GYNECOLOGY: FREQUENTLY ASKED QUESTIONS

For your convenience, we have listed answers to commonly asked questions. Please feel free to ask any questions at your prenatal visits or on the patient portal. For any urgent questions, you must call 609-924-9300, do not use the patient portal.

If you are experiencing a life-threatening emergency, call 911 immediately or proceed to the nearest emergency room. 

Princeton Medical Group ObGyn is affiliated with Penn Medicine Princeton Medical Center (1 Plainsboro Rd, Plainsboro, NJ 08536). We have an ObGyn physician in our practice on call 24 hours a day, 7 days per week available to emergencies. 

If you have a gynecologic medical emergency, you call our main number 609-924-9300 to reach the on-call physician. 

Prescription refills and routine questions are not considered a medical emergency and should be addressed Monday-Friday 7am-5pm.

You may request a prescription refill through your Patient Portal account or by contacting your pharmacy to request the pharmacy submit an e-refill request to our office. Prescription refills take up to 72 hours for your physician to approve.  

Routine prescription refill requests are NOT emergencies and will not be answered after hours.

Out of respect for our patients, we make every effort to see patients on time.  Therefore, if you are 15 minutes or later for your appointment, please expect that we may reschedule your appointment. Please call the office if you are going to be late to reschedule your appointment.  We cannot guarantee the same physician/ office or on the same day.

We offer in-office ultrasound, colposcopy, LEEP, and biopsy procedures at our PRINCETON LOCATION (419 N Harrison St, Princeton, NJ 08540) for your convenience.

You should try to schedule your annual exam when you are not having your period. However, sometimes bleeding is unexpected. You can have a pap smear during your period as long as the flow is not very heavy.

Routine HPV testing is performed with your pap smear for women age 30 and over.  HPV testing can also be performed in other circumstances based on guidelines and after a review of your medical history.

HPV stands for human papillomavirus. HPVs are a group of more than 150 related viruses. Each HPV virus in the group is given a number, and is called an HPV type (for instance, HPV-16).

HPVs are called papillomaviruses because some of the HPV types cause warts or papillomas, which are non-cancerous tumors. But some types of HPV are known for causing cancer. HPV causes most cases of cervical cancer, as well as many vaginal, vulvar, anal, penile, and oropharyngeal cancers (cancers of the throat and mouth).

Though there is no evidence that the HPV vaccination is harmful during pregnancy, it is NOT recommended during pregnancy. The HPV vaccination series can be delayed until after pregnancy.

While most women expect to have a decrease in their period flow when they are on birth control pills, it is not unusual for the period to get so light that there is no obvious bleeding, even on the placebo pills. If you are taking your pill properly, this is perfectly normal and not a cause for concern. There is no need to “take a break” from the pill to have a period. 

Sometimes you may have light bleeding or spotting randomly on birth control pills. This is called “breakthrough bleeding” and is a common side effect with birth control pills. This can be due to irregular pill taking, sickness, stress, other medications, or can happen for no obvious reason. Most of the time, you will go back to normal in one or two cycles. If the bleeding is concerning to you, please contact the office to discuss this issue further.  

If you are not taking the pill properly, please use back up contraception (condoms). 

If you have not had a period for a long time (not on hormonal birth control) or your uterine lining has built up, your doctor may give you a prescription for progesterone to help your period start. It is important that you take all the pills prescribed, even if your period starts while you are taking them. It may take up to two weeks past the time that you finish the last pill for your period to start. Every woman’s body may react a little differently.

Princeton Medical Group ObGyn follows the American College of ObGyn guidelines regarding mammography.  

Women age 40 and older should have mammograms every 1 – 2 years. However, the likelihood of developing breast cancer is higher if a close blood relative has been diagnosed with the disease, especially if they were diagnosed before the age of 50. Likewise, women who began having their periods before the age of 12 or who went through menopause after the age of 55 are at higher risk, as are women who had their first child after age 30 or who never had a child. 

Mammography is performed at a radiology facility. Please make sure the radiology facility you choose accepts your insurance. 

