Over 90 Percent of What Planned Parenthood Does, Part 24: Miscarriage Management and Counseling

Welcome to the latest installment of “Over 90 Percent of What Planned Parenthood Does,” a series on Planned Parenthood Advocates of Arizona’s blog that highlights Planned Parenthood’s diverse array of services — the ones Jon Kyl never knew about.

holding handsMiscarriage. It’s a common occurrence — at least 10 to 15 percent of all pregnancies end this way — but one that is not often spoken about. When carrying a wanted pregnancy, its sudden loss can trigger a range of emotions. During this time, Planned Parenthood can help.


There is no “right” or “wrong” way to feel after having a miscarriage.


What Is Miscarriage?

When a pregnancy ends before it has reached the 20-week mark, a miscarriage has occurred; most miscarriages occur within the first eight weeks of pregnancy. Pregnancy loss after the 20-week mark is called stillbirth, and while it isn’t as common as miscarriage, stillbirth occurs in 1 out of 160 pregnancies.

Signs of a miscarriage include vaginal bleeding or spotting, severe abdominal pain or cramping, pain or pressure in the lower back, or a change in vaginal discharge. These symptoms aren’t specific to miscarriage — they could indicate other problems, so visit a health-care provider if you experience them during your pregnancy.

After a miscarriage, you might have pregnancy-related hormones circulating in your body for one or two months. Your period will most likely return within 4 to 6 weeks. While you may be physically ready to get pregnant again after you’ve had a normal period, you might want to consult with a health-care provider about the need for medical tests. You also might need to think about when you will be emotionally ready to try for another pregnancy. Continue reading

STD Awareness: Gonorrhea, Women, and the Pre-Antibiotic Era

Penicillin, the first cure for gonorrhea, was developed for mass production in the 1940s.

Penicillin, the first reliable cure for gonorrhea, was mass produced in the 1940s.

It’s Women’s History Month, a time to reflect on the achievements of women worldwide — like Margaret Sanger, Rosalind Franklin, and Florence Nightingale, or contemporary heroes like Wangari Maathai. But it may also be a time to examine some of the sadder aspects of womanhood, including the increased burden gonorrhea imposes on women. While gonorrhea is no picnic for anyone, it wreaks the most havoc in female reproductive tracts. In fact, before antibiotics, gonorrhea was a leading cause of infertility — one 19th century physician attributed 90 percent of female infertility to gonorrhea. Not only that, but the effects of gonorrhea could seriously reduce a woman’s overall quality of life.


With gonorrhea becoming more resistant to antibiotics, the CDC warns of a return to the pre-antibiotic era.


Gonorrhea is described by written records dating back hundreds of years B.C. Ancient Greeks treated it with cold baths, massage, “cooling” foods, and vinegar. In the Middle Ages, Persians might have recommended sleeping in a cool bed with a metal plate over the groin. A bit to the west, Arabs tried to cure gonorrhea with injections of vinegar into the urethra. Kings of medieval England might have had their gonorrhea treated with injections of breast milk, almond milk, sugar, and violet oil.

Although gonorrhea is as ancient an STD as they come, because women rarely have symptoms while men usually do, for much of history it was mostly discussed in terms of men. The name gonorrhea itself derives from the ancient Greek words for “seed flow” — gonorrhea was thought to be characterized by the leakage of semen from the penis. This confusion inspired many misguided notions throughout the millennia, such as the idea that almost all women carried gonorrhea and transmitted it to their unwitting male partners. Continue reading

Mythbusting: Does Emergency Contraception Cause Abortion?

The Centers for Disease Control and Prevention reported recently that one in nine sexually active women, or 5.8 million women, has used emergency contraceptive pills, such as Plan B. Emergency contraception is a woman’s back-up method to prevent an unwanted pregnancy, and women report using it when they feel their contraceptive method has failed, such as a broken condom, or they do not use a regular contraceptive like birth control pills.


The latest scientific evidence shows that Plan B works mainly by delaying ovulation — not by affecting a fertilized egg.


Some conservative politicians have been stating publicly that emergency contraceptive pills (ECPs), such as Plan B, cause abortions. They may believe that life begins at conception (fertilization of the egg by the sperm) and argue that ECPs disrupt a fertilized egg’s ability to implant in the uterus, which they consider equivalent to abortion. The American Congress of Obstetricians and Gynecologists and experts from the Food and Drug Administration and the National Institutes of Health consider a pregnancy to be established when a fertilized egg settles itself on the wall of the uterus — implantation. A woman is most likely to become pregnant when she ovulates, which is usually about two weeks before her next period. Sperm can live for up to three days. So, if an egg is fertilized, there are still possibly six to 12 days before the implantation may take place.

When ECPs were first developed and information about them was submitted to the FDA for market approval, the drug manufacturers included mention of every possible mechanism on how the pill might work to prevent pregnancy. This included wording about preventing or delaying ovulation, making the sperm or egg less able to meet, and possibly preventing implantation. However, the latest scientific evidence has shown that ECPs such as Plan B mainly work by delaying ovulation — Plan B does not affect implantation and has no effect on existing pregnancies. Several prominent researchers have stated that if in fact Plan B disrupted implantation, it would be 100 percent effective at preventing a pregnancy, and that is not the case. Continue reading

STD Awareness: “Can STDs Lead to Infertility?”

Being diagnosed with a sexually transmitted disease (STD) can be upsetting. Some take it as evidence that they’ve been cheated on; others wonder if they can ever have sex again. Some people who have long dreamed of having children might worry about what impact, if any, their STD could have on future fertility. The bad news is that certain STDs can make it difficult or impossible to have children. But the good news is that STDs are avoidable — and regular STD screening can ensure that infections are caught and treated before they have time to do damage.


