Here are some tips I have outlined for clinicians caring for women:

Weight Gain:  A Teachable Moment

When you see a patient who is very heavy or has gained some weight that disturbs her or simply wants to be super-careful not to gain weight, you have a teachable moment.  BE PREPARED FOR THAT TEACHABLE MOMENT.  Here are several suggestions that take but a minute to share:

Helping someone to lose weight in 60 seconds!  Encourage her to program her life to:

1. Eat less
2. Exercise more
3. Find patterns of eating and exercising that you will enjoy
4. Call Overeaters Anonymous (OA)
5. Encourage her to drink 8-10 glasses of water daily

 Her reply on 11-3: “I profoundly appreciate your taking precious time to respond to my query.  By eye twitching, I had meant “movement of the lid”.  My right upper eye lid had been twitching. 

Email received 11-6: “Soon after having intercourse with my partner, I felt a burning sensation as ejaculation leaked out.  The burning sensation ended soon after all ejaculation was discharged and I washed myself.  Never before have I experienced this burning sensation after intercourse.  What could be causing it?  Could it be due to the birth control pills Levora that I am on now?”

“Also, I keep forgetting to take the Levora at preciously the same time very day.  The time I started the pills on the first day was 1:10 PM. I try to make sure to take the pill around 1:10 or 1:15 PM, but there’s always a delay of 15 to 40 minutes before I remember to take the pill.  Could that delay debilitate Levora’s effectiveness in preventing pregnancy?

Any other thoughts, Dr. Pluhar?

From Dr. Erika Pluhar on 11-8: “I would have said the same thing…nothing more to add.”

Her email 11-11: “It has been 15 days since the Mirena IUD removal and I had been bleeding for 20 days and was switched to Levora that same day.  The bleeding was like a menstrual period for the first 7 days and was followed by continued spotting and light bleeding.  I didn’t stop taking the Levora during what I believed to be my 7-day menstrual period out of 15 days.  Could this bleeding/spotting be an ominous portent or is it just my body’s day of adjusting to Levora?  Is it expected that my body would respond to ordinary modifications by pills through continuous bleeding for the first month?  I am concerned the IUD that I had removed might have failed at preventing pregnancy and I might have ended up with an ectopic pregnancy.  I feel pain around my uterus area.”

“Kindly do respond to my questions.”

If you are not experiencing pain now, the 35 days of spotting/bleeding probably does not have ominous portent.  But if it continues through the weekend (2 more days), I would suggest that you call your clinician again.

Erika Pluhar, PhD, EdS

Licensed Marriage and Family Therapist

Licensed Professional Counselor

AASECT Certified Sex Therapist

Atlanta, GA

Key Words:  Mirena IUD, strings, vagina, Levora birth control pills, menstruation, twitching eye lid, side-effects, weight gain, ectopic pregnancy, safe, healthy reproductive-age women, burning sensation, intercourse, ejaculation, infection