If you believe you may be at a higher risk, ask your PMG ObGyn physician when you should start screening mammography.

Pelvic floor PT involves exercises and feedback to encourage relaxation and strengthening of the muscles of the lower pelvis. A physical therapist places biofeedback sensors on the vaginal wall to measure muscle tone and the strength of muscle contractions, which are then printed on a machine for you to see. After practicing your exercises at home, you can see your improvement on the machine the next time you visit the physical therapist. Sometimes the therapist will use a massage-like technique called myofascial release to help stretch and release the connective tissue between the skin and the muscles and bones in your pelvic region.

Pelvic floor physical therapy can help address sexual problems by improving chronic vaginal or pelvic pain and urinary incontinence. Typically several sessions of pelvic floor physical therapy are needed to achieve satisfactory results.

For more information about pelvic floor physical therapy

Infertility is caused by a problem that prevents conception or the ability to carry a pregnancy to delivery. The duration of unprotected intercourse with failure to conceive should be about 12 months before an infertility evaluation is undertaken, unless medical history, age, or physical findings dictate earlier evaluation and treatment.

Please click here to learn more about PMG ObGyn Infertility evaluation.

Each individual insurance plan has a formulary of covered medications. This information can be located on your insurance website. Many prescription drug plans only cover generic medication. Be prepared that the pharmacist may switch your medication to a generic medication that is covered by your insurance. if you wish to have a specific or name brand medication, please indicate this to your physician so that it can be sent in “dispense as written / no substitutions”. 

Yes, Princeton Medical Group has an electronic health record and you are welcome to be seen in any of our offices.  ObGyn currently works out of the Princeton and Plainsboro locations.

We open our schedules approximately three months in advance, and appointments are usually booked approximately two months in advance. Please take the time to schedule your appointment as soon as you receive a reminder message. It is always recommended that you check with your insurance company to familiarize yourself with your insurance benefits. You will be asked to present your insurance card and a photo ID at your visit. We recommend that you bring your medication list and any pertinent outside medical records to your appointment.

Due to COVID-19, Princeton Medical Group is not allowing visitors at this time. These restrictions may change. Please consult the main PMG page for visitor information. 

When visitors are allowed: our exam rooms are not childproofed and we cannot provide supervision during exams. Infants and toddlers are welcome in carriers or strollers or with another person who can provide supervision. We respect parents’ judgment in the case of older children. Children are not permitted to be in the room during any special procedures.

Cervical cancer screening (pap smear) guidelines from the ASCCP  change frequently. It can be hard to know what is right for you. 

In general, women who have not had any significant Pap smear abnormalities in the past or have not required treatment for significant abnormalities (laser, cryosurgery, LEEP or cone biopsy) may not need a pap every year. 

There is more to a women’s health than having a Pap smear.  We continue to recommend that you receive a gynecologic exam every year including a breast and pelvic exam. It is also an opportunity for your doctor to review any other concerns you may have.

Please check with your insurance provider to verify your coverage for routine gynecologic check-ups. 

Unless there is a medical problem, you should have your first pelvic exam around the age of 21 years or sooner if you begin sexual activity.

The HPV vaccination is offered at Princeton Medical Group.

The HPV vaccine series is recommended for ALL women ages 9 – 26.  The vaccine is ideally given before the woman is sexually active. The HPV vaccination is FDA approved for women up to age 45. For women age 27 – 45, please discuss with your physician whether the HPV vaccine is right for you.

Most young women are vaccinated at their pediatrician’s office around the age of 11. It is typically 2-3 injections given over the course of a year. If you are unsure whether you received the HPV vaccination as a teen, please check with your pediatrician’s office. 

As of 2020, Gardasil 9  is the only HPV vaccine available in the United States. 

In general, you should either start taking birth control pills on the first day of your period (the first day you start bleeding) or the first Sunday after the start of your period (not the end), whichever your doctor recommended. 

