time for the people in the back – YOU NEED TO SEE YOUR GYNECOLOGIST EVERY YEAR. Ok. I think I have made my point.

You need to see your gynecologist every year for your annual exam even if cervical cancer screening is not needed. At an annual exam, other important things occur such as:

• Blood pressure check
• Weight check (Yeah, I hate it too.)
• Breast exam
• Pelvic Exam
• Birth control options
• Risk factor screening for medical illnesses and cancers
• Menopause discussion
• Blood work
• Ordering mammograms
• Options for colon cancer screening (colonoscopy, Cologard)
• And more!

Yearly visits help to maintain the doctor-patient relationship. This is important for many reasons. But one huge perk of being seen each year is that if you develop health concerns between your yearly visits, you won’t be considered a new patient and won’t have to wait as long to be seen. Just remember, it is important to see your doctor every year even if you don’t have cervical cancer screening performed.

I’m on my period. Now what?

Myth #4:  If you are on your period, you should cancel your yearly exam.

Fact:  If you are having CERVICAL CANCER SCREENING, it is best to reschedule your appointment. The blood obtained on the specimen can make it difficult for the pathologist to interpret the results. This means that we would need to repeat your cervical cancer screening when you are not on your period.

If you are having your ANNUAL EXAM without cervical cancer screening, you can still keep your appointment. I know it may feel embarrassing being examined while you are on your period. But let me assure you, it is ok. However, if you feel uncomfortable, you can always call to reschedule your appointment.

It is understandable that it can be confusing trying to keep up with when you are due for your cervical cancer screening. If you aren’t sure and need to know before your appointment, just call. We can let you know if your cervical cancer screening is “to be, or not to be” (thank you, Shakespeare). But whatever you do, don’t just not show up for your appointment with your doctor. Always call if you need to cancel, reschedule, or have questions about your appointment.

Can cervical cancer screening look for cancers other than cervical cancer?

Myth #5:  Cervical cancer screening lets you know if you have cervical cancer, uterine cancer, and ovarian cancer.

Fact:  Cervical cancer screening only screens for cancer of the cervix. It does not screen for any other cancers. Here are how other cancers are screened for.

• Ovarian cancer – Yearly pelvic exams can help your doctor determine if there are concerns for ovarian cancer. A pelvic exam can look for any physical signs concerning for ovarian cancer. But it is also important for you to listen to your body and report any persistent swelling/bloating and or abdominal/pelvic pain. Your family history is also an important consideration.
• Uterine cancer – If you have not gone through menopause, look for significant, persistent changes in your period such as them being heavier, longer, or more frequent. If you have already gone through menopause and have not had a period for at least one year, you should report any vaginal spotting or bleeding.
• Vulvar cancer – Once again, yearly pelvic exams with your doctor are key. Also, you should report any itching on the outside of the vaginal area that is persistent.

So, back to the original question –Do I need a pap smear?  Well let’s change that question to – Do I need cervical cancer screening? The answer is… maybe. There are a few factors that go into the correct answer for each individual woman. The takeaway message is not everyone needs to have cervical cancer screening every year, but you should still see your gynecologist every year. But do not worry if you can’t remember all the ins and outs of cervical cancer screening. That’s what we are here for!

I hope that the information shared in this blog helped to shed some light on what may be right for you. Now, you can walk with your head held up high, knowing what to do, and confidently tell your girlfriends and family what they need to do as well.

Keep in mind that recommendations could very well change again in the future. But for now, you’ve got it! Plus, you’ll be going to see your gynecologist every year anyways, right?

Dr. Kristin Williams

Medical Director of Women’s Health Specialists of North Texas

About the author: Dr. Kristin Williams is a board-certified Ob/Gyn. She graduated from Wayne State University School of Medicine in Detroit, Michigan. After completing one year of training at Tulane University in New Orleans, Louisiana, Dr. Williams moved to Dallas, Texas to complete her residency at Parkland Hospital. She worked in private practice with Women’s Health Specialists of North Texas for 16 years and now works with the office as the office Medical Director.

This blog provides general information and discussions about health and related topics. The information and other content provided in this blog, or in any linked materials, are not intended and should not be construed as medical advice. This information is not a substitute for professional medical expertise or treatment.

If you or any other person has a medical concern, please consult with your healthcare provider, or seek other professional medical treatment. Never disregard professional medical advice or delay seeking care based on the information you have read on this blog or in any linked materials. If you think you may have a medical emergency, call or go to the Emergency Room or dial 9-1-1.

Source: https://www.cdc.gov/coronavirus/2019-ncov/prepare/pregnancy-breastfeeding.html

• LARC stands for long acting reversible contraception. This category includes intrauterine contraception (IUCs/ IUDs) which can last for 3-10 years, and implanted devices (Nexplanon®) which are effective for up to three years.
• LARCs are >99% effective at preventing pregnancy. That is as effective as permanent sterilization procedures!
• All LARCs are completely reversible. After removal, resumption in fertility is almost immediate.
• LARCs are safe for most women and teens, even if you’ve never had a baby.
• If you are not a candidate for hormonal birth control like birth control pills, a LARC may be appropriate for you.
• The ParaGard® device may also be used as emergency contraception within 120 hours of unprotected intercourse.
• Some LARCs may also provide non-contraceptive benefits like shorter, lighter periods.

