Hi, this is Doctor Benham of Southern Utah Women’s Health Center. I will be posting on our Facebook page periodic informative explanations of the changes that take place during pregnancy. I decided to call it the Pregnancy Zone. As a child growing up in the 60’s, one of the shows I used to watch on TV was called the Twilight Zone. In this weekly series, ordinary people had their lives impacted by strange factors beyond their control. In pregnancy your body is changed by forces beyond your control. The result is to feel and experience physical changes that at times can be very uncomfortable, and concerning. Often I am asked if such changes are normal, and if so, why they weren’t noticed during previous pregnancies. These are great questions I love to answer during your prenatal visits to our office. The Pregnancy Zone is intended to be another resource to help you understand what is happening to you during your pregnancy.
Doctor Brady Benham
What is it? What are the risks? What are the choices? Who man benefit?
Menopause is the cessation of a woman’s reproductive ability. It is usually a natural change and typically occurs in the late 40’s or early 50’s. Most women stop having menstrual cycles and many have symptoms of lower estrogen levels commonly called “hot flashes” and “night sweats”. The ovaries stop producing “eggs” and that also means that estrogen and progesterone levels fall sharply. It is this fall in natural hormone levels (estrogen and progesterone) that are responsible for the bothersome symptoms of vaginal dryness, night sweats, hot flashes and insomnia. The loss of bone calcium leading to osteoporosis also begins at menopause.
Menopause can occur earlier due to the surgical removal of the ovaries or their premature but spontaneous failure. Younger women are often very symptomatic.
Replacing a woman’s hormones to help relieve her bothersome symptoms and to protect her strength is referred to as HRT or hormone replacement therapy. Chemically identical estrogen and progesterone are referred to as bio-identical hormones and are commonly used. You should ask your physician about theses hormones. If the uterus is still present, then both estrogen and progesterone must be used to prevent problems such as bleeding, endometrial hyperplasia, (thickening of the endometrium within the uterus), and even uterine cancer. Those women without a uterus do not require progesterone replacement.
There is still some debate about the overall long-term risk of HRT. Studies have showed a small increased risk of breast cancer for women using estrogen and progesterone. This risk equates to the same risk of dying in an automobile accident. A decreased risk of breast cancer was seen in those taking only estrogen. There is also an increased risk of deep vein thrombosis, (blood clot in a major deep vein), and pulmonary emboli (blood clot traveling to the lungs). Overall, most women experience relief of postmenopausal symptoms by accepting relatively small risk. In fact, recent data shows significant morbidity and increased mortality among women who experience menopause early in life due to removal of the ovaries and don’t receive HRT. The current recommendations suggest starting HRT within 10 years of becoming menopausal.
IS HRT FOR YOU?
It will depend on many factors including your own health history and your family history. It will be necessary to discuss these factors and your risks with your gynecologist. The number of years one continues on HRT must also be individualized with the help and advice of your gynecologist. Your relief of symptoms, quality of life and risk factors should all be considered in the decision.
It is the opinion of the author that the fear of HRT has been largely created by a media seeking to publish dire and sensational issues. As calmer and clearer thinking has come into play, many more healthy menopausal women are once again enjoying enhanced quality of life by choosing to receive hormone replacement therapy. Recent studies continue to show the benefits usually outweigh the risks.
Dr Craig Astle
About 8% of first pregnancies will bleed in the first 20 weeks. Subsequent pregnancies have a 25% rate of bleeding in the first 20 wks. Bleeding in early pregnancy is always concerning, but does not automatically mean there is a problem. The technical name for any vaginal bleeding in the first 20 wks of gestation is called a threatened abortion. With the overall rate of miscarriage at 15%, this means that close to 50% of pregnancies that bleed in the first trimester will abort.
Bleeding in a viable pregnancy is usually scant and will last only a few days but may recur. This is known as implantation bleeding. Sometimes it can be heavy and we may see the hemorrhage on ultrasound. We then call it a subchorionic hemorrhage. Bleeding may also come from the cervix due to the increased vascularity of the cervix during pregnancy. This increased vascularity also occurs in the nose and gums. As a result, bleeding from the nose after blowing and the gums after brushing is common. Bleeding after intercourse can occur any time in pregnancy due to mechanical forces on the cervix.
What should you do if you have vaginal bleeding during pregnancy? Since this could be a sign of an emergency such as a tubal pregnancy, call our office. We will probably want to see you. If after hours, we may have you go to the emergency room.
