We have compiled a list of valuable tips so you can arm yourself with facts! As always, we are here to help seven days a week!

What are hormonal birth control pills?

Combined estrogen-progestin oral contraceptives (COCs), also known as birth control pills, provide reliable contraception as well as several non-contraceptive benefits. COCs contain an estrogen component and one of a dozen different progestins. For healthy, nonsmoking women, COCs may be continued until the age of menopause. The type of pill selection should include a patient’s experience with COCs, patient preferences, clinical characteristics, insurance coverage, and cost. Shared decision-making improves adherence to any contraceptive method.

How does the pill work?

The COCPs suppress ovulation by inhibiting gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and the mid-cycle LH surge. This effect is mediated by the synergistic action of the COC’s progestin and estrogen components.

How effective is the pill?

When taken correctly, COCs are a highly effective form of contraception. Although the perfect-use failure rate is 0.3 percent, the typical-use failure rate is more typically approximately 7 percent, due primarily to missed pills or failure to resume therapy after the pill-free interval.

Who should avoid taking the pill, and when?

We call these absolute contra-indications (Unacceptable risks: CDC – category 4 rating)  because of the risk of blood clots, stroke, and death!

• Undiagnosed abnormal vaginal bleeding (Irregular cycles or heavy bleeding)
• Age ≥35 years and smoking ≥15 cigarettes per day
• Multiple risk factors for arterial cardiovascular disease (such as older age, smoking, diabetes, and hypertension)
• Hypertension (systolic ≥160 mmHg or diastolic ≥100 mmHg)
• Venous thromboembolism
• Known thrombogenic mutations- genetic mutations that can cause blood clots.
• Known ischemic heart disease
• History of stroke
• Complicated valvular heart disease (pulmonary hypertension, risk for atrial fibrillation, history of subacute bacterial endocarditis)
• Current breast cancer
• Severe (decompensated) cirrhosis
• Hepatocellular adenoma or malignant hepatoma
• Migraine with aura
• Diabetes mellitus of >20 years duration or with nephropathy, retinopathy, or neuropathy.

When can you take the pill but under close supervision?

We call these relative contra-indications (CDC- Category 3 rating).

OCPs may be considered individually if no other acceptable alternative is available.

• Age ≥35 years and smoking <15 cigarettes per day
• Hypertension (systolic 140 to 159 mmHg or diastolic 90 to 99 mmHg)
• Hypertension adequately controlled on medications
• Past breast cancer and no evidence of current disease for five years
• Current gallbladder disease
• Malabsorptive bariatric surgery
• Superficial venous thrombosis (acute or history)
• Inflammatory bowel disease with risk factors for venous thromboembolism (active or extensive disease, surgery, immobilization, corticosteroid use, vitamin deficiencies, or fluid depletion)

I have a family history of breast cancer and/or have the BRCA gene-positive status.

A family history of breast cancer or BRCA-positive status is NOT a contra-indication. COCPs can help reduce the risk of ovarian cancer and colon cancer in such patients.

There are so many birth control pills; how do I know where to start?

Again, a healthcare professional knowledgeable about the types, side effects, and dosing can guide you properly.

Below is a primer to help you get armed with facts!

Types of Combination Oral Contraceptive pills and dosing.

There are three types of OCPs based on the dose of Ethinyl Estradiol in the pill.

Ethinyl Estradiol (Estrogen types)

• Ultra low dose (<20mcg)
• Low dose (20 mcg)
• Standard dose (30-35mcg)

Progestin types

• High androgenicity but low blood clot risk. – Norethindrone/ Levonorgestrel.
• Low androgenicity but slightly increased clot risk – Norgestimate/ desogestrel.
• Anti-androgenic – Drospironone/ dienogest/ cyproterone acetate

The overall effect of all COCs, however, is antiandrogenic (suppress testosterone), regardless of the type of progestin used

1. Oral Contraceptives (Mono-phasic)- these pills have the same dose of estrogen and progesterone throughout the cycle

First choice:

Low dose  – for routine use, low side effects

(Ethinyl estradiol/ desogestrel or levonorgestrel)

Generic –Microgestin Fe 1/20 x 28/ Junel Fe 1/20 x 28 days/ Alesse/ Mircette

Second choice: (if history of breakthrough bleeding)

Standard dose (30-35 mcg) –  Apri/ Microgestin – 1/30/ Junel 1/30

Ultra-low dose (10mcg) – Lo-loestrin.

This is usually preferred for patients unable to tolerate low-dose pills.

2) Oral contraceptives (Tri-phasic)

These pills have a different dose of estrogen and progesterone every week of the cycle. Below are some examples:

• Ortho-tricyclen Lo
• Camrese
• Tri-sprintec, regular or lo

Usually, these are not the first preference because of varying doses, but if you are already on one, there is no need to switch. 

3) Oral contraceptives – 3 monthly – Endometriosis/ chronic pelvic pain

Skipping the placebo in Monophasic pills is the best option.

Or

• Quattro (4 months)
• Seasonique ( 30mcg EE).
• Jolessa (3 monthly packs – 30mcg EE).
• Lo-loestrin – skip placebo.

4) Transdermal – These are the same as the pill but come as a patch.

If you have increased breakthrough bleeding / are forgetful/ have a busy lifestyle, you can miss pills/ have small kids/ shift workers/ PMS, etc.

XULANE patch 1 q weekly x 3 weeks, then one week off.

5) Transvaginal – If increased breakthrough bleeding / forgetful/ lifestyle – missing pills/ have small kids/ shift workers/ PMS

Nuvaring – 1 ring every three weeks in, one week off.

THERE is a LOWER  RISK OF THROMBOSIS WITH NUVA-RING -/ PATCH because it bypasses the liver, and there is constant absorption with stable serum levels. Avoids the peaks and troughs from oral absorption.

How should I start, and what should I watch out for?

• Start on the first Sunday after the period or Day 1 of the period. If start on Day 1 of period, will be protected in the same cycle. If Sunday start, use additional contraception in the first cycle. We do not recommend an early start or immediate start (even though many other providers do, we want to be safe).
• Take bedtime after meals (Never on an empty stomach).
• Initial few days – nausea/ increased appetite – body develops quick tolerance.
• Very low dose ones like Loestrin/ lo loestrin – you may have irregular spotting throughout the cycle for the first three months. Just wait it out. No need to change the pill.
• Some of you may have decreased libido, hair fall, and weight loss.

I want to get pregnant; how long should I wait after stopping the pill?

COCPs do not cause infertility. There is no waiting time recommendation.

Always complete the pack when you stop the pills; otherwise, you can get irregular cycles.

I am 50 years old and on the pill. How do I know I am in menopause?

