Women's Health | Mount Sinai Today

Vaccine Facts: COVID-19 Vaccines Are Safe—and Essential—for Pregnant Women

Sep 23, 2021 | COVID-19, Featured, OB/GYN, Vaccines, Women's Health, Your Health

For those who are pregnant or considering getting pregnant, there are so many health questions, from “Is caffeine okay?” to “Can I still exercise?” But during the COVID-19 pandemic, some are also wondering if the COVID-19 vaccines are safe to take.

In this Q&A, Joanne Stone, MD, MS, Director of Maternal Fetal Medicine at the Mount Sinai Health System, explains the dangerous risks of COVID-19 during pregnancy, shares the facts on why you should get the vaccine, and offers reassurance for those who may be worried.

New Guidance on COVID-19 Vaccines: In April 2023, the Food and Drug Administration and the Centers for Disease Control and Prevention announced some major changes for COVID-19 vaccines. Click here to read more about what you need to know.

Update: The Centers for Disease Control and Prevention on September 29, 2021, strongly recommended COVID-19 vaccination either before or during pregnancy because the benefits of vaccination outweigh known or potential risks. Read more from the CDC

If someone is pregnant, or trying to get pregnant, should they get vaccinated?

Yes, if you’re pregnant, or thinking of getting pregnant, or even if you’re breastfeeding, this is absolutely the time to get the vaccine. I would not wait one extra day. I would get it today because there’s a lot of data that shows the vaccine is very safe and it’s not associated with miscarriage or infertility. Also, it’s the most important way to prevent COVID-19 infection.

Joanne Stone, MD, MS

Are pregnant people especially at risk for COVID-19?

Pregnant women who get COVID-19 infection are at a much higher risk for adverse outcomes, such as severe disease and even maternal death. There’s also higher risk for complications, including preeclampsia, which is high blood pressure in pregnancy, as well as increased risk for the baby, including preterm delivery. For all these reasons, the risks of COVID-19 infection are much higher for both mom and baby. So it’s extremely important to prevent this disease during pregnancy through vaccination plus other measures like mask wearing and social distancing.

What else should patients know about the vaccines and pregnancy?

Patients should understand there are a lot of myths out there that have not proven to be true. For example, there’s no increased risk of infertility if you get the vaccine prior to getting pregnant. Pregnant people should also know that there are complications associated with COVID-19 in pregnancy, and these complications that can be prevented by getting the vaccine. Also, the vaccine has been studied extensively. All the major organizations involved with women’s health care—including the Society for Maternal-Fetal Medicine and the Centers for Disease Control and Prevention—are strongly advocating that people who are pregnant get the vaccine.

Is It Safe to Eat That? — Debunking Pregnancy Dietary Myths

Updated on Jun 30, 2022 | Diet and Nutrition, OB/GYN, Women's Health, Your Health

Cropped side view portrait of pregnant African-American woman buying groceries while shopping in supermarket

Old wives’ tales about pregnancy have been around for centuries. While some myths vary from the lighthearted—carrying high? You’re having a girl—to those of a serious nature—spicy foods causes blindness in babies. Not true!—, we wanted to debunk some of those rumors.

Valerie D. Lewis-Morris, MD, Assistant Professor of the Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, gives us the facts on what to eat and what to avoid to ensure a healthy pregnancy.

If I didn’t eat a healthy diet before becoming pregnant, is it too late to start while I’m pregnant?

It’s never too late to change your dietary habits. And once you find out that you are pregnant, it’s really important to begin eating nutritious food for the health of you and your baby. If you need help with healthy meal planning, Mount Sinai nutritionists are available to answer your questions.

Can I drink coffee while I am pregnant?

Yes, but pregnant women should not consume more than 200 milligrams of caffeine each day—that’s about two, eight ounce cups of brewed coffee. Caffeine can increase your blood pressure and can cause unusual heart rhythms, so energy drinks, energy boosters, and too much coffee should be avoided.

Is alcohol okay to drink on special occasions while I am pregnant?

