Q&A with Dr. Randy Fink

Q&A with Dr. Randy Fink

As the Medical Director and Managing Partner here at Miami Center of Excellence for Obstetrics & Gynecology, Dr. Fink is asked a lot of questions about women’s health! Although each woman is different and requires her personal questions to be answered according to her specific health issues, we put together a list of some of the most common questions that come his way along with his responses.

How likely can birth control pills cause blood clots in non-smoking women?

Deep vein thrombosis and pulmonary embolus – a blood clot that travels to the lungs – are called thromboembolic events. Consider the rate of blood clots in women who are not on hormonal birth control. The common estimate is that it happens in 5 to 10 cases per 100,000 woman years. {A more recent study even suggests it happens much more frequently: 50 to 100 cases per 100,000 woman years.} On hormonal birth control, a clotting complication is said to occur in 20 to 30 cases per 100,000 woman years. This is clearly higher than the 5-10 per 100,000 for women not on birth control. So, while the increase may seem frightening, the risk of these same clotting complications occurring during pregnancy is 60-96 per 100,000. During the post-partum period, it is 511 per 100,000 woman years! So, while birth control is not without risk, the risk of pregnancy itself is clearly much higher. Thus, hormonal birth control is said to be a safe way to avoid an unintended pregnancy.

How likely are birth control pills to cause blood clots in smoking women?

Women who are current smokers on birth control have an 8.8-fold higher risk for having a thromboembolic event than nonsmoking women not on birth control. The other concern in smokers is that of heart attack or stroke. The incidence varies with age. For instance, smokers who do not use birth control pills have the following absolute risks for heart attack: 1.083 per one million woman years for women ages 20 to 24; 13.58 for women ages 30 to 34; and 170 per one million woman years for women ages 40 to 44. Corresponding risks for smokers who use combined hormonal contraception are: 1.6 per one million women-years for ages 20 to 24; 20 per million woman-years for those ages 30 to 34 and 255.3 per one million woman-years for women ages 40 to 44.

What is best way to transition from breastfeeding to formula?

Breastfeeding meet all the nutritional requirements of the baby for the first six months of life. After six months of age, solid foods help to supplement energy, iron, vitamins, and trace elements, and prepare the infant for a more diversified diet. Weaning is best accomplished by eliminating one breastfeeding session every 2 to 5 days. A midday feeding is often the best to start eliminating, as babies are usually more attached to the first and last feedings of the day when their need for comfort is greater. It is often helpful if another parent or caregiver introduces the bottle, since the baby may prefer the breast if he/she knows it is available. It is also helps if the baby is not super hungry when introducing the bottle, as they might have more patience with it.

What causes burning sensation in breast from breastfeeding?

If I understand the sensation you are describing, I believe you are referring to what is known as the “milk letdown reflex”, or simply “letdown”. Suckling, or nipple stimulation, or even just the sound of the baby crying may stimulate the hormone that causes milk production (prolactin). This hormone causes the breast glands to produce milk, and can sometimes be described as a burning deep within.

Is it okay for an overweight woman to lose weight safely during her breastfeeding phase?

Excessive weight loss can affect both the quality and the amount of breast milk. Most women lose weight gradually in the first 6 months post-partum, and weight loss in general is slower in women who were obese before pregnancyLosing a . moderate amount of weight by diet and exercise has not been shown to negatively affect breastfeeding, but may have a significant effect on mom’s overall health. Breastfeeding moms should consume at least 1500 calories a day in order to maintain the quantity and nutritional content of milk.

What can women do about loose skin from pregnancy?

Strengthening the abdominal muscles through exercise can certainly tone a loose abdominal wall, but surgery (a “tummy tuck”) is the only true way to completely be rid of loose skin. Some loose skin will tighten itself over time, which is why surgery should not be considered for at least 6 months.

Can pregnancy cause nosebleeds, and if so, why?

Yes, and nosebleeds are common during pregnancy. Probably as a result of hormone changes (estrogen) on the lining of the respiratory tract, the tissues become swollen, drier, and more irritable. This leads to nasal stuffiness and nosebleeds. The effect may be similar to an allergic type response, and pregnant women may have some increased susceptibility to allergens, as well.

Is there a way to detect an early miscarriage?

Not reliably, on one’s own. Some women suddenly don’t “feel pregnant” anymore, or have a sudden resolution of nausea, breast tenderness, or other early signs of pregnancy. Vaginal bleeding during the first trimester is extremely common, and even when heavy does not necessarily mean that the pregnancy will miscarry. The best move in these circumstances is to perform an ultrasound. When ultrasound shows a fetal heart beat, more than 90% of these pregnancies will continue without a problem.

Can a woman tell difference between early miscarriage and implantation spotting?

Again, not reliably on her own. Implantation bleeding typically occurs 10-14 days after fertilization – or right at the time of the “missed period”. In fact, sometimes a woman many not even realize she is pregnant because the implantation bleeding occurs at the time of her expected menses.

Why can ovarian cancer sometimes cause leg pain?

Presumably, growth of tumor in the pelvis may cause compression on one or more nerve groups. Leg pain can be associated with any process that has potential to cause pelvic pain: uterine fibroids, benign ovarian cysts, ovulation, endometriosis, or even just routine period cramps.

Can migraine headaches be prevented when caused by period?

Some women suffer from menstrual migraine headaches. These headaches are thought to be caused by a drop in the normal hormone levels, leading to menstruation. When the brain realizes pregnancy has not occurred, it says, “Okay. Shut off the hormones, clean everything out, and let’s try again next month.” This is the signal to have a normal period. The falling off of the hormone level from normal is thought to be one cause of menstrual migraines. Therefore, one way of treating menstrual migraines is to use continuous birth control. By not letting the hormone levels drop (i.e. “skipping the period”, menstrual migraines resolve in over 80% of women.

Have you heard of vaginal trigger point therapy to treat painful sex?

Yes. Trigger point injections use a type of long-acting local anesthetic, sometimes combined with an anti-inflammatory such as a steroid, to alter the function of the nerves that contribute to certain types of pain syndromes. This is best described for women in one called Myofascial Pelvic Pain Syndrome (MPPS). The pain may occur in the pelvis, vagina, vulva, rectum, or bladder, or in more distant referral areas such as the thighs, buttocks, or lower abdomen. Commonly associated symptoms include a sense of aching, heaviness, or burning in these areas, sometimes with symptoms of overactive bladder, constipation, or painful sex. Many experts believe that many, if not most, women with chronic pelvic pain have some degree of MPPS.

Why does PMS cause swollen ankles?

Bloating and water retention are common symptoms ascribed to PMS. The exact mechanisms of PMS are unfortunately not known; if we knew, we could much more effectively treat and prevent it. PMS certainly has a hormonal connection, as by definition it occurs during a particular time of the cycle. “Retaining water” tends to cause excess fluid to accumulate in the lowest, most gravity dependent areas, i.e. the feet (and ankles) from standing, the finger tips, or even in the lower back or coccyx bone in those who sit or lie down for extended periods.

Dr. Randy A. Fink, MD is the Medical Director and Managing Partner here at Miami Center of Excellence for Obstetrics & Gynecology.