Dr. Victoria J. Mondloch, M.D.

Your young age and healthy pelvic muscles will do you well, especially if this is your 1st pregnancy. However, 60hr/wk is hard on anyone’s body and you will benefit from having your doctor write a lifting restriction for you of no >25 or whatever number the 2 of you decide is safe. You will also need to take protective measures for your back as it will be under additional strain being pregnant as your body’s center of gravity shifts and you tend to sway your back when back muscles are under stress which actually makes it worse, not better. So invest in a pregnancy support belt that is Velcro adjusted so it grows with your pregnancy and helps support your low back and your low abdomen/pelvis. I would also invest in some sort of foot support like Dr. Scholl’s insert for your boots/shoes and I DEFINITELY recommend wearing support knee-high or even panty-hose support stockings or you will have significant varicose veins much earlier than you would ever want.

Pregnancy increases your blood supply by 50% by the time you reach term or 40wks; that 50% extra blood supply is still put through your same heart and your same blood vessels so they are under a lot of stress. Arteries have muscles in their walls to push blood through but veins rely on the muscles that surround them to help the blood back to your heart so they are affected faster than most people think. Your insurance should cover these support stockings as ‘medically necessary’; make certain that you are not paying out of pocket for these stockings. There are 2 medical-grade stockings: Jobst and L&R; the L&R is a better value and you can get them in black or beige so they look just like regular knee-high stockings. Lastly, watch for a mucousy vaginal discharge; that may be a prolonged ‘mucous plug’ which may signal that you at risk for a premature labor situation. Talk often with your doctor as premature delivery carries a lot of respiratory risk for your baby, even 6 weeks early is too early; your baby would have to stay in the hospital while you are sent home so be informed and keep your doctor informed.

Having ‘period cramps’ or muscle cramps can happen throughout pregnancy. Remember, your uterus is smooth muscle, it will increase in actual muscle mass as well as it will grow and stretch without rupturing and then be able to handle labor and contract to push out your baby when you are ready to deliver. In the 1st 12weeks of any woman’s 1st pregnancy, the uterus grows for the 1st time and a lot of cramping is quite normal as this is ‘new’ for the uterus, it’s used to cramping to expel the lining every month as your period. Then from 20-30weeks, the fetus and uterus grow at the fastest rate, at 1cm/week when your doctor or midwife actually measures you with a tape measure. So fast growth of muscle can sometimes result in ‘growing pains’. Then from 30-40weeks, the fetus puts most of its actual weight on and the uterus will slow down its growth. This is the normal course of events. However, sometimes cramping can signal not so normal things; there could be problems with the placenta that you may see as external bleeding or spotting; contact your doctor immediately. You may have uterine fibroids that are also stimulated to grow as well as your uterus grows and sometimes the fibroids grow FASTER than the uterus and cause trouble. Sometimes you will actually develop an ovarian cyst that can grow and twist on itself and that can be a surgical emergency. And don’t forget there is your GI tract that is getting pushed around; if you had prior endometriosis, prior GYN surgery, or pelvic infection, there may be scar tissue that is getting stretched and it’s going to let you know! Always report cramping to your doctor; more than 90% of the time it will be the normal muscle stretch of the uterus. But that’s why you have a doctor; it’s their job to make certain that there is nothing else going on. You may require an ultrasound to check on uterine fibroids or placenta or to see if an ovarian cyst is present, but an ultrasound will not help if it is GI in nature. Personally, I had to deal with scar tissue and bowel obstructions from a ruptured appendix that had happened 10years before and it resulted in being operated on in the middle and at the end of my pregnancy, including a bowel resection. So bad things DO HAPPEN, even to doctors!