Not drinking alcohol is the safest choice. However, a glass of wine—which means a six to eight ounce glass—, a beer, or a toast of champagne a couple of times during pregnancy should not harm your baby, especially if you’re not in the first trimester.

If you are in your first trimester, then abstaining from alcohol is the best, safest choice and you should avoid hard liquor.

Can eating nuts during pregnancy prevent my baby from developing a peanut allergy?

This is an old wives’ tale with absolutely no truth to it. Nuts are a nutritious snack and an excellent source of protein, but consuming them while you’re pregnant will not have an impact on whether your baby will have allergies in the future.

Is it true that you should avoid cheese while pregnant?

Not exactly. The goal here is not to avoid all cheese and dairy, but you should not consume raw cheese or unpasteurized milk as these foods may contain bacteria that is harmful to your baby. All of the dairy you consume should have been pasteurized.

Avoid raw goat cheese, or cheese that has been mold ripened such as gorgonzola, or Roquefort. Hard cheeses, such as cheddar cheese or Swiss, are a safer option. And make sure that you read your food labels to make sure that all of your dairy has been pasteurized.

In addition to dairy, make sure that eggs are completely cooked before you eat them. So, save the runny yolks for after pregnancy.

Is it safe to eat fish?

Yes, as long as it is not raw or high in mercury.

Fish is an excellent food that is low in fat and contains high-quality proteins in omega three fatty acids, which are very important for your baby’s brain development. You want to avoid fish that are high in mercury as it can interfere with your baby’s brain and spinal cord development. These are fish such as shark, swordfish, towel fish, and king mackerel. However, fish that are low in mercury are safe to consume and those are fish like salmon, tilapia, and flounder. Enjoy those as much as you want a couple of times a week.

Should I be eating for two?

Eating for two is a very common myth, but the reality is that you should not be consuming double the portions of every meal and snack. You only need about an additional 350 calories per day and that can be easily achieved by adding two or three small healthy snacks like: a banana with a couple of tablespoons of peanut butter or three to five wheat crackers with about an ounce and a half of cheddar cheese cubes. You don’t have to eat a lot of extra food while you’re pregnant; don’t feel that you have to splurge.

Is it safe to exercise?

If you’re healthy and you have a low risk pregnancy, then the risk of moderate intensity exercise is safe. Consistent exercise during pregnancy can minimize constipation as well as decrease the risk of gestational diabetes and depression. If you incorporate aerobic exercises, such as brisk walking two to three times a week for 20 to 30 minutes or flexibility and strength workouts like yoga, that is all you need.

If you have a high-risk pregnancy, you should discuss adding exercise or continuing the exercises you are doing with your provider to make sure it is safe for you and your baby.

Finally, ignore the old wives’ tales and the misinformation that’s out there. When you’re in doubt, reach out to your obstetrician or midwife to get the most accurate and up-to-date information about your pregnancy and nutritional needs.

Make an appointment with Dr. Lewis-Morris

Learn more about OB/GYN Services at Mount Sinai

Is It Normal to Have Irregular Periods?

Updated on Jun 30, 2022 | OB/GYN, Women's Health, Your Health

Young woman lies on sofa with stomach cramps

Most people know menstruation is normal vaginal bleeding that is part of the monthly cycle which prepares the body for a possible pregnancy. But you may have some questions about the regular—or irregular—ebb and flow of your cycle.

Tamara N. Kolev, MD, Assistant Professor, Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, explains how mundane activities can affect your cycle and why one or two irregular periods is nothing to worry about.

Is it normal to have irregular periods? When should I worry about them?

Your menstrual cycle tells us about your overall health and hormone balance. Most people find that the time from the first day of one period to the first day of the next is about the same every month. This time span, called a cycle, can be anywhere from 22 to 35 days. Women on birth control tend to have periods that are shorter, lighter, or—depending on the birth control—disappear altogether.