This ensures that you are not pregnant, and helps maintain your period on the pill close to the time it would normally occur. It is very important to take your pill at the same time every day and take every pill. If you ever forget, take it as soon as you remember. If you miss more than one pill, take two pills a day until you catch up, but expect to get some irregular bleeding.  If you do not take your pill properly, or need to catch up on pills, you will need to use back-up contraception with a condom. As you finish each pack of pills, make sure you have already received your next pack from your pharmacy so you can go straight from one to the next.

There is no established amount of time that it is “safe” to take the pill, and depends entirely on your history and particular circumstances. Your doctor will discuss this with you when you come in for your annual exam.

If you are having a problem with one or both breasts, such as pain, a lump, or something else, please call our office first. In some cases, we may need to order a different/additional test, or we may need to see you first.  If you are having a breast problem and radiology tests are ordered, you will need diagnostic (not routine) imaging.

Call the office at 609-924-9300 to schedule an exam. If you get frequent urinary tract infections, you may be asked to leave a urine sample at the lab.

Please contact the office at 609-924-9300 to set up a consultation with one of our physicians if you are having urinary issues or the sensation that your uterus or bladder is falling.

After your office evaluation, you may be referred to a urogynecologist or urologist and / or referred for pelvic floor physical therapy.

Kegel exercises strengthen your pelvic floor muscles. This can help you manage or prevent physical problems such as incontinence and improve your sexual health. 

CONTRACEPTION FAQ

Princeton Medical Group provides many types of contraceptive care to meet your family planning needs.

Contraception is a method to prevent pregnancy and there are many different types. Some are more effective than others.

An IUD is a small device shaped like a “T” that is inserted into your uterus (through the vagina) by your physician at the office. This device is extremely effective long-acting reversible contraception. The IUD prevents conception (prevents the sperm from meeting the egg).  Depending on the device you select, it can provide contraception from 3 – 10 years.

PMG ObGyn stocks Mirena, Kyleena, Skyla and Paragard IUDs at both the Princeton and Plainsboro office locations. You can have an intrauterine device (IUD) inserted during an office visit. Please call to schedule your device insertion. Our office will need to check your insurance coverage of the device prior to the insertion.

Types of Intrauterine Devices (IUD)

Copper IUD Available Since Years Effective Use and FDA Approval Possible side effects
Approved only in parous women, but available to all women regardless of parity. Abnormal menstrual bleeding.
Copper IUD (Paragard) 1988 10 years Can be used as Emergency Contraception when inserted within 5 days. Higher frequency or intensity of cramps/ pain.
Hormonal IUDs Available Since Years Effective FDA Approval Possible side effects
Mirena (52mg) 2001 6 years Approved only in parous women, but available to all women regardless of parity. Inter-menstrual spotting in the early months.
Skyla (13.5mg) 2013 3 years Approved for women regardless of parity Reduces menstrual blood loss significantly.
Liletta (52mg) 2015 6 years Approved for women regardless of parity. Hormone-related: headaches, nausea, breast tenderness, depression, cyst formation.
Kyleena (19.5mg) 2016 5 years Approved for women regardless of parity. Hormone-related: headaches, nausea, breast tenderness, depression, cyst formation.

Changes in bleeding is the most common side effect. With all IUDs, you may have bleeding and spotting between menstrual periods, especially during the first 3 to 6 months. This is extremely common as your body acclimates to the device and is an expected side effect. Depending on the type of device you choose, your bleeding may change.

The paragard (nonhormonal copper) IUD can cause longer, heavier, painful periods. This is an expected change and patients should anticipate this.

The Mirena, Kyleena & Skyla IUDs all contain varying doses of progesterone hormone. These types of IUDs affect the lining of your uterus by thinning and randomly shedding the lining. After insertion, the bleeding is occasionally heavier than usual at first. However, the bleeding usually becomes lighter than usual and may be irregular.  It is common for patients to skip periods or for periods to be completely absent with the hormonal IUDs.

Call the office if the bleeding remains heavier than usual or increases after it has been light for a while.

Yes, it is safe to use a tampon while you have an IUD.

No. IUDs do not protect against sexually transmitted diseases. Please consistently use a condom to protect yourself against STDs.

