MFMA offers complete, professional OB-GYN care throughout the full spectrum of women’s reproductive lives - from the routine to the complex. Maternal Fetal Medicine Associates is leading the way in women’s obstetrics and gynecological healthcare for your reproductive lifetime and beyond.
Polycystic ovarian syndrome, or PCOS, is an incorrectly named and poorly misunderstood disorder that affects about 10 million women world-wide. Although not much is known about it and its causes, it’s important to know about it and what to expect if your gynecologist suspects you’re living with it. Although it can primarily affect your quality of life, it can affect many other areas of your health like fertility and emotional health. Here’s what to know about this syndrome and your treatment options with your gynecologist.
What is PCOS?
PCOS is a defect in the production of ovulatory hormones in women. It does not inherently mean that you have cysts on your ovaries if you have PCOS. Rather, it means that not enough of certain hormones are being produced to contribute to ovulation (where an egg is emitted from the ovaries with the intent of fertilization).
Specifically, it means that an over-secretion of Luteinizing Hormone (LH) is happening, resulting in excess testosterone. Excess testosterone means that Follicle Stimulating Hormone (FSH) can’t effectively convert the testosterone to estrogens, which play an important role in ovulation.
What causes PCOS?
Although PCOS is caused by excess androgens, or male hormones, it’s not known what causes this excess in certain women. Many experts think genetics plays a role in the presence of PCOS, as well as insulin resistance. For this reason, it’s important to speak with the women in your family if you’re experiencing symptoms. However, there is still much study being performed on possible contributing factors like environment, certain medications, and lifestyle.
What are the symptoms?
Some symptoms that can be cause for an appointment with your gynecologist are:
Hirsutism (hair grown in unsuspected areas)
Menstrual abnormality (rare menses, too frequent menses)
Fatigue or sleep problems
It can be helpful to keep track of these symptoms and discuss their frequency and severity with your gynecologist if you suspect something is wrong. PCOS primarily affects women during childbearing age, commonly in your 20s or 30s. However, PCOS can happen at any age after puberty is complete.
What are some treatment options?
It’s important to remember that ultrasounds shouldn’t be relied on when diagnosing PCOS— after all, ovarian cysts are more so a result of PCOS rather than the cause of it. Rather, your gynecologist can perform a blood test to check for conditions that present similarly to PCOS. Then, your gynecologist can recommend your best treatment options. Often, hormonal birth control can effectively help to regulate your menstrual and hormonal cycles. However, there are many other medications that can help regulate your body’s hormone production, and your gynecologist can recommend the right one. Since general health, fertility, and contraception are all affected by PCOS, the diagnosis and treatment are essential.
Schedule an Appointment
PCOS can be difficult to live with and difficult to diagnose, so it’s important to partner with a knowledgeable gynecologist who can assess your symptoms and recommend the right steps. To meet with our expert team, contact our New York City office by calling or filling out our online form.
The size or the estimated weight of the baby can be monitored to ensure that the baby is growing at the right pace. If the baby isn’t growing as fast as usual, it is called intrauterine growth restriction, and may put them at an increased risk of complications. By following your pregnancy more closely, we can help to prevent possible complications.
Finding Out the Length of a Baby Through Ultrasound - YouTube
We monitor the baby’s growth through ultrasound. During the first trimester, the length of the baby is used to estimate the size. Later on, it is not possible to measure the length due to the fetal position, therefore, the baby’s weight is estimated by measuring the head, the abdomen and thigh bone.
At Carnegie Imaging we offer a wide selection of ultrasound services. One type of ultrasound that we do, typically in the third trimester, is called a biophysical profile, or a BPP.
This appointment typically takes 30 minutes. In this ultrasound, our team checks the following parameters:
We’re going to look at the amount of amniotic fluid surrounding the baby.
We’re going to look for movements of the baby
We’re going to look for tone.
We’re also going to see if the baby is practicing breathing.
If the baby does all these tasks, as and has a normal amount of amniotic fluid, we will tell you the baby had a normal biophysical profile and you will need to come as your doctor requested.