If you have an irregular period once or twice, that’s probably fine. But, if you notice that you’re continually having irregular periods, it’s better to get evaluated to diagnose the underlying reason and get your body back in balance.

Why am I bleeding in between periods?

There are several reasons why some women have minor bleeding (spotting) between periods. It could be as simple as too much stress, too little sleep or certain medications. The cause could also be a physical condition, such as fibroids, cervical or uterine polyps, or a chromosomal abnormality, all of which are generally non-cancerous (benign).If you’re at all concerned, you should check in with your primary care doctor or gynecologist.

If I exercise regularly, will my period be lighter–or will I even skip a period?

Exercise can help regulate your periods. When you exercise, your body releases hormones such as endorphins and serotonin, which can also help with menstrual pain, cramps, and mood disturbance. But if you exercise too much—especially if you also don’t eat enough—you may skip a period because your body needs a certain amount of body fat to produce estrogen and maintain the hormonal balance required to have normal periods.

What about diet and weight gain, will either—or both—affect my period?

Gaining or losing a few pounds shouldn’t affect your menstrual cycle. But if your weight changes dramatically, especially if it happens quickly, it can affect your periods. Along the same lines, if you’re not getting enough calories and nutrients to maintain a healthy hormonal balance and produce enough estrogen, your periods may become irregular or may skip a month altogether.

In terms of your daily eating habits, there is growing evidence that what you eat can affect premenstrual syndrome symptoms, such as mood swings, bloating, and fatigue. It can help to eat foods that are rich in omega-3 fatty acids, vitamin D, and calcium or take vitamin D or calcium supplements. Doctors also recommend reducing your intake of fat, salt, and caffeine. Additionally, not having enough iron in your system can make your periods shorter and less regular. And if you have heavy bleeding when you menstruate, that may lower your iron level.

Alcohol use and smoking can also affect your period. While a glass or two of wine shouldn’t cause fluctuations, heavy drinking can disrupt your hormones and lead to late or irregular periods. Heavy smoking can shorten your menstrual cycle and make periods heavier and more painful.

How will stress and lack of sleep affect my period?

When your body is under stress, it can go into fight-or-flight mode, which may signal the body to overproduce certain stress hormones. This could change your overall hormonal balance. Lack of sleep, in particular, affects both stress hormones and melatonin levels. Melatonin is a hormone that helps to regulate the start of your period and the length of your cycle. For this reason, changes in melatonin levels can affect your cycle. You may find your periods delayed, or they might skip a month altogether.

When should I see a doctor?

Typically, if you often have bleeding between periods or especially heavy bleeding, you should get it checked out. For premenopausal women, if you don’t have a regular cycle, or if you miss your periods regularly or for several months, you should be evaluated, even if you think the reason is excessive diet or exercise or not getting enough sleep. In general, if you’re at all concerned, make an appointment with your gynecologist for a check-up.

Can I get pregnant during my period?

If it’s truly your period, then no, you cannot get pregnant while menstruating. However, if you’ve been having irregular bleeding between periods, you may be unsure if the bleeding is a real period or if you are bleeding during ovulation. If you are bleeding while ovulating, then you could get pregnant.

Will my period change as I get older?

Yes. After menarche (onset of menses) your period may be irregular and unpredictable. But as you get older, certainly by your 20s, it should become more regular. As you get older, and you approach menopause, your periods will likely start to spread apart and become lighter and less regular. If, instead, they get heavier or more frequent, then it’s important to have that evaluated.

Make an appointment with Dr. Kolev

Learn more about OB/GYN Services at Mount Sinai

Could My Painful Periods Be Endometriosis?

Updated on Jun 30, 2022 | OB/GYN, Women's Health, Your Health

Menstruation can be uncomfortable. But, for some, “that time of the month” is also a period of extreme pain accompanied with heavy bleeding and pelvic discomfort. Affecting 2 to 10 percent of premenopausal women, endometriosis is often difficult to diagnose and can hamper the day-to-day living of those with the condition.

