Regimens other than the "follow the pack"
method may work well for you. All the following regimens provide contraception
after the first two packs of pills (56 days). You must use a backup method until
then.
Birth control pills (BCP) provide many health benefits to women.
They decrease menstrual cramps, menstrual blood flow, anemia, acne, premenstrual
symptoms (PMS), and menstrual headaches, after three to six months of use.
Longer BCP use decreases the risk of osteoporosis, endometrial cancer, ovarian
cysts, endometriosis, and fibroid tumor growth. Weight gain is rare. Long term
BCP use is okay; you do not need to take a birth control "vacation" every few
years. Prolonged pill use does not decrease future fertility, and in some
circumstances BCP use may decrease causes of infertility.
The
following are alternative regimens:
REGIMEN ONE: FOLLOW THE
PACK
Take the pills continuously in your pill pack. Take the first
pill on the first Sunday after your period begins. Then take the 21 days of
active pills followed by 7 days of placebo. This regimen will give you a
"period" every 28 days.
REGIMEN TWO: TWO PACKS ON, FOUR DAYS
OFF
Begin to take an active pill on the 2nd or 3rd day of your
menstrual cycle. Take active pills for 42 days (2 x 21 active pills from two
packs) and then take 4 inactive (placebo) pills. Change the pack label to
coincide with the day you begin the active pills. With this regimen you will get
a period approximately every six weeks.
REGIMEN THREE: GRADUAL
PROLONGATION OF PILL CYCLES (Less periods!!!)
For the first 3
pack of pills begin your pills on the 2nd or 3rd day of your cycle, and take 21
active pills followed by four placebo pills. After the first pack you can being
to extend your cycles. To do this, take two packs (2 x 21) or 42 active pills in
sequence, then four placebo pills. Then begin active pills again. Now you can
continue on active pills for 63 days (3 packs ( 21 x 3) and then take four
placebo pills. This regimen gives you a period approximately every seven weeks.
YOU can extend to four packs (4 x 3 weeks = 12 weeks) on and then 4 placebo
pills. Always remember to change the day label to coincide with the day you
resume the active pills.
REGIMEN 4: PERIODS NO
MORE?
Begin taking your pills the 2nd or 3rd day of your period. Then
an active pill every day for as long as you want. You choose when and how often
to stop. If you get prolonged breakthrough bleeding (usually more than two
weeks) or bleeding like a period, you can stop the active pills for four days
(take the placebo pills if you like, but this is not necessary). Next, resume
the active pills and change the day label on your pack. Continue with an active
pill each day for at least 21 days. Continue on the active pills until you have
bothersome breakthrough bleeding, a ?period?, or just want to stop. You can
continue on active pills indefinitely if no bleeding occurs. Breakthrough
bleeding will often stop after a week or so if you continue on active
pills.
REGIMEN FIVE: SAME TIME EACH MONTH
Take an
active pill every day of the month except the four days you choose to be of and
have a period. For example, if you pick calendar days one to four each month,
you will take a placebo pill day one to four, and an active pill day five to the
end of the month (days 5 to 31). With this regimen you will have your withdrawal
bleed the same time each month. Be sure to change the day label on your pack.
Notes:
With birth control pill use, the uterine lining gets thin and stays thin.
Unlike regular menstrual cycles, it does not build up and need to be shed. It
does not "back up in there" and need to come out. After several cycles on pills
your period may get very light or stop altogether. This is normal.
Birth control pills turn off ovulation after the first month of use. A back
up method of birth control must be used for at least the first month, or two
months for extra assurance.
The birth control regimens just outlined provide contraception if followed
correctly. If you forget to take one active pill, take two pills the next day.
If you forget two pills, take two pills the next day and resume one active pill
a day after that. If you forget more than two pills but less than seven, resume
your active pills for at least 21 days and use back-up contraception for the
next month.
If you forget to resume your active pills after you four days of placebos,
and have not exceeded seven days since taking the active pills, you can resume
your active pills and they will still provide contraception. If you have
exceeded seven-day since the active pills, begin the active pills and use backup
contraception for one month.
With prolonged pill use, your withdrawal bleed ("periods") may get less and
less or cease altogether. This is okay. It does not increase your risk of
pregnancy. Most women, when reassured that not bleeding is okay, prefer not to
have periods.
Remember, pills do not provide protection from sexually transmitted
diseases.
Antibiotics may interfere with pill effectiveness and a backup method of
birth control should be used for a month after completion of the
medication.
When beginning birth control pills, it takes up to three to six months to
achieve the non-contraceptive effects, such as reduction in cramps, bleeding,
acne and PMS. Please "hang in there."
