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Feeling warm from the hot summer weather is to be expected, but for certain women, hot flashes may be a sign that they are perimenopausal, the medical term for approaching menopause. In this article, we will cover common perimenopausal symptoms, demystify facts from fiction, and provide tips for effectively handling this stage of life.

What is Menopause?

A woman has reached menopause when her ovaries no longer produce the hormone estrogen. The official sign that menopause has arrived is 12 consecutive months without a period. This time signals an end to a woman’s fertility.

Naturally, menopause occurs at different times for each woman. Most women can expect to enter menopause between age 45 and 58. However, about 95% of women will encounter menopause between 45 and 55.  According to the American College of Obstetricians and Gynecologists (ACOG), the average age when women in the United States become menopausal is 51. The age at which periods began (menarche) has no impact on when menopause comes on.

Note that premature menopause can occur at a much younger age than 51 due to medical conditions or treatments such as chemotherapy or radiation therapy. Additionally, women who have their uterus and ovaries surgically removed during a  total hysterectomy or bilateral oophorectomy will experience surgical menopause. Since the ovaries are no longer present to produce hormones and the uterus is absent, these women immediately stop having periods and are likely to have pronounced menopausal symptoms.

What Does Perimenopausal Mean?

“Perimenopausal” refers to the time leading up to menopause during which a woman’s ovaries gradually produce less and less estrogen. The National Institute on Aging (NIA) states that this period typically lasts between seven and 14 years. The good news is that 40% of women have no noticeable symptoms during their perimenopausal time. The other 60% will experience different signs of approaching menopause in varying severity.

Also, just because perimenopause can last for years does not mean that a woman will experience symptoms during this entire time. While a decrease in estrogen defines the official beginning of perimenopause, a woman may not notice symptoms until a few months before menopause definitively arrives.

What are the Symptoms of Approaching Menopause?

Hot flashes are probably the most well-known perimenopausal symptom. While hot flashes are certainly a common problem for women approaching menopause, not all women will encounter this issue. Additionally, there are several other signs that are common in perimenopause. These are, in summary:

  • Hot flashes, often occurring during sleep
  • Trouble sleeping due to hot flashes and other causes like night sweats and chills
  • Moodiness and irritability, often exacerbated by lack of sleep
  • Decreased libido (sex drive) as well as pain during sex, often from vaginal dryness
  • Abnormal menstruation. Periods may be heavy, light, erratic, or any combination of the three.
  • Thinning hair
  • Weight gain from a slowed metabolism
  • Dry skin
  • Decreased breast fullness
  • Appetite changes
How to Address Menopausal Symptoms?

An OB-GYN is the medical specialist best suited to help women through menopause. Depending on the type and severity of symptoms, treatment can range from counseling to hormone therapy. At Dr. Garofalo’s office, Laury Berkwitt, APRN, specializes in women’s Hormone Replacement Therapy. Click here to request a consultation.

As a woman nears menopause, her body undergoes dramatic hormonal changes. Some would say that these changes are as significant as those experienced during puberty. Women can experience emotional issues during this time, not only as a result of hormonal fluctuations but also from the stress of dealing with other perimenopausal symptoms. It is important that women in this situation seek assistance from their support network, including their medical team.

Even though period changes are a normal part of menopause, women should always keep their OB-GYN aware of menstrual changes, just to make sure there is no underlying concern. Additionally, women should inform their doctors of all symptoms, including hot flashes and insomnia, and should tell their physicians about any depression and/or anxiety right away.

Hormone replacement therapy (HRT) to alleviate menopausal symptoms may be available if your OB-GYN deems it appropriate. These treatments can take the form of injections, pills, vaginal creams or gels, and transdermal patches. Many women find HRT to be enormously helpful in dealing with menopause.

Additionally, OB-GYNs and primary care physicians can offer invaluable advice on the management of symptoms, such as over-the-counter medications. They are also an excellent source of guidance on diet and exercise to combat the weight gain that many women notice during menopause.

Menopause often brings many changes to a woman’s body, but you do not have to go it alone. Turn to your OB-GYN and other healthcare providers for help with both physical and emotional issues during this time of transition.

About the Connecticut OBGYN Practice

Dr. John Garofalo, M.D., is a CT OBGYN based in Fairfield County, providing care for Norwalk, Darien, New Canaan, Weston, Rowayton and the surrounding areas. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.

Laury Berkwitt, APRN, is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Women undergoing signs and symptoms of menopause can make an appointment with Laury for Hormone Replacement Therapy. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for more than 10 years, caring for women of all ages.

The post Are Your Hot Flashes from the Summer Heat or an Early Sign of Menopause? appeared first on Dr. John Garofalo, OBGYN.

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An ectopic pregnancy is any pregnancy where the fertilized egg attaches and begins to grow outside of the uterus or womb. In a normal pregnancy, a fertilized egg develops into a fetus in the lining of the uterus. In an ectopic pregnancy, the fertilized egg implants elsewhere within the female reproductive system. Over 95% of the time, an ectopic pregnancy implants in the fallopian tubes, the tubes that run from the ovaries to the uterus. However, in rare cases, an ectopic pregnancy may occur in the cervix, intra-abdominal area, or another location.

The fertilized egg cannot grow appropriately in an ectopic pregnancy, and ectopic pregnancy may endanger the health of the mother. In the United States, ectopic pregnancies occur in 1 out of 50 pregnancies. This problem is the chief cause of pregnancy-related maternal deaths in the first trimester. As the fertilized egg grows outside the uterus, it can rupture internal structures and cause hemorrhaging.