In this Q & A, endometriosis specialist Susan S. Khalil, MD, Assistant Professor of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, explains the condition, its symptoms, and why early diagnosis and treatment is important.

What is endometriosis?

Endometriosis is a condition in which there is an ectopic implantation of the endometrium. In layman’s terms, the lining of the uterus is implanted in sites outside of the uterus. Implantation can be in the fallopian tubes, the ovaries, or inside the belly. It can also be in areas of the body very distant from the reproductive organs, such as the lungs or even the brain. The condition typically effects women who are still having their period.

What causes the condition, and can it be prevented?

The cause of endometriosis is largely unknown, but there are a few different theories. One is that, in some women, blood from menstruation flows backward into the belly instead of flowing downward, causing incorrect implantation. Another is “de novo” formation, meaning that it just happens on its own. Yet another theory is that local cell changes can lead to endometriosis.

There is no cure for endometriosis, but there are treatments. And early diagnosis leads to less invasive methods of managing the condition.

I think I have endometriosis. What are the symptoms?

The most common symptoms of endometriosis are pelvic pain and painful periods.

If you are wondering how much period pain is too much, remember that your period should not routinely interfere with your ability to go to work or school, or to go about the activities of daily living. If you are missing out on these activities due to your period, please see a gynecologist.

Patients with endometriosis may also experience unexplained painful urination, painful bowel movements, and painful intercourse. Occasionally, women will get evaluated for the condition if they are having difficulty getting pregnant. Based on your symptoms, endometriosis can be suspected, but the condition is confirmed through laparoscopy.

I was diagnosed with endometriosis. Can I still get pregnant?

Yes, you can get pregnant. However, you may require some assistance. For instance, some people with the condition may need to undergo minimally invasive surgery to remove endometrial tissue.

There is a wide spectrum of severity with endometriosis. While many women actively pursue treatment or diagnosis because they are having difficulty conceiving, there are also pregnant women whose diagnosis is only discovered during routine examination.

What are the treatment options for the condition? Will I need surgery?

Generally, the treatment for endometriosis includes medication and, for some, a surgical option.

Common medications prescribed for the condition depend on the patient’s primary goals, which may include pain control or suppression, or pain control while trying to conceive. The medications include hormonal agents with progesterone only, a combination of estrogen and progesterone, and gonadotropin-releasing hormone (GNRH) agonists or antagonists. The treatments are tailored to the patient when they are evaluated.

If patients need surgical intervention, laparoscopy is one option. It can be used to diagnose endometriosis and to remove growths and scar tissue from the reproductive area. The procedure is often regarded as a fertility-sparing operation that also helps to reduce the pain associated with endometriosis and improve quality of life.

How important is early treatment, and diagnosis, of endometriosis?

Early treatment and diagnosis is important to maintain fertility and manage pain symptoms. It also helps with identifying patients who have endometriosis, and patterns in their family history.

At Mount Sinai, we offer a team-based approach that includes various services, such as pelvic floor therapy, acupuncture, dietary management, and pain management. All of these services are intended to make endometriosis a more livable condition for patients as well as to provide them with a good framework for support.

Make an appointment with Dr. Khalil

Learn about OB/GYN Services at Mount Sinai

Can the COVID-19 Vaccines Affect My Fertility?

Updated on Jun 30, 2022 | COVID-19, Featured, Men's Health, Vaccines, Women's Health, Your Health

Worried young woman holding pregnancy test

Some men and women may be reluctant to get the COVID-19 vaccination because of concerns about fertility. You may be wondering if any of the vaccines used in the United States can have an effect on your sperm count, or on your eggs, embryo, or the pregnancy itself.

In this Q&A, Alan Copperman, MD, Director of the Division of Reproductive Endocrinology and Infertility and Vice Chair of the Department of Obstetrics, Gynecology, and Reproductive Science at the Mount Sinai Health System, says the evidence shows that the vaccines do not pose a concern.

Does the COVID-19 vaccine affect my sperm count?