Vulvar boils and ingrown hairs are difficult due to their location; it hurts to sit, stand, walk, urinate and even turn over in your sleep. Shaving is an irritant that is a direct cause of ingrown hairs; usually a very sharp razor is best; never use it more than 2-3X to that area and never use that same razor on your legs, it dulls the blade. It’s also why others get a Brazilian wax or laser hair removal but that’s expensive. When you feel that a boil is coming, you may benefit from an Epsom salt soak to your bottom; 1-2Tbsp Epsom salt to a plastic wash tub large enough to fit your bottom into and soak in warm to hot water and it will act like a drawing agent. Once it gets close to popping, then a slurry of baking soda + Hydrogen peroxide to make a paste will act as a drawing agent to help finish bringing the boil to the surface and letting it pop or resolve. If you get recurrent boils, then you may have supporative hidradenitis which is associated with PCO or Polycystic Ovary Disease. PCO means multiple small <1cm ovarian cysts that make Testosterone which can be a higher value and override your female hormone values. It is really important to know if you have PCO or possible PCO because that is genetic and it’s associated with a number of other possible issues: trouble getting pregnant, sudden weight gain (due to the higher Testosterone levels), Depression and increased risk of poor sugar control/insulin resistance and even Type 2 diabetes. So if you have recurrent boils, ask your doctor to check bloodwork for your hormone levels; there is help with meds to drop Testosterone levels but you can only treat it if you can diagnose it.

Depo Provera is a long acting synthetic Progesterone; this medication has been proven to be the med responsible for causing an increased risk of breast cancer, stroke and heart attack in the Women’s Health Initiative study that was prematurely stopped in 2002, 3years earlier than it was supposed to be. Depo Provera is also associated with increased depression, weight gain, increased acne and infertility; in other words, there are very few positive things that come from being on this shot. My professional advice is that there is no good reason to be on this shot; there are many other options for birth control and there are more natural options for excess bleeding and cycle control. The risks far outweigh the benefits on this shot and I would advise you to stop it and switch to another form on treatment. You will not get periods on this shot; it suppresses your ovaries. Birth control pills also suppress your ovaries and also contain artificial hormones. The pill is also associated with an increased risk of depression and weight gain but it is a safer option than the Depo shot.

At 21 weeks, your uterus is enlarged enough to fill lower ½ of abdomen, pushing your small intestines up, but your descending large colon is physically attached in the 4 corners of your abdomen, including your left lower quadrant where your stool has to already make a 90-degree turn with your waste product before it passes. You may have had a more constipated stool that was having a harder time maneuvering around that curve with the pressure of a pregnant uterus pressing against it. Remember, your large colon still has muscle bands on the outside to help propulse your stool along. Ligaments at this point have been pretty well stretched so they don’t have much to "fight back" with. It may help to put some regular fiber with fluids in your daily regimen to ensure regularly with your lower GI tract. Also, remember, your ovaries are no longer in your pelvis, they are brought out of your pelvis as your uterus grows so it shouldn’t be anything ovarian.

Spotting pre-period is a sign of low Progesterone; this happens with perimenopause, so you are likely heading into that phase of your hormone career sooner than what medicine likes to tell you, which is 1-year pre-menopause. You may continue to have this type of multi-day spotting for several more years to come unless you get your levels checked and take natural micronized Progesterone to balance your hormones out. Have your doctor check your hormone levels on day 21 of your cycle (day 1 is the first real day of your cycle, not the spotting), and have your doctor balance your Progesterone with your Estradiol. If your doctor is not able to do this for you, then get a copy of my book, Full Bloom on Amazon. There is a chapter toward the back of the book about how to talk to your doctor and let them know the labs that you need drawn.

Absolutely; it is just that you need to know how often your PCOS cycle ovulates for you to know when you are likely to get pregnant. Some women will ovulate every 3-4 months while others may not ovulate except every 6 or up to 16 months; so, you need to follow your hormone levels with your doctor, especially because it may take you longer to become pregnant and you may require fertility medication. Also, know that you are at a higher risk for Gestational Diabetes during your pregnancy, so you need to be screened earlier.