As you can see, an ectopic pregnancy is a potentially serious condition. Here is information on causes of ectopic pregnancy and ways you can help prevent them from occurring.

Ectopic Pregnancy Causes

According to the American College of Obstetricians and Gynecologists (ACOG), the majority of women with an ectopic pregnancy have no known risk factors. However, doctors have identified several situations that increase the likelihood of experiencing an ectopic pregnancy. These include:

  • Previous ectopic pregnancy
  • Maternal age over 35 years
  • A history of pelvic inflammatory disease
  • Smoking
  • Fallopian tube surgery history
  • Previous infertility or fertility treatments
  • Conception with an intrauterine device (IUD) in place

Women who have had a previous ectopic pregnancy have about a 10% chance of having another ectopic pregnancy, on top of any other risk factors. As for maternal age, women over 35 have a greater likelihood of experiencing many types of pregnancy complications, including ectopic pregnancy. A history of smoking also increases the risk of ectopic pregnancy.

Another risk factor for ectopic pregnancy is pelvic inflammatory disease (PID). PID is a bacterial infection of the reproductive organs and is usually caused by gonorrhea and/or chlamydia, sexually transmitted diseases. Some PID cases are accompanied by no obvious symptoms, but signs can include pelvic pain, pain during sexual intercourse, and burning when urinating. Fortunately, treatment with specific antibiotics is usually successful against PID.

You also stand a greater chance of developing an ectopic pregnancy if you’ve had surgery on your fallopian tubes – a tubal ligation (tubes tied), for example. Furthermore, getting pregnant with an IUD in place is extremely rare, but this occurrence dramatically raises the likelihood of ectopic pregnancy. Up to 53% of pregnancies that happen in the presence of an IUD are ectopic pregnancies.

Finally, a history of female fertility problems is a risk factor for ectopic pregnancies, particularly if you have received medical or surgical treatments for the issues. Such treatments include fertility drugs, hormonal therapy, in vitro fertilization (IVF), and other treatments using assisted reproductive technologies.

Lowering the Risk of an Ectopic Pregnancy

Although it is not possible to totally eliminate the chance of an ectopic pregnancy, there are ways to lower your risk. You can decrease your chances of developing PID by limiting your number of sexual partners and using condoms to protect against sexually transmitted infections.

Detection of an ectopic pregnancy is paramount so that your OB-GYN can treat the condition and avoid the possibility of rupture. While pelvic pain and vaginal bleeding may occur, many ectopic pregnancies produce no symptoms. For this reason, it is important that you visit your OB-GYN as soon as you suspect you are pregnant. Even better, schedule an appointment with your OB-GYN as soon as you decide to try to become pregnant.

A transvaginal ultrasound, which is a specialized imaging procedure, is usually required to diagnose an ectopic pregnancy. Your doctor may also use blood tests to aid in diagnosis. Some ectopic pregnancies can be addressed with medication, while others require surgical treatment.

Even if you have no risk factors for ectopic pregnancy, early prenatal care is crucial. Schedule an appointment with your OB-GYN, and give them a complete and honest account of your medical history, habits, family medical history, and more. Ectopic pregnancy may not be completely avoidable, but together with your doctor, you can maximize your chances of a healthy pregnancy.

About the Connecticut OBGYN Practice
Dr. John Garofalo, M.D., is a CT OBGYN based in Fairfield County, providing care for Norwalk, Darien, New Canaan, Weston, Rowaytan and the surrounding areas. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.

Laury Berkwitt, APRN, is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for more than 10 years, caring for women of all ages.

John Garofalo, MD, and Laury Berkwitt, APRN, can be reached for personal consultations and well-woman exams by calling 203.803.1098.

The post Ectopic Pregnancy Causes & How to Help Prevent It appeared first on Dr. John Garofalo, OBGYN.

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Learn the Facts about Postpartum Depression and this New Medication

The Centers for Disease Control and Prevention (CDC) reports that approximately 20 percent of new mothers are affected by some degree of postpartum depression. While treatments for postpartum depression have long been available, there has never been a drug specifically intended to address this potentially serious condition — until now. The approval of brexanolone (brand name Zulesso) by the Food and Drug Administration (FDA) represents a promising step forward for women suffering from postpartum depression and offers new hope for both them and their loved ones.

Read on for more detailed information on postpartum depression as well as the possible benefits and side-effects of taking Zulesso.

What is Postpartum Depression?

A woman’s body undergoes profound hormonal changes during pregnancy and for some time after delivery. These changes have well-known physical effects, but they can also have a psychological impact. Many women can experience depressive symptoms during pregnancy and after childbirth, a condition colloquially known as “baby blues.” Postpartum depression is the medical term for this occurrence which has some some common symptoms, including: anxiety, irritability, mood swings, sleep difficulties, unexplained sadness, lethargy, and loss of appetite. Postpartum depression typically appears soon after childbirth, around three to four days after delivery, but its onset may be delayed for months. This feeling is a normal part of childbirth, but if it lasts for longer and does not go away within 10 days after delivery, it may be time to speak with your doctor.

Postpartum depression not only affects the mother, but it can also hinder maternal bonding with the newborn. This condition is often accompanied by intense feelings of guilt. New mothers may feel that they are responsible for their depression and are “insufficiently maternal.” In reality, postpartum depression is caused by biochemical factors such as shifts in hormones and neurotransmitter levels.

