Dr. Victoria J. Mondloch, M.D.

The Valacyclovir 1gm daily and the lack of prodrome and lack of lesions should be the best set of conditions that you can have to ensure lack of transmission of both HSV1 and HSV2; you are good to try for pregnancy.

You are correct, 2 yolk sacs means 2 pregnancies. But there are several questions that need to be answered. How many weeks pregnant was the 1st ultrasound done at? Typically, a fetus can be seen by 5wks along with a beating heart; so if the yolk sacs are different sizes, it could mean 2 separate times that conception and therefore implantation occurred. If one of the yolk sacs looks abnormal, then it likely may either resorb by itself with or without spotting and you may not even pass anything vaginally. Or you may actually pass the abnormal sac which may or may not trigger the healthy yolk sac to be compromised and possibly passed, even if it is healthy. If your ultrasound was done after 5-6wks and there was no fetus inside the yolk sac, then that is a pregnancy but without a fetus; this is called a blighted ovum and it will not progress past 10-12wks because there is no fetus to support.

Following an HCG level is always a good approach; but remember, if one of the sacs is supporting a healthy placenta/implantation, whether there is a fetus or not, that HCG level will increase appropriately and it doesn’t mean there is a fetus, just a healthy placenta. You should ask for a weekly ultrasound as your OB likely has an ultrasound in their office and they can do a ‘quick look US’ for a less expensive cost as they are not doing fetal measurements. If your OB tells you that the ultrasounds weekly are too expensive, then they are charging you full cost and you need to ask why they cannot do it more inexpensively. If your OB only has the option to do ultrasounds at the hospital, then you can still have your doctor request the quick look US vs all of the measurements of a regular US.

Another blood test to check at this time is a progesterone level; if your level is not at 20, then this alone may mean you could miscarry, whether or not you have a good HCG level or not.

Hope this helps put a little more clarity to your situation.

Your heavy bleeding and cramping is indeed hormones out of balance but there is DEFINITELY something that can be done about this. What you need to do is get your bloodwork done for the following labs: Estradiol, Progesterone, Ferritin, CBC and thyroid panel plus thyroid antibodies; all of these hormone groups work together but the most important ones are the 2 female hormones of Estradiol and Progesterone. You are likely Estradiol dominant and that builds a larger lining that you have to bleed out; if your uterus doesn’t stabilize that lining with Progesterone, then you just bleed out quite heavily and your cervix needs to dilate (like you are in labor) in order to pass any clots and the uterus will cramp VERY HARD in order to help pass all of that extra blood because the uterus is a muscle that doesn’t like to be stretched. I recommend that you get a copy of my book, FULL BLOOM, Perimenopause, Menopause, Postmenopause and Beyond which is available on Amazon; it will further explain what is going on and there is a section in the back of the book that is all about how to talk to your doctor. If your doctor is unable or unwilling to do your bloodwork for you, then feel free to contact my office: 262-524-9116 and we will send you the lab requisition that is properly filled out in order to find out where your levels are. YOU DO NOT HAVE TO SUFFER due to the ignorance of the medical profession.

It sounds like you had a regular period in May (to reflect what happened in your April hormone levels) and that you missed your June period and then got a period in July, correct? If that is the case, then you likely didn’t ovulate in your May cycle which means your body only made Estradiol which grows a lining. After 2wks, your body normally ovulates (d14 of your cycle) and you start to make Progesterone which peaks 1wk later on d21 of cycle and then if you are not pregnant on d21, your body starts to drop Progesterone and by d28 the drop is big enough to trigger your menstrual bleed. That is what happens in a normal cycle; it reflects what happened the month before. So, when you skipped June and didn’t bleed until July, it is reflecting what happened in June. When you don’t ovulate, you do not make Progesterone (P4); P4 stabilizes and enriches a lining but prevents it from continuing to grow. So, when you do not ovulate you cannot stabilize the lining that the Estradiol is growing so it will bleed at unusual times and with no warning; and it can last longer because you built more lining to have to bleed out. The ovarian cyst at 2.5 x 2.2cm is actually a normal sized cyst; depending on the timing of your cycle, a cyst this size can be a follicular cyst that you will ovulate your egg from on d14 of your cycle. As you had this scan on d11 of your bleed, then it was likely this follicular cyst and it means that you will likely have your August cycle on time and with the appropriate number of days that you will bleed. So, what causes you to not ovulate? STRESS is the biggest reason; stress of any kind, whether physical stress, emotional stress or even financial stress. I highly recommend that you ask your doctor to check your hormone levels on d21 of your cycle which is when you peak both your Estradiol and P4 levels; it will give you a window into how your reproductive system is working for you that month. Remember, knowledge is power and it’s important to know how your body works. I also highly encourage you to obtain a copy of my book, Blossoming, Becoming a Woman as it walks you through how your cycles work and what are some of the other signs and symptoms of hormone imbalance. Blossoming is available on Amazon. All women will have a cycle here and there where they don’t ovulate; but knowing how to recognize that puts you back in control of your health.

