Medical App & Medical Advice with Hello Doctor

Nine months after the night before the morning after pill

The first week of September is one of the most popular weeks for unprotected sex in South Africa. We don’t know if it’s the smell of blossoms in the air, the first rays of sun or those floral skirts parading the streets, but this time of year, people everywhere are getting it on.

How do we know this? Because, come June, our hospitals will be filled to the brim with brand-spanking new babies. (It also means, if you’re a June baby, you were conceived in this very month.)

So, if you want to avoid being part of the statistics, here are three words of advice: use birth control! And if ‘contraception’ sounds like a passion-killer to you, you’ll need to weigh it up against sleepless nights, nappy-changes and preparing a small adult for their life.

Not ready for that? Then we have four (plus one back-up) ways to have adult fun, in an adult way:

1. Cover your lover

Ribbed, unribbed, strawberry-flavour, glow-in-the-dark, extra strength, extra thin and even warming condoms: the latex industry sure knows how to turn protection into a sport (or a circus). If there’s one thing you can’t say, it’s that condoms will make sex boring. If anything, it opens up whole new levels of experience.

You can even take turns wearing the ‘glove’. Yes, gents – there are also female condoms and diaphragms available. Just take note: it’s not as comfortable or effective as a male condom.

2. One-a-day

No, we’re not talking about apples here. Although an apple a day won’t keep the doctor away; a tablet a day will prevent babies – 99,9% of the time. Yes, that is not a typo. If you take the pill every day, you only have a 1 in 1000 chance of falling pregnant.

So what about your neighbour and her cousin and who fell pregnant while on the pill? Although the drug itself is almost 100% effective, omen aren’t nearly as effective at taking them every single day, which brings us to our next option:

3. Fit and forget

It’s one of the simplest, least painful procedures, and can last you up to 5 years. The IUD (or intrauterine device) is a small T-shaped device that the doctor inserts into your uterus. They are

  • effective at preventing pregnancy
  • have almost no side-effects (unlike the pill)
  • can be taken out once you’re ready to welcome another bundle of joy into your life.

There you have it: three fantastic reasons to pick up your phone right now, and book an appointment with your Gynae.

4. Closing the factory

Then, of course, there are the more permanent options: vasectomy for the men, or tubal ligation for the women. These operations have low-risk, quick recovery, and permanent results.
This is the best option if you’re at the stage of life where you can’t imagine another run of nappies, school-fees, teenage drama and study loans. When your family is at capacity, just go for the snip. Then you can rekindle those flames of passion from B.C. (Before Children) with zero worries.

EEK! The condom broke!

When all else fails, the morning after pill is an effective (but controversial) back-up plan, available at most pharmacies. Just remember to take it as soon as possible after unprotected sex: no later than 5 days.

Here are some classic situations where you may need it:

  • you’re reading this article the morning after, and did not use protection last night
  • you didn’t check the expiry date on your condom, and it broke
  • you forgot to take the pill yesterday and the day before (set reminders on your phone!)
  • you’ve been vomiting or had diarrhoea while on the pill

So, while spring is in the air, and love is all around, rubber-up, pop a pill or snip. Just don’t get caught with your pants down!

By Dr. Albert J. Viljoen

The bad advice you need to question

“I heard from my second cousin’s friend that you can’t get an STD from…” This is like a terribly-played game of broken telephone – the original information may have been incorrect from the beginning, or lost down the line. And, with the internet, anyone’s opinion quickly becomes fake news.

Here’s what you should know:

“Condoms will stop you from getting STDs”

You may have heard this from one of your friends, but it’s not entirely true. Condoms are highly effective at reducing – but not completely preventing – the chance of transmission of an STD. It’s vital to note that there are different degrees of protection; it depends on the type of STD that you get.

Important: Make sure you know how to put on a condom correctly before you have sex – otherwise it may slip off or even break. When used correctly, condoms are 98% effective.

“You will know if you have an STD”

No, you won’t always know; it depends on the type of STD. The Human Papilloma Virus (HPV), for example, usually doesn’t show any symptoms because you body’s immune system is able to kill the virus. The sexual partner that infected you may not even know that they have it.