• If you need to check for menopause, stop OCPs for at least six weeks and then get blood work done with your provider to check for FSH and Estradiol levels.

I am on the pill. Can I still get STDs?

No, OCPs do not offer protection against STDs.

I have severe PMS. Will the oral pill help?

NO! That’s a myth!!!

Check out our PMS blog to learn more!

Do pills help with Acne?

Yes, if the acne is from high testosterone

Prefer Low androgenic and monophasic types.

Example: Junel 1/20 ( Desogestrel containing).

*https://www.cdc.gov/reproductivehealth/contraception/pdf/summary-chart-us-medical-eligibility-criteria_508tagged.pdf

How do I know if any other drugs that I am taking can affect the pill?

It’s hard to know! That’s why you should consult your healthcare provider. Still, we have compiled some interactions to watch for:

DECREASED EFFICACY (High chance of failure)

The efficacy of COCPs may be decreased by any drug that increases liver microsomal enzyme activity.

Anticonvulsants :

Anticonvulsants that reduce the efficacy:

Phenytoin, carbamezapine, barbiturates, primidone, topiramate, felbamate, or oxcarbazepine.

If using OCPs with above anticonvulsants:

• Use a standard dose OCP with a minimum of 30 mcg of ethinyl estradiol + progestin with a longer half-life (drospirenone, desogestrel, levonorgestrel).
• Skip placebo or preparation with a four-day hormone-free interval.

Anticonvulsants that do not appear to reduce contraceptive efficacy:

Gabapentin, levetiracetam, valproate, zonisamide, and tiagabine.

Lamotigrine and OCP’s

COCs can result in a decrease in plasma lamotrigine concentrations by 45 to 60 percent. This can increase the risk of seizure.

• Consult with neurology to adjust dosing.
• To avoid fluctuating lamotrigine levels, continuous dosing of the COC rather than cyclic is recommended.

Antibiotics

Rifampin is the only antibiotic proven to decrease serum ethinyl estradiol and progestin levels in women taking COCs (due to enzyme-inducing effects).

Antiretrovirals – Refer to current texts.

 St. John’s wort –May increase the risk of ovulation.

Useful things to remember:

1. If you have irregular cycles or bleeding between cycles or after sex, it’s essential that you see a GYN for a complete evaluation, including an ultrasound and blood work!
2. If you are obese or overweight patients – please get blood work to rule out pre-existing elevated liver enzymes.
3. NEVER do an immediate start.
4. If you miss one pill, take two the next day and finish the pack. If you miss two, finish the pack but use additional protection in that cycle.
5. With many pills, your periods may get lighter and may even go away, but please do a pregnancy test to confirm.
6. Try and take the pills at the same time every day – set an alarm on your phone.
7. Pills do not cause weight gain by themselves, but if your body is not a good estrogen metabolizer, you may experience bloating breast tenderness, and water retention.

Overall, it’s great to have easy access to hormonal birth control, but please remember to be well-informed!

Be safe, be strong, and be prepared!

Dr. Adeeti Gupta and the lovely team at Walk In GYN Care

The post Oral Contraceptive Pills!! Must know facts! appeared first on Walk In GYN Care.

Read on as we break down the what, why, and how of this impressive herb and who can benefit from it.

What is Berberine?

Berberine is a plant alkaloid with a long history of medicinal use in both Ayurvedic and Chinese medicine. It is present in Hydrastis canadensis (goldenseal), Coptis chinensis (Coptis or goldenthread), Berberis aquifolium (Oregon grape), Berberis vulgaris (barberry), and Berberis aristata (tree turmeric). The berberine alkaloid can be found in the roots, rhizomes, and stem bark of these plants.

When was it discovered and what has been going on since?

 The earliest record of Rhizoma Coptidis as a medicinal herb was in A.D. 200 in The Herbal Classic of the Divine Plowman (Shen Nong Ben Cao Jing). In about A.D. 500, the anti-diabetes activity of Rhizoma Coptidis was recorded for the first time in a book titled “Note of Elite Physicians.”

Most berberine used in medical practice is not extracted from this herb because of its high cost. Usually, it is prepared from other herbs such as Berberis amurense Rupr. and Phellodendron amurense Rupr. Among many chemical forms of berberine, i.e., berberine hydrochloride, berberine sulfate, berberine citrate or phosphate, berberine hydrochloride is the most common form.

A literature search of Berberine, its uses, mechanism of action, new developments, and delivery systems revealed over 10,000 results. I will try to narrow down the most relevant and easily digestible fragments to inform you of its uses, side effects, and much more.

What are some proven benefits of Berberine?

Recently, basic research has proven that berberine can be used to lower the blood glucose level (Liang et al., 2019), improve insulin resistance (Lou et al., 2011), improve hyperlipidemia (Li et al., 2016), and prevent mild cognitive impairment (Kumar et al., 2016). This feature improves the shortcomings of the combination of statins and metformin and shows potential as a new first-line treatment drug.

Here is a brief list of the purported and proven benefits of Berberine. In the following section, I will elaborate on the mechanisms that lead to these benefits.

1. Lower blood sugar – improve glycemic control in diabetics.
2. Improve metabolic syndrome parameters (weight, waist circumference, blood pressure and lipid profile).
3. Improve Polycystic Ovarian Syndrome (PCOS).
4. Antimicrobial properties that assists in fighting bacterial and other microbial gut and skin infections.
5. Improve lipid profile, especially LDL, HDL and Triglycerides.
6. Improvement in NAFLD (nonalcoholic fatty liver disease).
7. Reduce cognitive impairment in diabetics.

How does Berberine do the magic?

Glycemic control:

Several animal and human studies have shown Berberine’s unequivocal effects on glucose control. Here is how it helps:

1. Berberine activates AMP-activated protein kinase (AMPK).

AMPK is a key energy-sensing/signaling system in the cells and acts as a fuel gauge by monitoring cellular energy levels.

2) It has an insulin-independent hypoglycemic effect that is related to inhibition of mitochondrial function, stimulation of glycolysis and activation of AMPK pathway. In the newly-diagnosed type 2 diabetic patients, berberine is able to lower blood insulin level via enhancing insulin sensitivity. However, berberine may improve insulin secretion in patients with poor β-cell function by resuscitating exhausted islets.

This study confirmed that administration of berberine (0.5 g three times daily) at the beginning of each meal was able to reduce fasting blood glucose (FBG) and postprandial blood glucose (PBG) in patients with newly-diagnosed type 2 diabetes. Hemoglobin A1c (HbA1c) levels were dropped by 2.0%, comparable to the effect of metformin. In poorly-controlled diabetic patients with insulin injection, berberine reduced HbA1c by 0.8%.

