diane a. christopher m.d.

My practice style

First, I practice evidenced based medicine.  It is my commitment to my patients to read the journals of my field, and to remain up to date on advances in women's care.  In consultation, I will inform my patients when evidence supports my recommendations and when my recommendation simply follows physiologic plausibility (common medical thought).    

I am a woman's advocate.  I will never recommend a medication, surgery, or treatment that I would not also recommend to my own mother, sister or friend.

I am a cost conscious physician.   I order tests that are medically necessary for my patients’ age, family history and medical conditions.  I strive to provide the best care to my patients with the medical evidence and tools available.  I will not recommend tests for the purpose of my own financial benefit.

I believe pregnancy and birth are a normal, healthy process - not a disease.  Medical science has provided us the ability to make childbirth safer for women and babies.  For this reason, I will recommend screening tests and medications to improve outcomes based on evidence.  I do not cut routine episiotomies.  I respect skin-to-skin practices post delivery for healthy newborns. I encourage breastfeeding.

For a complete listing of my services, please see "Services and Procedures" offerred.  

Diane A. Christopher MD
Obstetrician and Gynecologist
Boulder, Colorado
303-938-4710

Boulder Medical Center

Apps for new parents

Check out the following article highlighting new apps for new parents.  

Apps and Other Digital Tools to Lend a Hand to New Mothers - New York Times

Diane A. Christopher MD
Obstetrician and Gynecologist
Boulder, Colorado 
303-938-4710

Boulder Medical Center

 

 

 

 

The HPV vaccine

Should my daughter (and my son) get the HPV vaccine?

Diane A. Christopher MD
Obstetrician and Gynecologist
Boulder, Colorado 
303-938-4710

Boulder Medical Center

 

 

It's flu season again...

With school back in session and the weather getting cooler, we are spending more time indoors.  Spending more time together leads to increased opportunities to spread germs…. More coughs, congestion, sneezes and sniffles. 

 Although we tend to get sick more frequently in the winter, the “flu season” I’m referring to, is more accurately called “the influenza season.”  Influenza is a specific illness.  It causes fever, body aches, sore throat, cough and can lead to a very dangerous viral pneumonia.  When patients get influenza, it often takes effect suddenly, and can make even healthy young adults terribly sick.  Most people think, “sure, I’ve had a bad cold before,” but the influenza virus is much worse than a case of the sniffles.  At it’s worst, patients are admitted to the hospital, and sometimes require care in an intensive care unit.  The most vulnerable patients are the very old, the very young, and those with an altered immune system.  However, it’s important to remember that everyone is vulnerable.

 During pregnancy, the immune system is altered making pregnant women more likely to contract influenza.  And when pregnant women contract influenza, they are 4 times more likely to need hospitalization than a non-pregnant woman.  Multiple studies have found that women who are pregnant with influenza are more likely to have a preterm baby, and more likely to have a low birth weight infant. 

 Luckily, we have a vaccine to protect us from the influenza virus.  The influenza vaccine has been available for almost 60 years.  Not only is it safe to receive the influenza vaccine in pregnancy, it’s highly recommended.  The vaccine protects mom from getting influenza.  Plus, infants born to vaccinated women are less likely to get the illness.   Infants cannot be vaccinated until 6 months of age, so a vaccinated parents help protect infants.  Protect yourself against the flu – talk to your provider at your next prenatal visit.

How do I get the vaccine?

Talk to your obstetric provider about getting the flu shot.  Pregnant women should not receive the intranasal formula.

Will the flu shot make me sick?

No.  Most people do feel some soreness at the injection site.  Some people will feel tired or have a mild increase in temperature, but the flu shot will not give you influenza.

I got the flu shot last year and I still got sick, why should I get it now?

The influenza vaccine only protects us from the influenza virus.  Unfortunately, there are hundreds of other viruses that can give us colds, coughs and stomach upset.  So while getting the flu shot will protect you against influenza, you might still catch a cold.  

I got the vaccine last year, why do I have to get it again?