PCOS doesn’t increase multiple pregnancy or multiple ovulations; however, coming off of birth control pills and having your ovary go back to work can result in a hyperstimulation of your ovaries or double ovulation so coming off of the pill, whether you have PCOS or not can increase the incidence of twins. Also, patients with PCOS are usually given fertility meds to help them conceive; fertility meds such as Clomid can increase your risk of multiple ovulation or twins.

The better answer to that question is how long does it take ovaries to go back to functioning after coming off of the pill? For some women, they will ovulate within a month or two; the higher the pill dose, the longer it will take you to resume ovulating. Some patients will take more than 6-12months; if it takes more than 6 months, I usually suggest getting your hormone levels checked with your doctor and make certain that you don’t have any other abnormality going on like fibroids, endometriosis, uterine polyps, or PCOS as you might have been put on the pill for any of these diagnoses originally, but the diagnosis was just "covered up" or delayed while on the pill. Once the pill is stopped, the diagnosis is going to resurface so it will need to be dealt with.

PCOS is a complex diagnosis; it has variable degrees of manifesting, but the main issue with PCOS is a higher than normal percentage of Free Testosterone and variable female hormones that go from age appropriate to low and age inappropriate. Every woman will cycle month to month from normal age appropriate to abnormal age inappropriate hormone levels, sometimes every 2-4 months, but it can also happen as low as every 8-16 months; the only way to know is to follow hormone levels with your doctor on a regular basis. Whatever pattern of normal vs. abnormal hormone levels you then have will dictate how often you will ovulate. There are very few resources for the lay person that explain PCOS; it will be in my next book that I write, but that book is still in its development stage. Please check out my other 2 books, Blossoming and Full Bloom, which go into significant, but easy to read detail about hormone balancing in adolescence through perimenopause, menopause, and beyond.

Always get agdominal pain checked out with your doctor, especially after doing something like douching. I generally do NOT recommend any type of douche; realize that water is a pH of 7.0 vs the normal pH of the vagina which is 5.5 or more acid; so you are disturbing your vaginal bacterial mix every time that you douche; that is likely to cause an imbalance or possible infection every time that you change your vaginal pH.

Yes, you can run the ‘active hormone pills’ together and skip the placebo pills to ‘skip’ your period; you can do this for 3months in a row, then I usually recommend having a cycle.

Every woman has anovulatory or dysfunctional periods that can happen on their own or can be brought on by stress. An anovulatory cycle means you didn’t ovulate that cycle so you continue to have unopposed Estradiol which can hyperstimulate breast and uterus. With no Progesterone being made, your PMS symptoms take over and you also get constipated; this imbalance will only correct when you ovulate again. The only way to really know if this is going on is to have your hormone levels checked by bloodwork; then your doctor can use natural progesterone to help ‘reset’ your cycles.

I am not certain what your physical ‘body-slam’ was about but a potential bone break or dislocation could have occurred and needs to be checked by X-ray or by a chiropractor or physical therapist. ‘Lumps’ that shouldn’t be there are not a normal finding; please see a healthcare specialist to get this checked out.

The best position is Vertex or head down in an occiput anterior positioning vs posterior positioning; this allows the baby’s chin to flex down onto their neck to present a smaller diameter of the fetal head through the maternal pelvis. Of course, there are many other factors that go into whether a mom will successfully vaginally deliver her baby.

I’m not certain what p2 means; is that placebo pill #2? Or Progesterone pill #2 from a Progesterone of P4 only pill pack? Either way, you are protected if you only missed 1 placebo pill as your ovaries should be adequately suppressed by being on birth control pills. The exception is patients who are placed on tri-phasic birth control pills as the doses of hormone in these ultra low pills doesn’t always suppress ovaries; I have checked patients and found NORMAL levels of hormone when they appropriate taking their birth control; this means their ovaries are not suppressed. If you are on a triphasic pill (it changes color each week of the pill pack), then ask you doctor to check your bloodwork for Estradiol and Progesterone so that you know if you are adequately suppressed or if your ovary is actually functioning at a normal level. If it is functioning at a normal level, then you need a higher dose birth control pill and a repeat set of labs to prove it is indeed shutting your ovarian hormone production down.