Treatments Before Zulesso

Before the arrival of Zulesso, a drug intended for moderate to severe postpartum depression, treatments for postpartum depression mainly consisted of generalized antidepressant medications and psychological counseling. Although these treatments were often helpful, there were several drawbacks to the pharmaceutical use. For example, antidepressant therapy can often take several weeks before producing noticeable results. Also, some antidepressant medications cannot be used by women who are breastfeeding.

How is Zulesso Different?

One of the primary benefits of Zulesso over pre-existing medication is its rapid action. As reported by the American College of Obstetricians and Gynecologists (ACOG), women taking Zulesso showed improvement in their depression symptoms as soon as 48 hours after initiating treatment. This brief onset of action could be greatly beneficial to women experiencing postpartum depression soon after the birth of their child, as successful treatment could allow them to begin bonding with their infant earlier than was previously possible.

Unlike most other antidepressant medications, Zulesso acts on the gamma-aminobutyric acid (GABA) system in the brain. The GABA system is largely responsible for mediating stress responses like fear and anxiety. According to Dr. Kristina Deligiannidis, lead researcher on the Zulesso clinical trials, the stress response system does not act normally in women experiencing postpartum depression. Since Zulesso inhibits this system, it is specifically intended to treat postpartum depression.

Potential Drawbacks and Risks

Zulesso seems promising, but there are some considerations to think about before taking this new drug. First, Zulesso is not currently available as an oral medication. It must be received through an intravenous (IV) infusion, and this infusion cannot be performed at home. Women receiving Zulesso must have their infusion in a clinic under medical supervision. The infusion time is lengthy. While Zulesso begins to act rapidly, the total infusion time is 60 hours or two-and-a-half days.

This means a woman must spend over two days away from her home. Additionally, breastfeeding must cease for seven days after a new mother receives Zulesso. These restrictions may place a burden on women experiencing postpartum depression and cause some OB-GYNs to doubt that the drug will become a first-choice treatment for the condition.   

There are also some reported side-effects that may occur with Zulesso. These include headaches, dizziness, and insomnia. Loss of consciousness was a rarely-experienced side effect, and this possible occurrence is one reason for the required medical monitoring during Zulesso infusion.

Postpartum depression is a recognized medical condition that your OBGYN can help you treat. You should always let your OB-GYN know if you experience anxiety, depression, listlessness, or any other symptoms during your pregnancy or after your delivery. If you have any questions regarding postpartum depression treatment, you can contact Dr. Garofalo here.


About the Connecticut OBGYN Practice

Dr. John Garofalo, M.D., is a CT OBGYN based in Fairfield County, providing care for Norwalk, Darien, New Canaan, Weston, Rowaytan and the surrounding areas. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.

Laury Berkwitt, APRN, is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for more than 10 years, caring for women of all ages.

For more information, go to www.garofaloobygn.com. John Garofalo, MD, and Laury Berkwitt, APRN, can be reached for personal consultations and well woman exams by calling 203.803.1098.

The post FDA Approves First-Ever Postpartum Depression Drug appeared first on Dr. John Garofalo, OBGYN.

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Amenorrhea is the absence of menstruation of one or more menstrual periods. A woman is considered to have amenorrhea if she has missed at least three periods in a row or if she has not received their first menstrual cycle yet. In other words, amenorrhea is the term for when you do not have periods. Here are six facts about this condition, including possible causes.

Fact 1: There are two types of amenorrhea.

The first major type of amenorrhea, primary amenorrhea, is really a delay in menarche. Menarche is the onset of menstruation at the beginning of puberty. While menarche starts at different ages, it usually begins by the age of 15. If a girl has not had her first period by 15, she is experiencing primary amenorrhea and should be seen by an OB-GYN to determine the cause.

Secondary amenorrhea, on the other hand, is defined by the American College of Obstetricians and Gynecologists (ACOG) as the absence of menses for three or more cycles, after the establishment of regular menses. Simply put, secondary amenorrhea is when you miss your period for at least three months. There are many possible causes of secondary menorrhea which we will discuss below, but you should know that it is a good idea to consult your OB-GYN before a full three months of missed periods.

Fact 2: The most common cause of amenorrhea is not a medical disorder.

As you may have guessed, the top cause of amenorrhea is not a medical disorder. It is pregnancy. For many women, the first sign of pregnancy is a missed period, and a pregnancy test is one of the first diagnostics your doctor will perform when investigating amenorrhea.

Fact 3: Primary amenorrhea does not necessarily indicate a problem.

Some girls get their first period at 11 or 12, or even earlier. While most girls will reach menarche by 15, the failure to have a period by this age does not necessarily mean there is a medical issue. Just as some girls begin to form breasts later than others, every girl reaches menarche in their own time.

Still, primary amenorrhea does need to be evaluated. Sometimes late menarche may run in a family, but your OB-GYN will need to conduct tests to ensure there are no medical issues. These tests may include an ovary function test where important hormone levels like follicle stimulating hormone and luteinizing hormone numbers are measured. A pregnancy test is also a standard diagnostic for primary amenorrhea.

Fact 4: Certain contraceptives can cause amenorrhea.

Pharmaceutical contraceptives, such as birth control pills, injectable contraceptives and intrauterine devices (IUDs) can cause a woman’s period to stop. Since some contraceptives introduce new hormones to a woman’s body, it can affect their menstruation cycle. In some cases, even after a woman stops taking contraceptives, it can take a few weeks for regular menstruation to return. When considering birth control, ask your doctor about any possible side effects to your period.