The influenza virus changes annually.   Each year scientists estimate what this year’s virus will look like, and design a vaccine to protect against it.  The vaccines are designed to be administered once yearly.

I didn’t get the flu shot in my last pregnancy, why should I get it now?

Each year, the flu is different.  Some years, it is incredibly dangerous.  Historically, influenza has caused a pandemic illness such as the flu seasons of 1918 and 1957.  In 2009 we saw emergence of the H1N1 virus, often misnamed as “swine flu.”  We are unable to predict exactly how dangerous the flu will be, so it’s a good idea to get vaccinated in advance.

Will the flu shot cause a miscarriage or birth defects?

No data has ever demonstrated that the flu vaccine has caused birth defects or spontaneous abortion.  Women who are sick with the influenza virus may be more likely to have a spontaneous abortion.  Women who are vaccinated are less likely to have their baby before their due date and less likely to have a low birth weight infant.

When is the best time to get the vaccine?

The influenza vaccine is safe to receive in all trimesters of pregnancy, post partum, and women trying to become pregnant.

Should my spouse also be vaccinated?

Yes, especially if you are bringing home a new baby.  The Center for Disease Control recommends everyone 6 months and older be vaccinated.  Since children under 6 months cannot receive the vaccine, everyone in the household should be vaccinated. 

Diane A. Christopher MD
Obstetrician and Gynecologist
Boulder, Colorado 
303-938-4710

Boulder Medical Center

USA Today- "Flu Season turning out to be a harsh one"

http://www.flu.gov/

http://www.cdc.gov/flu/index.htm

Healthy Technology

With smart phones and tablets, information is at our fingertips.  Text4Baby is a free application that sends text messages to your phone.  Three informative messages are sent per week to help guide you through pregnancy. 

 Visit their website to get started, or text “BABY” to 511411.  Supply your baby’s due date and zip code when prompted.

 https://text4baby.org/

Diane A. Christopher MD
Obstetrician and Gynecologist
Boulder, Colorado 
303-938-4710

Boulder Medical Center

Can I drink caffeine when I'm pregnant?

    The controversy of caffeine during pregnancy is somewhat conflicting.  While some studies have reported an increase in first trimester miscarriage with consumption of over 200mg per day, other studies have disproven this finding.  The best advise is the old saying, "everything in moderation, nothing in excess."  Keep in mind that if you stop drinking caffeine abruptly, you may develop headaches.  Overall, it's better to limit caffeine consumption.  If you are trying to cutback, do so slowly.

Safe Fish in Pregnancy

    The fear of eating the "wrong fish" prevents some expectant moms from consuming it all together.  Fish is actually one of the best foods to eat during pregnancy!  Fish is the best natural source  of omega 3 fatty acids.   Omega 3 fatty acids are known to boost the development of your baby's brain and eyes.  Fish is also a great source of lean protein, so we recommend two servings of low mercury containing fish per week.  The controversy around fish stems from the concern of excess mercury. An excess of mercury can be toxic to the developing neurologic system.  However, the human body absorbs and retains mercury over time.  So eating one "wrong" fish won't affect fetal development.  Because bigger fish have more mercury, we recommend avoid just a few species during pregnancy.  Most fish are safe and recommended!  The chart above is a good reference, but to keep it simple, here are a few easy rules to remember:

    1) Avoid eating raw fish (parasites and food based illness).

    2) Any fish which "fits in a pan" is safe (smaller fish have less mercury).

    3) Shellfish are safe- fish, crab, lobster, cooked mussels, cooked oysters, cooked clams.

Diane A. Christopher MD
Obstetrician and Gynecologist
Boulder, Colorado 
303-938-4710

Boulder Medical Center

Heavy Menstrual Bleeding

Wondering why your periods are so heavy?

Why do I have heavy periods?  at Boulder Mom's Connect

 

Diane A. Christopher MD

Obstetrician and Gynecologist

Boulder Medical Center, P.C.

