HRT in Perimenopause

You’re having hot flashes, or maybe you’ve noticed changes to arousal and your sex drive has decreased. Over the past few months, you just haven’t quite felt like yourself. These could be just a few signs that you are in perimenopause.  

In this article, we cover the basics of perimenopause, including main symptoms. Then, we’re going to delve into hormone replacement therapy (HRT): what it is, how it could help, and the risk factors associated with it.

What is Perimenopause?

Perimenopause is the term for the time that begins with transitional phase  through complete entry into menopause and the whole process start to finish can take as long as ten years, though you’ll likely not pick up on all of it. Every woman is different, so it’s hard to pinpoint how long perimenopause could last for you. Perimenopause is a hormonal shift in the body and results in some specific changes within the body.

Common symptoms of perimenopause include:

  • Fatigue
  • Irregular Periods, sometimes with heavier than average bleeding
  • Vaginal Dryness
  • Increased Urinary Frequency and Urgency
  • Mood Fluctuations or Depression and Anxiety
  • Hot Flashes or Night Sweats
  • Sleep Disturbances

What is HRT?

Hormone replacement therapy, or HRT, can be used to reduce the symptoms of perimenopause. The primary indication for HRT is the vasomotor symptoms more commonly known as “hot flashes.” HRT typically means taking two hormones, estrogen and progestin.

Estrogen naturally decreases with age and contributes to most of the perimenopausal symptoms. Taking progestin alongside estrogen in HRT reduces the possibility of developing uterine cancer, which is associated with taking estrogen alone. Estrogen may be prescribed on its own in specific cases where the patient has no uterus. This is referred to as “estrogen therapy.”

How Can HRT Help in Perimenopause?

Hormone replacement therapy has been shown to reduce vaginal dryness. It is also supported as the most effective treatment for hot flashes and night sweats. A positive side effect of HRT is that it can also helps protect against bone loss and prevent spine and hip fractures, which are associated with menopause, though we don’t specifically prescribe it for these indications.

There are many different forms of estrogen available, including patches, gels, sprays, and pill form. Progestin can be administered separately from estrogen or combined in a pill or skin patch. If vaginal dryness is your main concern, you also have the option of local treatment using a ring, tablet, or cream.

Are There Any Risks Associated with HRT?

If you are considering HRT, it is important to be aware of the risks. Estrogen-only therapy is not recommended to women who have not had their uterus removed, as this is associated with uterine cancer.

There is a small risk of heart attack on HRT. This is influenced by other factors, such as age and pre-existing medical conditions. There’s also a small increased risk for breast cancer, stroke, and deep vein thrombosis (formation of a blood clot). Some oral forms of HRT come with a slightly greater risk for gallbladder disease.

Less serious adverse effects commonly associated with HRT include nausea, breast tenderness, bloating, weight gain, and breakthrough bleeding. These typically last a short time at the beginning of your transition into HRT.

Contraindications to HRT

Some conditions are contraindicated with HRT. In these unique cases, HRT may not be the best way for you to treat your symptoms of perimenopause. These conditions include endometriosis, fibroids, porphyria, active liver disease, hypertriglyceridemia, and thromboembolic disorders.

If you have a history of breast cancer or endometrial cancer, HRT may not be right for you.

Before starting HRT, your health professional should adequately counsel and test to ensure you are a good candidate for this kind of treatment.

If any of these conditions resonate with you, don’t be discouraged. There are other avenues you can explore to lessen the symptoms of your HRT. If your perimenopause symptoms impact the quality of your life, ask your health professional about your other options outside of HRT.

How to Know if HRT is Right for You

If you’re considering hormone replacement therapy, you should be evaluated by a medical professional. A baseline should be established by analyzing your blood and urine closely. Tests may also include ultrasonography, electrocardiography, and mammography.

Your health professional may also test your serum follicle stimulating hormone (FSH) levels. This helps with monitoring, especially in women who intend to take HRT orally. Serum estradiol levels may also be looked at. This helps monitor women who continue to have symptoms even after they begin HRT.

There’s a Lot to Consider

There are proven benefits to HRT in perimenopause, but there are also some risk factors to consider. If you’re considering starting hormone replacement therapy, discuss it with your healthcare professional thoroughly so that you can decide with confidence whether or not it’s suitable for you.


If you’d like more information, please call our Wilmette or Glenview offices to schedule an appointment.

Am I In Labor?

The feeling of anticipation leading up to labor can be very overwhelming, especially if you’ve never been through it before. It’s normal to want to know when you’re going into labor. So how can you tell? In this article, we will cover classic signs of labor, early labor, false labor, and stages of labor.

