Latest news with #OBGYN
Yahoo
a day ago
- General
- Yahoo
What Medical Guidelines (Finally) Say About Pain Management for IUD Insertion
Intrauterine devices, or IUDs, are an extremely effective and convenient form of birth control for many people—but it can also very painful to get one inserted. Current medical guidelines say that your doctor should be discussing pain management with you, and they also give advice to doctors on what methods tend to work best for most people. The newest set of guidelines is from ACOG, the American College of Obstetricians and Gynecologists. These guidelines actually cover a variety of procedures, including endometrial and cervical biopsies, but today I'll be talking about the IUD insertion portions. And in 2024, the Centers for Disease Control and Prevention's released new contraceptive recommendations that include a section on how and why providers should help you with pain relief. Before we get into the new recommendations and what they say, it's important to keep in mind that that not everybody feels severe pain with insertion—the estimate is that insertion is severely painful for 50% of people who haven't given birth, and only 10% of people who have, according to Rachel Flink, the OB-GYN I spoke with for my article on what to expect when you get an IUD. (She also gave me a great rundown of pain management options and their pros and cons, which I included in the article.) I'm making sure to point this out because I've met people who are terrified at the thought of getting an IUD, because they think that severe pain is guaranteed and that doctors are lying if they say otherwise. In reality, there's a whole spectrum of possible experiences, and both you and your provider should be informed and prepared for anything along that spectrum. Your provider should discuss pain management with you The biggest thing in both sets of guidelines is not just the pain management options they discuss, but the guideline that says there is a place for this discussion and that it is important! You've always been able to ask about pain management, but providers are now expected to know that they need to discuss this with their patients. The ACOG guidelines say: "Options to manage pain should be discussed with and offered to all patients seeking in-office gynecologic procedures." And the CDC says: Before IUD placement, all patients should be counseled on potential pain during placement as well as the risks, benefits, and alternatives of different options for pain management. A person-centered plan for IUD placement and pain management should be made based on patient preference. 'Person-centered' means that the plan should take into account what you want and need, not just what the provider is used to doing or thinks will be easiest. (This has sometimes been called 'patient-centered' care, but 'person-centered' is meant to convey that you and your provider understand that they are treating a whole person, with concerns outside of just their health, and you're not only a patient who exists in a medical context.) The CDC guidelines also say: 'When considering patient pain, it is important to recognize that the experience of pain is individualized and might be influenced by previous experiences including trauma and mental health conditions, such as depression or anxiety.' The ACOG guidelines, similarly, say that talking over the procedure and what to expect can help make the procedure more tolerable, regardless of how physically painful it ends up being. (Dr. Flink told me that anti-anxiety medications during insertion are helpful for some of her patients, and that she'll discuss them alongside options for physical pain relief.) Lidocaine paracervical blocks may relieve pain There's good news and bad news about the recommended pain medications. The good news is that there are recommendations. The bad news is that none of them are guaranteed to work for everyone, and it's not clear if they work very well at all. The CDC says that a paracervical block (done by injection, similar to the numbing injections used for dental work) 'might' reduce pain with insertion. Three studies showed that the injections worked to reduce pain, while three others found they did not. The CDC rates the certainty of evidence as 'low' for pain and for satisfaction with the procedure. The ACOG guidelines also mention local anesthetics, including lidocaine paracervical blocks, as one of the best options for pain management. Dr. Flink told me that while some of her patients appreciate this option, it's often impossible to numb all of the nerves in the cervix, and the injection itself can be painful—so in many cases, patients decide it's not worth it. Still, it's worth discussing with your provider if this sounds like something you would like to try. Topical lidocaine may also help Lidocaine, the same numbing medication, can also be applied to the cervix as a cream, spray, or gel. Again, evidence is mixed, with six trials finding that it helped, and seven finding that it did not. The ACOG guidelines note that sometimes topical lidocaine has worked better than the injected kind. Unfortunately, they also say that it can be hard for doctors to find an appropriate spray-on product that can be used on the cervix. The CDC judged the certainty of to be a bit better here compared to the injection—moderate for reducing pain, and high for improving placement success (meaning that the provider was able to get the IUD inserted properly). Other methods aren't well supported by the evidence (yet?) For the other pain management methods that the CDC group studied, there wasn't enough evidence to say whether they work. These included analgesics like ibuprofen, and smooth-muscle-relaxing medications. The ACOG guidelines say that taking NSAIDS (like ibuprofen) before insertion doesn't seem to help with insertion pain, even though that's commonly recommended. That approach does seem to work for some other procedures, though, and may help with pain that occurs after an IUD insertion. So it may not be a bad idea to take those four Advil if that's what your doc recommends, but it shouldn't be your only option. Or as the ACOG paper puts it: "Although recommending preprocedural NSAIDs is a benign, low-risk intervention unlikely to cause harm, relying on NSAIDs alone for pain management during IUD insertion is ineffective and does not provide the immediate pain control patients need at the time of the procedure." Both sets of guidelines also don't recommend misoprostol, which is sometimes used to soften and open the cervix before inserting an IUD. The ACOG guidelines describe the evidence as mixed, and the CDC guidelines specifically recommend against it. Moderate certainty evidence says that misoprostol doesn't help with pain, and low certainty evidence says that it may increase the risk of adverse events like cramping and vomiting. What this means for you The publication of these guidelines won't change anything overnight at your local OB-GYN office, but it's a good sign that discussions about pain management with IUD placement are happening more openly. The new guidelines also don't necessarily take any options off the table. Even misoprostol, which the CDC now says not to use for routine insertions, 'might be useful in selected circumstances (e.g., in patients with a recent failed placement),' it writes. Don't be afraid to ask about pain management before your appointment; as we discussed before, some medications and procedures require that you and your provider plan ahead. And definitely don't accept a dismissive reply about how taking a few Advil should be enough; it may help for some people, but that shouldn't be the end of the discussion. You deserve to have your provider take your concerns seriously.
