Fertility Awareness empowers women with the knowledge about their body’s natural hormone cycles. This allows women the freedom to prevent and or achieve pregnancy without the use of synthetic hormones or birth control methods. Multiple renowned medical studies have shown that synthetic hormones, such as found in birth control pills, implants, and hormonal IUD’s, increases a woman’s risk for breast cancer by 40% (Morch et al., 2017), heart disease by 80% (Manson et al., 2013), blood clots by four-fold (ACOG, 2012), and stroke by 41% (Manson et al., 2013). CRWH does not refer nor prescribe birth control methods. We do remove devices if this is the woman’s preference and provide education about the natural menstrual cycle. Understanding how your body works can help achieve or prevent pregnancy naturally without increasing your risk for breast cancer, heart disease, blood clots, and stroke. Fertility awareness methods (FAM) incorporate various ways to track and monitor your cycles. We do not limit FAM’s to one particular method (such as Billing’s or Rhythm). There is not a “one size fits all” method. Every woman is a unique individual and should be able to learn the various FAM’s to see what will work for her needs. For more information about fertility awareness, please visit www.factsaboutfertility.org  or  www.naturalwomanhood.org 

Hormones are complex molecules made in the endocrine system. They are essential for many bodily functions such as regulating body temperature, growth and development, heart rate, mood and stress, reproductive cycles, sexual function, sleep cycles, and weight management.  Hormonal balance or imbalance can be influenced by diet, environment, medications, medical conditions such as diabetes or thyroid function, stress, and exposure to toxins or pollutants. At CRWH, we believe that equipping women with knowledge about their hormones is the first step to achieving good hormone balance and empowering women to take charge of their health. CRWH also utilizes lifestyle, diet, natural herbs and bio-identical hormones to help promote hormonal balance in all stages of life.

References:

American College of Obstetricians and Gynecologists (ACOG). (2012). Risk of venous thromboembolism among users of drospirenone-containing oral contraceptive pills. Committee Opinion No. 540. Obstetrics and Gynecology, 120, 1239-42.

Manson, J. E., Chlebowski, D. R. T., Stefanick, M. L., Aragaki, M. A. K., Rossouw, J. E., Prentice, R. L., … & Wactawski-Wende, J. (2013). The Women’s Health Initiative hormone therapy trials: update and overview of health outcomes during the intervention and post-stopping phases. JAMA: The Journal of the American Medical Association, 310(13), 1353.

Mørch, L. S., Skovlund, C. W., Hannaford, P. C., Iversen, L., Fielding, S., & Lidegaard, Ø. (2017). Contemporary hormonal contraception and the risk of breast cancer. New England Journal of Medicine, 377(23), 2228-2239.

What is ultrasound?

Ultrasound is a diagnostic tool that uses sound waves through various types of probes to detect “tissues, body fluids, and bones” (ACOG, 2017). These sound waves bounce off the tissue, fluid, or bones and relay the information back through the transducer and the information is transformed into images displayed on the screen.

What is “limited ultrasound”?

Parameters for ultrasound use in pregnancy are set by the American Institute of Ultrasound in Medicine (AIUM) and the American College of Obstetricians and Gynecologists (ACOG). At CRM we provide “limited ultrasounds” according to the AIUM and ACOG for women to confirm pregnancy, determine that the baby is in the right location (uterus), and the determine the presence of cardiac activity (viability). This type of ultrasound does not look at congenital anomalies.

Is an ultrasound safe?

To date there is no evidence of harm from the ultrasound on the baby at this time. However, there is the possibility that long-term effects could eventually emerge. Thus, it is recommended that only professionals perform ultrasounds and that ultrasounds should only be used as medically necessary and not casually (ACOG, 2017).

When do I have an ultrasound?

During your pregnancy you may have an ultrasound to confirm your pregnancy, estimate the gestational age, verify location, and viability (between 6-8 weeks since your last menstrual period). This ultrasound can be done at CRWH. “Standard ultrasounds” are completed between 18-22 weeks to look at fetal health and development, location of the placenta, screen for major congenital anomalies, amount of amniotic fluid, fetal cardiac activity, and fetal size.

What should I expect when I have an ultrasound?

During your ultrasound you will lie on your back on an exam table. For a transabdominal ultrasound, your abdomen will be exposed, ultrasonic gel is placed on your abdomen for the transducer, and then the transducer is moved across your abdomen to view images of the baby. Transabdominal ultrasound is typically used in the second trimester when the baby is bigger. It is helpful to have a full bladder for a transabdominal ultrasound to view the baby and surrounding structures. Drink several cups of water two hours prior to your exam. A transvaginal ultrasound may be done in the first trimester to obtain a better image of the baby. You will need to undress from the waist down and a sheet is provided for you to cover up and you lie down on the exam table. Your feet will be in stir ups similar to a pelvic exam. The transvaginal probe is a wand shape (much like a tampon), covered with a latex sheath (similar to a condom) and sterile lubricant, then it is placed into the vagina. A transvaginal ultrasound is best done with an empty bladder.

References

American College of Obstetricians and Gynecologists (ACOG) (2017). Frequently asked questions: Ultrasound exams. Retrieved from https://www.acog.org/Patients/FAQs/Ultrasound-Exams?IsMobileSet=false.

American Institute of Ultrasound in Medicine (AIUM) (2018). AIUM practice parameter for the performance of limited obstetric ultrasound examinations by advanced clinical providers. Journal of Ultrasound Medicine, 37, 1587-1596.

