Dr. Yadalla is Board
Certified in Obstetrics and Gynecology and is a Fellow of The American Congress
of Obstetricians and Gynecologists (FACOG). She offers a full range of OBGyn
services at the MCH ProCare Women’s Clinic and can be reached at (432)
Body changes during early pregnancy
many body changes in women. In early pregnancy, most symptoms begin at about six
weeks. Every pregnancy, and every woman, is different … so some women can
experience symptoms sooner than six weeks and some will experience symptoms
later than six weeks. Some women do not experience symptoms of early pregnancy
Body changes in the first trimester
Very early in the first trimester (one to two weeks after
conception), some women notice vaginal spotting or light bleeding when the
fertilized egg implants in the uterus. This is also known as “Implantation
Due to softening of the cervix, it is common to spot or
bleed after intercourse, especially in early pregnancy.
Light abdominal cramping that comes and goes may also
occur, due to growth of the uterus. Bleeding like a period or painful abdominal
cramping is not normal and should be evaluated by your physician.
Most women experience breast changes during pregnancy.
The breasts feel heavier and become much fuller. The color of the areola may
change to a darker hue.
Most women complain of breast tenderness, but this eases
through the pregnancy. It is recommended that pregnant women wear comfortable,
supportive bras. It is important to be sure it is sized correctly, especially
as the breasts grow during pregnancy.
experiences many changes as progesterone, a pregnancy hormone, levels increase:
A small amount of white discharge is normal in pregnancy,
as long as it is not associated with vaginal pain, itching or odor.
Many women experience lack of energy or fatigue. Pregnant
women require a healthy sleep routine and are encouraged to get plenty of rest.
Your body is growing a human, after all!
The increase in progesterone can also cause nausea and
vomiting. Due to the nausea, increased sensitivity to smells is not uncommon.
Nausea/vomiting in pregnancy can sometimes lead to dehydration. Symptoms of
dehydration include abdominal cramping and headaches. It is encouraged to
continue proper hydration, as tolerated. Nausea and vomiting usually improves
near the end of the first trimester and the appetite returns.
Some pregnant women
experience emotional changes early in pregnancy:
Sometimes, women report mood swings, being irrational or
Many women are anxious about being pregnant, which can
also cause an emotional reaction.
As the pregnancy progresses, many women feel much more
relaxed and calm. Many start getting excited in anticipation for the new
Body changes in the second trimester
With the start of
the second trimester of pregnancy, many pregnancy symptoms may stay the same
but there will be new changes as well:
For many women, morning sickness will improve or only
occur sporadically and appetite seems to increase. Changes in appetite can
cause constipation, gas or bloating. It is also common to experience heartburn
Although there will be a decrease in breast tenderness,
the breasts will continue to grow. A supportive, well-fitting bra is still
recommended for optimal comfort.
White vaginal discharge due to hormone changes is still
common as long as it is not associated with other symptoms like vaginal
burning, pain or odor.
There are many new
changes that can occur during the second trimester of pregnancy:
The fatigue from the first trimester fades and the
pregnant woman usually has increased energy.
An increase in blood volume during pregnancy can cause
some mild swelling of ankles or feet, especially when standing for an extended
period of time.
Some women experience sensitive gums that bleed when
brushing. It is important to continue routine dental check-ups.
Many pregnant women experience nasal congestion or nose
bleeds. It helps to keep the nasal passages moist with saline spray and by
using a humidifier at home.
The uterus is supported in place by a group of ligaments.
As the uterus grows, these ligaments stretch or pull. It is not uncommon for
this stretching or pulling to cause aches in the lower abdomen or on either
side of the abdomen. As the uterus grows, it becomes heavier. It is encouraged
for the expectant mother to use a maternity belt or support to help alleviate
these pains. Extreme abdominal pain is never normal in pregnancy and should be
evaluated by a physician.
During the second trimester, the uterus continues to grow
out of the pelvic cavity. Many women see changes in the size and shape of the
abdomen. As the uterus grows, posture may change due to the pregnant belly protruding.
This change in posture can cause back pain in the pregnant woman.
The favorite change of the second trimester to many
pregnant women is the ability to feel fetal movement. Feeling fetal movement is
sporadic at first, as the fetus is so small. By the end of the second
trimester, a pregnant woman should feel consistent fetal movement. Movements in
the second trimester may feel “clunky” and as though they are big
Body changes during the third trimester
In the third
trimester, most women become increasingly uncomfortable. As the baby becomes larger
and settles in the pelvis, new physical discomforts can occur:
Due to increased fluid volume produced, there may be an
increase in swelling of the ankles and feet, as well as hands and face.