CTV News
2 days ago
- General
- CTV News
Kelowna General Hospital's maternity ward faces crisis
Vancouver Watch OB/GYNs say a lack of family physicians at Kelowna General Hospital's maternity ward heightens the risk of pregnant patients being without adequate care.
Medscape
2 days ago
- General
- Medscape
Should You Still Recommend COVID-19 Vaccines?
The Trump administration announced today that the CDC will no longer recommend COVID-19 vaccines for many children and pregnant people. No details were immediately published on the CDC website, but Health and Human Services Secretary Robert F. Kennedy Jr. said in a video on X that the recommendation for "healthy children and healthy pregnant women has been removed from the CDC recommended immunization schedule." He cited lack of clinical data to support "a repeat booster strategy in children." Still, that may not affect the advice clinicians give their patients. Should Pregnant People Get the COVID Shot? Kennedy's announcement did not explain why the recommendation for pregnant women changed. Previously, the CDC advised pregnant people to get COVID vaccines every 6 months – just like others at high risk of severe illness. There have been about 70 studies of COVID vaccination in pregnant people, and the evidence shows the shots are safe and provide important protection to both mother and baby during pregnancy and after birth, according to Kevin Ault, MD, a practicing OB/GYN and former CDC COVID vaccine adviser. "I'm disappointed because there's no new data to support the change that I'm aware of, and if there is data, it should be discussed publicly," said Ault, a professor at the Western Michigan University Homer Stryker M.D. School of Medicine in Kalamazoo. He said he will continue to advise his pregnant patients to get vaccinated. During an interview with WebMD, he became notably emotional and said he worried for his patients on Medicaid if the program stops covering vaccination. Ault was a member of the CDC expert panel that initially crafted the nation's COVID vaccine recommendations. "Most obstetricians in their lifetimes have had a bad experience with flu and now COVID," he said. "We don't want sick people in the ICU who are pregnant. And the best way to avoid that is having those vaccines that prevent severe maternal complications." The recommendation for pregnant women is also at odds with a plan put forward by federal officials last week in The New England Journal of Medicine, which listed pregnancy among the conditions for which COVID vaccination would be recommended. "As ob-gyns who treat patients every day, we have seen firsthand how dangerous COVID-19 infection can be during pregnancy and for newborns who depend on maternal antibodies from the vaccine for protection," Steven J. Fleischman, MD, president of the American College of Obstetricians and Gynecologists, said in a statement. "We also understand that despite the change in recommendations from HHS, the science has not changed. It is very clear that COVID infection during pregnancy can be catastrophic and lead to major disability, and it can cause devastating consequences for families. The COVID vaccine is safe during pregnancy, and vaccination can protect our patients and their infants." When a pregnant person gets vaccinated, antibodies travel through the placenta and are passed to the fetus, protecting the newborn during the first critical months of life. That's important because babies from newborn to 6 months old (who are not yet eligible for vaccination) are among those most often hospitalized for severe COVID. COVID vaccination during pregnancy cuts hospitalization risk by 52%. What About Children? Public health experts continue to emphasize that COVID-19 vaccines offer significant benefits for children. While severe illness is less common in kids than in adults, COVID-19 can still cause serious outcomes. About 1% of U.S. children – equivalent to roughly 1 million – have had long COVID, according to CDC data. Research also shows that vaccination may reduce the risk of long COVID in children. Decisions about vaccinating healthy children have often been complex, in part because their risk of severe illness is lower than that of adults, making it harder to show clear benefits in large clinical trials. The relatively low uptake of pediatric COVID vaccines also means there's less real-world data compared to data for adults, which can complicate public messaging and policy. Experts say the decision often comes down to individual risk. For children with health conditions, vaccination is more strongly recommended due to a higher risk of complications. But for otherwise healthy kids – especially those who've already had COVID – the benefits can appear less clear-cut, even if vaccination remains safe and reasonable. Pediatric infectious disease expert Sean O'Leary, MD, MPH, said in a statement that research has demonstrated that children, babies, and pregnant people are "at higher risk of hospitalization from COVID, and the safety of the COVID vaccine has been widely demonstrated." Previously, the recommendation was for COVID vaccines to begin when a child turns 6 months old. "By removing the recommendation, the decision could strip families of choice. Those who want to vaccinate may no longer be able to, as the implications for insurance coverage remain unclear," said O'Leary, on behalf of the American Academy of Pediatrics. "It's also unclear whether health care workers would be eligible to be vaccinated." Just 13% of children ages 6 months old to 17 years old are up to date with COVID vaccination, and another 7% of parents said they definitely planned to get their child vaccinated. Just over 14% of pregnant women have received a COVID vaccine since the latest version came out last fall, according to CDC data.