In the first in vitro study using hepatocytes (HepG2 cell line), berberine was shown to stimulate glucose consumption in an insulin-independent manner, and the activity was similar to that of metformin. Several studies have confirmed the insulin-independent activity of berberine in other cell models e.g., muscle cells (L6 and C2C12 cell lines) and adipocytes (3T3-L1 cell line). In the presence of insulin, berberine exhibited a synergetic effect on insulin-induced glucose consumption and glucose uptake. It is unclear if Berberine acts through the GLUT receptors.

3) The antioxidant and aldose reductase inhibitory activities of berberine may be useful in alleviating diabetic nephropathy.

Oxidative stress and aldose reductase activities are closely related to diabetic complications. Several groups have explored the obvious beneficial effect of berberine in this field. In STZ and high-carbohydrate/high-fat diet induced diabetic rats with hyperlipidemia, berberine markedly decreased malondialdehyde level and increased catalase, superoxide dismutase, glutathione peroxidase, and glutathione activities. Berberine also improved cognitive performance, lowered hyperglycemia, oxidative stress, and choline esterase activity in diabetic rats.

4) Berberine was shown to protect against endothelial injury, enhance the endothelium-dependent vasodilatation, and downregulate proinflammatory responses through activation of the AMPK signaling cascade.

5) Berberine also acts as an α-glucosidase inhibitor. α-Glucosidase is an intestinal enzyme that breaks down carbohydrates into monosaccharides. Inhibition of the enzyme will lead to diminished absorption of dietary carbohydrates.

6) Berberine may have extra beneficial effects on diabetic cardiovascular complications due to its cholesterol-lowering, anti-arrhythmias and nitric oxide (NO) inducing properties.

Cholesterol-lowering effects

Berberine (BBR) was reported to improve lipid metabolism in both animals and human subjects. Two clinical trials showed that berberine decreased triglycerides by 35% and 22%, serum cholesterol by 29% and 16%, and LDL-C by 25% and 20% in patients with dyslipidemia.

Reduction of cholesterol with berberine is related to the induction of LDL receptor (LDLR) expression in liver, which may be due to extended half-life of LDLR mRNA via activation of extracellular signal-regulated kinases (ERK) by berberine.

The results in this study showed that Berberine (BBR) supplementation can significantly lower TC, TG, LDL, Fasting blood glucose (FBG), insulin, HbA1c, HOMA-IR, SBP, weight, BMI, and waist circumference (WC) and can elevate HDL. According to the subgroup analysis, Berberine supplementation in participants with normal BMIs (18.5–24.9) was ineffective for changing TG, TC, LDL, HDL, insulin, SBP, weight, BMI, and WC. The significant effects of Berberine on HDL and WC were only seen in doses of more than 1 g/day, on FBG and HOMA-IR in the durations of more than 8 weeks, and on HbA1c and weight in both mentioned higher subgroups of dose (>1 g/d) and duration (>8 weeks). Moreover, BBR was significantly effective in alleviating cardiovascular risk factors, mainly in subgroups with impaired metabolic health such as NAFLD, type 2 diabetes, and metabolic syndrome. In addition, BBR was effective for the improvement of LDL, HDL, and FBG only in subgroups with abnormal ranges (HDL ≤ 40, LDL > 100 mg/dl, and FBG > 100 mg/dl). The optimum dose for BBR was 1 g/day for TG, TC, and weight, 1.8 g/day for insulin and HOMA-IR, and 5 g/day for HDL. The most effective duration was 40 weeks for FBG and 50 weeks from the beginning of BBR supplementation for DBP and WC.

BBR is suggested to upregulate the expression of LDL receptors in the human hepatoma cell line (HepG2) and to inhibit both cholesterol and TG synthesis in the liver, dose-dependently. This effect of BBR on lipid synthesis is mediated by the mitogen-activated protein kinase (MAPK/ERK) pathway, and can also be owing to the decrease in proprotein convertase subtilisin/kexin type 9 (PCSK9) mRNA. PCSK9 downregulates the LDL receptor (LDLR) and BBR acts against it. Another mechanism of action for BBR could be that it is an agonist for AMPK, a fuel gauge. This activation leads to the inhibition of cholesterol and TG synthesis by inactivating two enzymes, β-Hydroxy β-methylglutaryl-CoA (HMG-CoA) and ACC (acetyl-coenzyme A carboxylase). AMPK activation also increases energy production hence normalizing the imbalance between glucose, lipid, and energy. This activation can also impose anti-inflammatory effects and can speed up the transport of glucose in the serum by promoting glucose transporter type 4 (GLUT4) translocation, although GLUT4 involvement is still unclear.

Antimicrobial and antioxidant activities of Berberine

 The antimicrobial activity of berberine is well-established in treatment of infection caused by bacteria, viruses, fungi, protozoans and helminthes.

This study showed a significant effect of Berberine against Staph Aureus. In this study, Berberine showed antimicrobial activity against all tested strains of MRSA. Minimum inhibition concentrations (MICs) of berberine against MRSA ranged from 32 to 128 µg/mL. Ninety percent inhibition of MRSA was obtained with 64 µg/mL or less of berberine.

The authors concluded that BBR reduced the antioxidant capacity of S. aureus. Accumulation of the precursors (UDP-GlcNAc, CDP-ribitol, and CDP-glycerol) and downregulation of the key metabolite D-Ala-D-Ala suggest the inhibition of cell wall synthesis, especially the peptidoglycan synthesis. Metabolites involved in the shikimate pathway (such as 3-dehydroshikimate) and downstream aromatic amino acid synthesis were disturbed.

Improvement in NAFLD (Non Alcoholic Fatty Liver Disease)

Since liver plays a central role in glucose metabolism, numerous studies focused on effects of berberine, especially in fatty liver disease. In newly diagnosed type 2 diabetics with nonalcoholic fatty liver disease as comorbidity, berberine obviously ameliorated liver steatosis in ultrasonic images, decreased AST and ALT, reduced hemorheology indicators, and improved lipids profile. Similar results were obtained in another study. Berberine lowered FBG effectively in chronic hepatitis B and hepatitis C patients with T2DM or impaired fasting glucose. Liver function was improved greatly in these patients as indicated by the reduction of liver enzymes. This data showed that hepatic steatosis was alleviated by berberine through inhibition of fatty acid synthase (FAS) expression. Berberine decreased fasting blood glucose by direct inhibition of gluconeogenic genes, phosphoenolpyruvate carboxykinase (PEPCK) and glucose-6-phosphatase (G6Pase) in liver.

Complex I of the electron transport chain is the major place of superoxide production, and is the target of berberine.  The antioxidant activity of berberine may directly result from complex I inhibition.

Mitochondrial inhibition may play a key role in the activities of berberine such as preventing fatty liver, reducing blood glucose and decreasing blood lipids. The details of the regulation remain to be explored.