• If you know you don’t want a pregnancy within the next few years, a LARC may be a great option for you.

A pregnant woman can undergo fetal screening for certain birth defects during her pregnancy. Birth defects may be caused by problems with genes, chromosomes, or exposure to certain agents. However, 70% of birth defects have no known cause.

Prenatal screening tests can show whether you are at high risk or low risk of having a baby with a particular disorder.

If the screening test shows that you are high risk for a birth defect, a diagnostic test will have to be done to determine if your baby actually has the disorder.

Here are some screening tests which can help determine your baby’s risk of having a birth defect.

Prenatal Screening Tests

Glossary

Trisomy:

a condition in which there is an extra chromosome.

Monosomy:

a condition in which there is a missing chromosome.

Trisomy 13:

Patau syndrome is a genetic disorder characterized by heart defects and other developmental problems. Most affected infants die within the first year of life.

Trisomy 18:

Edwards Syndrome is a genetic disorder that causes serious mental and developmental problems. Most affected infants die within the first year of life.

Trisomy 21:

Down Syndrome is a genetic disorder in which abnormal features of the face and body, medical problems such as heart defects, and intellectual disability occur.

Monosomy X:

Turner Syndrome is a condition affecting females in which there is a missing or damaged X chromosome. It causes a webbed neck, short height, and heart problems.

Neural Tube Defect:

Birth defects of the brain, spine, or spinal cord. The most common neural tube defects are spina bifida and anencephaly. In spina bifida, the fetal spinal column doesn’t close completely. In anencephaly, most of the brain and skull do not develop.

Information adapted from ACOG Patient Information FAQ 165

Smart phones are an inescapable part of modern life. They are convenient and increase efficiency in many areas. Here are some apps that we here at Women’s Healthcare Specialists of North Texas may help improve your health and quality of life.*

My Pregnancy Today App and Contraction Timer
iOS | Android

Period Tracker
iOS | Android

Pill Reminder by Drugs.com
iOS | Android

Red Cross First Aid App
iOS | Android

Omvana Meditation App
iOS | Android

MyFitnessPal – Calorie and Fitness Tracker App
iOS | Android

* Medical health and lifestyle apps are no substitute for personalized medical advice. If you have medical questions or concerns, please contact your healthcare provider.

Don’t panic.  A pap smear is a screening test for cervical cancer and pre-cancer.  The pap test is usually done in conjunction with an HPV test. There are many causes of abnormal pap smears, and most can be managed in the office.  Once your test comes back abnormal, your provider reviews the test results and decides on a plan of action.

What are the different types of abnormal pap test results?

• Atypical squamous cells of undetermined significance (ASC-US)—ASC-US means that changes in the cervical cells have been found. The changes are almost always a sign of an HPV infection. The changes may also be a result of infection or inflammation. ASC-US is the most common abnormal Pap test result.
• Low-grade squamous intraepithelial lesion (LSIL)—LSIL means that the cervical cells show changes that are mildly abnormal. LSIL usually is caused by an HPV infection that often goes away on its own.
• High-grade squamous intraepithelial lesion (HSIL)—HSIL suggests more serious changes in the cervix than LSIL. It is more likely than LSIL to be associated with pre-cancer and cancer.
• Atypical squamous cells, cannot exclude HSIL (ASC-H)—ASC-H means that changes in the cervical cells have been found that raise concern for the presence of HSIL.
• Atypical glandular cells (AGC)—Glandular cells are another type of cell that make up the thin layer of tissue that covers the inner canal of the cervix. Glandular cells also are present inside the uterus. An AGC result means that changes have been found in glandular cells that raise concern for the presence of pre-cancer or cancer.

What testing is done after an abnormal result?

• Colposcopy with or without cervical biopsy—Colposcopy is an in office exam of the cervix with a magnifying device. If an area of abnormal cells is seen, your health care provider may decide that a cervical biopsy is needed. For a biopsy, the health care provider removes a small sample of tissue and sends it to a lab for testing. The lab tests can determine whether abnormal cells are present and, if so, how severe.
• Endocervical sampling – A small brush or other instrument is used to take a tissue sample from the cervical canal.
• Endometrial sampling— In the case of an AGC result, a sample of the endometrium (the lining of the uterus) may be collected for study using an instrument which looks like a small straw.

What are the potential results of the biopsy?

• Cervical intraepithelial lesion (CIN) is used to report cervical biopsy results. CIN is graded as 1, 2, or 3.
• CIN 1 is used for mild (low-grade) changes in the cells that usually go away on their own without treatment.
• CIN 2 is used for moderate changes.
• CIN 3 is used for more severe (high-grade) changes.
• Moderate and high-grade changes can progress to cancer. For this reason, they may be described as “pre-cancer,” and are usually treated.

How are abnormal cervical cells treated?

• Loop electrosurgical excision procedure (LEEP)—A thin wire loop that carries an electric current is used to remove abnormal areas of the cervix. This procedure can be done in the office or in the operating room.
• Conization—A cone-shaped piece of the cervix that contains the abnormal cells is removed. This procedure must be done in the operating room.

These procedures are usually curative.  Once complete, patients are asked to come in for a follow up visit two weeks after the procedure to review pathology results and to form a plan for future testing.

Information adapted from ACOG Patient Information FAQ 187