NEXPLANON is a hormone-releasing birth control implant placed in the inner upper arm to prevent pregnancy for up to 3 years. The implant is ONE flexible plastic rod about the size of a matchstick that contains a progesterone hormone called etonogestrel. The implant is placed in the office by PMG ObGyn physicians.

Your progesterone only options include a daily pill called the “mini pill”, an injection of “depo provera” every 3 months, Nexplanon upper arm implant, or an intrauterine device (IUD) that contains a small amount of progesterone.   All of these work in different ways to prevent ovulation or to prevent sperm from entering the uterus.  

None of these options protect you against sexually transmitted diseases. 

Only condoms prevent sexually transmitted diseases. 

Please contact the office at 609-924-9300 if you are interested in any of these options.

A laparoscopic tubal sterilization is an elective surgery.  A camera is placed through a small incision in the belly button and another small incision may be placed on your abdomen. An instrument is used to burn or remove the fallopian tubes for permanent (cannot be reversed) sterilization.

Tubal sterilization can also be performed at the time of your repeat cesarean section.  During the cesarean section, the fallopian tubes are usually seen and can be removed for permanent sterilization.  This procedure usually adds about 10 minutes to the cesarean section.  Please discuss with your physician PRIOR to your scheduled cesarean section if you are interested in sterilization at the same time.  

A vasectomy is an in-office outpatient surgery performed by a Urologist for permanent sterilization. This is a minor surgery for men and is NOT performed at PMG ObGyn. 

MENOPAUSE FAQ

Menopause is defined as an interval of 12 consecutive months with no menstrual cycle. It represents a time in a woman’s life when the egg supply or reserve in the ovaries has completely depleted, therefore there is a decline in natural estrogen stores. During this “menopausal” period, women can undergo many changes and some may experience symptoms such as hot flashes, vaginal dryness, low libido, changes in mood, etc. 

All of our providers have experience with menopause and managing menopause symptoms, if something is concerning you, please call to schedule an appointment. 

When women experience menopause and the body’s natural estrogen levels decline, the natural thermostat or body temperature slightly decreases. To compensate for this, many women experience a hot flash or hot flush – which is usually a sudden sensation of warm in the face or bodily, usually followed by chills or sweats. This can be a very normal “vasomotor” symptom of menopause that many women experience. 

If your hot flashes are bothering you and negatively affecting your daily life, please talk to one of our ObGyn physicians about treatment options. 

There are both easy behavioral modifications as well as medication options available to treat options. Some easy remedies include cutting back triggers of hot flashes (coffee, caffeine, cola, chocolate, alcohol, liquor). Others include using a bedside or ceiling fan, sleeping with loose 100% cotton clothing, purchasing cool sheets/mattress, etc. There are also both hormonal and non-hormonal medication options to treat hot flashes if they are VERY bothersome and behavioral modifications do not work. Read here about some options and talk to your doctor about the benefits/side effects of the different drug therapies. 

Vaginal dryness is an extremely common symptom of menopause. The decrease in your body’s estrogen hormone causes the vagina to lose its local estrogen. Normally estrogen helps keep the vagina strong, lubricated, and healthy. Dryness can cause pain with sex, discomfort, higher susceptibility to vaginal infection and urinary infections, and problems with activity/exercise. There are over the counter vaginal moisturizers you can use daily to start with (Luvena, Replens, Aquaphor, Coconut oil, etc). 

If this does not work, talk to your doctor about possible prescription vaginal estrogens to help with your condition. 

Unfortunately, there is no “female Viagra” or quick fix medication to improve libido. However, there are many other remedies to help improve libido. Female sex drive is closely tied in with other physical, emotional, and psychologic factors. Common causes of decreased libido can be depression, anxiety, difficulties with your partner, stress, vaginal dryness, pain with sex, lack of energy, fatigue, or other health problems. 

Talk to your doctor if your lack of libido is distressing you and/or affecting your relationship. 

It is not normal to have vaginal bleeding after menopause. Please call our office at 609-924-9300 to schedule an appointment.