Fact 5: Your weight can cause secondary amenorrhea.

Women who are overweight, as well as those who are extremely underweight, may experience secondary amenorrhea. Getting back to a healthy weight under the guidance of a physician can help to restore normal periods.

Even women with normal body mass indexes (BMIs) may experience amenorrhea if their body fat percentage is too low. For example, female athletes and competitive bodybuilders can develop amenorrhea due to very low percentages of body fat. The Mayo Clinic states that even being 10 percent below a normal BMI can disrupt regular menstruation cycles. While athletics and exercise are generally healthy, having too little body fat can interfere with hormone production and cause issues with menstruation, fertility, and other functions.

Being overweight is linked to a number of health conditions, including amenorrhea. Being overweight can cause your body to produce excess hormones, including estrogen and testosterone, and result in a disruption of menstruation.

Fact 6: Effective amenorrhea treatment depends on the cause.

Amenorrhea can be successfully treated in many cases, but the type of treatment depends on the cause of the amenorrhea. For instance, birth control pills or hormonal therapy may help to “jump start” your menstrual cycle if you have polycystic ovarian syndrome (PCOS) or primary ovarian insufficiency (POI). Surgery may be necessary in other cases like uterine scarring.

Sometimes amenorrhea does not have a gynecologic cause; a tumor of the pituitary gland is one example. These are non-cancerous tumors that may interfere with the productions of hormones crucial to menstruation. Pituitary tumors are usually treated with a combination of surgery and radiation.

Whatever the ultimate cause of your amenorrhea, treatment begins with an evaluation from your OB-GYN. If you are:

  • missing periods
  • having unusually heavy periods
  • having irregular periods
  • having painful periods

If you have any questions about abnormal bleeding or amenorrhea,  you can schedule a consultation at Dr. Garofalo’s practice by clicking the button below.


About the Connecticut OBGYN Practice

Dr. John Garofalo, M.D., is a CT OBGYN based in Fairfield County, providing care for Norwalk, Darien, New Canaan, Weston, Rowaytan and the surrounding areas. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.

Laury Berkwitt, APRN, is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for more than 10 years, caring for women of all ages.

For more information, go to www.garofaloobygn.com. John Garofalo, MD, and Laury Berkwitt, APRN, can be reached for personal consultations and well woman exams by calling 203.803.1098.

The post Amenorrhea in Women: 6 Facts You Should Know appeared first on Dr. John Garofalo, OBGYN.

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Human papillomavirus (HPV) is a widespread sexually-transmitted infection (STI). In fact, The Centers for Disease Control and Prevention (CDC) reports that HPV is the most common STI in the United States, with nearly 80 million people infected. The virus is easily transmitted through sexual contact and occasionally may be transmitted without sexual contact.

Anxiety and trepidation are normal reactions to any abnormal medical test result. However, as is the case with most viral infections, a healthy person’s immune system will usually eliminate HPV without the need for medical treatment. Therefore a positive HPV test is usually not linked to an ominous diagnosis. In the small minority of individuals with HPV infections that persist for many years, there is an increase in the risk of developing precursors to cervical cancer (dysplasia), which may eventually develop into cervical cancer.

A positive HPV result will usually call for further testing to better investigate your risk of cervical cancer. Here is what you can expect next if you have a positive HPV test result.

HPV Testing and Pap Smear Results

HPV testing typically occurs during cervical cancer screening, which consists of a pelvic examination, Pap test, and sometimes HPV testing. The HPV test is usually only given to women age 30 and older, or women who have had abnormal Pap test results. HPV testing in conjunction with Pap testing is more accurate at detecting cervical cancer than Pap testing alone in women over 30.

While the HPV test alone does not check for abnormal or cancerous cervical cells, a positive HPV test result indicates that you have at least one of the HPV strains that has been linked to cervical cancer. If your Pap smear is abnormal or you have two or more separate, positive HPV tests, your OB-GYN will likely recommend additional testing to check for cervical cancer.

Repeat Testing

If you pap smear is normal and your HPV test is positive, your OB-GYN will usually recommend simply repeating your Pap smear and HPV test in 12 and 24 months.  If the repeated testing comes back without abnormalities, you can go back to a normal screening schedule. If the virus is still present on the repeated Pap test or there are changes present, patients will undergo additional tests.

Further Testing

If indicated, your OB-GYN may order further testing to rule out or confirm cervical cancer. If severe cell changes are detected or evidence of the HPV16 or HPV 18 strand is detected, a colposcopy procedure may be recommended. This is a procedure where your doctor uses a scope to examine your cervix and vagina internally. A colposcopy does not typically require hospitalization and can be done on an outpatient basis.

During the colposcopy, your OB-GYN will be searching for signs of cancer as well as other diseases. They will be looking for inflammation, warts, and anything else they deem suspicious. If your physician does find something concerning, they may elect to take a cervical biopsy. during which they will remove tissue for later analysis by a pathologist. The pathologist will look for abnormal cells or tissue changes that indicate cancer.

Watchful Waiting

If further testing is negative for cervical cancer or your OB-GYN does not believe such testing is necessary in your case, they may recommend a strategy of watchful waiting. This means that you will need to continue your cervical cancer screening and other well-woman care, including regular HPV testing and Pap tests. Your OB-GYN may keep you on the routine schedule, or they may recommend an increase in testing frequency.