Colostrum (or “Pre-Milk”) may start leaking
from nipples as the breast prepare to begin producing milk.
Some women may alternate times of extra energy (nesting)
and extra fatigue as time gets closer to delivery.
These discomforts may cause problems sleeping comfortably
After the baby
After the baby “drops” or settles in the
pelvis, a pregnant woman may be able to breathe easier, as there is less
pressure on her diaphragm and more room for her lungs to expand. But there will
be more pressure placed on the bladder by the baby being lower in the pelvis
which may cause more frequent urination.
Increased backache and heaviness, as well as buttock and
pelvic discomfort are common. Some women even have a sensation of a sudden
sharp pain or shock in the pelvic area if the baby settles on a nerve. While
uncomfortable, all of these experiences are normal parts of the third
Pregnant women in the third trimester, may have more
frequent and intense contractions, called “Braxton-Hicks
Contractions”. These contractions are irregular and can be eased with
rest, Tylenol administration and hydration.
Labor contractions become stronger over time and come at
regular intervals. Labor can also be distinguished by vaginal bleeding or
leakage of amniotic fluid. If these symptoms occur, a pregnant woman needs to
be evaluated by her doctor.
changes the pregnant body can experience helps an expecting woman feel calmer
about what she is experiencing. If you have any questions or need additional
information, reach out to your OBGyn provider. If you do not yet have a
provider, the OBGyns at MCH ProCare Women’s Clinic are available to become your
provider for your pregnancy and upcoming arrival of your bundle of joy.
Breastfeeding is a vital part of healthy child development and provides the best start to life for any baby. According to the American Academy of Pediatrics, breastfeeding is the standard for infant feeding.
The World Health Organization recommends:
early initiation of breastfeeding within one hour of birth
exclusive breastfeeding for the first six months of life
introduction of nutritionally adequate and safe complementary (solid) foods at six months together with continued breastfeeding up to two years of age or beyond
Why is breastfeeding important for your baby?
Breastfeeding provides essential nutrients and antibodies that boost an infant’s immune system, providing protection from childhood illnesses. Benefits for breastfed infants include:
reduced risks for diarrhea and respiratory infections
protection against childhood obesity
protection against non-communicable diseases later in life, including cardiovascular diseases and diabetes mellitus
higher intelligence quotient
reduced risk for allergies.
Is there any benefit for the mother?
Yes, breastfeeding is important for mothers too. Women who breastfeed have a reduced risk of breast cancer, ovarian cancer, obesity and osteoporosis.
World Breastfeeding Week
World Breastfeeding Week occurs annually the first week of August and is celebrated in more than 170 countries worldwide. During the week, the World Health Organization promotes the benefits of breastfeeding and raises awareness about this essential part of every person’s life course.
The 2018 theme, “Breastfeeding: Foundation of Life”, encourages breastfeeding as a way to promote mother-child bonding and to provide vital long-term health benefits to both mother and child. According to the Lancet 2016 Breastfeeding Series, “Improved breastfeeding practices have the potential to save the lives of 823,000 children and 20,000 women a year.”
World Breastfeeding Week also calls attention to local efforts that support breastfeeding.
Available local breastfeeding assistance and information
Medical Center Hospital’s Center for Women and Infants (CWI) Infants is designated as a Texas Ten Step Hospital which means policies and practices promote breastfeeding. CWI staff encourages and supports new mothers to breastfeed by giving them information and support throughout their pregnancy, in the hospital and after they are home.
Baby Café (FREE Drop-in Breastfeeding Center)
The MCH Baby Café is a free, drop-in breastfeeding center for mothers seeking more information or help with breastfeeding. Baby Café is free and open to breastfeeding mothers every Wednesday from 10 a.m. to noon in the CWI fourth floor classroom.
Oh Baby! Breastfeeding Basics (FREE CLASS)
Learn about the basics of breastfeeding and how to start off breastfeeding with tips on positioning, latching, how to recognize a good latch and how milk is produced.
Date and Time: Saturday, August 4, 2018, 10:00 a.m. to noon
Location: MCH Center for Women and Infants, Fourth Floor Classroom
Sustaining Breastfeeding and Returning to Work (FREE CLASS)
Learn about accommodation laws and your rights in the workplace, child care, pumping to maintain and enhance milk supply and how to smoothen transitions from home to work and back.