However, there are warning signs that you may have an STD; these include:

  • Sores or warts on your genitals
  • Pain when you pee
  • Nausea, fatigue, fever
  • Discharge and/or odour from your genitals

If you experience any of these symptoms soon after sex, make an appointment with your doctor to get tested for an STD.

“You can’t get pregnant while on your period”

Nope. Ladies, you can still become pregnant while you’re on your period. A menstrual cycle normally lasts 28 days, but certain women have a shorter menstrual cycle – sometimes only 22 days. This means that you may ovulate a few days after your period.

Sperm remains in your genital system for six days and so if you did have sex during your period, it is possible that the sperm will still be there when you ovulate, fertilising the egg.

“Birth control pills make you gain weight”

This is not completely accurate. Perhaps 50 years ago when birth control pills contained a lot of oestrogen, but today’s pills do not contain as much of this hormone anymore. If you do pick up a bit of weight when you start taking them, it’s usually a temporary side effect.

Generally, birth control pills will not make you gain weight; if you do pick up a few kilos, it is probably due to the type of pill that you are using. You should go and see your doctor and they will suggest a different type.

So, the next time your uncle gives you his usual “2 cents” – think twice. Rather ask one of our doctors. Just log onto the app, and text us a question. We’ll get back to you within an hour, so you can give your uncle our two cents worth!

Sources

How stress can influence your fertility

Could stress really prevent you from getting pregnant?

Stress is often described as an event that a person sees or feels as threatening to their life. So, the body responds with a “fight or flight” response in order to protect itself.

According to research on the relationship between stress and infertility, the cause of infertility isn’t always clear. There may be a basic health condition like polycystic ovarian syndrome (PCOS), endometriosis, male infertility, or the frustrating diagnosis of unexplained infertility.

Stress, depression and anxiety are described as common consequences of infertility.

Stress and your behaviour

While stress alone doesn’t necessarily cause infertility, it can push a person toward unhealthy behaviours. These unhealthy behaviours can affect your fertility.

We all resort to unwholesome patterns or routines when stressed. But the following habits can actually affect your fertility:

  • Binge eating, emotional eating or not eating enough.
  • Sleeping too much or too little.
  • Not exercising enough or pushing yourself to overdo it.
  • Drinking too much alcohol.
  • Smoking.
  • Drinking too much caffeine, especially if you’re sleep-deprived.
  • Loss of interest in sex with your partner.

Infertility and stress

Stress can affect the gland in the brain that manages your emotions, appetite and the hormones that tell your ovaries to release eggs. When you’re stressed out, you may ovulate later in your cycle or not at all. So, if you’re only having sex around day 14, thinking that you’re about to ovulate, you may miss your opportunity to conceive.

Research has shown that people who get less than five hours of sleep each night are more likely to suffer from obesity, and obesity can lead to problems with fertility.

Don’t let stress get in the way

Reducing stress is good for your health, and may improve your chances of falling pregnant. Finding ways to keep stress in check by developing better coping strategies to help you feel more in control and improve your overall wellbeing.

Improve emotional health

Try these:

  • Acupuncture.
  • Aerobic exercise (may be reduced during treatment).
  • Journaling.
  • Listening to music.
  • Massage therapy.
  • Meditation.
  • Mind-body groups.
  • Mindfulness.
  • Progressive muscle relaxation.
  • Psychotherapy and cognitive behavioural therapy.
  • Self-help books.
  • Support/educational groups.
  • Walking/hiking.
  • Yoga.

References:

Struggling to fall pregnant? It could be an ovarian cyst

Ovarian cysts are more common than you realize. Often, they don’t present with symptoms, but sometimes they can create a lot of trouble – including infertility. 

A cyst is a fluid-filled sac that can form in many places in the body. Ovarian cysts form in or on the ovaries.

The most common causes of ovarian cysts include:

Hormonal problems or drugs used to help you ovulate. These cysts usually go away on their own without treatment.

Pregnancy. An ovarian cyst normally develops in early pregnancy to help support the pregnancy until the placenta forms. Sometimes, the cyst stays on the ovary until later in the pregnancy and may need to be removed.

Endometriosis. Women with endometriosis can form a type of ovarian cyst, called an endometrioma. The endometriosis tissue may attach to the ovary and form a growth. These cysts can be painful during sex and during your period.