What is a Bio Physical Profile (BPP) ? - YouTube
There are times during the biophysical profile that the baby may be sleeping, or the baby may not be moving or practicing breathing, in these cases, you will need additional testing. Usually, that additional testing is done either at your doctor’s office or in labor and delivery.
Although it’s common for women to see a gynecologist for their women’s health concerns or Well-Woman’s screenings, gynecologists are more commonly becoming a source of general care for their patients. Called a general practitioner, this can mean that your gynecologist can provide some care beyond the typical women’s care. Here’s what to know about general practice.
Types of Prevention
There are three types of prevention that your general practitioner can provide that serve different purposes. These include:
Primary prevention keeps disease from occurring at all by removing its causes. The most common clinical primary care preventive activities involve immunizations to prevent communicable diseases, drugs, and behavioral counseling. Primary prevention has prevented many deaths from two major killers, lung cancer and cardiovascular disease. Primary prevention is now possible for cervical, skin and breast cancer; bone fractures, and alcoholism.
Secondary prevention detects early disease when it is asymptomatic and when treatment can stop it from progressing. Secondary prevention is a two-step process involving a screening test and follow-up diagnosis, as well as treatment for those with the condition of interest. Testing asymptomatic patients with routine Pap smears and screening mammography are examples.
Tertiary prevention describes clinical activities that prevent deterioration or reduce complications after a disease has declared itself. Tertiary prevention is just another term for treatment.
There are four major types of clinical preventive care which apply throughout the lifespan of each patient. These include:
Childhood immunizations to prevent 15 different diseases largely determine visit schedules to the pediatrician in the early months of life. Human papillomavirus (HPV) vaccinations of adolescent girls and boys has recently been added for prevention of cervical cancer. Adult immunizations include diphtheria, pertussis, and tetanus (TDaP), as well as vaccinations to prevent influenza, pneumococcal pneumonia, hepatitis A and B, and herpes zoster.
Screening is the identification of an asymptomatic disease, harmful condition, or risk factor. Screening tests start in the prenatal period (such as testing for Down syndrome) and continue throughout life (eg. Pap smears, mammography, fasting lipids).
Clinicians counsel patients to stop smoking, eat a prudent diet, drink alcohol moderately, exercise, and engage in safe sexual practices. It’s important to have evidence that behavior change decreases the risk for the condition of interest, and counseling leads to behavior change before spending time and effort on this approach to prevention.
Chemoprevention is the use of drugs to prevent disease. It is used to prevent disease early in life (eg. folate during pregnancy to prevent neural tube defects and ocular antibiotic prophylaxis in all newborns to prevent gonococcal ophthalmia neonatorum) but is also common in adults (eg. low-dose aspirin prophylaxis to prevent myocardial infarction, and statins to treat hypercholesterolemia and thus prevent cardiovascular disease).
Schedule an Appointment
Prevention is extremely important in making sure you live a long, healthy life with the help of your gynecologist and general practitioner. To schedule an appointment and begin discussing your options, contact our New York City office by calling or filling out our online form.
Dr. Ana Monteagudo has been working at Carnegie Imaging since 2015. Prior to joining Carnegie Imaging, she spent 18 years at the New York University School of Medicine. She grew up in the New York area, went to medical school in the Bronx at Albert Einstein, and did her my in Maternal-Fetal Medicine at the College of Physicians & Surgeons of Columbia University at New York-Presbyterian/Columbia Medical Center.
“During my residency at the Albert Einstein College of Medicine, it took me a little while to figure out what exactly I wanted to do,” Dr. Monteagudo said. “After rotating through all the specialties, I realized that obstetrics and gynecology was the rotation that made me the happiest. Therefore, I decided to become an obstetrician gynecologist. Subsequent to that, after leaving my residency, I worked in an inner-city clinic for two years as a generalist. And once I realized the need of Maternal-Fetal Medicine specialist, I decided that this is something that I wanted to pursue. And subsequently I went to New York- Presbyterian/Columbia Medical Center and I did my fellowship in Maternal-Fetal Medicine.”