Yahoo
6 days ago
- Health
- Yahoo
How to safely have sex while pregnant, according to health experts
Being pregnant doesn't have to put a pause on your sex life. Sure, it may change your sex drive or comfort levels. But from a health and safety perspective, the good news is that "most people can safely have sex while pregnant," says Dr. Karen Tang, author of "It's Not Hysteria: Everything You Need to Know About Your Reproductive Health (But Were Never Told)." For the record, health experts say it's completely normal if you or your partner don't feel like having sex while pregnant, for any reason. The key is keeping an open dialogue about how you're feeling, and any worries about how the current pregnancy could impact your sex life as a couple. But if you are interested in learning the dos and don'ts of having sex while pregnant, Tang is answering your FAQs. 'Pregnancy nose' videos go viral. Here's the problem with the trend. In most cases, there's no need to worry about vaginal penetration, sperm or orgasms hurting a "normally-developing pregnancy," she adds. The uterine muscles and amniotic fluid are there to protect the baby, according to the Mayo Clinic. But there are certain cases in which a doctor might suggest putting a pause on bedroom activity. Conditions that might lead an OB/GYN to recommend against having sex, according to Tang, include an early cervical dilation or weakening, concern about risk of uterine infection, placenta covering the opening of the cervix, a history of early labor, leaking amniotic fluid or experiencing vaginal bleeding. Folate is crucial for prenatal care. But it could also prolong your life. As long as your doctor has said you don't have any of the aforementioned conditions that could make sex during pregnancy unsafe, you're fine to have sex throughout your pregnancy, experts say. Ultimately, pregnancy sex should be discussed on a personal basis with your doctor, who can offer guidance depending on your unique situation, Tang says. Condoms obviously aren't needed to prevent pregnancy if you already are pregnant, but the Mayo Clinic notes that condom usage is vital if your partner has a sexually transmitted infection, or if either of you have sex with a new partner while pregnant, as an STI can cause serious health issues for you and the baby. This article originally appeared on USA TODAY: Can you have sex while pregnant? You likely won't hurt the baby.
Daily Mail
6 days ago
- Health
- Daily Mail
The supplement clinically shown to help you shed pounds more easily: 'I lost SEVEN pounds in the first month!'
Hormonal changes can really throw things out of whack. They can sneak up on you, leading to everything from fatigue to weight gain to irregular periods. You aren't here for it, but Perelel Hormonal Balance Support is here for you. The OBGYN-formulated supplement is designed to support hormonal balance. Taken regularly, it may regulate your blood sugar levels and periods while supporting your mood, boosting energy, and making weight loss easier. Taken as a part of your daily wellness routine, Perelel Hormonal Balance Support could regulate hormone levels and boost energy to support easier weight loss One of the supplement's standout features is a 40:1 blend of myo-inositol and d-chiro inositol, which helps regulate your insulin and follicle-stimulating hormone (FSH). Both of these are vital to your overall hormonal health. When your insulin is better balanced, the ripple effect can be powerful. You may notice you have more energy, for example, and your ovulation could improve. Even your skin might look clearer! Each dose of Perelel Hormonal Balance Support also contains a Metabolic Balance Blend of berberine, alpha-lipoic acid, and DIM. These ingredients are known to support healthy glucose metabolism and hormonal regulation. Taken as directed, the supplement may also address issues like blood sugar instability, which is closely linked to both hormonal imbalance and symptoms like fatigue and weight gain. Alpha-lipoic acid, in particular, is noted for its potential role in improving menstrual regularity and supporting ovarian function, making it a key part of the formulation. While nothing is a quick fix, the progress you can make by including Hormonal Balance Support in your wellness regimen could make all the difference — especially when you pair it alongside healthy choices like eating well and exercising regularly. And that is easy to do, as you just need two pills in the morning and two at night taken with food and water to begin your ritual. This is a small and effortless habit that could potentially translate into truly life-changing results. There is clinical proof to back it up, too. During a 12-week study of 30 women, an impressive 76 percent noted an improvement in weight management (not to mention fewer mood swings and less irritability). 'I did not realize just how out of whack my body was until I started taking this!' exclaimed one user. 'I feel so much more settled, calm, relaxed, and balanced.' 'Life-changing! I can't recommend this supplement enough,' declared another. 'In addition to the supplement, I made a couple changes to diet and exercise and in the first month lost 7 pounds!' No matter what your goals, be it a smoother path to weight loss and a potentially easier route to pregnancy, Perelel Hormonal Balance Support could be just what you need to get there. Don't miss this chance to get your bottle for the sale price!