Severe pelvic infections. Infections can spread to the ovaries and fallopian tubes that can result in cysts forming.

In many cases, ovarian cysts have no real symptoms but can include:

  • Mild stomach ache.
  • Stomach swelling or a feeling of fullness or pressure.
  • Pain during sex.
  • Period issues, including a lack of bleeding, heavy bleeding or painful periods.
  • Painful, frequent peeing if a cyst presses against the bladder.
  • Sudden, sharp stomach pain, fever, and nausea if a cyst becomes twisted or “bursts”.
  • Unusual hair growth on the face and body caused by an increased production of the male hormone.

Diagnosis of ovarian cysts


A gynaecologist will help diagnose an ovarian cyst. If a lump or mass in the ovary is found, further tests will be done to check for ovarian cancer. These will include:

Pelvic exam


Usually ovarian cysts are discovered during a pelvic check-up. But, a pelvic exam can’t produce a final diagnosis, so the next step for your doctor would be to perform a vaginal sonogram.

Vaginal sonogram


This test allows the doctor to get the clearest picture of the ovary and cyst. The test is done by inserting a small instrument into the vagina that forms a picture on a monitor.

This image allows the doctor to figure out the size of the cyst and see inside it to check whether it’s solid or fluid-filled. While the vaginal sonogram can pick up a cyst, it won’t be able to tell whether there is a cancerous or non-cancerous growth. So, if the sonogram shows there’s a cyst, the next step may be the surgical removal of the cyst (laparoscopy) to find out if it’s cancerous or non-cancerous.

Laparoscopy


This operation is performed in the stomach or pelvis and allows your doctor to see and remove the cyst by making a small cut. The laparoscope is inserted through a small cut into your stomach and small instruments are then placed near the pubic bone to allow the doctor to remove the cyst.

Treatment of ovarian cysts

Ovarian cysts often disappear without treatment. Surgery to remove the cyst may be needed if cancer is suspected, or if the cyst doesn’t go away and is causing symptoms. In many cases, it can be removed without damaging the ovary, but sometimes the ovary must be taken out. In rare cases, an ovarian cyst may be drained during laparoscopy.

Your doctor may recommend hormonal therapy to help prevent future ovarian cysts.

If you experience any of the symptoms of ovarian cysts, see your doctor or gynaecologist. If you’ve been diagnosed with an ovarian cyst and you experience sudden, sharp stomach pain, fever, or vomiting, see a doctor immediately.

References:

Stopped The Pill? Here’s why you’re not menstruating.

Maybe you’ve decided it’s time to have a baby. Or, you just want to go off contraception. When you go off the pill, you expect your menstrual cycle to get back to normal; but what happens when your cycle doesn’t start?

Post-pill amenorrhea

This is a fancy way of saying that many women experience a delay of menstruation after stopping the birth control pill. You could also experience spotting, or a much lighter flow during your period. It might carry on this way for up to six months. In most cases, the effect is temporary and your cycle may return on its own after a couple of months.

Why it happens

Birth control pills suppress your pituitary gland from making hormones involved in ovulation and menstruation. When you stop taking the pill, it may take some time for your body to return to normal production of these hormones.

It’s like your body has unlearnt how to produce the hormones, so it may take some time to get back into the normal cycle.

What can you do about it?

Technically, this isn’t a medical condition, and you can just wait for your body to get back to normal. If you don’t get your period within the first three months, take a pregnancy test or go see a doctor. Once you stop taking the pill, your ovaries take about two weeks before the process of ovulation starts again and normal menstrual cycle restarts after a few months.

Can I get pregnant after stopping the pill?

Research suggests that most of the time, birth control doesn’t necessarily have a negative impact on fertility. Many women go off the pill and conceive on the very first cycle. Your body will gradually begin to get back to its normal state. The good news is that you can get pregnant during your first cycle after stopping the pill.

When do I see the doctor?

The time-limit to get your period may vary; it could be between six to nine months. See your doctor if you’re anxious and the wait feels too long. He may advise an active treatment that can be started as soon as possible. He may prescribe Clomiphene Citrate. This is a medication that’s used to treat infertility in women who don’t ovulate. It works by stimulating your pituitary gland to produce FSH and LH. There are other medications available that your doctor may prescribe too, but the best is to let your body take its normal course.