Classic Signs of Labor

Being armed with the information on how to know when you’re going into labor will make you feel more confident about going through the process. One of the first signs that your body is preparing for labor is feeling your baby drop, also called lightening. After this, the baby’s head will be much deeper in your pelvis. That can occur from a few weeks to a few hours before labor.

You may also notice an increase in vaginal discharge. It may be slightly pink in color. This is called show. It is actually a sign that the cervix has begun to dilate, as the thick mucus plug that once accumulated at the cervix moves down through the vagina. This can occur between days or hours before labor, or sometimes not at all.

False Labor

The contraction of the uterus sometimes leads mothers to believe that they are going into labor; however, when this happens before true labor begins, it is called false labor. Also known as Braxton Hicks contractions, they are normal, but can still sometimes be uncomfortable.

There are ways to tell the difference between false labor and actual labor. First, irregular contractions are a sign of false labor, as are shorter (45 seconds or less) ones. In true labor, contractions have a progressive quality and develop a pattern with increasingly regular intervals and begin to take place with increasing frequency over time. The strength of the contractions will also increase in labor, whereas in false labor, the strength of the contractions is sometimes weak and sometimes strong.

Another way to tell is where you feel the contractions. If you feel them in the front, where your uterus is, it may indicate Braxton Hicks. If your contractions feel like they begin toward the back of you and move towards the front, it indicates true labor.

If you’re still not sure, moving around can help you figure out if you’re in false or true labor. In false labor, the contractions will typically subside when you begin moving around. In true labor, the contractions will likely increase in frequency and strength no matter what you do!

Early Labor

Early labor is the first stage of labor, before the labor pattern becomes “active.” Every labor is different, but typical hallmarks of early labor are contractions that are not yet consistently every 3-4 minutes apart, lasting a minute or longer, and too intense to talk or maintain current activity through. Although it’s common to feel like you want to do something during this stage, the best thing you can do to help yourself along in early labor is to hydrate, eat something, and try to rest.

The duration of this phase of labor is highly variable, but with a first pregnancy can last hours to days, during which you will likely experience about 5 to 30 minutes between contractions. Your water typically won’t break during this time. During early labor, it’s important to conserve resources. Avoid the urge to rush to the birth center or hospital; instead, touch base with your midwife or doctor as directed for advice on how to make yourself more comfortable and when to plan follow-up. Massage, heat packs, showers, and baths are great relaxation tools during this phase.

Stages of Labor

It can be easier to understand labor once it’s divided into its three stages. The first stage of labor includes early labor, active labor (commonly defined as 6 cm or more of cervical dilation with regular, strong contractions), and the transition phase (where you progress from 8- 10 cm cervical dilation).

The second stage is all about moving your baby down through the vaginal canal, and the special time where you give birth to your baby. Your baby being born concludes the second stage of labor.

The third and last stage of labor is when you deliver the placenta. This stage typically lasts anywhere from 5 to 30 minutes and begins with small contractions and a small gush of bleeding that indicate your placenta has separated from the uterine wall. Once the placenta has delivered you’ve made it through all the stages of labor.

As you near your due date, we don’t expect you to know exactly where you are in the labor process, but it’s important to know the answer to this question: When should I call my doctor or midwife about labor? Ask your practice for their specific recommendations. Knowing the cues to look for from your body will give you greater confidence in approaching the labor and birth process.


If you have a question or you’d like more information, please call our Wilmette or Glenview offices to schedule an appointment.

Options for Breast Cancer Screening

As we mature, we begin to appreciate our health that much more. Our bodies have grown with us through it all. In some cases, you can catch an issue before it becomes something more serious. That is why tests like breast cancer screenings are so vital to your continued health.

What is Breast Cancer Screening and Why Does It Matter?

Breast cancer screening is the screening of healthy, asymptomatic women for breast cancer at its early stage. The goal of breast cancer screening is to catch breast cancer as early as possible, as this is when it is most treatable. You do not need to have any symptoms, concerns, or family history of breast cancer to undergo a breast cancer screening.

Breast cancer is the second leading cause of cancer death among women. One in eight women will be diagnosed with breast cancer in her lifetime. Breast cancer screening gives a woman the opportunity to catch her breast cancer in its early stages to ensure treatment is given when it is most effective.

How to Screen for Breast Cancer at Home

As women, we often neglect ourselves to put others first. It’s not uncommon to give the excuse that we are too busy to go in and get screened for breast cancer. The great news is that breast cancer screening can start in the comfort of your own home. It is done with a simple breast self-examination.

Home Breast Cancer Screening Steps

You can start doing a breast exam in the shower. Move around your breast on the pads of your fingers in a circular motion. Move from the outer areas toward the center—don’t forget your armpit area. If you notice any lumps or knots, let your OBGYN know.

The next part of your self-examination should be done in front of a mirror. Doing a breast exam in front of a mirror has some advantages. It allows you to visually evaluate any changes like swelling, dimpling, and differences in nipple appearance.