It’s common for STDs not to have symptoms, and infections can cause tissue damage — unbeknownst to you!


Fertility can be impacted in several ways. The ability to become pregnant and bear children can be affected by a condition called pelvic inflammatory disease, which is usually caused by untreated gonorrhea or chlamydia infections. If you have a cervix, an infection with a high-risk strain of HPV can require invasive treatment, which in some cases might affect the ability to carry a pregnancy. If you have a penis, an untreated STD might lead to epididymitis, which in extreme cases can cause infertility.

Pelvic Inflammatory Disease (PID)

Many sexually transmitted infections are localized; for example, the bacteria that cause gonorrhea usually just hang out on the cervix. But untreated infections can spread on their own, and bacteria can also hitch a ride on sperm or the upward flow of a douche, which can take them into the cervix, through the uterus, down the fallopian tubes, and to the ovaries. At any of these locations, microbes can stake claim on your reproductive real estate, establishing colonies deep in your reproductive system. As these colonies grow, the bacterial infections become more widespread, and can cause scarring and other tissue damage. To keep these interlopers from getting through the front door, sexually active people can use barrier methods, such as latex condoms — especially with spermicides. There’s no need to host an open house for sexually transmitted bacteria in your uterus. Continue reading

Diagnosing Endometriosis

If you missed it, you can read the previous post explaining the basics of endometriosis here. In this post, we’ll look a little more at how endometriosis is diagnosed as well as some current barriers to diagnosis.


Wait. So you’re telling me that killer cramps of doom aren’t normal? If I did suspect I had endo, how would I go about getting diagnosed?

Endometriosis diagnosis is a tricky thing in that there’s no in-office procedure that can definitively determine whether someone has the condition or not. However, because the “gold standard” test is laparoscopy with biopsy — a surgical procedure — many health care providers prefer to do some in-office tests before recommending laparoscopy. The most common such procedures are pelvic exams and ultrasounds, which may allow a provider to see or feel if the endometrial lesions have formed cysts (known as “endometriomas”), but won’t pick up on smaller lesions.

Another complicating factor is that endometriosis isn’t the only cause of either dysmenorrhea or chronic pelvic pain. Other causes can include uterine fibroids, pelvic floor dysfunction, pelvic inflammatory disease, irritable bowel syndrome, and interstitial cystitis.

Even with laparoscopy, diagnosis isn’t necessarily straightforward. Not only is it a surgical procedure, which carries with it extra expense and risk, but even then, presence of the disease is often missed or underestimated. Seeking out a doctor who specializes in endometriosis can minimize this, but of course, due to geographic, cost, or other access issues, this isn’t always possible. Continue reading

March Is Endometriosis Awareness Month

As my ever-creative title suggests, March is Endometriosis Awareness Month. I have endometriosis (“endo” for short), and I like this month because I know plenty of people in my life who could definitely use some more awareness as to what endometriosis is and how it impacts the lives of those who have it.

So what is endometriosis, anyway?

Endometriosis is a condition where the endometrium, the lining of the uterus, grows outside the uterus — often on the ovaries, bladder, bowel, and/or lining of the pelvic area. This can be a problem for two reasons. One is that during menstruation, there’s nowhere for this “rogue endometrium” (not a technical term) to go, not having a way to the cervix and vagina and all. This can cause pain — most often pain during menstruation — as well as a buildup of tissue that remains throughout subsequent cycles, where even more “rogue endometrium” is added to it. The other is that the endometrial lesions can contribute to infertility, particularly if the endo obstructs the ovaries or fallopian tubes.

That doesn’t sound like fun. Is endometriosis rare?

Surprisingly, no. Exact numbers are hard to come by because a lot of cases are thought to go undiagnosed (which is part of the reason for this whole “awareness month” thing). But the estimate is that endo affects just over 10 percent of people with ovaries during their reproductive years — and about 30 to 50 percent of such people who have problems with infertility or pelvic pain. Odds are pretty good that you personally know someone with endometriosis, even if you don’t (or they don’t!) know they have it. Continue reading

September 9: Fetal Alcohol Awareness Day

September 9 is Fetal Alcohol Awareness Day. At 9 a.m. the bells of the St. Augustine Cathedral in downtown Tucson will ring, so we can remember on the ninth hour of the ninth day of the ninth month not to drink alcohol during the nine months of pregnancy.


Fetal alcohol syndrome is entirely preventable.


I became aware of fetal alcohol syndrome the way many parents do — by dealing with a child affected by a mother’s drinking while pregnant. I had to learn about it to parent my son, who had come to me when he was 7 years old, and who, in his teens, had regressed in his emotional and cognitive functioning. I needed to understand the outbursts that resulted in holes punched or kicked in the walls; broken mirrors, broken windows, broken china; stolen jewelry, my winter jacket that I saw walking down the street worn by his friend, who had given money for it; the daily swearing and the inability to understand that his behavior had consequences.

What is fetal alcohol syndrome (FAS)?

Fetal alcohol syndrome is the leading cause of IQ scores below 70 in this country (though most people with FAS have normal intelligence), and is entirely preventable. You have probably seen ads talking about the importance of not drinking during pregnancy. But it is not only women of childbearing age who need to be educated. Doctors, especially ob/gyns and pediatricians, teachers, and social workers — everyone who works with children, in fact — need to learn about the effects of prenatal exposure to alcohol. Also judges, probation officers, and others working in the juvenile and adult criminal justice systems need to be educated; most of them have quite a bit of contact with the victims of fetal alcohol exposure, whether diagnosed or not. Continue reading