Pills may cause mild nausea. This usually subsides after one pack. Taking
your pills at bedtime may alleviate this.
Take your pills at the same time every day. Develop a routine and stick to
it. Always have the next pack handy at least a week before you need it. If you
use mail order prescriptions, allow one month for delivery. Keeping extra pills
handy in your pocketbook (7 pills- cut out strip) will help if you are out of
town and forget your pack.
Prior to attempting pregnancy, there is no need to stop pills for three to
six months. You may attempt pregnancy after you complete your last pack.
Some women feel reassured about avoiding pregnancy by taking the pill
according to package directions (21 active, 7 placebo) and getting a "pill
period." This is falsely reassuring. By taking active pills continuously
(without placebos), you actually have a lower risk of pill failure and
pregnancy.
A colposcopy examination is a method the
physician uses to look at the cervix with a magnifying tool called a colposcope.
Usually biopsies are taken. You may have some mild cramping for a few minutes
during the procedure.
You will need to wear a pad for the next 2 to 5
days. Some post-treatment bloody spotting may occur. The medication used during
the procedure may give your discharge a coffee ground color.
FOR 5
DAYS AFTER THE COLPOSCOPY:
DO NOT USE TAMPONS
AVOID SEXUAL INTERCOURSE
AVOID HEAVY LIFTING, JOGGING, AEROBICS AND HORSEBACK
RIDING
CONTACT DR. THIEL'S OFFICE FOLLOWING THE COLPOSCOPY
IF YOU EXPERIENCE ANY OF THE FOLLOWING SYMPTOMS:
HEAVY BLEEDING
SEVERE PAIN
VAGINAL DISCHARGE WITH STRONG UNPLEASANT ODOR
FEVER GREATER THAN 100.4
Dr. Thiel's office will call you
when the biopsy results are received, usually in 2-3 weeks. If no biopsies are
done, you will be advised at the time of the colposcope of plans for follow-up
care.
Vulvar Vestibulitis
By M J Thiel, MD,
PC
"The stabbing,
stinging, burning pains are near the vaginal opening. They come and go and I
just want them gone." ---Patient
"I feel like I'm burning and
ripping down there. Sex hurts, tampons hurt. I've tried everything, creams,
antibiotics, and it won't go away." ---Patient
"The vaginal
opening exists anatomically, but it should not be present in our daily
consciousness." Melissa J. Thiel, M.D.,
P.C.
Definition
Vulvar vestibulitis is pain
confined to the vulvar vestibule. It is often described as burning, stinging,
pulling, itching, or rawness which may be chronic in nature and occur
intermittently. The cause of vulvar vestibulitis is often unknown, but can be
triggered by infections or chemical or mechanical irritation to the area
encompassing the vaginal opening. As many as one in seven woman can have some
signs of vulvar tenderness and fit the clinical definition of Vulvar
Vestibulitis Syndrome.
Presentation
Vulvar
vestibulitis presents as pain in the area near the opening of the vagina. The
vulvar vestibule is the area just outside the vagina extending from the hymen,
outward to the internal labia. Vestibulitis will often present with pain when a
tampon is inserted or following intercourse. Women can experience burning,
throbbing, stinging or stabbing pains when jogging, riding bikes or doing other
exercises. In some very severe cases, women experience pain while just sitting
or walking. The duration of vulvar vestibulitis may vary from days to weeks to
years. It can be continuous or intermittent. Symptoms can begin after a woman
has had a vaginal infection or trauma, such as childbirth. Often, this pain is
mistaken for vaginal dryness associated with perimenopause, vaginal infections,
or yeast infections. Women have often tried a multitude of home remedies and
over-the-counter medications prior to seeing their gynecologist. Sometimes a
specific cause can be identified, such as a yeast infection or bacterial
infection. However, most of the time vulvar vestibulitis has no obvious
cause.
Diagnosis
The diagnosis of vulvar
vestibulitis can be made upon examination if the patient has very localized pain
when gentle pressure is applied with a cotton swab in the area of the vaginal
opening. Often, small red tender points are noted at approximately the
four/eight o'clock position of the vaginal opening. Vulvar vestibulitis is
difficult to treat since often no clear cause can be identified. Vaginal
cultures for bacteria or yeast are done. Multiple treatment regimens are tried
and patients may become frustrated with the failure to identify a specific cause
for their symptoms. Treatment often involves eliminating chemical and mechanical
irritation to this very sensitive area. Improvement may take weeks or months,
but sometimes, spontaneous remissions do occur.