And to answer your other question, is this abnormal bleeding pattern related to an infection? Highly unlikely, based on what you described.

I really and truly hope that whoever prescribed your birth control counselled you on this information as it’s crucial to understand how birth control works. When you start ANY birth control pill, you NEVER TRUST THE FIRST MONTH on that pill pack as you cannot guarantee that you will stop the process of ovulation that first month. If takes a sustained overriding of your system to prevent ovulation. When you start a birth control pack on d5 or 6 and you ovulate on d14, then your body cannot usually interrupt the ovulation cycle fast enough that month, you must use a barrier form of contraception during that first month to further insure that you will not become pregnant. And if you miss 1 day, you take 2 pills the next day (AM and PM) and then resume taking once/day, that will not get you in trouble. And if you miss 2 days on your pack of pills, then you take 2 pills the next 2 days (AM and PM for 2 days) and that will usually keep you on track and you will not get pregnant. And if you have the misfortune of missing 3 days on your pack of pills, then you cannot make that up; you need to finish out your pack of pills AND CONTINUE TO USE CONDOMS FOR THE REMAINDER OF THAT MONTH AND FOR THE NEXT MONTH to be certain that you will not become pregnant. OR, you can allow yourself to have your bleed as you have now missed 3 pills in a row and then start a whole new pack, but you MUST USE CONDOMS THE ENTIRE NEW MONTH and NOT TRUST that first month back on the pill. Birth control pills work really well…when you take them as directed.

Breast development is not always equal or even from L to R side and as hormones kick in irregularly, the stimulation of the milk ducts can be erratic. This stimulation causes discomfort, especially to moderate touch or with jumping or laying on your stomach with pressure against the breast tissue. If breast pain gets too uncomfortable, then Vitamin E 600-1000mcg daily can really help take away that pain. Also, cutting down on any possible caffeine in soda or in energy drinks can actually stimulate breast tissue and cause pain. Most of the time, breast tissue will settle down once periods become a little more regular. If you are looking for a resource book for the adolescent, I encourage you to check out Blossoming, Becoming a Woman available on Amazon. In this book, I write about what the typical hormone swings of the adolescent look like, describe a lot of the symptoms that girls experience and explain the changes that occur so that this time can make sense.
If you have any further questions, check with your daughter’s healthcare provider.

Breast development is not always equal or even from L to R side and as hormones kick in irregularly, the stimulation of the milk ducts can be erratic. This stimulation causes discomfort, especially to moderate touch or with jumping or laying on your stomach with pressure against the breast tissue. If breast pain gets too uncomfortable, then Vitamin E 600-1000mcg daily can really help take away that pain. Also, cutting down on any possible caffeine in soda or in energy drinks can actually stimulate breast tissue and cause pain. Most of the time, breast tissue will settle down once periods become a little more regular. If you are looking for a resource book for the adolescent, I encourage you to check out Blossoming, Becoming a Woman available on Amazon. In this book, I write about what the typical hormone swings of the adolescent look like, describe a lot of the symptoms that girls experience and explain the changes that occur so that this time can make sense.
If you have any further questions, check with your daughter’s healthcare provider.

Your hymen is a tissue covering that protects the internal vagina, think of it as a lid on a pot. Many women will have that ‘lid’ or hymen normally worked or torn just with physical activity alone such as as bike riding or saddle riding. Many women will have a natural opening to their hymen that then allows for a tampon to enter the vagina to help with their periods. Many women may then actually be able to use a tampon or have digital stimulation without disturbing the outer hymen without any physical discomfort whatsoever. However, a physical penetration of a vibrator or an engorged male penis is usually large enough to stretch even the outer hymen and this is what causes the ‘bleeding’ of a virgin encounter. Some women who have very low Estradiol levels will have tissues like a menopausal woman that resists the natural elasticity and stretch that a healthy vagina with normal Estradiol levels has so even these women may have a burning sensation with the stretch of the vaginal opening that will tear due to inelastic tissues. Sometimes use of a vibrator without adequate lubricant will be a very dry and rubbing encounter of dry skin on a foreign body that can cause the skin to catch and tear.