Date and time: Wednesday, August 8, 2018, 11:00 a.m. to noon
Location: MCH Center for Women and Infants, Fourth Floor Classroom
For more information on these free local resources, contact:
Many women assume that once a hysterectomy (removal of the uterus) is completed, they no longer have need for a gynecologist. This, in fact, is not true! There are many health care needs for women, even after hysterectomy.
Pelvic Pain or Pain with Intercourse
A yearly pelvic examination is encouraged for all women, even after child bearing years. During a pelvic exam, the gynecologist assesses the vaginal anatomy, looking for any skin abnormalities or lesions. During a bi-manual examination, the gynecologist feels internally and externally for any masses or abnormalities. These examinations also help to assess women who suffer from pelvic pain or pain with intercourse.
Bladder or Bowel Issues
Some women have problems with pelvic support, or a relaxation of the muscles that support the bladder and rectum. These women may suffer from urinary leakage, difficulty completely emptying the bladder or issues moving the bowels. These are issues that can be diagnosed and assessed by an annual pelvic examination by a gynecologist.
As women age, menopausal symptoms can occur, even long after a hysterectomy. Some women suffer from hot flashes, especially at night. Many women complain of problems falling or staying asleep. After menopause, vaginal dryness and recurrent infections in the urinary tract (bladder infections) are very common, which can also lead to painful intercourse or pelvic pain. These are also important issues that are addressed by a gynecologist during your annual examination.
Bone changes occur as women age. According to The American College of Obstetricians and Gynecologists (www.acog.org), “A small amount of bone loss after age 35 years is normal for both men and women. But during the first four to eight years after menopause, women lose bone more rapidly.” This increases the risk for osteopenia or osteoporosis. This is addressed by Bone Density Screenings (DEXA Scans) that are ordered every other year after the age of 65.
Breast health is also an important issue addressed yearly by the gynecologist. During an annual examination, a breast exam is completed by the provider. Yearly mammograms are ordered to screen for breast cancer.
Yearly examinations by a gynecologist are still important, even if you do not have uterus. Make your health a priority! Call MCH ProCare Women’s Clinic for an appointment today at (432) 640-2491.
Though many are embarrassed to discuss it, urinary incontinence is very common among women. Urinary incontinence is leakage of urine. It can range from leaking just a few drops of urine to complete bladder emptying. Other accompanying symptoms include having the strong urge to urinate, urinating frequently, waking up several times during the night to urinate, burning with urination or leaking urine while sleeping.
There are three main types of urinary incontinence in women.
Stress Urinary Incontinence (SUI) is leakage of urine when laughing, coughing, sneezing or exercising.
Urgency Urinary Incontinence (UUI) is a sudden urge to urinate that cannot be stopped. Many women leak urine before they can make it to the restroom.
Mixed incontinence combines the symptoms of both SUI and UUI.
Several things can cause or worsen urinary incontinence. Urinary tract infections can cause leakage of urine. Certain types of medications, like diuretics, caffeine and alcohol, can contribute to urinary incontinence, as these are substances that cause your body to create more urine and/or are bladder irritants. Different disorders caused by weakening of the muscles of the pelvic floor can cause problems controlling urination. Long term constipation is often a trigger for urinary incontinence, especially in older women. Neuromuscular or anatomical problems can also cause problems controlling urinary leakage.
Urinary incontinence is diagnosed by medical history and a physical exam. A pelvic exam is necessary to determine if there is pelvic organ prolapse. Certain tests may be done during the physical examination to see if there is complete emptying of the bladder after urination. In some cases, imaging and bladder function tests can be ordered for further information.
The first line of treatment for urinary incontinence is nonsurgical. This may include lifestyle changes, like discontinuing caffeine and alcohol, and managing fluid intake during the day. Weight loss in overweight patients is beneficial for reducing leakage of urine. Bladder training may be discussed by your provider. According to the American College of Obstetricians and Gynecologists (ACOG), “the goal of bladder training is the learn how to control the urge to empty the bladder and increase the time span between urinating to normal intervals (every three to four hours during the day and every four to eight hours at night).”
Performing Kegel exercises helps strengthen pelvic muscles and can improve all types of urinary incontinence. There are many medications that help improve UUI by controlling bladder spasms, manage to relieve the urge to urinate and urinary frequency.