Points to Keep in Mind After a Positive HPV Test

Remember, HPV is the most common sexually transmitted infection in the U.S. and is especially prevalent among young adults. Approximately 80% of men and women who are sexually active will come into contact with HPV at some point during their lives. The HPV test is a tool to help assess cervical cancer risk, and a positive HPV test is not the same as a diagnosis of cervical cancer.

Your OB-GYN will want to investigate a positive HPV test result further out of caution. If cervical dysplasia is present, is can almost always be treated with minor procedures that will eliminate your risk of cancer without limiting your future fertility.

Please do not hesitate to ask your OB-GYN about what your test results mean, their treatment plan, and any other inquiries or concerns you have. Your doctor can help support you with their knowledge and experience as you face any health questions together.

The post What to Do Next After a Positive HPV Test Result appeared first on Dr. John Garofalo, OBGYN.

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Pregnant women and their unborn children are particularly vulnerable to many common infections. While these infections may not normally impact the general population, they are exceptionally dangerous for expectant mothers and can cause serious health problems. There are several steps you can take to prevent prenatal infections in both yourself and your baby. Here is a compendium of critical tips from the Centers for Disease Control and Prevention and the American Academy of Pediatrics.

1. Leave Some of the Pet Care to Someone Else

Pets can be wonderful companions, but can also present an infectious threat to pregnant women and unborn children. Specifically, pregnant women should avoid cleaning cat litter boxes due to the danger of toxoplasmosis, a life-threatening disease caused by a parasite that lives in cat feces. This disease can also be transmitted from mother to fetus. If this can’t be avoided, wearing protective gloves and thoroughly washing your hands afterward is recommended.

Pregnant women should also refrain from interacting with pet rodents (hamsters, guinea pigs, mice, rats, etc.) and pet reptiles. All wild animals, even animals that seem harmless like small lizards and turtles, should also be avoided while you are pregnant. These animals can carry a virus called lymphocytic choriomeningitis virus (LCMV) that can lead to severe birth defects and even miscarriage.

2. Become Up to Date on Your Vaccinations

It is crucial for pregnant women to have all their vaccinations for the sake of themselves and their children. This includes the annual flu vaccine. All professional healthcare organizations strongly encourage pregnant women to receive this vaccine and agree that the flu shot is safe for the mother and her baby. Being pregnant puts women in a high-risk group for developing life-threatening infections that are flu-related. The flu shot is the best protection available against contracting influenza and avoiding complications.

If you scheduled an upcoming prenatal appointment with Dr.Garofalo, you can also receive a flu vaccine at this time. When booking your next appointment, let us know that you’re interested in receiving a flu vaccine, and we will be happy to include it in your next appointment. 

The CDC also recommends that expectant mothers receive the whooping cough (pertussis) vaccine. While this is a serious illness for mothers, for unborn children, this can be life-threatening.

Check with your primary care physician and OB-GYN to ensure you are protected against preventable illnesses. Maintaining vaccinations during pregnancy transfers protection from the mother to the unborn baby.

3. Be Vigilant About What You Eat

You may notice some strange food cravings during your pregnancy, but always be cautious about what you eat. Undercooked or raw meats, eggs, fish, and shellfish can be a potential threat due to parasites and bacteria. Be sure to have your meals well done with juices that run clear and are free of any blood. Deli meat is another food item that pregnant women should avoid. This is due to possible Listeria contamination. Listeria is dangerous because it has the potential to transfer into the placenta and cause prenatal infection. 

Consuming any raw (unpasteurized) milk or dairy products, including cheese is also not recommended. Dangerous microorganisms such as Salmonella, E. coli, and Listeria that can be found in unpasteurized dairy can pose a serious health risk to your unborn baby.

4. Avoid Traveling to Certain Areas

If pregnant, always consult with your doctor before traveling outside of the United States. Some regions have endemic diseases (such as malaria) that are dangerous for pregnant women. A vaccination may be required before visiting certain regions in Africa, Asia, the Caribbean and Central America. Depending on the location of your trip, your OBGYN may suggest delaying travel until after your delivery.

Zika virus, carried by mosquitoes, is a particular threat to expectant mothers. Women and their sexual partner should not travel to Zika endemic areas starting six months prior to conception and throughout pregnancy.

There is currently no vaccination against the virus; adhering to these precautions is critical.

5. Undergo Testing for Sexually Transmitted Infections (STis) and Other Infections

Testing for some STIs, such as chlamydia, HIV, and syphilis, is part of standard prenatal care. However, your OB-GYN may order additional testing if you meet certain risk factors. It’s important to always be honest with your physicians about your past medical history and sexual activity. Your doctors are not there to judge, but rather to provide the best care possible for you and your baby.

Group B Strep (also called GBS) is another infection that can potentially harm newborns. This is a bacterial infection that can be treated with antibiotics if identified. Group B Strep testing is simple and consists of a quick swab of your vaginal and anal area.

6. Avoid Sick People

Pregnant women can minimize their chances of contracting many viral and bacterial infections by avoiding those who are actively ill. You should avoid contact with friends or family members who have a cold, the flu, a sinus infection, etc. If the sick person is a member of your household, try to isolate yourself from them as much as possible and do not handle their items.

7. Always Wash Your Hands

Finally, frequent hand washing is always of the utmost importance. Hand washing with warm water and soap is one of the best ways to prevent the spread of disease even when you are not pregnant. Wash your hands many times a day – before and after meals, before and after using the bathroom, and any other time you may be exposed to contaminants. Carry a bottle of alcohol-based hand sanitizer so that you can still clean your hands if you do not have access to soap and water.