Monthly pain in the pelvic region can be typical ovulation but the only way to know is to have your hormone levels checked to confirm hormone balance. When you don’t have typical ovulation, then mid-cycle pain can represent many things but they all fall under the category of Estrogen dominance or E dominance. Estrogen is responsible for ‘building’ and our 2nd female hormone, Progesterone or P4 is responsible for ‘stabilizing’, so balance is key. E dominance over time can cause ovarian cysts that can grow to a size that may twist on itself or rupture, both causing pain and possible scar tissue. E dominance can also cause uterine polyps, fibroids and endometriosis which over time, even over years can cause heavy periods, anemia, severe cramping and even scar tissue in the pelvis with possible infertility. The only way to know if you are starting down a road of hormone balance vs imbalance is to work with a healthcare provider that will follow your hormone levels and keep you hormone balanced. Please check out my book, Blossoming, Becoming A Woman which will give you all of the tools that you need to check out where your health is and how to go about getting your hormone levels checked. Blossoming is available on Amazon in print or Kindle; it is a patient’s guide to taking your female health into your own hands. And if your doctor isn’t familiar or comfortable with checking or following hormone levels, then contact my office and let me help. Bloodwork can be ordered by any healthycare provider and insurance can cover your labs and any hormones needed for rebalancing. Take charge of your health!

Having irregular menses is not a common trend, esp if 17yo and your periods have never been normal. My recommendation is always to go to the source; know what your hormone levels are, both female and male. That means you need to have Estradiol, Progesterone, Total Testosterone and Free Testosterone drawn. Usually having your blood drawn d21 of your cycle is most appropriate but if you don’t have regular periods, then just pick a day to get your bloodwork done because you need to start somewhere. You may actually have more male hormone than female hormone; or you may not be regularly ovulating. Or you may have ovarian suppression due to excess aerobic exercise. If you have ever been on birth control pills or a Depo shot or an IUD, that can cause your periods to stop. Sometimes, you can also have your periods stop when you start an Adkin’s diet or strict Ketogenic diet if that is a significant difference from your usual dietary approach. In other words, there can be dietary, excess exercise and hormonal reasons why there are loss of periods; checking your hormone levels is one of most important things that you can do to help figure out which one of these is happening to you.

The best way to know if you are pregnant is to get a blood serum pregnancy test done that is called a Quantitative HCG test. It actually gives you a number that will double every 2 days if you are pregnant and if the pregnancy is growing properly, but it won’t always tell you if the pregnancy is growing in the right place (in the uterus, but it could also grow in the tube which is a big problem). Condoms can be outdated and ‘leaky’ even if there appears to be no holes, so always check the expiration on the wrapper. The fact that you may not have had orgasm with contractions doesn’t mean you aren’t pregnant. Best to let your blood give you the answer.

Missing your period for several months at a time is usually hormonal with a male hormone overriding a female hormone picture which is called PCO or Polycystic Ovary. PCO is poorly understood by most MD’s and rarely looked for unless you are trying to become pregnant, but it causes a lot of trouble due to higher male hormone levels in your body than you are supposed to have. I always check my patients male and female hormone levels to be certain this diagnosis is not happening; but it may take a few months of checking your levels every 2-3months to actually make the diagnosis so find a doc that is willing to entertain this approach. The blood tests that you want checked are: Estradiol, Progesterone, Total Testosterone and Free Testosterone. In addition, you want to also check your other 3 foundational hormone groups: thyroid (TSH, Free T3, Free T4, Thyroglobulin AB and Thyroid peroxidase AB), adrenal (AM Cortisol) and fasting insulin/blood sugar (4-hour fast).