Meet Dr. Ana Mounteagudo - YouTube
Maternal-Fetal Medicine is a specialty in which specialists take care of two patients: the mother and the baby. Dr. Monteagudo decided to choose the path of imaging to be able to look at the fetus and make sure the fetus was developing as it should.
To learn more about Dr. Monteagudo, check out her profile.
Although skin cancer is one of the most common forms of cancer, it’s easily preventable with the right steps. At its core, daylight consist of two forms of ultraviolet light (UV), UVA and UVB. UVA rays are the least harmful, and are present more abundantly in sunlight than ‘B’; it is constantly present, no matter the season or the weather. They are so powerful that they also penetrate some clothing and even glass. They can even age cells, and are therefore linked to long-term skin damage such as wrinkles.
UVB are more harmful, and increase the risk of skin cancers; these are the rays you can blame when you get a sunburn. Unlike UVA rays, these rays aren’t always the same strength year-round and are more prevalent in the summer months; they are even able to reflect off of water or snow. It’s important to keep in mind that it’s important to prevent both types of rays from damaging your skin, so here are some steps to take.
Although many people think of sunscreen when they think of SPF, sun protection factor extends even to the clothing you wear when you’re outside. We recommend daily, broad-spectrum sunscreen use of at least SPF 30, applied 30 minutes or so before you go outside. It’s also important to make sure your clothing and eyewear are protective as well, since UV rays can even penetrate certain types of cloth. You should make sure your skin is mostly covered with sunscreen and clothing with a high UPF, or ultraviolet protection factor. Additionally, a wide-brimmed hat and UV-blocking sunglasses are a must-have. And don’t forget lip protection that contains SPF!
It’s well established that even a handful of sunburns in your life can have significant impact on your risk of skin cancer. The best way to avoid sunburn is by practicing good sun protection and avoiding direct sunlight as much as possible. The middle part of the day, or between mid-morning and mid-afternoon, is when your exposure to UV rays is at its highest. If you have plans to be outside during this time, you should be sure to seek shade or bring your own.
According to the Skin Cancer Foundation, more people develop skin cancer because of indoor tanning than develop lung cancer because of smoking. If you’ve ever tanned using a tanning booth even once, your chances of developing certain types of skin cancer goes up by well over 50%. If you use tanning beds or tan outdoors, it’s extremely important to stop as soon as possible.
Although you should screen yourself regularly at home (from head to toe!), it’s extremely beneficial to see a medical professional for an in-office screening. A physician can examine any troublesome areas up close and also see areas you might not be able to on your own. It’s important to wear no makeup, make sure your hair is loose and unstyled, and remove any nail polish. This can ensure your physician can examine every area, even your scalp and fingernails.
Know What to Look For
There are some specific signs you should know how to recognize when you check yourself at home. The most significant things are changes in your existing moles or skin. If you notice anything unusual, you should see your physician who can assess the area and make a recommendation. During an appointment, our gynecologists can make sure you know what signs to look for.
Schedule an Appointment
Our expert gynecologists are here to help when it comes to keeping your whole body healthy and cancer-free. To speak with our gynecologists and learn more about keeping your skin safe, contact our New York City office by calling or filling out our online form.
Although everyone should be concerned about their chances of cancer, it’s important to know about the cancers that affect women so you know what to look for and discuss with your gynecologist or primary physician. When it’s detected early, you have many more options for effective and life-saving treatment. Here are some things to know about these cancers.
In the United States, the most common cancer in women is breast (124,000 cases), and approximately 20,000 women die of this disease. Breast cancer can happen at any age, but your risk goes up as you get older. Genetic factors can be one of the highest risks for breast cancer, so it’s very important to talk to your family about any members who have experienced it. The American Cancer Society recommends early detection as the best way to defend against breast cancer. We recommend you begin getting mammogram screenings annually beginning at 40. Most often, early breast cancers are cured by combinations of lumpectomy (removing breast tissue surrounding the tumor), lymph node sampling, and chemotherapy.