The most important action you can take to reducing your risk of prenatal infection is to follow the advice of your healthcare team. If you’d like to request a consultation at Dr. Garofalo’s practice, please click the button below.

The post 7 Critical Steps for Preventing Prenatal Infections During Pregnancy appeared first on Dr. John Garofalo, OBGYN.

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Every year, nearly 13,000 women in the U.S. are diagnosed with cervical cancer. One of the most effective ways for reducing your chances of developing cervical cancer is to receive the human papillomavirus (HPV) vaccine. This vaccine can help prevent the vast majority of cervical cancer cases.

Early detection can improve the chances of successful treatment. The best way to detect cervical cancer early is through regular screening with a Pap test. By monitoring for abnormal cells in your cervix, your OB-GYN can identify cancerous or precancerous conditions before they progress. Early detection means treatment for cervical cancer can begin sooner, leading to higher survival rates. The primary surveillance methods for cervical cancer are pelvic examinations that include Pap smears.

What is a Pelvic Examination with a Pap Smear?

During a “pelvic examination,” your OB-GYN examines your inner and outer genitalia and reproductive organs. They check for general health and signs of many conditions, including sexually-transmitted infections, pelvic organ prolapse, and cervical cancer. During a pelvic exam, your OB-GYN may remove cervical cells using a gentle brushing technique. The specimen is then examined in a laboratory to check for abnormal cells. This procedure is called a Pap smear.

When Should I First Have a Pelvic Exam and Pap Smear?

For most women, this answer is at 21 years old, according to the American College of Obstetricians and Gynecologists (ACOG) as well as the Centers for Disease Control and Prevention (CDC). However, there are conditions that may necessitate testing women before age 21. These conditions include women with HIV infections, prior cervical cancer patients, and women with weakened immune systems. Your OB-GYN will let you know if you fall into this category.

Once you have your first pelvic exam, you will need another exam every three years until the age of 29, assuming all your testing is negative. Once you turn 30, you will likely be able to have a pelvic exam and Pap smear every five years. However, beginning at age 30, you will also likely need to also receive HPV testing, which can be performed at the same time as your pelvic exam and Pap smear.

Why Do I Need HPV Testing?

Researchers have found an extremely strong link between HPV infections and cervical cancer. In fact, upward of 90% of all cervical cancer cases are associated with an HPV infection. There are numerous strains of HPV. However, about 13 strains are thought to be high-risk for cervical cancer. Testing for these HPV strains will let your OB-GYN know if more frequent monitoring is needed or further, more invasive tests – like a colposcopy (examination of your cervix with a scope) or cervical biopsy – are warranted. It is important to note that you still need HPV testing even if you received the HPV vaccine. 

Should I Stop Testing for Cervical Cancer?

Most women no longer need pelvic examinations for cervical cancer, Pap smears, or HPV testing past the age of 65, as long as their recent results have all been normal. You may be able to stop testing at a younger age, especially if you have had your cervix surgically removed for a non-cancerous condition. For a definitive answer, ask your OB-GYN.

However, most women who have undergone a hysterectomy without cervix removal still need testing up to age 65. During some types of hysterectomies, only the uterus is removed, not the cervix. So, these women will still require standard testing for cervical cancer.

Do Abnormal Results Mean I Have Cervical Cancer?

Not necessarily. An abnormal Pap smear means that the laboratory detected abnormal cells. This is not a definitive cancer diagnosis. The smear may need to be repeated, or you may need different diagnostic testing.

A positive HPV test also does not necessarily indicate cancer. However, a positive test is likely a reason for more diligent and frequent monitoring.

Unlike other types of cancer, cervical cancer is that it is generally slow to progress than other cancer types. Most cases take anywhere from three to seven years to become advanced. This slow progression means that regular examinations and testing are of the utmost importance so that treatment can begin before the cancer spreads. 

Take time this January and every month to be mindful of cervical cancer risks, and do not neglect your pelvic examinations. You can schedule an appointment with Dr. John Garofalo, OB-GYN, by clicking here.


The post How Often Should I Receive Cervical Cancer Screening? appeared first on Dr. John Garofalo, OBGYN.

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Women from all walks of life can suffer from disruptive symptoms secondary to pelvic floor dysfunction. The pelvis encircles multiple vital structures in women, such as the uterus, bladder and rectum. The muscles that support these structures are known as the pelvic floor.

The pelvic floor can become weakened from childbirth, obesity and even the natural aging process. Several problems may arise from pelvic floor weakening, such as urinary incontinence, fecal incontinence and pelvic organ prolapse. When the pelvic floor is hypertonic, or too tense, pelvic pain or painful intercourse may occur as well. We refer to this as pelvic floor dysfunction.   

While surgery may be necessary to correct pelvic floor dysfunction, the problem can often be addressed with pelvic floor rehabilitation.  This form of rehabilitation is non-surgical, safe, and “trains” women with pelvic floor dysfunction to strengthen or relax the muscles in the pelvic area. 

In addition to surgical management, Dr. Garofalo’s office offers pelvic floor rehabilitation to help women suffering from these common gynecological complaints. If you feel you may be experiencing pelvic floor dysfunction, schedule a consultation with Laury Berkwitt by clicking here.