Doctor Brady Benham
This is not a complaint during pregnancy, but is frequently expressed 2 or more months following birth. During pregnancy there is normally an increase in body hair, that can be of concern to patients. This will improve once pregnancy is over, and I rarely hear anyone complain of facial hair growth. However, I frequently will have patients make appointments to discuss significant hair loss occurring around 2 or more months post delivery. This of course is of major concern to patients. Have no fear, this is actually very normal and will resolve. Hair goes through normal phases of growth, stabilization, falling out, and starting over. Growth phase, called anagen, lasts 2-6 years. The resting phase, called telogen, lasts about 3 months, then the hair falls out, and a new one grows. The average person loses 200 hairs per day. During pregnancy the amount of hair in anagen phase is increased. As a result less hair is falling out, and the scalp thickens. The down side is that about 2-4 months after delivery, a larger portion of hair will enter the telogen phase, and then start falling out. By the time you are 6 months out, you not only notice more than normal hair falling out in the shower, you begin to notice the scalp thinning. This phase won’t last and hair will begin to grow back in 6-12 months, and the scalp will return to normal within 8 to 16 months after delivery.
Doctor Brady Benham
These are very common complaints and are usually due to normal changes in pregnancy. Toward the end of pregnancy they could be signs of “Preeclampsia” or “Toxemia of Pregnancy”. During the pregnancy the body can normally retain 6.5 to 8.5 liters of extra water. This is around 14 ½ to just over 19 lbs of water. Wow! That’s a lot of water. Some will actually gain more than this. In the early weeks of pregnancy the thirst goes up and urine output goes down resulting in retention of water. Most the extra water is in the vascular system. This huge increase in vascular volume would result in extremely high blood pressures if nothing else changed. In fact blood pressure tends to decrease over the first 28 wks of pregnancy. The reason blood pressure drops rather go up is due to the fact that the vessels in the body, especially the arteries, can relax and expand to allow for the increase in water. This relaxation results in vessels that get thinner, and as they get thinner, they get leaky. The fluid molecules in the vessels can escape the vessels and enter the tissues. This is most notable where gravity is most at work. The hands and feet can swell. Swelling can be very uncomfortable and is usually at its worst toward the end of pregnancy and during the hotter months. The median nerve runs through a tight space in the wrist called the carpel tunnel, and gets compressed in that spot causing pain in the hands. The fingers and hands swell and rings must be removed and feet swell to where only sandals and house slippers fit. What can be done about this? Nothing really, but you can try putting your feet up during the day, and it might help a little. Most will notice the symptoms worsen as the day goes on. The happy ending is that usually within the first 2-3 weeks after delivery, this whole process reverses itself and you get your body back. In the end it is better to be puffy than fluffy. Puffy goes away without doing anything, fluffy requires some PTA. (Pain, Torture, and Agony).
Doctor Brady Benham
Also known as “morning sickness” is present in 70% of pregnancies. The exact cause is not known. There is poor correlation with hormonal changes. The onset is usually between 4 and 8 weeks and subsides in most pregnancies by 14-16 weeks. Interestingly enough, 56% of the worst cases involve a female infant. Also, pregnancies afflicted with nausea and vomiting generally have more favorable outcomes.
In a small percent of pregnancies the nausea and vomiting can be severe enough to lead to dehydration and weight loss. The majority of these will have improvement by 16 weeks, but may still suffer symptoms the entire pregnancy. Treatment for the most severe cases will involve hospitalization with IV fluid hydration, electrolyte supplementation, and on occasion, tube feedings, or IV nutritional feedings. For the majority of cases simple steps can get mom through those tough first 14 to 16 weeks. These steps include good supportive psychological support from the husband and family members. Moms feel bad enough physically, and emotionally with the inability to perform daily functions, without having, husbands and others making demands upon them during these times of distressing illness. Moms need to understand that the pregnancy is usually just fine and the developing baby is not adversely affected. The baby/placental unit is very efficient at getting from mom what it needs, and the needs initially are very small. About the time the nausea improves is the time that mom’s nutritional intake becomes more important. Helping mom with meals, housework, and tending the other children helps reduce the stress and guilt mom feels when she is unable to keep up with her own expectations. Avoid foods that trigger nausea, (including the smell). Eat frequent but small meals. Ginger root, vitamin B6, and prescribed medications can be helpful.
Most importantly stay hydrated! Dehydration only makes the problem worse. In studies of bulimics, induces vomiting only removed 50% at best of what was contained in the stomach. Dehydration occurs because moms don’t drink, not because they can’t keep anything down. The nausea removes all desire to drink, and fear of vomiting makes that worse. Dehydration will lead to weakness, dizzy or lightheadedness, and more nausea. When mom is dehydrated her body tries to conserve fluid by concentrating the urine. Infrequent and dark urine is the best sign of dehydration.