Evidence for effects on inflammatory markers and liver enzymes has been conflicting.

Improvement in Metabolic Syndrome

 The metabolic disorder includes a spectrum of conditions such as nonalcoholic fatty liver disease (NAFLD), type 2 diabetes, impaired glucose tolerance (prediabetes), polycystic ovarian syndrome (PCOS), and hyperlipidemia. Previous studies have demonstrated that metabolic disorders are prone to diabetic encephalopathy and atherosclerosis (Barenbrock et al., 1995), which will generate Alzheimer’s disease and coronary heart disease (Razay et al., 2007). NAFLD is closely related to type 2 diabetes and dyslipidemia (Marchesini and Babini, 2006). Characteristic changes in patients with metabolic disorders include a decrease in serum high-density lipoprotein (HDL) or an increase in serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), fasting plasma glucose (FPG), and homeostasis model assessment-insulin resistance (HOMA-IR).

In this study, the authors showed that berberine significantly reduced waist circumference and waist/hip ratio significantly in the absence of weight change. Similar results were also reported by other groups. It was indicated berberine may inhibit visceral fat accumulation. In diabetic rats, adipocyte size and the ratio of white adipose tissue to body weight were decreased, and adipocyte number was increased with berberine treatment.

Although berberine was shown to suppress fat accumulation, the current evidence on mechanisms is controversial.

Berberine may also reduce the risk of developing metabolic syndrome through its beneficial effects on the gut microbiota. In the last decade, many studies have indicated that the composition of gut microbiota is associated with the regulation of the host’s health and metabolism. Dysbiosis, defined as an alteration in the quality and/or quantity of the intestinal microbiota, can affect the host’s physiology and may be a factor that leads to the onset of various diseases, including obesity and T2DM, as well as cardiovascular diseases, Crohn’s disease, and cancer

 Berberine and cancer treatment

 Berberine has exhibited ability to suppress tumor metastasis (Lin et al., 2006; Serafim et al., 2008; Cai et al., 2014). Matrix metalloproteinases (MMPs) degrade the tissue matrix, allowing tumor cells to break through the normal tissue barrier and invade the surrounding normal tissue and distant organs. Berberine inhibits the release of MMP-2 from tumor cells and thus inhibits tumor cell destruction of the tissue matrix.

In vitro studies have demonstrated that the inhibition of FAK, IKK, NF-kB, u-PA, MMP-2, and MMP-9 significantly reduced metastasis.

How is Berberine absorbed in the human body?

Berberine exhibits poor absorption, efflux and extensive metabolism in the human gut.  The absolute bioavailability of berberine is far less than 1%. Accordingly, one of the approaches for improving berberine’s efficacy is through studying the a variety of formulations to improve its bioavailability from the gut.

Which formulations of Berberine are the best?

Honestly, we don’t know. Berberine HCL is the most commonly available preparation. There is explosive research in progress to figure out the best way to increase the bioavailability of Berberine.

One groundbreaking area is of nanoparticles. Nanoparticles are fat-loving particles that help in protecting a drug from the breakdown of gastric enzymes and transport the drug to the bloodstream. Various nanoparticle formulations are being used in cancer treatments.

Nanoparticle formulations that encapsulate berberine for sustained release and improved bioavailability include the use of polymeric natural (e.g., chitosan) and synthetic (PLGA, PLGA-PEG, etc.) agents. Others include a self-micro emulsifying berberine-phospholipid complex of polyethylene glycol 1000 succinate (TPGS 1000) and SiO₂, phytosomes loaded with berberine-phospholipid complex, solid lipid nanoparticles, micelles, liposomes of various nature, etc.

Berberine NPs produced by both APSP and EPN methods have shown promising activities against Gram-positive and Gram-negative bacteria, and yeasts, with NPs prepared through the EPN method showing superior results compared to those made with the APSP method and the unprocessed drug.

So, now we know that Berberine is a magical herbal supplement. What are the negatives or side effects?

Berberine is clinically safe and well-tolerated by the human body. Few adverse reactions are reported, and no negative effect is observed on participants’ diet.

In this study, none of the patients suffered from severe gastrointestinal adverse events when berberine was used alone. In combination-therapy (Metformin + Berberine) the adverse events disappeared in one week after reduction in berberine dosage. The data suggest that berberine at dosage of 30mmg three times daily is well tolerated in combination therapy. Liver and kidney functions were monitored in this study. No significant changes in plasma ALT, γ-GT and creatinine were observed during the 13 weeks of berberine treatment.

It is recommended that Berberine be taken with food and if possible use gastroprotective coated formulations.

As always, please consult your health care practitioner who has knowledge about the mechanism of action of such herbal preparations and their possible interactions with any medications that you might be on. The quality of the preparation that you decide to take also matters.
Feel free to orders yours through this link to take advantage of our patient discount codes.

If you need a functional (holistic) approach to your PCOS, weight or any related or unrelated issues, feel free to schedule a functional consult here.

As always..

Be safe, be prepared and be ready,

Dr. Adeeti Gupta

References:

Yin, J., Ye, J., & Jia, W. (2012). Effects and mechanisms of berberine in diabetes treatment. Acta Pharmaceutica Sinica B, 2(4), 327-334. https://doi.org/10.1016/j.apsb.2012.06.003

Yin, J., Ye, J., & Jia, W. (2012). Effects and mechanisms of berberine in diabetes treatment. Acta Pharmaceutica Sinica B, 2(4), 327-334. https://doi.org/10.1016/j.apsb.2012.06.003

Zamani M, Zarei M, Nikbaf-Shandiz M, Hosseini S, Shiraseb F, Asbaghi O. The effects of berberine supplementation on cardiovascular risk factors in adults: A systematic review and dose-response meta-analysis. Front Nutr. 2022 Oct 14;9:1013055. doi: 10.3389/fnut.2022.1013055. PMID: 36313096; PMCID: PMC9614282.

Ye Y, Liu X, Wu N, Han Y, Wang J, Yu Y, Chen Q. Efficacy and Safety of Berberine Alone for Several Metabolic Disorders: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Front Pharmacol. 2021 Apr 26;12:653887. doi: 10.3389/fphar.2021.653887. PMID: 33981233; PMCID: PMC8107691.

Front. Pharmacol., 15 January 2020
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Comincini S, Manai F, Sorrenti M, Perteghella S, D’Amato C, Miele D, Catenacci L, Bonferoni MC. Development of Berberine-Loaded Nanoparticles for Astrocytoma Cells Administration and Photodynamic Therapy Stimulation. Pharmaceutics. 2023; 15(4):1078.