Here are the top three benefits of undergoing pelvic floor rehabilitation for women:

1. Pelvic Floor Rehabilitation Improves Incontinence Issues

One of the most common complaints in gynecological care is urinary incontinence. The leakage may be severe such as complete, unexpected emptying of the bowels or bladder – or more subtle, with leaking only a few drops of urine when sneezing or laughing. Further incontinence problems may include urinary urgency, fecal leakage, urinary frequency, and urination during sleep. 

Pelvic floor rehabilitation is especially helpful for incontinence problems. A qualified healthcare provider can address these issues by retraining the pelvic floor musculature in the office through the use of biofeedback therapy, employing behavior modification techniques, and creating individualized home exercise programs for patients. You can learn more about our pelvic floor rehabilitation treatment plans here.

2. Pelvic Floor Rehabilitation Improves Organ Prolapse

The pelvic floor muscles form a sort of sling, supporting many of the pelvic organs. When these muscles and associated connective tissues weaken, the organs may drop into the lower pelvic cavity. Often, this drop is not noticeable to the patient and is only discovered by a physician during a pelvic examination. However, organs may noticeably protrude, or prolapse, from the vagina, which can be very bothersome to women.   

Common causes of prolapse include vaginal trauma such as childbirth, pelvic pressure from being overweight, straining from constipation, frequent heavy lifting, and simply aging. In fact, most women with pelvic organ prolapse are post-menopausal, although the problem can strike younger women as well. 

Pelvic floor rehabilitation has been shown to improve pelvic organ prolapse by strengthening the pelvic floor musculature. Clinical studies show that rehabilitation will not reverse prolapse, but can slow its progression. 

3. Pelvic Floor Rehabilitation Decreases Pelvic Pain

There are many possible causes of pelvic pain. We now know that pelvic floor dysfunction may be the cause for pelvic pain. In many cases of pelvic floor dysfunction, women experience pain with urination or pain during intercourse. Rehabilitation may help to significantly reduce this pain.

Through the use of biofeedback in the office, patients can learn how to identify and relax the pelvic floor musculature. Home exercises, stretches and the use of breathing techniques may also help improve pelvic pain. Adherence to these exercises can go a long way toward improving pelvic pain. 

If you are experiencing pelvic pain, a sensation of pelvic fullness, incontinence, or other problems, it is important that you contact your OB/GYN for a definitive diagnosis and treatment plan. We can develop a pelvic floor rehabilitation plan that is right for you. To schedule a consultation with Laury Berkwitt, click the button below.


The post 3 Benefits of Undergoing Pelvic Floor Rehabilitation for Women appeared first on Dr. John Garofalo, OBGYN.

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Ask any doctor and they’ll tell you… One of the most important parts of their job is to answer patients’ questions accurately and thoroughly. By providing this education, we can develop a stronger patient-provider relationship and empower women to make the most informed health decisions possible. Answering reproductive questions daily in our Connecticut office, we think it’s helpful to share the most common questions about women’s health, specifically those concerning female reproduction, as well as our answers.

Of course, your reproductive questions and concerns are best addressed with an in-person consultation with Dr. Garofalo. You can set up an appointment by clicking here.

1. How do I know when I am fertile?

A woman can become pregnant when she is ovulating. There are some telltale signs of ovulation that, while not certain, may clue you into when you’re most fertile. One is the nature of your cervical mucus. This mucus will often be transparent and sticky during ovulation.

Increased breast tenderness and sensitivity is another sign that some women experience when ovulating. However, one of the best ways to predict your most fertile days is by charting your monthly cycle. Ovulation peaks around 14 days before the beginning of your next period. If you have irregular periods, speak with your OB-GYN about other possible methods of determining your ovulation days.

2. How long does it typically take to become pregnant?

There is no “typical” timing scenario when it comes to conception. Every situation is unique. But according to the UK’s National Health Service, about 84% of couples successfully conceive within one year of consistent, unprotected sex. If you haven’t conceived after a year of trying, it’s certainly time to visit your OB-GYN. However, you do not have to wait a full year. You should feel free to ask your OB-GYN for guidance as soon as you feel you’re having difficulty conceiving.

3. Should I visit my doctor before I start trying to conceive?

Yes. Good prenatal care begins even before conception. It’s an excellent idea to see your OB-GYN for a physical exam and to begin important prenatal supplements before attempting to conceive.

4. What is the best day of my cycle to have intercourse to become pregnant?

Ovulation typically begins 12 to 14 days before your period starts, so anytime during this interval are the best times to try to conceive. Of course, increasing the frequency of intercourse a few days earlier or later will help the odds of conception.

5. Does progesterone supplementation help to prevent miscarriage?

With the exception of pregnancies conceived with In-Vitro-Fertilization (IVF), no studies have yet to support progesterone supplementation as a means to prevent miscarriage. As summarized in this publication by Harvard Medical School, the unfortunate truth is that doctors do not know the exact cause of every miscarriage. However, you can help reduce your chances of miscarriage with consistent prenatal care, exercise, a healthy diet, and avoiding harmful substances like alcohol, tobacco, and illicit drugs.

6. Is it safe to have sex during pregnancy?

Yes, it is almost always safe to have sex during pregnancy. As reported by the Mayo Clinic, there are some rare medical conditions where your OB-GYN may advise refraining from intercourse, but these are few and far between. Your partner will not injure the baby during sex, even in the third trimester, as the amniotic sac and amniotic fluid ensure your baby is well-protected.