Patients should do
the following:
Keep the vulva dry. Wet bathing suits, sweaty clothes and pantyhose should
be avoided. If possible, wear loose fitting cotton underwear and no underwear
while sleeping.
Avoid vulvar irritants such as soaps, shampoos, douches, vaginal
suppositories, spermicides, deodorant sprays and bubble bath. Use unscented
toilet paper, white preferably, and pat dry or use a spray bottle filled with
water to rinse the vulva and dry using a clean towel. Never use soap between the
vaginal lips. Wash this area using water only. The outside vulva (which is hair
covered) may be washed with Neutrogena soap and thoroughly rinsed. Do not engage
in oral sex. Salivary enzymes are very irritating to the vulva. After
intercourse, douche gently with warm water to remove any semen or residual latex
from condoms. Rinse all towels and underwear with a second clean water rinse. Do
not use fabric softeners or dryer sheets on towels or undergarments.
When urinating, separate the labia so urine does not touch the labia or
vaginal opening. Rinse with cool water after voiding and pat dry with a clean,
dry towel or toilet paper.
Avoid mechanical irritation to the vulva. Wear loose clothing when
exercising - no spandex. Do not bicycle or horseback ride. Avoid pantyhose. Use
thigh high or knee-high hose instead.
Use only 100% natural, unbleached cotton tampons or menstrual pads. Normal
pads and tampons contain bleach and may contain other chemicals that can be
irritating. Be sure to stick the tampon string up into the vagina so that it
does not irritate the opening. Cotton menstrual supplies can be obtained by
ordering through natural catalogues (Seventh Generation) or Fresh
Fields.
Use lubricants with sex and exercise. Suggested lubricants include KY Jelly
or Astroglide, which can be purchased at pharmacies. A good lubricant for
exercise or intercourse is Crisco solid shortening. It is not irritating and
contains no chemicals. Put a pea-sized dab on each tender point and gently rub
the Crisco into the area twice a day, as well as before exercise. This acts as a
barrier to chemical and mechanical irritation. Hurricane gel (Banana or Pina
Colada flavor) is a topical anesthetic used by dentists, and can be purchased
over the counter at most pharmacies. It can be used prior to exercise or
intercourse to help with pain. Apply a pea-sized dab to the tender areas at the
vaginal opening and gently rub in for approximately ten seconds. Hurricane works
rapidly, but may need to be re-applied after ten or fifteen minutes.
Patients with vestibulitis often have tight, contracted vaginal levator
muscles. These are the muscles that are used to stop urine flow and are
exercised after having a baby using kegel exercises. Patients with vestibulitis
need to practice relaxing these muscles, as they often remain tense. This can be
done by placing your fingers in the vagina and tightening the opening. i.e., the
levators, and then relaxing these muscles as much as possible and having them
stay relaxed. With intercourse, your partner may be able to put pressure on
these muscles, using their fingers, while taking care to avoid the tender
vaginal opening. Gentle massage, with you relaxing, can make intercourse less
uncomfortable. Adequate foreplay is also necessary for adequate lubrication and
helps relaxation. Remember, the clitoris is the most sensitive area of arousal
and can be stimulated without involving the sensitive vestibular
area.
These measures usually significantly improve
vestibular pain. Other treatments include topical antibiotics and steroids,
anti-fungal therapy, birth control pills, trigger point injections, and surgical
excision.
Often, low dose anti-depressant therapy using Amitriptyline is
effective. These medications are taken at bedtime and have been used
successfully to treat many chronic pain conditions that lack an obvious cause.
Women with vestibulitis are often very frustrated by their pain, lack of a
timely diagnosis, and absence of a set specific cure. Sometimes, just knowing
that they have a recognized syndrome and that there are things that they can do
to decrease their pain and help them function sexually is reassuring. Much of
what can be done to treat vestibulitis is the patient's responsibility and takes
time and considerable behavioral changes. Discuss your symptoms with your
partner and explain what can be done to improve sexual relations. It is
important to maintain intimacy and communication, while modifying, at least
temporarily, a couple's sexual relationship.
For more
information contact: National Vulvodynia Association PO Box
4491 Silver Spring, MD 20914-4491
Abnormal Pap Smear Results
By M J Thiel, MD,
PC
ASCUS -
Atypical squamous cells of undetermined significance
In other
words, the lab has picked up changes in the cells that line the outside of the
cervix. Many researchers call the the "I don't know" category.
You
generally may wait 3 to 6 months and have a repeat Pap smear. Many of these
changes will disappear without treatment. However, colposcopy also may be
appropriate. If the second Pap is positive, you should be evaluated further via
colposcopy and a biopsy (or biopsies) may need to be done. If follow-up
treatment is needed, the cells can be destroyed or surgically removed.