Wu S, Yang K, Hong Y, Gong Y, Ni J, Yang N, Ding W. A New Perspective on the Antimicrobial Mechanism of Berberine Hydrochloride Against Staphylococcus aureus Revealed by Untargeted Metabolomic Studies. Front Microbiol. 2022 Jul 13;13:917414. doi: 10.3389/fmicb.2022.917414. PMID: 35910599; PMCID: PMC9328669.

Och A, Och M, Nowak R, Podgórska D, Podgórski R. Berberine, a Herbal Metabolite in the Metabolic Syndrome: The Risk Factors, Course, and Consequences of the Disease. Molecules. 2022 Feb 17;27(4):1351. doi: 10.3390/molecules27041351. PMID: 35209140; PMCID: PMC8874997.

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Zhao, J., Wang, Z., Karrar, E., Xu, D., & Sun, X. (2022). Inhibition Mechanism of Berberine on α-Amylase and α-Glucosidase in Vitro. Starch – Stärke, 74(3-4), 2100231. https://doi.org/10.1002/star.202100231

Xing, L., Zhou, X., Li, A., Li, H., He, C., Qin, W., Zhao, D., Li, P., Zhu, L., & Cao, H. (2021). Atheroprotective Effects and Molecular Mechanism of Berberine. Frontiers in Molecular Biosciences, 8, 762673. https://doi.org/10.3389/fmolb.2021.762673

Ma, X., Chen, Z., Wang, L., Wang, G., Wang, Z., Dong, X., Wen, B., & Zhang, Z. (2017). The Pathogenesis of Diabetes Mellitus by Oxidative Stress and Inflammation: Its Inhibition by Berberine. Frontiers in Pharmacology, 9. https://doi.org/10.3389/fphar.2018.00782

Koppen, L. M., Whitaker, A., Rosene, A., & Beckett, R. D. (2017). Efficacy of Berberine Alone and in Combination for the Treatment of Hyperlipidemia: A Systematic Review. Journal of Evidence-based Complementary & Alternative Medicine, 22(4), 956-968. https://doi.org/10.1177/2156587216687695

Yu HH, Kim KJ, Cha JD, Kim HK, Lee YE, Choi NY, You YO. Antimicrobial activity of berberine alone and in combination with ampicillin or oxacillin against methicillin-resistant Staphylococcus aureus. J Med Food. 2005 Winter;8(4):454-61. doi: 10.1089/jmf.2005.8.454. PMID: 16379555.

Koperska, A., Wesołek, A., Moszak, M., & Szulińska, M. (2022). Berberine in Non-Alcoholic Fatty Liver Disease—A Review. Nutrients, 14(17). https://doi.org/10.3390/nu14173459

Ye Y, Liu X, Wu N, Han Y, Wang J, Yu Y, Chen Q. Efficacy and Safety of Berberine Alone for Several Metabolic Disorders: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Front Pharmacol. 2021 Apr 26;12:653887. doi: 10.3389/fphar.2021.653887. PMID: 33981233; PMCID: PMC8107691.

Lou T, Zhang Z, Xi Z, Liu K, Li L, Liu B, Huang F. Berberine inhibits inflammatory response and ameliorates insulin resistance in hepatocytes. Inflammation. 2011 Dec;34(6):659-67. doi: 10.1007/s10753-010-9276-2. PMID: 21110076.

Petrangolini, G., Corti, F., Ronchi, M., Arnoldi, L., Allegrini, P., & Riva, A. (2020). Development of an Innovative Berberine Food-Grade Formulation with an Ameliorated Absorption: In Vitro Evidence Confirmed by Healthy Human Volunteers Pharmacokinetic Study. Evidence-based Complementary and Alternative Medicine : ECAM, 2021. https://doi.org/10.1155/2021/7563889

Javed Iqbal, M., Quispe, C., Javed, Z., Sadia, H., Qadri, Q. R., Raza, S., Salehi, B., Abdulwanis Mohamed, Z., Sani Jaafaru, M., & Abdull Razis, A. F. (2021). Nanotechnology-Based Strategies for Berberine Delivery System in Cancer Treatment: Pulling Strings to Keep Berberine in Power. Frontiers in Molecular Biosciences, 7, 624494. https://doi.org/10.3389/fmolb.2020.624494

Yin, J., Xing, H., & Ye, J. (2008). Efficacy of Berberine in Patients with Type 2 Diabetes. Metabolism: Clinical and experimental, 57(5), 712. https://doi.org/10.1016/j.metabol.2008.01.013

Zhang, C., Sheng, J., Li, G., Zhao, L., Wang, Y., Yang, W., Yao, X., Sun, L., Zhang, Z., & Cui, R. (2020). Effects of Berberine and Its Derivatives on Cancer: A Systems Pharmacology Review. Frontiers in Pharmacology, 10, 481416. https://doi.org/10.3389/fphar.2019.01461

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We know how frustrating it is to get those bills that we were not expecting. Yes, we know…You pay almost $900 per month for your insurance plan and you just got hit by a $1000 bill! WHY???

Health care financial FAQs

Read on as we attempt to simplify and break down the complicated world of health insurance…..

What does a covered service mean?

This simply means that your insurance carrier has agreed to cover the service. It can be confusing because “covered” statement can imply that you are no longer responsible for the charges associated with the service. “Covered” simply means that your insurance carrier agrees that the service provided is within the scope of the contract between the insurance carrier and the practice.

How come I still got a bill from the practice even though the services are stated as “covered”?

The bill that you receive could be due to any of the below reasons despite the service being covered.

Co-pay: Your particular plan may have a certain amount of co-pay associated with different types of visits. For example, you may have differing co-pays for an office visit with a specialist, a primary care physician, an ER visit or a hospital visit.

Co-insurance: This is another caveat that you may not know about. Certain plans pass on a portion of financial responsibility to you as a subscriber in the form of co-insurance. This amount may also vary according to the type of visit as above and according to the type of plan.

Deductible: Most insurance carriers have a certain amount of deductible that is required to be met before they start paying out towards your visits. Just like when you have car insurance and you get into an accident. For example, if your plan has a deductible of $5000 and your car repair bill comes out to be $15,000. You will need to pay $5000 out of your own pocket first and then the insurance carrier will be the remaining $10,000. This seems unnerving and scary. However, that’s how the insurance industry works and tries to give you low-cost plans by keeping high deductibles.

You can choose to keep your deductible low by paying a higher monthly premium. It is a choice that you have to make. If you are a healthy young person who might not need a lot of visits with your doctor, you may choose a low premium, high deductible plan.

On the other hand, if you have multiple health conditions that require frequent visits, multiple medications etc., then you may choose a high premium, low deductible plan.