Uterine (Endometrial) Cancer
In the United States, uterine cancer results in about 27,000 cases and 5.000 deaths. Uterine cancer is more common in women who have not had children (called a nullipara) and who are overweight, have diabetes, or hypertension. Uterine cancer usually affects the different layers of tissue inside it, called endometrium. Uterine cancers are often diagnosed because of vaginal bleeding after menopause, and the American Cancer Society recommends all women be told about these symptoms and risks when they begin menopause. Endometrial cancer can often be treated with a hysterectomy, or removal of the uterus.
In the United States, ovarian cancer can produce about 10,300 cases and 6,800 deaths. While a small portion of these are because of genetic risk factors, the majority are sporadic and difficult to screen for. Ovarian cancer seems to be more common in women who have not had children. The use of combination (estrogen and progesterone) birth control pills may reduce the incidence. There are currently no reliable screening tests for this cancer. However, symptoms like swelling, bloating, digestive problems, abdominal pain, and frequent urination should be reported to your gynecologist.
In the United States, cervical cancer can result in about 12,000 cases, and 4,200 deaths. Cervical cancer is primarily caused by certain types of the human papilloma virus (HPV) which can be transmitted during sex with someone who has HPV. Additionally, risk factors can include smoking, having HIV or AIDS, poor nutrition, and infrequent Pap testing. The Pap smear and HPV screening are excellent tools for reducing both the incidence and risk of death from this disease. The American Cancer Society recommends cervical cancer screening should begin at 21 years old, and your gynecologist can recommend the right frequency for your age group and risk factors. Additionally, an HPV vaccine exists and can prevent infection from cancer-causing HPV when given to older children and teenagers.
In the United States, lung cancer results in 49,600 cases, and approximately 31,900 women die from this form of cancer. It’s estimated that 8 out of 10 lung cancer deaths are caused by smoking. For this reason, not smoking is the most effective way to prevent lung cancer, even if you already smoke. However, yearly screenings are recommended for both men and women at age 55 who smoke or previously smoked.
In the United States, colon cancer produces about 33,000 cases with about 11,500 deaths as a result. It begins with small growths that develop on the lining of the colon or rectum called polyps. Sometimes, polyps are not cancerous and are not cause for concern. However, some polyps can be pre-cancerous and need to be removed. If they are removed early, colon cancer can be prevented. This means that regular screenings are the most important step in preventing it. It’s recommended that everyone, both men and women, begin having regular exams beginning at 45. Colon cancer can occur based on risk factors like a family history of colon cancer.
Schedule an Appointment
During an appointment at our New York City office, our experienced gynecologists can make sure you have the information you need to keep your body healthy and happy. We can also perform comprehensive tests during a Well-Woman’s Appointment and recommend the right specialists. To schedule an appointment, we invite you to call or fill out our online form.
At Carnegie Imaging, there are several kinds of ultrasounds that we perform during pregnancy. Some of these include:
Nuchal Translucency (or NT)
The nuchal translucency is performed between 11 and 13 weeks. Typically, for this exam, we would recommend you come in with a full bladder. A full bladder is necessary because it allows the ultrasound to be clear and we can see that baby much better. During the nuchal translucency ultrasound, we will be measuring the back of the baby’s neck, as well as looking for something called the nasal bone. This ultrasound, in combination with some blood, will give you a risk related to Down syndrome.
Initial Anatomy Scan
Another type of appointment that we have is the initial anatomy scan. The initial anatomy scan is performed between 16 and 18 weeks. In this ultrasound, not only are we going to check the size and weight of the baby, but we’re also going to start looking for different structures of the baby to make sure that the baby’s developing the way that it should.
Different Types of Ultrasounds at MFMA - YouTube
Detailed Anatomical Survey
The most important kind of ultrasound that we perform during the pregnancy is called the detailed anatomical survey. That ultrasound is performed between 20 and 22 weeks. This exam can take an average of 45 minutes to an hour, all depending on the position of the baby and how easy it is to obtain the necessary images. In this ultrasound, we’re going to assess the baby from head to toe, from making sure that there are five fingers and five toes, to making sure the heart and other organs of the baby are developing appropriately.
