FAQ

Pregnancy

• Are screening tests for trisomy 21 compulsory?

  These tests are certainly not compulsory. They are available to those who consider it important to have the information they can provide. It may be worthwhile for you to have such a test if it is important for you to know whether there is a risk of your unborn child carrying trisomy 21. You should also realize that, if the results are abnormal, the next step is amniocentesis in order to have a definite diagnosis.

• Is nuchal transparency 100% sure as an indicator?

  Nuchal transparency is a tool used to screen for trisomy 21. It is 70% accurate when used alone. It is important for the people measuring nuchal transparency to be experienced and specially trained, otherwise the accuracy level will be even lower. When combined with 1st and/or 2nd trimester blood markers, the test's accuracy improves. You should discuss the availability of nuchal transparency screening in your area with your doctor.

• How accurate is early ultrasound in determining the expected delivery date?

  We use the ultrasound expected delivery date when there is more than five days' difference between this and the one based on the date of the last menstrual period. When an ultrasound is done during the second trimester (at 20 weeks), the two dates must differ by more than 10 days for the ultrasound date to be used.

STI (sexually transmitted infections)

• Why are STIs (sexually transmitted infections) so prevalent?

  In most cases, such diseases are transmitted by people who have no signs or symptoms. In addition, contraceptive methods like the birth control pill and IUD (intrauterine device) provide no protection against STIs, unlike the barrier methods (e.g., condoms). The number of partners, having sexual relations during trips or while under the influence of illicit drugs and/or alcohol are also increased risk factors.

• How long does it take STI symptoms to appear following contact?

  It can take as little as 1 or 2 days in the case of gonorrhea, herpes or chlamydia but, for condylomata or AIDS, it can take several months or years. The incubation period for hepatitis A, B and C is 15 to 180 days. In certain cases (e.g., herpes, condylomata), a person may remain a carrier for many years, passing the infection to other partners or even developing complications without ever knowing that he/she is a carrier.

• What complications can happen with an STI?

  The most frequent complications with chlamydia and gonorrhea are infertility, ectopic pregnancy or chronic pelvic pain. In addition, some infections can be passed from an infected mother to her baby through the placenta or through contact with her blood and vaginal secretions during childbirth. Hepatitis will cause severe, permanent impairment of the liver.

• How do I know if I have an STI?

  A doctor can screen for STIs by carrying out a gynecological examination, including a PAP test, typing human papillomaviruses and taking specimens from the external genitalia, cervix and vagina for culture. Blood can be taken to test for hepatitis A, B and C, HIV and syphilis, as well as herpes antibodies and liver-specific antigens.

• How can I protect myself against STIs?

  Reduce the number of your partners, use a male or female condom, use spermicidal products, avoid unprotected anal relations and oral-anal contact, be vaccinated against hepatitis (and soon human papillomavirus), all before starting sexual activity.

• How successful is the treatment of endometriosis?

  In terms of pregnancy, the Canadian ENDOCAN (Endometriosis-Canada) study reported a cumulative rate of 30.7% after nine months for less advanced stages. Pregnancy rates higher than 60% were found, even with severe endometriosis. Treatment is also effective in relieving painful symptoms. It has been said that symptoms improve in 90% of patients, but there is a 20% chance of recurrence in the two years following treatment.

Infertility and endometriosis

• Does pregnancy cure endometriosis?

  In terms of pregnancy, the Canadian ENDOCAN (Endometriosis-Canada) study reported a cumulative rate of 30.7% after nine months for less advanced stages. Pregnancy rates higher than 60% were found, even with severe endometriosis. Treatment is also effective in relieving painful symptoms. It has been said that symptoms improve in 90% of patients, but there is a 20% chance of recurrence in the two years following treatment.

• Is stress a cause of infertility?

  Hormones present during pregnancy facilitate the resorption of endometriosis, but we cannot really talk about a cure. In many cases, the condition is in remission and symptoms will recur when menstruation begins again following childbirth.

• Should a specialist be consulted after two consecutive miscarriages?