None of the COVID-19 vaccines in use in the United States affect sperm count or the sperm’s ability to move toward an egg (motility). It is true that contracting a severe case of COVID-19 can lower sperm count for a time. But studies show that the vaccine itself does not affect sperm. In fact, we recently completed a study looking at sperm donors around the country before and after getting the vaccine. We saw no change in count or motility.

Can the vaccine affect my ability to get pregnant and have a baby?

We have found that the COVID-19 vaccinations do not affect a woman’s fertility. Pregnancy involves a number of steps:

Your ovaries release an egg.
The egg travels through the fallopian tube to the womb (uterus).
Sperm fertilizes the egg as it travels.
The fertilized egg attaches to the inside of the uterus (implantation) and grows.

A problem at any one of these steps can lead to infertility. We’ve been studying women who have gone through several fertility cycles to see if any of the COVID-19 vaccines used in the United States affects any of these steps. We have found that:

The vaccine does not decrease egg production.
It doesn’t affect the ability to make an embryo.
It doesn’t affect a chromosomally normal embryo’s ability to grow in the uterus.

Will the COVID-19 vaccine have any effect on my pregnancy?

This is a good question because we’ve found that pregnant women who get COVID-19 tend to become very ill. That’s why we recommend taking the vaccine. As of now, three billion COVID-19 vaccinations have been administered, have of them to women, and we haven’t heard any reports of them affecting a woman’s pregnancy. We have also seen women getting the vaccine while undergoing in vitro fertilization—and it has had no effect on their outcomes. In fact, we have found that the vaccine not only protects the pregnant woman, but it keeps them safe at vulnerable times, such as when they deliver—and the fetus gets some immunity as well. We hypothesize that the vaccine prevents severe illness in these babies.

Should I get the COVID-19 vaccine if I’m planning a pregnancy in the near future?

The best time to get the vaccine is as soon as it becomes available to you. You may feel tired after the shot, and you may have short-term symptoms like fever. Some people have an allergic reaction to the vaccine, but that is very rare. We definitely recommend getting the COVID-19 vaccine to protect you, your pregnancy, and your infant.

If I’m already pregnant should I get the vaccine?

Safety data from around the world shows that women taking the vaccine during pregnancy have seen no effect on their pregnancy. The vaccine has shown itself to be safe and effective. As a result, all the major organizations involved with women’s health care—including the Society for Maternal-Fetal Medicine and the Centers for Disease Control and Prevention—are strongly advocating that people who are pregnant get the vaccine.

Which vaccine is best for a pregnant woman?

There’s no data suggesting that any one of the vaccines is better than any of the others for pregnant women. We know that the effectiveness against preventing disease seems a little bit higher in the mRNA vaccines (Pfizer-BioNTech and Moderna), but all the vaccines that have been authorized by the Food and Drug Administration (FDA) are up to 99 percent effective in preventing severe disease and death. Get whatever vaccine is most readily available to you.

What should I do if I have questions about the vaccine and my fertility?

If you have any questions, ask your health care provider. You can also check the online guidelines from organizations like the World Health Organization and the FDA. There is a lot of great information out there to help us fight back against this pandemic.

Get more COVID-19 vaccine information from Mount Sinai

Female Incontinence: What You Can Do About It

Updated on Jun 30, 2022 | Urogynecology, Women's Health, Your Health

If you’ve ever had a sudden urge or leakage of urine, you’re not alone. Lisa Dabney, MD, a specialist in urogynecology for the Mount Sinai Health System, notes that 30 percent of women aged 60 years and older will experience episodes of incontinence that interfere with their quality of life. In this Q&A, she explains some treatment options and lifestyle changes that could help.

What causes female urinary incontinence?

Female urinary incontinence has two main causes. One is called stress incontinence. This does not mean emotional stress, but rather stress on the bladder in the form of increased pressure from running, jumping, laughing, coughing, or sneezing that causes a loss of bladder control. The other is called urge incontinence. This occurs when you have a strong desire to void and the urge is so sudden you may not have time to get to the bathroom. The condition called overactive bladder encompasses urge incontinence, but can also include simple urinary frequency and urgency without incontinence.