LSIL - Low-grade squamous intraepithelial
lesion
In this instance, the cells show some degree of minor
abnormality. "Mild dysplasia" is a common diagnosis. Most LSIL lesions resolve
spontaneously, same are thought to persist or progress. (CIN stands for
cervical intraepithelial neoplasia.)
You should be scheduled for
repeat Pap smears every 3 to 6 months until three in a row prove negative. If a
repeat Pap is positive, you should have a colposcopic exam with a biopsy or
biopsies. (If you are at high risk of developing cervical cancer, your doctor
may choose to skip the waiting period and proceed directlyto colposcopy and
biopsy). If follow-up treatment is needed, the cells can be destroyed or
surgically removed.
HSIL - High-grade squamous
intraepithelial lesion
This covers CIN2 and CIN3 (carcinoma in situ.)
In this instance, cells show moderate to severe changes.
You should have
a colposcopic exam and biopsy to confirm the degree of abnormality. If follow-up
treatment is needed, the lesions can usually be removed. If you have invansive
disease, you should be referred to a gynecological oncologist.
AGUS - Atypical glandular cells of undetermined
significance
In this instance, the lab has picked up changes in the
cells that line the canal between the cervix and the uterus, the uterine cavity,
or rarely, from extrauterine locations.
If the lab report says AGUS
favoring a reactive reading, schedule a repeat Pap exam in 3 to 6
months.
If the lab report says AGUS (unqualified), you may need to have a
biopsy or a scraping of the site, depending on the lab's reading. If the biopsy
shows premalignant cells, they can be removed, but if they are reactive, you can
be scheduled for repeat Pap smears. If you have invasive disease, you should be
referred to a gynecological oncologist.
If the lab report says AGUS
favoring neoplasia, have a biopsy and/or scraping immediately. If the cells are
premalignant, they can be removed. If they are reactive, your case should be
reviewed to see whether the biopsy missed anything, If this review turns up no
premalignant or malignant cells, you can be scheduled for repeat Pap smears
until three in a row prove negative. If you have invasive disease, you should be
referred to a gynecological oncologist.
Inflammation on Pap Smears
By M J Thiel, MD,
PC
Inflammation is a
common finding on Pap smears. It often corrects to normal and is caused by the
normal bacteria in the vagina. It is not precancerous. If your Pap was otherwise
okay, it does not need to be repeated. If you have signs of a vaginitis, i.e.
odor, abnormal discharge or itching or are planning a pregnancy or are not in a
long-term monogamous relationship, please make an appointment for further
evaluation.
Hepatitis B Antibody Results
By M J Thiel, MD,
PC
It you tested
positive for the Hepatitis B antibody:
Your vaccination for Hepatitis
B worked. You are immune to Hepatitis B.
If you tested
negative for the Hepatitis B antibody:
Your Hepatitis B Antibody
result was negative. You are NOT immune to Hepatitis B. Hepatitis B Infection
can cause liver damage and sever illness. It is transmitted via blood and sex.
Please take your results and get the Hepatitis B vaccination series. Call your
primary care physician or your local health department.
Specific Gravity - Your urine's
specific gravity reflects your kidney's ability to concentrate urine. It is an
important screening test for the diagnosis of kidney disease, as well as certain
respiratory diseases and metabolic disorders.
pH - The pH is a
measurement of the acidity and alkalinity of your urine. It is an important
screening test for the diagnosis of kidney disease, as well as certain
respiratory diseases and metabolic disorders.
Protein - This is a
measurement of the amount of albumin (protein) in your urine. This test is used
to evaluate kidney function.
Glucose - This is a measure of the
amount of glucose, or sugar, in the urine. Because the primary cause of sugar in
the urine is diabetes, this test is mainly used to screen for and monitor the
treatment of diabetes.
Ketones - Ketones appear in the urine when
the body breaks down proteins. Urine ketones are associated with diabetes.
Strenuous activity, fasting, or eating a low-carbohydrate diet can also cause
ketones to appear in the urine.
Urine
Microscopic
RBC - This value represents the number of
red blood cells seen when urine sediment is examined under a high power
microscopic field. It is used primarily to evaluate your kidney
function.
WBC - This value represents the number of white blood
cells seen when urine sediment is examined under a high power microscopic field.
It is used to evaluate your kidney function as well as to investigate the
possibility of infection in the kidneys or urinary tract. At times, the presence
of white blood cells in the urine may represent contamination at the time of
urine sample collection.