Paget’s disease is a precancerous and sometimes cancerous diagnosis but not very common. Usually an itchy nipple is more simple; soap residue that is irritating, rubbing of the nipple on a loose shirt of poorly fit bra/top or going without a bra and clothing that rubs or chafes. Hot weather and sweating, whether you wear a bra or top with a bra shelf or swim suit top may all leave a salty residue on the areola/nipple and irritate. Avoid using any hand soap or body wash directly to the breast/nipple, avoid chlorine or pools/hot tubs with chlorine or fluoride and use a hair dryer on warm or cool setting when you get out of the shower to dry the breast/nipple vs a towel which can be too irritating. Women who are breastfeeding have this from frequent stimulation and moisture from their baby’s suckling; then using an udder balm to act as a protective layer can help. If none of these seem to fit your situation, then seek the advice of a healthcare provider.

Medicine is very confusing when it comes to the definitions of perimenopause vs menopause. Perimenopause is the ‘year before menopause’ and Menopause is ‘a year without periods’; so you can see how confusing that really is. As a doctor who writes books to help women decipher these definitions, I feel I have a little expertise in this area. Actually, the best way to help you through perimenopause is to realize that your female hormone levels will naturally go up and down and your periods will be irregular, both too close and too far apart as well as skipping for months at a time before kicking in again. I follow my patients with levels of their female hormones and help track those levels with their symptoms and then adjust bio-identical hormones to help with their roller-coaster of how they feel one month to the next. Many women will even go more than a year without bleeding and then kick back in and start to bleed again; it’s hard to make sense of a biologic system that just doesn’t have an ‘on-off’ switch. I encourage you to check out my book, Full Bloom: Perimenopause, Menopause and Beyond as I put a lot of the science of this time into an easy to read step by step ‘how to’ handle this crazy time; it’s available on Amazon for only $20. I also highly encourage you to consider bio-identical hormones due to your seizure disorder; many patients with seizures actually have less seizures keeping their hormone levels intact and balanced. In fact, in the European literature, Progesterone is the drug of choice in a traumatic brain injury; that’s what seizures are considered is originating from a traumatic tissue event, either vascular or electrical in the brain that triggers the seizure; this is certainly traumatic!

Pain in the vaginal area can be from an infection; this is usually assoc with a discharge and many times a malodor or bad smell. Many infections may also cause bleeding which can trigger a 2nd infection called BV or bacterial vaginosis and this may require an antibiotic to clear. Hot weather, wearing a wet swim suit all day and especially eating a lot of sugar can all trigger a yeast infection which can itch and be painful all at the same time. The best way to determine which of these is going on is to see a healthcare provider who can do a simple check to let you know as they all respond to different types of treatment. If you are on an antibiotic or if you are on a steroid inhaler for asthma or on steroids for any other reason, then a yeast infection is your most likely reason; then Monistat cream is over the counter and can help. If you have recurrent yeast infections and you aren’t sure why, then get checked for insulin resistance or diabetes. But be sure that you are NOT using hand soap or soap of ANY KIND on your very sensitive bottom as this can cause drying and cracking of this sensitive tissue and can cause pain to your entire bottom, including the vaginal opening. Lastly, wearing a tampon for longer than 4-5hrs can be irritating to the vagina, esp if your tampon is relatively dry against sensitive vaginal tissues. No one likes a tampon to fall out prematurely from getting soaked but keeping a dry tampon in too long can cause trouble too. In a worst case, it can cause a condition caused Toxic Shock Syndrome that can put you into the hospital. If none of these sound like they fit, then seek a healthcare provider to help you.

Bleeding with clots of any size is not a good sign, esp when it occurs together with cramping, it usually implies the pregnancy is not going well. You need to see your doctor as soon as possible and get both your Progesterone level and your HCG quantitative level checked; they may also wish to ultrasound you to be certain that you have a viable pregnancy. Small blood clots can happen when the placenta tries to implant over a previous C-section scar, or over a fibroid that is internal and on the inside surface of the uterus. Yes, it could be implantation bleeding but again, clotting is not usual. It could even mean a possible ectopic as it would be growing in the tube and that can cause significant trouble.

There are 3 things that I tell my patients: 1) NEVER mix 2 forms of artificial hormone together as this is so bad for your body, it will send you into a tailspin metabolically that may take you months to get out of. 2) NEVER take the Depo shot as the artificial Progesterone in the DepoProvera shot is the cause of increased breast cancer, increased heart attack and increased stroke from the Women’s Health Initiative. And NEVER take the oral form of Provera either. Barrier protection can be used and removed: condoms may be annoying because they can fall off or you have to check the expiration date… but they don’t cause cancer. And using a diaphragm means that you put it in no more than 1hr pre-relations and you have to leave it in for at least 12-24hrs post-relations but it doesn’t cause cancer. NEVER, NEVER, NEVER mix artificial hormones together; it’s a recipe for disaster. Sprintec is a 35microgram birth control pill and it should protect you well, especially if you don’t miss any doses and if you always take your pill close to the same time of day.