Dr. Brady Benham
I hear this complaint a lot from pregnant patients including my wife when she was pregnant. Are there changes in pregnancy that cause these symptoms? The answer is yes. In pregnancy cardiac output goes up about 50%. Cardiac output is determined by heart rate and stroke volume. Stroke volume is how much blood the heart pumps every time it contracts. The stroke volume goes up as does the rate. Added to this is the increase in blood volume of 45% which all would result in extremely high blood pressures except that vessels in the body relax to increase capacity to offset these other changes. In fact the vessels tend to over compensate and blood pressure in pregnancy drops. These dynamic changes are subject to volatility. Normal events can result in dramatic and sudden drops in blood pressure that means less blood flow to the brain and passing out. These symptoms almost always occur when sitting or standing. They do not occur when lying down or walking. A perfect example is when a pregnant woman becomes lightheaded while standing in the check-out line at the grocery store. Walking around the store creates increased body heat. When standing in line to check out, the body comes to rest and mom rests by locking her knees and leaning on the grocery cart. The body wants to get rid of the excess heat, so it dilates the vessels. The vessels are our body’s radiator system. Suddenly mom feels her face flush with heat as the vessels dissipate the heat. With the increase in vessel size the blood pressure falls. You may feel your heart rate go up as it beats faster to try and make up for the lack of blood coming into it. At the same time the lack of muscle action in the resting legs allows large amounts of blood to pool in the legs. The result is passing out. These changes happen very quickly. The flushing heat in the face is a warning you are about to become very lightheaded. What to do? Pump the muscles in your legs. Get your head lower to the level of your heart. If you sit down, you still must get your head down because sitting allows even more pooling of blood in the lower body. Drink lots of fluid all the time. Stay cool, and get your feet up when you rest. Don’t try to rest your body while standing.
Doctor Brady Benham
Within the first 12 weeks of pregnancy there are mechanical changes to breathing. The chest wall expands. The diaphragm (the muscle that does most the breathing) relaxes more between breaths, and pulls down harder with each breath. The number breaths per minute stays about the same. These changes result in less air in the lungs between breaths and more air with breaths. The result is to move more air in and out of the lungs per minute than when not pregnant. This helps increase oxygen in the blood and breath off more CO2. This hyperventilation is mild but very important to getting more oxygen to your baby. For mom however, this can make them feel short of breath when in fact they are breathing very well. Yes, it is normal for mom to feel short of breath even in early pregnancy.
I hear a lot of complaints during pregnancy of acid reflux, 3rd trimester nausea and even vomiting, and hemorrhoids, and constipation. Are these more common in pregnancy? Yes, and gallstones as well! The data shows that during pregnancy the gallbladder is twice as full and empties slower. The end result is a greater opportunity for stones to form. If you get pain under the ribs on the right side after a meal rich in fats, you may have gallstones or sludge.
What about heartburn? The data shows that the sphincter in the esophagus which should prevent stomach contents from coming up, is loose during pregnancy allowing for reflux of stomach contents. Couple this with an enlarging uterus pushing on the stomach and you get acid coming up that can cause heartburn and or nausea. What to do? Use gravity, don’t lay down within 4 hours of eating. Take Tums to buffer the acid, take Zantac 150mg twice a day to reduce acid production.
When it comes to hemorrhoids, I always say there are two kinds of people in the world, those with hemorrhoids and those who will get them. There is a big increase in the hemorrhoid venous system during pregnancy, and these dilated veins are found around the anus. Sorry, not much you can do about the vascular system, but constipation makes it worse. This is more common in pregnancy due to decreased motility of the bowel and greater absorption of water in the colon. Drink, drink, drink, and lots of fiber in the diet.
Lastly, although not part of the gastrointestinal tract, I thought I would touch on the topic of kidney stones. Per the data, they are rare and occur in only about 1 in 2000-3300 pregnancy. Parkland Hospital in Dallas, Texas disputes this due to having a much higher rate. My experience is that while living in Illinois they were uncommon. My experience since coming to Utah is to call this Got Rocks Utah, because way too many pregnant women have rocks in their kidneys. I attribute this to the dry weather, minerals in the water, and lack of water intake in these conditions. Again, drink, drink, drink!
Brady Benham M.D.
I hear this complaint a lot from patients. Usually the symptoms are mild, but sometimes cause problems and may need medication to control. It all relates to the cardiovascular changes in pregnancy. Basically your heart, your blood volume, and your vessels (arteries and veins) undergo significant changes when you are pregnant, and most of those changes occur within the first 12 weeks. The blood volume actually increases on average about 45% during pregnancy. That is a big change and results in stretching the heart. The heart has 4 chambers that pump blood. The ventricles are very muscular and they pump the blood to your lungs and to the body. The atrium are 2 chambers on the top of the heart and they are thin walled and pump blood into the ventricles. With the increase in blood volume the atrium get stretched. Since the electrical conduction for the heat goes across the right atrium, it gets stretched as well. This can result in usually short bursts of rapid electrical conduction making the heart beat faster. If these symptoms last for more than a couple of minutes, it can decrease blood flow and make you feel like passing out. If you get palpitations lasting more than a couple of minutes or followed by feeling lightheaded, we need to know so you can be evaluated and treated.
Doctor Brady Benham