Begin with your arms at your side. Then, raise your arms up and look for any visual peculiarities. Next, put your hands on your hips and flex your chest muscles, again looking closely for any visual differences.

Lastly, examine your breasts lying down. Lying down spreads out the breast tissue, helping with the self-exam. Place a pillow under your right shoulder with your right hand placed behind your head. With your left hand, use the pads of your fingers to feel for any lumps and knots. Move your hand in a circular motion and ensure you cover the entire breast area. Squeeze the nipple with varying pressure to check for lumps or discharge. After this last step, your self-examination is complete.

Experts suggest performing a self-examination at least once a month at roughly the same time in your cycle. Schedule it in as a date with yourself and mark it on your calendar as a friendly reminder to get it done.

How Breast Cancer Screening is Done in Office

Even though breast cancer screenings can be done at home, it is important to still make time to be checked by your doctor regularly. Your doctor will also have access to tools that make for a much more effective screening process.

In a clinical breast examination, your doctor will examine your breasts by touch to look for any abnormalities. This clinical examination would also be a good time to bring up any concerns or changes with your doctor.

Your doctor may use other resources to evaluate your breast health, including a mammogram, an ultrasound, and an MRI.


Mammography is the X-ray screening of your breasts. A qualified technologist positions you through the mammogram by placing your breast on a platform. There will be a paddle that slowly comes down towards the platform, compressing your breast. This provides the images used to screen your breasts.


A breast ultrasound is quite a bit different from mammography. It uses sound waves to create images of your breasts. It is done by a radiologist or ultrasound technician using a clear gel and a transducer on your breasts. There are two major benefits to this. First, an ultrasound is better at “seeing” certain parts of the breast than mammography. It also helps to determine whether a breast lump is solid or fluid.


An MRI uses magnetic forces and radio frequencies to find abnormalities that are not found by mammography and ultrasound, as it produces very detailed pictures. It involves you lying face down on a platform, at which point an IV is put into your hand or arm. You are then placed into the MRI magnetic unit. Contrast material is injected through the IV line to help produce the images. An MRI is typically only done on women who are at high risk for breast cancer.

Benefits and Risks to Office Breast Cancer Screening

The benefit of in-office screenings is being evaluated by medical professionals who know exactly what to look for. Mammography, ultrasound, and MRI are all also useful tools in breast cancer screenings. However, there are risks associated with some of these screening tools.

Mammography, like all X-rays, exposes you to a small amount of radiation. There is a small chance that a false positive may occur. Women who are pregnant or may be pregnant should let their doctor or technologist know before the exam begins. An MRI comes with a slight risk of allergic reaction and may also produce false positive results. Ultrasounds come with little to no risk.

If breast cancer screening hasn’t been on your radar lately, you should make it a priority. Breast cancer screening is paramount to catching breast cancer early, and catching it early is key. If you’d like more information, please call our Wilmette or Glenview offices to schedule an appointment.


Prenatal Genetic Screening Options

Pregnancy is a very emotionally involved process. From time to time, you are bound to have concerns pop up about the health of your growing baby. Thankfully, there are plenty of prenatal genetic screening options to help you evaluate the health of your baby prenatally.

Genetic screening may be of interest to you because you have some underlying concerns, or perhaps your aim is to put your mind at ease. No matter what your reasoning, you’ll feel better knowing that you have options to assess the genetic factors of your baby.

What Types of Prenatal Genetic Screening are Available?

There are quite a few options when it comes to prenatal genetic screening. Most are available during the first trimester of pregnancy. Some tests assess history and risk, whereas others actually test the fetus’s DNA to determine any abnormalities.

Carrier Genetic Testing

During the first trimester, you may want to do carrier genetic testing. This is an optional screening that tests for recessive diseases like cystic fibrosis and spinal muscular atrophy.

Non-invasive Prenatal Testing (NIPS)

This type of testing can look for risk factors for triploidy, trisomy 13, trisomy 18, Down syndrome, and Turner’s syndrome by looking at the mother’s blood and analyzing it for fetal DNA fragments. This test is not used to look for all abnormalities, but rather the most common ones. This test provides 97% to 99% accuracy, with a 1% false positive rate.

First Trimester Screening

Using the mother’s blood and an ultrasound, this screening tests for trisomy 13, trisomy 18, and Down syndrome with 90% to 95% accuracy. The ultrasound is helpful in measuring the thickness of the fetal neck. A thick fetal neck fold (also called a nuchal fold) is associated with some congenital disorders.

Alpha Fetoprotein

A non-invasive screening test for Neural Tube Defects, such as Spina Bifida. This test is done between 15-20 weeks of gestation, and uses a blood sample from mom to assess risk of associated fetal disorders.