There are actually patients who have become pregnant without penetration of the vagina as moist vaginal secretions can help carry swimming sperm up to the cervix, even through underwear. 7days pre-ovulation is at the earliest timeframe of how long sperm remain viable in a woman’s reproductive system so that timeframe is a low but definite possibility. The best way to answer your question is to do a urine home pregnancy test or ‘pee on a stick’ which is only $1 at the Dollar Store; so get a handful and check, even if you miss your period. If you continue to have a negative test, then it’s likely you are not pregnant but the only absolute way to know for sure is to have a blood pregnancy test. The least expensive blood test is a Qualitative HCG; this is a yes/no test but goes no further. If you ask for a Qualitative HCG, Quant if positive, then they will give you an actual HCG number, but only if positive. Then you are not poked twice for the result of that test if it is positive.

In addition, there is a small percentage of all males that are ‘pre-ejaculators’; that means that some sperm get out in the first few drops without full ejaculation but those first few drops can still contain sperm, best to do a home pregnancy test.

Just because you have had an official diagnosis of ‘menopause’ or 1year without periods, doesn’t mean that you are done bleeding!!! The female pelvis doesn’t always just ‘stop’ because it’s been a 12month or 24month period of time; all women will go through their downward trend of irregular periods and skipped periods, then every woman will ALSO go through something that I call their ‘last hurrah’; when your body kicks in for another 1cycle or even up to a few months of cycles complete with pre-period symptoms of headache, backache, bloating, etc, JUST LIKE your former usual pattern of bleeding used to be. In my practice, I routinely follow my patients every 3-4months with symptom trackers and bloodwork to keep their female hormones of Estradiol and Progesterone (E + P4) in BALANCE and more prevalent than their male hormones of Total and Free Testosterone (T and Free T). This newly menopausal time is quite commonly associated with return of abnormal bleeding; but it is also quite commonly associated with Estradiol dominance which sets you up for an abnormal mammogram and possible breast cancer if your hormone balance is not reset. Checking your hormone levels is not that expensive; there are on-line sites that will offer cash discounts and they send you the test tubes for draw at a lab drawsite or some labs even do blood-spot testing where you prick your finger to fill an absorbent spot on the test paper and send it in for the lab to analyze. However, do NOT do salivary testing as it is not comparable to serum levels and can be misleading. Then to avoid needing to make a doctor’s appointment to interpret your values, get a copy of my book, Full Bloom; Perimenopause, Menopause, Post-Menopause and Beyond for only $19.95 on Amazon and learn how to interpret your results!

Dr. Vicki Mondloch

The average age of menarche or getting your periods in the US is approx. age 12 but that can vary 2years either direction and still be normal. Women who are physically active in sports or who are underweight for height will usually have a normal delay on onset of their periods and this can be normal. Even putting yourself on a calorie restrictive diet without being underweight can cause the delicate start-up of your female hormone cycle to get disrupted and it can delay your first period. Also remember that any STRESS! In your life can negatively impact your female hormone system, putting more male hormone into your system and preventing your periods as well as giving you acne! Please get a copy of my book, Blossoming: Becoming a Woman on Amazon for only $19.95; I outline the myths and truths about the female hormone system and answer a lot of questions that young women have. It’s a great resource for both you and your parents to have, saving you time going to your pediatrician or family practitioner who doesn’t always have enough medical information to help you through this journey.

Dr. Vicki Mondloch

With the accuracy of home urine pregnancy tests, and doing 5 tests, you are likely not pregnant. So why aren’t you getting your period? NEVER underestimate the power of stress and how stress can actually shut down your female ovulatory system; what that means is that you likely are not ovulating so your body continues to make a lining with your Estradiol or E but it doesn’t know when to release that lining because there is no rise and then fall of Progesterone or P4. A typical menstrual cycle is 28days; d1-4 is your bleed, then you make E along until d14 when your ovaries will typically ovulate; then you make your peak of P4 by d21 and if you are not pregnant, then your P4 levels drop to zero and your lining sheds, starting a new 28day cycle. Stress disrupts this cycle by interfering with ovulation; if that happens, you do not make P4 so your uterus doesn’t know WHEN to bleed so it keeps making a lining. May factors influence whether or not you ovulate but never underestimate what stress can do to prevent ovulation! Check out my book, Blossoming, Becoming a Woman on Amazon for $19.95; this resource is full of useful information about how our hormones affect us and how our environment affects how our hormones and bodies work! This book will answer many more questions that you may have and it will save you a trip to the doctor’s office and save you from not sleeping at night.