What are the symptoms?

The symptoms are generally leakage of urine or involuntary passage of urine when you’re not sitting on the toilet. Obviously, it can be a very embarrassing situation. These symptoms increase as women get older.

What causes stress incontinence?

Stress incontinence usually starts to appear in younger women after they give birth. During delivery the passage of the fetal head through the vagina can weaken the delicate supports of the urethra, and that’s when women start to develop stress incontinence. When women are young—in their 30s and 40s—they may not experience symptoms of stress incontinence because their musculature will still be quite strong. Strong pelvic floor muscles can compensate for the weakened support of the urethra.

What causes urge incontinence?

As women get older, urge incontinence becomes more and more common. In 80 year olds, approximately 50 percent of women have some degree of urge incontinence. In this case, the muscle that surrounds the bladder, called the detrusor muscle, contracts when we sit on the toilet. There’s a lot of complicated communication that goes on between our brains and our bladder. When we are toilet-trained, our brains maintain control over the detrusor muscle. It tells the muscle not to empty until one is sitting on the toilet. As we get older, some of those connections are lost and the detrusor muscle may start to contract when randomly. It’s not under as firm control from the brain anymore and so patients start to leak urine when they’re not on the toilet. So as you get older, you can’t hold your bladder as long, and that leads to urge incontinence.

How can women manage urinary incontinence and improve their quality of life?

There are a variety of ways to manage incontinence, from lifestyle changes to surgery. Many of these solutions work for both stress incontinence and urge incontinence. In fact, many women have a mixture of both types. Doing Kegel exercises and pelvic floor exercises are the first-line treatment for either type. They also help prevent the condition and prevent it from getting worse. These exercises strengthen the pelvic floor and help compensate for the weakened support of the urethra that causes stress incontinence.

What changes in lifestyle may help?

Dietary changes can help quite a bit with urge incontinence. For example, one lifestyle change is to limit the consumption of coffee, alcohol, and citrus drinks. These types of drinks are very irritating to the bladder, so patients who have urge incontinence should try to cut back on these types of liquids. It’s also important to understanding that as you get older you can’t hold your bladder for as long, and you simply have to go to the bathroom a little more frequently.

What are some treatment options?

There are a variety of treatments depending on the severity of the symptoms and what’s been tried before.

For stress incontinence, there are small devices called pessaries which can be placed in the vagina. They look like a little ring with a knob on it. When they are placed in the vagina the little knob will sit under the urethra and support it. When a woman coughs or sneezes, the urethra pushes against the knob and this helps with stress incontinence. There are also surgical options such as placing a sling underneath the urethra which replaces the urethral support which has been lost. This is a minimally invasive option that’s 90 percent effective for stress incontinence. Patients are in and out of the hospital the same day.

What about treatment options for urge incontinence?

For women who have gone through menopause, the tissues in the bladder and vagina get irritable, and that can make urge incontinence worse. Vaginal estrogen treatments can help as they reverse the effects of menopause on the bladder. There are also medications that relax the bladder. There is an acupuncture procedure called posterior tibial nerve stimulation. The nerve near the ankle is very similar to the nerve roots that enervate the bladder. Stimulating these nerves in the ankle has been shown to help with urinary frequency and urgency, and it’s very safe and effective.

Finally, there are Botox injections into the bladder wall. Botox is a substance that paralyzes muscles. The injection is given after giving some anesthetic to the bladder to decrease discomfort.

What is your overall approach to treating this condition?

As a practitioner, I spend a lot of time discussing the patient’s lifestyle with them and figuring out how incontinence is impacting their life. That way, we can come up with options that work for them. Treating incontinence is all about improving quality of life. As a doctor and clinician, I always work the patient to outline her objectives—and that means that there is a lot of flexibility and choices for each patient’s treatment.

Make an appointment with Dr. Dabney

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