  Infertility-related problems are a source of stress and intense emotional reaction. Stress has not been identified as a cause of infertility when it does not interfere with ovulation. It is important for the couple not to feel guilty when people close to them quickly say, "The reason things aren't working out is because you're thinking about it too much!" An appointment with a clinical psychologist specialized in fertility matters can help couples manage the stress created by those around them or, alternatively, the tests required to solve this problem.

• Some women become pregnant with no difficulty but have repeated miscarriages. After two or three miscarriages, an investigation will be suggested to find out whether there is some hormonal, immunological, genetic or anatomical cause (e.g., malformation of the uterus). In nearly 50% of cases, the problem(s) can be identified and treatment recommended.

Contraception

• How many times does a tubal ligation fail?

  Very few, in actual fact. However, even if the tubal ligation itself is perfect, pregnancy may occur in approximately 1 out of 1,000 cases. This may happen during the months immediately following the ligation or even several years later. If you have a tubal ligation and your period is late or there is abnormal bleeding, you should have a pregnancy test to make sure that you are not pregnant.

• I have had a tubal ligation, but would now like to have more children as my family situation has changed. Is this possible?

  A tubal ligation (reanastomosis) can be reversed in many cases. The success of the procedure however depends on which portion of the tube was destroyed during ligation. And, once the tubes are unblocked again, there is no guarantee of fertility. Your doctor will have to carry out certain examinations before deciding whether reanastomosis is possible. This type of surgery is more complex than the initial ligation and requires several weeks' convalescence if it is done via an abdominal incision. In short, when you have a ligation, you must be absolutely sure that you truly want to become and remain sterile ... even though you may be able to change your mind in certain cases!

• Are the patch and contraceptive ring as effective as the pill?

  Their efficacy has been studied and is very similar to that of the pill. Compliance is probably better with these two new methods, which do not have to be taken on a daily basis like the pill.

Menopause

• What is the average age at which menopause occurs?

  In the early 50's (in North America).

• Hot flashes are produced by the lack of a hormone: which one?

  Estrogen.

• When should I start taking hormones for my menopause?

  Menopause itself is not necessarily a reason for all women to take hormones. The decision regarding hormone therapy is up to the woman and should take into consideration the menopausal age, whether it occurs naturally or is due to a surgical procedure, the severity of the symptoms and the medical condition of the woman concerned. In many cases, when menopause occurs naturally, lifestyle changes will be enough to alleviate the symptoms.

• Are natural products effective against symptoms of menopause?

  No natural product covers the whole range of menopausal symptoms. Some are effective against hot flashes, while others improve sleep quality. On the other hand, a good number of natural products now marketed for menopause do not appear to be any better than a placebo ("sugar pill"). Generally speaking, clinical experience and research have shown that women experiencing hot flashes or affective sleep problems may note a minor improvement in their symptoms over a short period. Then, the beneficial effect seems to disappear. You should also remember that a number of natural products are, in fact, active pharmacological substances that can have definite side effects. You should therefore consult your doctor if you have to take medicine for a particular condition before taking any such product.

• How long do hot flashes last during menopause?

  It is estimated that around two-thirds of women who become menopausal naturally will experience hot flashes for a period of 3 to 5 years. The symptoms may, however, last longer. It has been noted that 20% of women aged 60 and up, as well as 8% to 10% of women of 70 and over can still have hot flashes. The situation is different for women who start their menopause at a young age, particularly when it is induced prematurely because of medication or surgery. Most of these women will present with severe hot flashes for a period that lasts more than 8 to 10 years.

• I have had my uterus removed. Am I menopausal?

  Not necessarily. If you had a hysterectomy while you were still having your periods and your gynecologist did not remove your ovaries, you will continue to produce sex hormones in the usual way even if you do not menstruate. You will become menopausal at a normal age, which will depend on your family history (mother, sisters) and personal factors.

• Should hormone therapy be used to prevent heart disease?