Women commonly develop stress urinary incontinence (urine leakage) and overactive bladder (the urge to go to the bathroom frequently) in menopause. This can be a source of embarrassment and can be treated.
  • Stop / decrease alcohol & caffeine
  • Stop drinking liquids close to bedtime
  • Wear a disposable pad or reusable underwear designed to absorb urine
  • Wear a vaginal insert that decreases leakage
  • Maintain a healthy weight
  • Learn Pelvic floor strengthening exercises
  • Purchase a “biofeedback device” to learn how your pelvic muscles are contracting. This device also helps teach you how to control your pelvic floor muscles.
  • Pelvic Floor Physical Therapy
  • Prescription medication from your physician
  • Surgery with a trained pelvic floor surgeon
  • Please contact the office if you wish to set up a consultation to discuss urinary incontinence with one of our providers.

Pelvic floor PT involves exercises and feedback to encourage relaxation and strengthening of the muscles of the lower pelvis. A physical therapist places biofeedback sensors on the vaginal wall to measure muscle tone and the strength of muscle contractions, which are then printed on a machine for you to see. After practicing your exercises at home, you can see your improvement on the machine the next time you visit the physical therapist. Sometimes the therapist will use a massage-like technique called myofascial release to help stretch and release the connective tissue between the skin and the muscles and bones in your pelvic region.
Pelvic floor physical therapy can help address sexual problems by improving chronic vaginal or pelvic pain and urinary incontinence. Typically several sessions of pelvic floor physical therapy are needed to achieve satisfactory results.

For more information about pelvic floor physical therapy

OSTEOPOROSIS FAQ

Osteoporosis  is a common but serious problem that is most prevalent in postmenopausal women. Osteoporosis means that the bone becomes more porous (has more holes) and becomes weaker. This is a painless problem that happens over time. As the bone becomes fragile, it is more likely to fracture, especially if you trip and fall. 

Screening for osteoporosis typically starts 10 years after menopause. However, some women have additional risk factors for osteoporosis that cause their bones to weaken prior to age 60. 

If you have questions about your risk, please ask your physician at your gynecologic office visit. 

A “DEXA scan is a low radiation X-ray capable of detecting small percentages of bone loss. It is used to measure spine and hip bone density, and can also measure bone density of the whole skeleton.  This scan is performed at a radiology facility. Please make sure the radiology facility you choose accepts your insurance.

Adults under the age of 50 should get 1,000 mg of calcium every day. Over the age of 50, the amount goes up to 1,200 mg. The best way to get your calcium is in your food. If you cannot get enough calcium in your diet, you can take a supplement.

Adults should get at least 600 IU of Vitamin D daily. 

Vitamin D and calcium work together. When food that contain calcium are digested, it interacts with vitamin D to get absorbed into the blood stream. Without sufficient Vitamin D, you will not absorb the calcium you eat.

Institutes of Medicine Recommendations for calcium & Vitamin D (RDA is recommended daily allowance)

Life Stage Group Calcium RDA (mg) Calcium-rich food servings Vitamin D
9-18 years old 1,300 4 600
19-50 years old 1,000 3 600
51-70 years old 1,200 4 600
71+ years old 1,200 4 800

There are many foods that are rich in calcium. It is important to space out these foods to allow proper absorption. Click here to for a list of calcium rich foods.

Weight-bearing exercises force you to work against gravity. They include walking, hiking, jogging, climbing stairs, playing tennis, and dancing. Resistance exercises – such as lifting weights – can also strengthen bones. Other exercises such as swimming and bicycling can help build and maintain strong muscles and have excellent cardiovascular benefits, but they are not the best way to exercise your bones.

Weight-bearing exercise is only one part of an osteoporosis prevention or treatment program. Like a diet rich in calcium and vitamin D, exercise helps strengthen bones at any age. But proper exercise and diet may not be enough to stop bone loss caused by medical conditions, menopause, or lifestyle choices such as tobacco use and excessive alcohol consumption. It is important to speak with your doctor about your bone health. Discuss whether you might be a candidate for a bone mineral density test. If you are diagnosed with low bone mass, ask what medications might help keep your bones strong.