Congratulations! Pregnancy can be an exciting time but also a time of many changes and challenges for women. Early prenatal care for both mother and baby is essential for a healthy start to your pregnancy. At this time, CRWH only offers prenatal care through the first 20 weeks of your pregnancy. CRWH will then connect you with your choice of provider–OBGYN, CNM, CPM, etc. and setting–hospital, birth center, or home birth. CRWH seeks to provide you with the knowledge, tools, and initial care to help you and your growing baby.

Call your provider immediately (720-432-6580) or go to the nearest emergency room if you are experiencing any

• *Heavy bleeding
• *Severe abdominal pain
• *Fever (temperature higher than 100.4 F)
• *Pain with urination
• *Severe nausea preventing you from eating or drinking for more than 12 hrs or vomiting more than 3 times per day for most days
• *Severe headache that is unrelieved with acetaminophen (Tylenol)

What is an STD/STI?

STD is an acronym for sexually transmitted disease and can be interchanged with the term sexually transmitted infection (STI) meaning the same thing. STD’s are very common but also can be preventable. According to the Center for Disease Control and Prevention (CDC), in 2017 over two million STD cases were reported in the United States. STD’s are transmitted from person to person by oral, vaginal, or anal sex, sharing needles, or an infected mother may pass it to her baby during pregnancy, birth, or breastfeeding.

What are the symptoms?

STD’s can either have no apparent symptoms or mild symptoms such as burning with urination, itching, sores, rashes, unusual discharge, poor appetite, or low grade fever. Despite the lack of obvious symptoms, if left untreated these infections can cause long-term health disparity and affect quality of life. Complications from untreated STD’s include infertility–every year approximately 20,000 cases of women struggling with infertility related to STD’s occur in the U.S. (CDC, 2018), cancer, organ damage, stroke, or blindness (CDC, 2018).

Who needs to be tested?

The following recommendations for who should be tested are made by the CDC (2014):

ALL sexually active women less than 25 years of age should be tested every year for chlamydia and gonorrhea.

Women over the age of 25 with risk factors such as a new partner or multiple partners should be tested annually.

ALL women, ages 13-64, should be tested at least once for HIV.

ALL pregnant women should be tested for syphilis, HIV, and hepatitis B early in their pregnancy. Pregnant women younger than 25 years or women older than 25 years with risk factors mentioned above should also be tested for chlamydia and gonorrhea early in the pregnancy. An STD panel including syphilis, HIV, hepatitis B, chlamydia and gonorrhea is usually completed at the first prenatal visit.

ANYONE who has unsafe sex or shares needles should be tested once a year for HIV.

What to expect at my appointment

Discussing your sexual health can be difficult but it is important to voice any concerns to ensure the best testing and treatment for you. At CRWH, we strive to maintain your privacy and confidentiality to help with this process. There are a few STD’s that are considered mandatory reporting to the CDC if the test result is positive (chlamydia, gonorrhea, HIV, hepatitis, syphilis, and chancroid). During your appointment you will receive a questionnaire to complete about risk factors and history to help determine what tests are the most appropriate for you. You will then receive a vaginal swab kit–you can complete yourself–or a sterile urine container to collect a sample. The test will be sent to a local laboratory for processing. Most test results are available within a week. Your provider will discuss your test results, plan of treatment if positive, or plan for prevention if negative. If you are pregnant, an STD panel will be completed at your first prenatal visit via a lab draw.

References

Centers for Disease Control and Prevention (CDC) (2018). Sexually Transmitted Disease Surveillance 2017. Atlanta: U.S. Department of Health and Human Services. doi: 10.15620/cdc.59237

Center for Disease Control and Prevention (CDC) (2014). Sexually transmitted disease: Prevention. Retrieved from: https://www.cdc.gov/std/prevention/screeningreccs.htm.

What is well-woman’s care?

Well-woman’s care refers to an annual exam for women where you can connect with your provider about your health and discuss any needs or concerns. This is one of the most important steps for women to take charge of your health. Annual exams help establish a relationship with your provider to discuss how your health is currently, examine any changes that could improve your health, identify potential problems, provide treatment or health and lifestyle support to help manage any problems, and address any concerns that you might have.

Who needs well-woman’s care?

Women from any age starting at 13 years should see a health care provider once a year for well-woman visit. Age appropriate screening, testing, evaluation, and health promotion and risk prevention is recommended by ACOG for all women annually over the age of 13 (2018).

What to expect at my appointment

Your well-woman visit will include a questionnaire about your medical history, surgical history, family history, medications, allergies, menstrual history, gynecological history, and any current concerns or symptoms. Next, we will check your height, weight, and blood pressure. A basic physical examination is completed to assess your thyroid, skin concerns, heart, lungs, mouth, eyes, ears, nose, breasts, and abdomen. A more specific exam may be indicated based on your history and presenting symptoms. Pelvic exams are only done based on your health history (Cansino & Chohan, 2018). A pap smear (screening for cervical cancer) is based on your age and risk factors. Your provider will inform you of when and how often a pap smear is indicated.

References

American College of Obstetrics and Gynecology. (2018). Well-woman visit. ACOG Committee Opinion No. 755. Obstetrics and Gynecology, 13, e181–86.

Cansino, C., & Chohan, L. (2018). The Utility of and Indications for Routine Pelvic Examination. ACOG Committee Opinion No. 754. Obstetrics and Gynecology, 132(4), E174-E180.