  Taking hormones to prevent cardiovascular diseases (infarction or stroke) is not recommended. Indeed, hormones during menopause can increase the incidence of these conditions in women already at risk for them.

• Does hormone therapy affect the health of your bones?

  Yes. All studies show that estrogens at the doses usually prescribed during menopause maintain a woman's bone structure and prevent fractures caused by osteoporosis. Estrogens are therefore first-class therapy for women presenting with menopausal symptoms who are also at risk of developing osteoporosis.

• Does hormone therapy cause breast cancer?

  The answer is "No" in the case of women who take hormones for a short period (3 to 5 years). If they continue hormone therapy beyond that point, there is a very slight additional risk of developing breast cancer when compared with women not taking hormones. The risk is estimated to be 1 or 2 for every 1,000 women taking hormones. The periodic examination of the breasts by a health professional, together with a screening mammography every 18 to 24 months, will help minimize this risk. There is no change in risk for women who have had their uterus removed and are not taking estrogen.

• I have been on hormone therapy for four years now. Should I stop?

  It all depends on why you chose this treatment. In theory, if you selected hormone therapy to improve your quality of life (in particular, hot flashes), your doctor can recommend you reduce the dose or even stop the hormones temporarily to evaluate whether the symptoms continue or disappear. On the other hand, the situation is more complicated if you chose hormone therapy to improve your bone health or treat a problem with genital atrophy (dryness), because the hormones will have to be replaced by alternative medication.

• I am on hormone therapy and experiencing irregular monthly bleeding. What should I do?

  In menopausal women who still have their uterus, the estrogens taken to treat the symptoms of menopause should be accompanied by a progestin which prevents uterine cancer. The ratio of estrogen to progesterone hormones is very important in stabilizing the inner membrane lining the uterus (the endometrium). The ratio changes with each woman and so dosage has to be individualized. Your doctor should prescribe the smallest dose of hormones to treat your symptoms and will be able to offer you a choice of sequential or combined treatment. If abnormal bleeding persists, your doctor will assess your endometrium to make sure that there is no organic reason for the bleeding (polyp, fibroma or, more rarely, endometrial cancer).

• Why add a progestin to estrogens during menopause?

  To avoid stimulating the endometrium (the inner lining of the uterus) and thus endometrial cancer.

• Is there any medication that is effective in treating hot flashes, but does not contain hormones?

  Yes. There are some well-designed medications to relieve hot flashes that contain neither estrogen nor progesterone. They have been widely studied and shown to be clinically effective against hot flashes, although their effect is less than that obtained with estrogens. Like any other pharmaceutical product, these medications can cause side effects. You should therefore discuss them with your doctor.

Osteopenia

• What is osteopenia?

  Osteopenia is defined as bone density that is somewhat low. It is used to describe the stage between "normal" and "osteoporosis". It indicates that the bones are starting to become more fragile and that the risk of fracture is greater (4 times greater, in actual fact). Untreated osteopenia will develop into osteoporosis. The health advice given for osteoporosis also applies to osteopenia.

• Do I need to take medication if I am taking calcium?

  Medicines and calcium have different purposes, and each is useful in its own way. Calcium is the essential raw material for the mineralization of bones or their solidity. Bones need calcium, whether they are fragile or not. Medication is the active agent that controls the balance between bone destruction and formation. It can be useful in preventing or treating osteoporosis. Therefore, the fact that you are taking calcium does not justify going without medication in an osteoporosis treatment program, and vice versa.

• Is it true that magnesium, vitamin D and zinc are absolutely necessary for a calcium supplement to be properly absorbed?

  Yes. Vitamin D is required for the absorption of calcium, whether contained in your diet or taken as a supplement. Magnesium is also involved in bone mineralization, but a balanced diet provides a sufficient quantity of this. As far as zinc is concerned, we know that it plays a part in the synthesis of collagen, a protein that forms the matrix of your bones. Neither magnesium nor zinc have a significant effect on calcium absorption, and there is no need to take them as supplements if you are eating a well-balanced diet.