Chorionic Villus Sampling (CVS)

In performing CVS, a needle is used to extract a sample from the placenta. This is done with the help of an ultrasound and is usually performed between 10 to 13 weeks of pregnancy. The cells from the placenta can then be used to test fetal chromosomes. This can reveal any chromosomal abnormalities or genetic disorders. CVS may be recommended in the case that risk factors are indicated in parental family history.


Amniocentesis is another early pregnancy test that uses a needle to extract fluid from around the fetus. Like the CVS, this test is done with the help of an ultrasound to ensure the safety of the fetus. Fetal cells found in the fluid can be used to test for chromosomal abnormalities, genetic disorders, and neural tube defects.

How to Find Someone Qualified to Do Your Prenatal Genetic Tests

When deciding where to go for your prenatal genetic tests, remember there are two components to a valid test result. First, you will want to make sure you have qualified counsel during the test, and that you have a trusted professional to turn to with any questions you may have about the test and the results.

Second, you want to ensure that the lab at which your results are being analyzed is also trustworthy. We have labs on site, which allows us to do your screening tests in house and return the results to you faster. That is just another way we provide you with the services that ease your mind in pregnancy.

When it comes to genetic prenatal testing, you have a lot of options. It helps to have a trusted source guide you through them. If you are interested in prenatal genetic testing, North Shore Associates in Gynecology and Obstetrics is a good place to start. If you’d like more information, please call our Wilmette or Glenview offices to schedule an appointment.


For First-Time Moms – When Will I Deliver?

As a first-time mom, you can’t wait to meet your baby. Of course, you also want to know when your baby is coming. Each pregnancy and delivery is unique, but there are certain signs you can look for to figure out when you could possibly be delivering your baby.

Before reading these signs, keep in mind that giving birth before or after full gestational age doesn’t necessarily equal a negative consequence for you or your baby. If you have any questions or concerns regarding early or late delivery, don’t hesitate to bring them up to your OBGYN or midwife.

Signs Your Baby is Coming Before Full Gestational Age (prior to 37 weeks of pregnancy)

Sometimes labor begins before your baby is considered full term, or full gestational age. Although this may seem scary, in many cases, the baby is just fine.

Though we can not always explain why this happens or predict it, there are some risk factors associated with premature labor. If the mother has any uterine abnormalities or is carrying multiples, there is a higher chance of early birth. If the mother experiences recurring bladder or kidney infections, deals with chronic illness, has experienced high fever in pregnancy, or has certain vaginal infections or sexually transmitted diseases, she is at higher risk to deliver her baby before full gestation.

If you are experiencing the following symptoms of labor, you could very well be going into labor and should contact your midwife or obstetrician. These include increased vaginal discharge, bleeding, the breaking of your water, and contractions that begin to increase in frequency and strength over time, or are occurring more than five times in an hour.

A birth occurring before 37 weeks is a more complicated by the pre-term gestation of the baby. Follow the guidance of your OBGYN or midwife through the process of birth and afterward to ensure the best outcome for you and your baby.

Signs Your Baby is Coming at Full Gestational Age

Every pregnancy is different, and it can be impossible to know in advance exactly when your baby is coming. However, the following are some signs that the time could be near… One classic labor sign is lightening, which is when the baby drops down into your pelvis. This indicates that the baby is becoming ready to be born. That being said, lightening can happen weeks or hours before your baby is born.

Other signs that your baby is coming include your water breaking, shedding of the mucus plug (also called show), and contractions that increase in strength and frequency over time. Every week matters when it comes to growing your baby, but once your baby has reached full gestation, you can be ready to welcome them into the world!

Signs Your Baby Will Be Delivered Late

The clock is ticking. You sit back and wonder: Jeez, when will I deliver? After all, that baby has been cooking for a while. Delivering late is normal, but it can also be difficult to wait.

A pregnancy extending more than a week beyond the due date is also referred to as  “post-term pregnancy.” Why does late post-term pregnancy happen? It’s actually unknown. However, there are some risk factors that may contribute to a late delivery of your baby.

Interestingly, male fetuses are more likely to be carried late. If you are carrying a male fetus, don’t be surprised if your pregnancy lasts longer than anticipated. As a first-time mom, it is also not uncommon to carry your baby later than expected. Obesity is also another risk factor for late delivery.

Most midwives and doctors are happy to support a pregnancy through 41-42 weeks of gestation, but it is important to stay in contact with your health professionals and let them know about any of your questions or concerns. During this time, you’ll see them twice a week!

You may have concerns about preterm delivery and post-term pregnancy, especially if you connect with any of the risk factors involved. We’re here to help. If you’d like more information, please call our Wilmette or Glenview offices to schedule an appointment.


March of Dimes

American College of Obstetricians and Gynecologists