4745 Arapahoe Ave, Suite 200

Boulder, Colorado 80301

303-938-4710

 

 

Ode to “The Pill”

Even though the birth control pill is greater than 50 years old, it still struggles with many “misconceptions.” 

 Let’s start with some common questions.

What's in the birth control pill?

 “The Pill” contains two hormones: estrogen and progesterone (also called progestins).  These are two hormones naturally synthesized in a woman’s body.  Estrogen is almost always ethinyl estradiol and it varies by dose.  Progestins come in 4 different varieties.

Estrogen		Progestin
50 mcg		1st Generation: norethindrone, lynestrenol
35 mcg		2nd Generation: levonorgestrel, norgestimate
30 mcg		3rd Generation:  desogestrel, gestodene
25 mcg		Drospirenone
20 mcg

  So, for example, “microgestin” is a pill which contains 20mcg of ethinyl estradiol and 1mg norethindrone.  “Yaz” is 20mcg of ethinyl estradiol with 3mg drospirenone.

 Typically, pills are taken on a 28 day cycle.  21 days of “active” pills and 7 days of “inactive” pills.  Women usually bleed during the inactive pills.

 Monophasic:  Every “active” pill has the same amounts of estrogen and progestin

 

 

 

 

 

 

 

 

Triphasic:   Active pills differ in their amount of progestin based on the week

Every week has a different dose of hormones.  

How does the pill work?

 The pill works in 4 different ways.  First, both estrogen and progesterone prevent ovulation (the release of an egg).  Second, the progesterone causes the cervical mucous to thicken, and prevents sperm from permeating the cervix.  Third, the lining of the endometrium becomes thinner, which prevents implantation.  Fourth, the pill decreases tubal motility, which prevents the egg from exiting the fallopian tube.

 How do I start the pill?

 Instructions for starting the pill are based on one concept:  First, make sure you are not pregnant.   For this reason, we recommend starting the pill after your period.  This is the best way to know you are not pregnant.   You can start the pill on the first Sunday after your period.  This is useful as it ensures your period will be during the week, rather than the weekend. 

 Note: if you are pregnant and realize you have been taking the pill, don’t worry.  Research has not demonstrated adverse outcomes in this scenario.  Stop taking the pill, and find an obstetric provider.

 How effective is the pill?

 When used perfectly, the pill is 99.7% effective.  This means every tablet is taken at the same time everyday.  Because the pill is used by humans, perfect use isn’t realistic.  Typical use yields an effectiveness of 91.3%.  The pill does not protect against sexually transmitted diseases like Gonorrhea, Chlamydia, HIV or Syphilis.  Condoms are the best way to protect yourself against sexually transmitted disease and they provide an extra barrier of contraception.

 Will the pill make me gain weight?

 Although many women report weight gain after starting the pill, large population studies demonstrate that the pill itself does not cause weight gain.  The weight gain is often just associated with the time period when the pill was initiated.

 Will the pill cause acne?

 The early birth control pill had 50mcg of ethynyl estradiol, a much higher dose than today’s pill.  With this high dose, some women did experience acne.  The low- dose pills used today have a better side effect profile and many women enjoy a clearer skin while on the pill.

 So what’s a “low-dose” pill?

 Low dose pills are those with 30-35mcg of ethinyl estradiol combined with a progestin.  This encompasses most pills prescribed today.  “Very-low” dose pills contain 20mcg of estrogen (plus a progestin).  And one of the newest pills on the market has just 10mcg of estrogen (plus a progestin).  Decreasing the dose of estrogen decreases the risk of adverse events (please see risks below).       

Will the pill make me infertile?

 No.  The pill will prevent pregnancy during the time that you use it correctly.  After discontinuing the pill, some women conceive immediately.  However, we expect your cycles to return to their previous state after about 2-3 months.

 Will my libido (sex drive) disappear after I start the pill?

 Some women report a decrease in sex drive after taking the pill.  Often this occurs after a few years of use.  A decrease in libido is reported in women who are in long term relationships.  Women in long term relationships are often taking the pill.  For this reason, it is difficult to study this problem.  Most women taking the pill do not experience a decrease in sex drive.  If you do develop a decrease in libido, there are other contraceptive options.