A pessary may be recommended for nonsurgical management of SUI and to improve pelvic support. A pessary is a small device that helps to support the walls of the vagina, thereby lifting the bladder and urethra. These devices come in many shapes and sizes and can be fitted by the provider during the pelvic exam. Pessaries can easily be removed for cleaning and re-inserted by the patient at home, making them a very convenient alternative to surgery for many women.
There are several surgeries that can be completed by the provider in a hospital setting to improve SUI. There are many different slings are available for the treatment of urinary leakage. A sling is a narrow strap made of synthetic materials that is placed under the urethra to lift and provide extra support. Other surgical procedures include lifting and securing the bladder neck to nearby supporting structures using stitches.
If you are suffering from urinary incontinence, call ProCare Women’s Clinic today and make an appointment at (432) 640-2491.
Why do women need to have yearly screening mammograms?
It reduces a woman’s risk of dying from breast cancer. Studies have shown that mammography screening cuts the risk of dying from breast cancer nearly in half.
When should a woman start having mammograms?
There are conflicting recommendations from different societies. We follow the American College of Radiology and Society of Breast Imaging guidelines which recommend yearly screening mammograms beginning at age 40 for women at average risk for breast cancer (most women). Studies have shown that this is how we will save the most lives.
Why yearly and not every other year?
It’s simple … yearly screening results in more lives saved than screening every other year.
Should a woman ever start having screening mammograms before age 40?
There are certain situations where a woman should start mammography screening before age 40 … women who are considered high risk. If you are unsure, then talk to your doctor. The American College of Radiology and Society of Breast Imaging never recommend screening mammograms before age 25.
What are some reasons a woman would be considered high risk for breast cancer?
Women with certain genetic mutations (BRCA1 or BRCA2), family history, women who received radiation to the chest at a young age (usually for treatment of Hodgkin’s disease) and women with a personal history of breast or ovarian cancer.
What is 3D mammography?
3D mammography, or breast tomosynthesis, is a breakthrough technology in breast imaging that allows a clearer, more accurate view of the breast (as opposed to the traditional 2D mammogram). It allows the breast radiologist to see through the different layers of tissue in the breast. This improves breast cancer detection.
What are the benefits of 3D mammography?
Earlier detection of small breast cancers
Clearer images of the breast tissue
Fewer additional tests or unnecessary biopsies
Greater likelihood of detecting multiple cancers
What does it mean if my doctor says I have dense breasts?
It has to do with the way you are made. It doesn’t mean that anything is wrong with you, though it can increase your breast cancer risk. Every breast has different amounts of fatty tissue versus glandular and connective tissue. When you look at a mammogram, the black/darker parts of the breast are the fatty tissues and the white/lighter parts of the breast are the glandular and connective tissues. When you have dense breasts, it means that there is more of the white/lighter tissues relative to the black/darker tissues.
What is the significance of having dense breasts when it comes to mammograms?
Most cancers also look white on the mammogram. So when you have dense breasts (more of the white/lighter tissues), it sometimes makes it harder for the radiologist to detect cancers. The dense breast tissue can sometimes obscure cancers (particularly smaller cancers) and make them difficult, or even impossible, to see.
What should I do if I have dense breasts?
It’s something to talk to your doctor about. DON’T stop having mammograms. Certain types of cancers, particularly those that present as tiny calcifications in the breast, can easily be detected on mammograms … even in dense breasts. Your doctor may recommend additional screening depending on your overall breast cancer risk. Additional screening with breast MRI can be a valuable tool in certain patients.
Do I need a “screening mammogram” or a “diagnostic mammogram”? What’s the difference?
Generally speaking, if you are not having any breast problems and it’s time for your yearly mammogram, a screening mammogram is recommended. Diagnostic mammograms are generally performed on patients that either had an abnormality detected on their screening mammogram, or are having some kind of breast problem (lump, pain, discharge, etc.)
If the patient had a potential abnormality on a screening mammogram, a diagnostic mammogram is performed for further evaluation. This usually involves specialized mammogram views and possible ultrasound of the area to determine the nature of the abnormality and determine if a biopsy is needed.
The diagnostic mammogram is not better pictures or better image quality than the screening mammogram. It is just performed in a way that allows the problem or potential abnormality to be fully evaluated with the necessary imaging while the patient is in the department. Personally, I like to talk to every patient that has a diagnostic mammogram so that they leave our department with peace of mind and understanding of what my recommendations are.
October is Breast Cancer Awareness Month. Please make your mammogram a priority in your life and encourage your loved ones to do the same. Early detection saves lives.