Another ultrasound that we do is the growth scan. This scan can be done anytime during the pregnancy when the size of the baby needs to be determined. During a growth scan, we’re going to measure the head, abdomen and thigh bone and we’re going to be able to give you an estimated weight.
A women’s taste and food preferences undoubtedly change during pregnancy. To-date we do not fully understand why some women crave vegetables and others crave cake. How and what women eat during pregnancy is influenced by culture, hormonal changes, and their views on food. For many, early pregnancy is marked by nausea, which often leads women to crave carbs-rich foods. Additionally, the smell and/or texture of foods can also influence its desirability. Rest assured for most food cravings/ aversions are not usually a sign of nutrient deficiency. A dietitian can work with you to help you better understand your food behaviors and to support an eating approach that works for your symptoms and needs. Cravings and food aversions are a normal part of your pregnancy experience, but if you find you are gaining too much weight or not gaining enough working with a dietitian can help.
Simple tips offered by our office dietitian:
Stay hydrated. Too often we confuse hunger with thirst.
Eat enough protein (there are adequate sources of animal and plant proteins to meet both carnivorous and plant-based diets).
Limit processed foods. These foods are often calorie-rich but nutrient poor. These foods are usually hard to stop eating once we have started (hint, hint… cakes, cookies, etc.).
Listen to your body’s hunger and satiety cues. Prior to be pregnancy we often ignore these cues especially when on restrictive diets or lead busy lives, and may have a hard time regulating them when we are pregnant.
Avoid liquid sugars; this means juices and sodas, maybe even smoothies.
Increase your intake of fiber. Fiber is a good appetite regulator but also helps improve digestion.
Imagine your bones as a series of bricks; by age 25, in the majority of women, all the bricks have been set in place. Over time, however, these bricks can begin to wear away. Bone loss is something that almost every woman experiences, but to a different degree. If bone loss becomes significant, it can have a largely negative impact on your overall health. It’s never too early to begin working against bone loss, so here are some things to know about it and what you can do to make sure you have a long and healthy life.
What causes bone loss?
There are many different factors that can cause bone loss in women. In most cases, it’s the result of a normal loss of estrogen as you begin to age and reach menopause. Until menopause, the body’s estrogen supports the cells that help build bones (osteoblasts) and inhibits the cells that break down bones (osteoclasts). After menopause, many women experience a drop in estrogen, causing the body to begin to break down its bones, some faster than others.
Additionally, women who have taken steroids, have a family history of bone loss, are excessively lean, are sedentary, use certain types of birth control, or have poor calcium intake may not accrue the proper number of bricks or might experience wear more quickly. If unchecked, bone loss can result in osteoporosis, which puts you at risk of injury and fracture with even everyday stresses on your bones.
How can I prevent bone loss?
Bone loss is not reversible, but it can be halted. Because there are many different factors that can affect your bone density, it’s important to discuss your options with your gynecologist since it may require addressing other health issues. For most women, though, an active lifestyle that includes weight-bearing exercise and calcium supplementation of 1500 mg a day may be sufficient to maintain your strength. In most cases, starting these preventative measures early can be a huge benefit later in life!
How can my gynecologist help?
If your skeleton is represented by a brick wall, plucking out every 8th or 10th brick shouldn’t impact the strength of the wall. Perhaps every 3rd or 4th might make it more susceptible to injury. Thus, a higher rate of bone loss not only increases your susceptibility to injury, but could allow spontaneous collapse where the pressure is the greatest, such as the spine. The asymptomatic collapse of the vertebrae results in a loss of stature (height) and an alteration in posture.
Screening the back and hip with DEXA (Dual Energy X-ray Absorbiometry) can assess that status of your bones well before a dangerous amount of bone loss has occurred. There are several medications that have been demonstrated to successfully arrest bone loss. We recommend DEXA in patients at greater risk of bone loss as well as all women within 3 years of menopause. Your gynecologist can discuss how this technology can help during an appointment.
Schedule an Appointment
Bone loss can be a serious concern that is never addressed too early. Our gynecologists can help you get the best out of your body in the years to come during an appointment at our New York City office. To schedule an appointment, we invite you to call or fill out our online form.