Ultimately, there are no free lunches in the world and you will be financially responsible for some portion either way unless you are eligible for a completely government funded plan such as straight Medicaid. Eligibility for straight Medicaid depends on your income level, number of dependents and your particular state.

My employer pays for my insurance. Why do I still get a bill?

The affordable care act made it mandatory for your employer to contribute a certain amount towards your health care costs. The employer responsibility varies from the size of the company, the type of company and may also depend on state specific laws.

Most employers will cover a portion of your health care premium and deduct the employee portion from your salary. You will see that as a line item in your pay-stub. Remember to ask your HR department at the time of onboarding to understand your contribution vs. your employer’s contribution.

I received a “bill” from my insurance? It states that this is an EOB. What is an EOB?

Insurance company never sends you a bill. They send you something called an EOB.

An EOB stands for “Explanation of Benefits”. Read carefully, at the bottom of that statement, there will be something that states, “This is not a bill”.

It is simply a statement explaining the below items:

• Charges billed by your provider to the insurance: These are sometimes quite high but this does not indicate how much the provider gets paid.
• Amount the plan paid your provider.
• Amount not covered by the plan (you may or may not be responsible for this portion depending on your particular plan).
• Amount you owe your health care provider: Again, this depends on your particular plan.

Remember this is only a statement; you will receive a separate bill from your health care provider or the lab if you owe something according to your specific plan. Do not pay the insurance carrier for this. Wait for a bill. If you have questions regarding your EOB, you should call your insurance carrier directly.

Why do I get surprised by these high amounts of extra charges coated in the guise of copay, co-insurance and deductible even though I pay a huge amount of premium towards my health insurance every month?

Well, that’s because the insurance companies are trying to offer you a range of plans that you can afford. Unfortunately, everything comes with a cost. If you have a low-cost plan with a low monthly premium, your deductible and co-insurance might be very high. In such cases, you better hope that your car doesn’t get into accident or you don’t get sick. However, health care can be tricky and almost all of us will require to seek care at some point in our lives. All you can do is be fully aware of the fine print that states the charges that you might be responsible for in addition to your monthly premium.

Sample insurance worksheet. Pay careful attention to yours.

I was told that I get a “free” visit once a year. What does that mean?

During the implementation of the Affordable Care Act, there was heavy emphasis on coverage of a preventative care visit or a wellness visit for all patients. All insurance carriers were required to build coverage for these visits in their plans.

An annual/ free or a wellness visit with a gynecologist usually does not have an associated co-pay. It covers only below items:

• Pap test

• Contraception counseling (counseling only – actual birth control may or may not be covered).

• STD testing.

The biggest thing to remember is that the “free” part only applies to the visit, not to the cost of your prescription, lab tests etc.

You may still have co-insurance or deductible applicable towards the lab fees or prescription costs. Your health care provider has no way of knowing which lab charges will or will not be paid for by your carrier.

If you have any additional problems that require attention such as fibroids, irregular periods etc., you will be required to pay a co-pay and may require a separate visit.

Why can’t the healthcare provider bill my visit as a “preventative visit” so that my insurance can cover it a 100%

As mentioned above, any issue other than a pap, STD testing and contraceptive counseling is not a part of the preventative visit. The provider cannot commit fraud by not billing appropriately for the services rendered.

Each problem and each service has certain codes and the insurance company will decide reimbursement accordingly.

In fact, many health care providers may not address any additional problems at the time of a preventative visit and ask you to make a separate appointment since they may not get reimbursed for the additional issues discussed.

I keep getting bills. Where are they coming from?

You just went to the doctor or were at the hospital. You can get bills from many places.

Doctor’s office or the hospital bill

This will be an actual bill that you will need to pay. The breakdown of charges, insurance payments, adjustments may or may not be listed there. You may see a high amount listed under “charges”. That is not what the doctor or the hospital got paid. You will see the service fees listed usually in the far right column.

Lab Bill

The lab gets paid by your insurance separately. The lab has nothing to do with your doctor’s or the hospital bill. Your insurance plan may have different copays and deductibles for lab tests. You need to be aware of these costs yourself. Do you own research. A Covered test does not mean that you will not be responsible for your plan’s deductible or co-insurance.

I have a large bill. I asked my doctor to give me discount but they said they can’t. Why?

The health care provider has a contract with each insurance company. The insurance company decides the exact amounts that they will pay the provider based on that contract. It doesn’t matter what the provider charges, the insurance will pay only the contracted amount.

It is the responsibility of the health care provider to collect the contracted amounts (as applicable via the copay or deductibles). If the provider does not collect the balance payment, the insurance company and the law can construe that as a bribe. That is illegal and a breach of contract. Hence, once the insurance company has been billed, the claim has been processed and the bill has been generated, the health care provider cannot waive the bill.

The health care provider can help you with a payment plan depending on their rules.

How can I avoid large bills if I have a high deductible?

You have a choice to use your insurance or not. If you do not want to get a large bill due to a high deductible, you can choose not to use the insurance and just pay cash for the services.

Why doesn’t the doctor take my insurance?

The in-network participation status of your health care provider depends on many factors. Some insurance companies have a lot of providers so they close the networks for new providers. In other cases, the health care provider may not want to be in-network with certain insurances due to low reimbursements, delayed payments, denials etc. There is not much you can do but find an in-network health care provider if you want to use your insurance. You cannot force this on your provider.

I have out of network benefits. Can I see whoever I want?

If you have out of network benefits then you may be able to see the provider you want. In that case, you may receive the reimbursement check directly. It is your legal responsibility to provide that check to your provider. Alternatively, the health care provider may take fees from you upfront. Then you will get reimbursed either the entire amount or a portion from your insurance company.

Why does my insurance require prior authorization for certain drugs or tests?

The insurance carriers place limits on various tests and prescriptions to keep their costs low. They will want you to have tried generic or lower cost medications before they can approve more expensive or branded medications.

Same applies to diagnostic testing. For example, even though your plan may state that they cover annual mammograms, they might not cover breast sonograms (or ultrasounds) which may be needed if you have dense breasts or a suspected mass on a screening mammogram. In that case, they will require prior authorization for that additional testing.

Whose responsibility is it to get prior authorizations?

Some practices will assist in obtaining prior authorizations as a courtesy to their patients. However, it is not entirely under their purview to do so. You as a patient may have to get the test or medication approved by your insurance carrier yourself by providing proof as requested.

Why do I have to pay when I go to pick up my prescription even though I paid a co-pay at my doctor’s visit and pay a monthly premium?

Again, these are fine print costs that many are not aware of when signing up for a plan. Your pharmacy benefits may be entirely different from your office visit benefits.

How can I be a more informed consumer?