What are the health benefits of pill use?

 When used for 5 years continuously, women have a 2 fold decrease in risk of ovarian cancer.  While the pill is used, it protects against endometrial cancer (cancer of the lining of the uterus).  The pill does not protect you from abnormal pap smears or cervical cancer.  Users of the pill have no increased risk of breast cancer.  Periods are generally lighter and shorter in women taking the pill.  This is particularly beneficial to women with heavy menstrual bleeding.

 What if my period stops while I’m on the pill?

 If you don’t bleed in your “inactive” pills, take a pregnancy test.  If it is negative, continue using your birth control pills.  It is not unusual to skip a period while taking the pill.  It is not dangerous to your body.  The pill prevents the uterus from building a thick lining.  So, at the end of the month, less lining exists to shed.   

 Can I breastfeed while on the pill?

Early studies and physiologic plausibility led practitioners to avoid prescribing breastfeeding women the pill.  Rather, the progesterone only pill (often referred to as "mini-pill") is prescribed instead.  The minipill does not affect milk production or fetal growth.  However, the progesterone only pill is less effective and needs to be taken at the same time everyday.   

 What are the risks?

 Each person reacts to the pill differently.   In general, all women are at risk of having high blood pressure, stroke or venous thromboembolism (a blood clot).  These risks are very small, but are dependent on your medical history, and lifestyle.  Smoking while on the pill increases your risk of developing a blood clot.  Talk to your physician to better understand your individual risk.

 

Diane A. Christopher MD
Obstetrician and Gynecologist
Boulder, Colorado 
303-938-4710

Boulder Medical Center

 

The “Morning After Pill” – Did I miss my window?

I’m sure you’re aware of the recent controversy that has arisen around Emergency Contraception.  Rather than discuss the politics, I thought I’d use this as an opportunity to provide medical information.

I’m impressed with how many young women today are aware of the morning after pill.  The most well known formulation is called “Plan B.”  “Plan B” is supplied in the form of two tablets.  If taken within 3 days of unprotected intercourse, “Plan B” will prevent 75% of unwanted pregnancies.  It doesn’t matter if the pills are taken together or 12 hours apart.  The formulation is most effective when taken closest to unprotected intercourse.   For women over 17 years of age, Plan B is available without a prescription.  Medical evidence has shown this medication is incredibly safe.  Side effects are also well tolerated and include irregular menstrual bleeding and nausea. 

While most women are aware of “Plan B”, I find that fewer women are aware of the newest member of the emergency contraceptive family: ulipristal, or “Ella.”  While “Plan B” is a progestin, ulipristal serves as an antidote to progestin.  This medication works differently than “Plan B,” but neither is an abortifacient (abortion pill).  What’s novel about ulipristal?  It is effective for 5 days after unprotected intercourse, and it’s efficacy does not wane over time.  At the current time, ulipristal does requires a prescription, but many pharmacies (including pharmacies in Boulder) stock the medication.  While “Plan B” and “Ella” have not been directly compared, “Ella” does appear to be more effective.  Side effects of “Ella” Include irregular menstrual bleeding, headache, and nausea.

If the condom broke, (or you didn’t have one available), the “morning after pill” is a safe option to prevent pregnancy from occurring.  Testing for sexually transmitted infections may also be necessary.  Call your Ob/Gyn to arrange short term treatment, and to discuss a long term birth control plan.  

Diane A. Christopher MD
Obstetrician and Gynecologist
Boulder, Colorado 
303-938-4710

Boulder Medical Center

 

Optimal Spacing of your Pregnancies

Wondering how long to wait before having another baby?  

Optimal Spacing of your Pregnancies at Boulder Moms Connect

 

Diane A. Christopher MD

Obstetrician and Gynecologist

Boulder Medical Center, P.C.

4745 Arapahoe Ave, Suite 200

Boulder, Colorado 80301

303-938-4710