Dr. Vicki Mondloch

Your HCG levels post miscarriage will drop fairly quickly but that all depends on how far along you were, whether there was a fetus and if you passed the ‘products of conception’ completely or incompletely despite not having a D&C. Progesterone (P4) is absolutely necessary for a healthy implantation of the fetus and a sustained healthy growth of the pregnancy. Without adequate levels of Progesterone, you can get pregnant, and then you may miscarry simply because your P4 levels are too low to sustain a healthy pregnancy. And many women may not even have a period on their own after a miscarriage; if your body triggers a menstrual cycle and you ovulate, you may actually become pregnant which would trigger by a urine pregnancy test as early as the day or 2 before you expect your period; but it would certainly trigger a urine pregnancy test if it was a weak positive, then followed by a stronger positive test 2days later. Despite a rising P4 level (which is excellent!) also get a quantitative serum pregnancy test of quant HCG; this number should double every 48hours if it’s growing appropriately. However, an ectopic can also mimic a normal pregnancy that’s inside the uterus; it will also double HCG numbers but you may have pain by 4-6wks with or without bleeding; then you need to be seen by and OB and rule out an ectopic which could rupture and end up with life-threatening internal hemorrhage, surgery or even loss of your tube on that side. Check out my book Blossoming: Becoming a Woman on Amazon for $19.95; it walks patients through the menstrual cycle and can be a great resource in helping you understand how your body works, saving you phone calls to your doctor’s office or costly appointments/time off of work to answer questions that you may continue to have.

Dr. Vicki Mondloch

Missing your period can be common for women at any time during their menstrual career; although it is more common at the beginning and at the end of your menstrual career, age 12-20 and age 40-50. Our female periods are controlled by the balance of your 2 female hormones Estradiol (E) and Progesterone (P4). Usually, we continue to make E on a regular daily basis but our production of P4 is more likely to be affected by STRESS which can prevent the process of ovulation when we make P4. Low P4 also causes abdominal bloating and constipation which can by themselves lead to a low grade nausea; so can stress lead to muscular tension in our head and neck. In our neck is a large muscle, the Sternocleidomastoid muscle that our Vagus nerve runs through. The Vagus nerve, if squeezed with muscle tension can trigger nausea as it runs down to our stomach; however, bloating from low P4 can also trigger nausea. Dehydration usually also has dizziness with bending over and then coming back upright but the resolution of dehydration is more simply answered by putting a cold wet cloth on the back of your neck and on your forehead, drinking 32oz water + a 6oz ‘shot’ of G2 or Propel or Gatorade or Pedialyte for the electrolyte in 15minutes, putting your feet up and see how you feel in 30min or so. If you are so dehydrated that you cannot drink fluids then you may need to have a friend feed you spoonfuls of crushed icecubes or frozen icecubes of Pedialyte (put icecubes of water or Pedialyte in a blender like an icee) and let the crushed ice/Pedialyte melt in your mouth little by little until you can drink oral fluids on your own. If you are so nauseated that you cannot handle crushed ice, you may require more advanced medical help with an IV placed. Either way, you will likely have a wicked headache as part of your recovery whether you regain your hydration quickly or slowly so be prepared for that.

When a pregnancy test turns positive, then negative, then positive, it is likely this is a pregnancy that may not be inside the uterus but actually be inside the Fallopian tube. This is a pregnancy that cannot continue, and some of the tissue may be halthy enough to grow and some of that tissue cannot grow so the levels can ‘swing’ vs increasing or doubling every 48hrs. Another possible explanation is being pregnant in both the uterus and in the tube; either way, the best thing to do is to see your doctor and get a bloodtest for pregnancy; this is called a quantitative HCG bloodtest which will give you an actual number vs a ‘yes/no’ pregnancy test. If this number doesn’t double in 48hours or if you have pain, then you may also need a pelvic ultrasound to actually make certain there is no problem with the pregnancy. And lastly, while you are getting a blood pregnancy test done, ask for a blood Progesterone level to be done as well. Progesterone helps you to maintain a healthy pregnancy; if your level is low or below 20, you are at higher risk of miscarriage and need to take bio-identical Progesterone to maintain a healthy pregnancy.