• READ: Read your entire benefits plan.
• LOOK: Be on the look-out for each of the below fees or percentages associated with each type of visit. Build your own cheat sheet as below.
• SHOP: Shop the market place and compare the below items and not just go for the lowest monthly premium.
• ASK: Ask questions: You are paying for your plan. You have the right to ask questions and reach out to your carrier.

We are living in a very confusing place. There are hundreds of insurance carriers and each one of them have hundreds of sub-plans. Last year on NY market place alone, there were 1700 plans to choose from. It is almost impossible for you to be able to understand the fine print and nuances for each of them. However, having some basic knowledge will make you a more informed consumer and prepare you for this mind-boggling arena.

Be safe, be strong and be prepared,

Dr. Adeeti Gupta and the Walk IN GYN Team

The post Co-Pays – Deductibles – Well visits.. Insurance FAQs appeared first on Walk In GYN Care.

• Painful Sex
• Pelvic pain
• Low back pain
• Irregular bleeding
• Mid-cycle bleeding
• Heavy bleeding
• IUD placement check
• Delayed periods
• Ovarian Cysts
• Uterine Fibroids
• Rule out Pregnancy
• Obesity/ Abdominal bloating – Unable to evaluate uterus on exam.
• Urinary Incontinence
• Pelvic Inflammatory disease (PID)
• Congenital abnormalities of genital tract (Uterus/ Ovaries)

Explanation of “Transabdominal” vs “Pelvic trans-abdominal” vs “Pelvic Transvaginal” Ultrasound studies.

Full Pelvic Ultrasound is a two part study as listed below. Both parts are important to complete a full evaluation of the pelvic organs.

1. Pelvic abdominal ultrasound.

The CPT code for this is 76856.

This is a part of a the full pelvic ultrasound which includes visualization of the lower abdomen from the lower part of the abdomen and includes evaluation of uterus/ bladder and any other additional masses (if present) from the lower abdominal angle.

2. Pelvic transvaginal ultrasound.

The CPT code for this is 76830

This is the second component of the full pelvic ultrasound. In this study, a vaginal probe is used to evaluate the uterus/ ovaries/ adnexal masses etc from the vagina.

Both the above studies are needed to a full pelvic evaluation and each are indicated by a separate CPT code hence billed separately since they are separate studies with different probes.

WE HAVE TO PERFORM BOTH OF THE ABOVE STUDIES TO COMPLETELY EVALUATE THE PELVIS.

Situations in which we may not do a Transvaginal sonogram:

• If you have never had vaginal intercourse (virgin).
• If you are actively bleeding from the vagina.
• If you are pregnant and you have placenta previa.

3D ultrasound (CPT- 76377) is done in addition if there are any masses, fibroids, IUD or any uterine pathology.

A Color Doppler (CPT-93975) is done in addition if there is pelvic pain/ ovarian cyst/ mass/ tumor etc.

Complete abdominal ultrasound is indicated by CPT codes from 76801-76812

This includes a full exam of your upper and mid abdomen and organs such as gall bladder/ liver/ stomach etc.

WE DO NOT PERFORM THIS STUDY AT OUR FACILITY SINCE WE ARE A GYN (WOMEN’S HEALTH) FACILITY.

Hope this helps clarify your concerns. We are happy to give you a CD with all the images and also a finalized report. Please note that the finalized report can take upto 10 days.

Sincerely

Walk IN GYN Team.

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You have decided to proceed with an IUD for birth control. This is how to prepare for your visit prior to the insertion.

At the office visit prior:

• Pap/ STD testing up to-date.
• Sonogram to check uterine cavity done.
• Paper work signed.

You will get a call from us to inform that we have the IUD.

If you don’t hear from us in 2 weeks, please call us or email us.

For IUD insertion visit:

• Call on Day 1 of period to schedule IUD insertion. Needs to be done towards the end of the period.
• Please eat something at least 1-2 hours before appt.
• Take 600 mg Ibuprofen (if not allergic) after food 1 hour before appt. OR Tylenol (1000mg) if allergic to Ibuprofen.
• Follow up appt. in 1 month for sonogram to check IUD placement.
• Expect cramping for 2-3 days after procedure and next few periods.
• Can take Ibuprofen (600mg) or Tylenol (650mg) every 6-8 hrs for that pain.
• Check IUD by Ultrasound once a year.

IUDs – HOW TO MAKE THAT CHOICE?

What is an intrauterine device (IUD)?

The intrauterine device (IUD) is used to prevent pregnancy. It’s a small, plastic, T-shaped device. Your doctor places the IUD in your uterus.

You have a choice between a hormonal IUD and a copper IUD.

The hormonal IUD prevents pregnancy by damaging or killing sperm. It also releases a type of the hormone progestin. Progestin prevents pregnancy in these ways: It thickens the mucus in the cervix. This makes it hard for sperm to travel into the uterus. It also thins the lining of the uterus, which makes it harder for a fertilized egg to attach to the uterus. Progestin can sometimes stop the ovaries from releasing an egg each month (ovulation).

There are two hormonal IUDs. One prevents pregnancy for 5 years, and the other prevents pregnancy for 3 years. Once you have it, you don’t have to do anything else to prevent pregnancy.

The copper IUD is wrapped in copper wire. Copper IUDs prevent pregnancy by making the uterus and fallopian tubes produce a fluid that kills sperm.

The copper IUD prevents pregnancy for 10 years. Once you have it, you don’t have to do anything else to prevent pregnancy.

A string tied to the end of the IUD hangs down through the opening of the uterus (called the cervix) into the vagina. You can check that the IUD is in place by feeling for the string. The IUD usually stays in the uterus until your doctor removes it.

How well does it work?

In the first year of use:

• When the hormonal IUD is used exactly as directed, fewer than 1 woman out of 100 has an unplanned pregnancy.
• When the copper IUD is used exactly as directed, fewer than 1 woman out of 100 has an unplanned pregnancy.

Be sure to tell your doctor about any health problems you have or medicines you take. He or she can help you choose the birth control method that is right for you.

What are the advantages of an IUD?

• An IUD is one of the most effective methods of birth control.
• It prevents pregnancy for 3 to 10 years, depending on the type. You don’t have to worry about birth control during this time.
• It’s safe to use while breast-feeding.
• IUDs don’t contain estrogen. So you can use an IUD if you don’t want to take estrogen or can’t take estrogen because you have certain health problems or concerns.
• An IUD is convenient. It is always providing birth control. You don’t need to remember to take a pill or get a shot. You don’t have to interrupt sex to protect against pregnancy.
• A hormonal IUD may reduce heavy bleeding and cramping.

What are the disadvantages of an IUD?