7. Are vaccines safe in pregnancy?

Yes, vaccines are safe during pregnancy. It is especially important for pregnant women to receive the influenza vaccine. The Centers for Disease Control and Prevention (CDC) points out that pregnancy can lower your immune response and that pregnant women are more susceptible to the flu than women who aren’t pregnant. Vaccination is of the utmost importance for both your own health and the health of your unborn child. Vaccines stop the spread of preventable illnesses every day, and side effects are incredibly rare and mild.

8. How does my age affect my fertility?

Women reach peak fertility around their late teens to early twenties. Your chances of conceiving naturally gradually start to decline as you age. Female fertility decreases significantly in the mid-thirties, bottoming out at approximately age 40 to 45.

Pregnancy complications are more frequently seen in older women. For example, mothers over 40 have a greater risk of preeclampsia. Birth defects are also more common in children born to older mothers, particularly chromosomal abnormalities like Down syndrome. A woman who is 20 years old has a one in 1,480 chance of having a child with Down syndrome. This risk climbs dramatically to 1 in 85 among mothers who are 40 years old.

Have reproductive questions of your own?

Your OB-GYN’s office should be your first stop for fertility issues and reproductive questions. They can often help, and, if necessary, refer you to a specialist in fertility medicine.

About the Connecticut OBGYN Practice

Dr. John Garofalo, M.D., is an OBGYN located in Fairfield County, Connecticut, providing care for Norwalk, Darien, New Canaan, Weston, Rowaytan and the surrounding areas. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.

Laury Berkwitt, APRN, is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Laury has a passion for providing quality women’s healthcare in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for more than 10 years, caring for women of all ages.

For more information on preparing for labor or prenatal care, schedule a new patient consultation online by clicking below.


The post We Answer The Top 8 Women’s Reproductive Questions appeared first on Dr. John Garofalo, OBGYN.

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Annual flu shots are an easily-accessible and preventative measure for almost everyone. The flu is much more than simply a bad cold. Although both the common cold and the flu may cause upper respiratory symptoms, influenza can be serious and even fatal. As reported by CBS News, around 80,000 Americans died from the flu and related complications during the winter of 2017/2018. The flu leaves patients open to other life-threatening infections like pneumonia. It is especially crucial that high-risk groups be vaccinated against the flu every year. These groups include the elderly, young children, and pregnant women.

If an expectant mother neglects to get the flu shot, she potentially puts both herself and her unborn child at risk. Yet, according to The Centers for Disease Control and Prevention (CDC), only half of pregnant women in the United States receive the flu vaccine. Here are specific reasons why obtaining the flu vaccine is an integral part of prenatal care.

1. The Flu Shot Protects Pregnant Women

Pregnancy puts a lot of stress on a woman’s body as she undergoes profound biological changes. One of these adjustments is a weakened immune system, which makes pregnant women more susceptible to serious illnesses than the general population, and the flu is no exception. The CDC states that unvaccinated pregnant women tend to contract the flu at greater rates than unvaccinated women who are not pregnant. Additionally, cases of influenza are likely to be more severe in pregnant women than in the general population.

The optimal treatment for any illness is never to develop the illness in the first place. The flu shot is the best protection available against contracting influenza and is certainly better than risking complications from the flu.

2. The Flu Shot Protects Babies

Influenza in pregnant women is associated with an increased number of severe birth defects in their unborn children, such as defects of the heart, brain or spine. The flu also produces a greater likelihood of miscarriage. Receiving the flu vaccine while pregnant goes a long way towards protecting unborn children from devastating health consequences.

Furthermore, the flu vaccine brings some immunity to infants after they are born. A child cannot receive the flu shot until they are at least six months old. But, if the mother received the vaccine while the child is in the womb, then the newborn will still have a degree of protection against the flu.

3. The Flu Shot is Safe for Pregnant Women and Their Babies

Pregnant mothers can safely receive the flu shot. The flu vaccine does not cause fever, coughing, the flu itself, or any other illness. The only reaction may be some soreness at the injection site – a small price to pay to safeguard the health of mother and child.

The vaccine also has no adverse effects on fetal growth and development. There is absolutely no reliable evidence that the influenza vaccine, or any vaccine, causes or contributes to autism in children. The few studies that suggested such have been thoroughly discredited. Conversely, there have been dozens of studies that demonstrated the safety of vaccinations for mothers and babies time and time again.

4. Experts Recommend the Flu Shot

All professional medical organizations strongly encourage pregnant women to receive the flu vaccine and agree that the flu shot is safe for expectant mothers and children. These groups include the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics who state, “Influenza vaccine should be given to all women who are pregnant, considering pregnancy or are in the postpartum period or are breastfeeding during the flu season.” The CDC also asserts the flu vaccine is safe for pregnant women and even directs healthcare providers to preferentially administer the vaccine to these women when there is a shortage of flu shots. Even for women who were previously cautious given their egg allergy, this allergy is no longer considered a contraindication and there is now a flu vaccine available where it has not been made in egg culture.

In summary, virtually all pregnant women should receive the flu vaccine no matter how far along they are in their pregnancy. The flu shot is safe and remains the best safeguard against the flu’s potentially dire effects on mothers and children.

Schedule a Flu Shot at Your Next Appointment

Did you know you can get a flu shot at an upcoming prenatal appointment? When booking your next appointment with Dr. Garofalo, let us know that you’re interested in receiving a flu vaccine, and we will be happy to include it in your next appointment. If you’re ready to schedule your next appointment online, please click the button below.


The post 4 Reasons to Get a Flu Shot If You’re Pregnant appeared first on Dr. John Garofalo, OBGYN.

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