References:

The basics of birth control

Today, there are more options than ever to prevent pregnancy – and stay sexually safe. With guidance from your doctors and the many options to choose from, you can go for a birth control of your choice that will fit your budget and lifestyle.

The job of birth control is to keep the sperm and egg apart during sexual intercourse. Here’s what you need to know about the most popular methods. Remember, contraceptives don’t protect you from sexually transmitted diseases and HIV/AIDS. So, it’s still a good idea to always use a condom as well.

Method How it works Good to know
Implant A small plastic rod is inserted under the skin of your upper arm. It releases a hormone called progesterone into your body. The hormone thickens the mucous of the neck of the womb to prevent sperm from entering. It prevents ovulation (stops eggs from leaving your ovaries) and thins the lining of the womb so it’s not able to support a fertilised egg.

 

·       It’s 99% effective within the first seven days of insertion.

·       You can have the implant for up to three years and it’s generally safe for most women to use.

·       Once it’s in, you don’t have to worry about a daily or monthly routine for your next contraceptive dose.

¡       There could be some side-effects like bruising, occasional soreness, irregular bleeding, headaches, nausea, and acne.

 

The patch The thin, beige plastic patch releases hormones through the skin to prevent pregnancy. It can be placed on your buttocks, abdomen, and arm.

 

·       It’s about 92-99% effective.

·       It’s generally safe, convenient, discreet, and doesn’t disrupt sex. This method is also easier for women who have trouble swallowing pills.

·       The side-effects may include your period flow being lighter or irregular. With generally no risks to using this method, there’s a slight risk of developing blood clots. Your oestrogen levels are higher and this could lead to weight gain, bloating, water retention, and other health issues.

 

The pill The hormones in the pill stop eggs from developing, therefore there is no egg released from the ovary.

 

¡       Taken daily at a specific time, it can give you 99% birth control.

¡       The pill does more than prevent pregnancy, but has other health perks too. It helps and reduces acne, menstrual pain, iron deficiency, and bone thinning. It also lowers the risk of ectopic pregnancy (a pregnancy outside of the uterus, which can damage organs and cause life threatening blood loss).

¡       You will have to take the pill every day at the same time.

¡       It may change the level of your sexual desire too.

¡       Weight gain may result because of fluid retention and not from the actual pill.

 

 

 

Before you choose your option, know that some digestive disorders make it difficult for your body to maintain an oral birth control (like pills). Certain antibiotics can also make your birth control ineffective, so talk to your doctor before using any new medications.

Other methods include:

  • Vaginal ring
  • Cervical cap
  • Condom
  • Diaphragm
  • Female condom
  • IUD
  • Abstinence
  • Spermicide
  • Vasectomy
  • Sterilisation

Check with your doctor to see what may be suitable for you.

References

 

Contraception 101 by Dr Lynelle Hoeks

This is my first blog post in a series of 4 on contraception – so yes, there’s clearly a lot of important information you need to know.

First things first; whether this topic is unchartered territory, or whether you’re wondering if your current contraceptive is still suitable for you, choosing a contraceptive method can be confusing and daunting. Each time I counsel someone on selecting a method that’s appropriate for them, I’m reminded of just how many factors influence their choice. From family support (or none), cultural beliefs, cost and access to health services, to ease of use and preconceived perceptions. Along with preventing pregnancy, many methods have additional benefits such as controlling heavy periods and acne, and protecting against STDs. This makes the discussion you have with your doctor incredibly important, in order to maximise the benefits of your chosen method of contraception.

So, let’s have a look at what’s out there.
Continue reading “Contraception 101 by Dr Lynelle Hoeks”

What are the hormonal methods of contraception? Written by Dr Lynelle

In my 1st blog post (Contraception 101) post we covered methods of contraceptives that don’t involve medical interventions. In my 2nd blog post (Contraceptives Which Prevent Pregnancy and STDs: Written by Dr Lynelle), we looked at barrier methods which prevent pregnancy and STDs.

Here, we take a look at hormonal methods of contraceptives.
Continue reading “What are the hormonal methods of contraception? Written by Dr Lynelle”