• An IUD doesn’t protect against sexually transmitted infections (STIs), such as herpes or HIV/AIDS. If you aren’t sure if your sex partner might have an STI, use a condom to protect against disease.
• A copper IUD may cause periods with more bleeding and cramping.
• You have to see a doctor to have an IUD inserted and removed.
• You have to check to see if the string is in place.

How to prepare for an IUD insertion?

• It can be a daunting idea to go for an IUD insertion. We recommend taking Advil or Ibuprofen 600 mg about 30 min before the insertion. If you are allergic to Ibuprofen, you can take 2 tablets for regular Acetaminophen (Tylenol) before coming in.
• The insertion should be planned towards the end of your menstrual cycle. Please call the office to schedule insertion when you are on your first day of the period.
• Do not plan any extensive physical activity the day of insertion, right after the procedure.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

• You may experience some mild cramping and light bleeding (spotting) for 1 or 2 days. Use a hot water bottle or a heating pad set on low on your belly for pain.
• Take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen (Aleve) if needed. Read and follow all instructions on the label.
• Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• Check the string of your IUD after every period. To do this, insert a finger into your vagina and feel for the cervix, which is at the top of the vagina and feels harder than the rest of your vagina. You should be able to feel the thin, plastic string coming out of the opening of your cervix. If you cannot feel the string, use another form of birth control and make an appointment with your doctor to have the string checked.
• If the IUD comes out, save it and call your doctor. Be sure to use another form of birth control while the IUD is out.
• Use latex condoms to protect against sexually transmitted infections (STIs), such as gonorrhea and chlamydia. An IUD does not protect you from STIs. Having one sex partner (who does not have STIs and does not have sex with anyone else) is a good way to avoid STIs.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

• You passed out (lost consciousness).
• You have sudden, severe pain in your belly or pelvis.

Call your doctor now or seek immediate medical care if:

• You have new belly or pelvic pain.
• You have severe vaginal bleeding. This means that you are soaking through your usual pads or tampons each hour for 2 or more hours.
• You are dizzy or lightheaded, or you feel like you may faint.
• You have a fever and pelvic pain or vaginal discharge.
• You have pelvic pain that is getting worse.

Watch closely for changes in your health, and be sure to contact your doctor if:

• You cannot feel the string, or the IUD comes out.
• You feel sick to your stomach, or you vomit.
• You think you may be pregnant.

See full video here

Be safe, be strong and be prepared.

Walk In GYN Team

The post IUD insertion – What to expect? appeared first on Walk In GYN Care.

Colposcopy lets a doctor look at your vulva, vagina, and cervix. If the doctor sees a possible problem, he or she can take a small sample of tissue. Then another doctor studies the tissue under a microscope. This is called a biopsy.
Most women have this procedure after they have abnormal results from a Pap test.

How is the test performed?
During the test, your doctor puts a lubricated tool into your vagina. This is called a speculum. It gently spreads apart the sides of your vagina. This allows your doctor to see inside your vagina and the cervix. The doctor also uses a magnifying device to help him or her see better. This device does not go inside your vagina.
The doctor may put diluted vinegar or iodine on your cervix. This can help the doctor to see any areas that are not normal. Sometimes the doctor also takes photos or videos.
When the speculum goes in, it can feel a little uncomfortable. If the doctor does a biopsy, you may feel a pinch and have some cramping.

How should I follow up?
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.
What happens before the procedure?
Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.
Preparing for the procedure
• Tell your doctor if:
o You are having your menstrual period. This test usually is not done during your period. This is because blood makes it harder to see your cervix.
o You are or might be pregnant. A blood or urine test may be done to see if you are pregnant. Colposcopy is safe during pregnancy. The chance of miscarriage is very small. But you may have some bleeding from a biopsy.
o You take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin.
• Do not douche, use tampons, have sexual intercourse, or use vaginal medicines for 24 hours before the test.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• Tell your doctors ALL the medicines, vitamins, supplements, or herbal remedies you take. Some of these can increase the risk of bleeding.
• Your doctor will tell you which medicines to take or stop before your procedure. You may need to stop taking certain medicines a week or more before the procedure. So talk to your doctor as soon as you can.
What happens on the day of the procedure?
• You may want to take a pain reliever 30 to 60 minutes before the test. This can help reduce any cramping pain from a biopsy. Ibuprofen (Advil or Motrin) is a good choice.
• Take a bath or shower before you come in for your procedure. Do not apply lotions, perfumes, deodorants, or nail polish.
At the doctor’s office
• Bring a picture ID.
• The procedure will take about 15 to 30 minutes.
Going home
• You will be given more specific instructions about recovering from your procedure.
When should you call your doctor?
• You have questions or concerns.
• You don’t understand how to prepare for your procedure.
• You become ill before the procedure (such as fever, flu, or a cold).
• You need to reschedule or have changed your mind about having the procedure.
Care instructions adapted under license by Adeeti Gupta Physician PC. This care instruction is for use with your licensed healthcare professional. If you have questions about a medical condition or this instruction, always ask your healthcare professional.

To view this in Spanish and Chinese, click here.

Be safe, be strong and be prepared.

Your friendly Walk In GYN Care team!

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http://www.womenshealthmag.com/weight-loss/increase-metabolism?lang=en&utm_campaign=SendToFriend&adbid=585472342949765120&cid=socWL_20150407_43343726&adbpr=25087685&utm_content=article&utm_source=email&part=sendtofriend&utm_medium=article&adbpl=tw&position=0&china_variant=False&uid=0

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Various reasons for Women to visit Urgent Care Gynecologist

1. Sudden onset lower abdominal pain
2. Missed period with pelvic pain
3. Missed period with heavy vaginal bleeding
4. Missed period with positive pregnancy test with pelvic pain
5. Nausea/ vomiting with pregnancy
6. Sudden fainting with missed periods
7. Heavy vaginal bleeding with or without passage of clots
8. Positive pregnancy test with pelvic pain
9. Foul smelling discharge
10. Severe vaginal irritation with or without discharge
11. Painful urination or burning while urination.
12. Migraines with periods
13. Painful periods
14. Painful periods with vomiting
15. Sharp stabbing lower abdominal pain, which comes, and goes.
16. Bleeding after Sex
17. Emergency contraception after accidental unprotected sex (e.g. condom broken)
18. Rape
19. Sexual intercourse without consent.
20. STD testing

The above symptoms could be an indication of some serious conditions such as Ovarian torsion (twisted ovary), Endometriosis, Miscarriage, Ectopic pregnancy (pregnancy outside the uterus), Pelvic Inflammatory Disease (PID), STD’s, Undiagnosed pregnancy etc.

Experiencing any of the above symptoms should encourage women to seek help of a Women’s health specialist (OBGYN) sooner rather than later so that there are no long term residual effects from treatment delay.

Stay Tuned

Adeeti Gupta MD, FACOG

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