Incontinence: More Common Than You Think

Did you know that 50% of women have incontinence at some point in their life? Here’s what you can do to take control.

Incontinence is the loss of urine in an uncontrollable fashion. There are many reasons as to why people have it. Some of them are very easy to treat successfully and are easily cured, and some of them are very challenging to cure. But we can usually get significant improvement with treatment. Incontinence is one of my favorite conditions to see a new patient with; I can often cure them outright and almost always make a big improvement for them with fairly little intervention.

Most people put up with it and hope that it’s going to get better, or put if off until tomorrow, only to realize that several years have passed and it’s only gotten worse.

In generations past, people have looked at the loss of urine as a normal part of aging or normal consequences of childbearing, both of which I think are mistakes. What I would encourage people to think about is the fact that although incontinence is not painful, it’s not normal. People really don’t like to deal with it because it’s embarrassing. But they should realize, it’s very common, and often very easy to treat.

However, correctly treating incontinence means also that you have an understanding of what the true diagnosis is, very much like a headache. There are many different causes for it and the headache itself is usually a symptom of an underlying abnormality of some type, just as incontinence can be caused by many different things. 

Relief for women dealing with bladder control issues typically takes one of three routes:

• It can be as simple as a 10-minute outpatient procedure or a prescription for  medication.
• It may require a combination of therapies to get someone to a much better function.
• Sometimes we need to treat an underlying, undiagnosed urinary tract infection, which should be evaluated further, as it could possibly be a sign of other diseases such as MS or diabetes. 

There are varying levels of incontinence, all of which can be diagnosed and treated to help you return to a normal, active lifestyle.

Spasm and bladder irritability:

• Conditions where a person is urinating frequently and up a lot at night with a sudden sense of urgency (similar to the television commercials you see)
• Tends to be a neurologic, irritational aspect to the bladder
• There are a handful of different medications that are typically used to treat this

Stress incontinence:

• People leak a small amount of predictable urine every time they cough, sneeze, lift or jump
• Will not get better with time
• Often times this can be treated effectively with proper Kegel exercises, but a lot of times that treatment requires ongoing and continuous exercise by the person, and sometimes even then it won’t hold up over time
• Should that fail, we can proceed with a small, 15-minute, outpatient procedure that is very successful (such as some type of sling procedure), which in the past was a very big surgery and nowadays really can be done quickly with a very fast return to full function status

When incontinence affects how you function, what you’re doing, your clothing choices or travel plans, it’s just a shame not to get an evaluation and treatment—because so often, it is actually fairly easy to fix with many different treatment modalities. 

Suffice it to say, there are many treatments for many different causes in the many unique types of patients out there. But I would encourage readers to not for a minute think that this is a normal part of aging and something they simply have to “put up with.”  I would encourage them to seek medical evaluation and intervention, because if you’re thinking about the fact that you’re leaking urine, then it is probably affecting you on a daily basis.

Dr. Eric Eberts is an Obstetrician/Gynecologist at Women’s Care of Wisconsin. Contact Dr. Eberts at 920-729-7105.

The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at www.womenscareofwi.com.

The Benefits of In-Office Procedures

There has been an interesting transition over the years from a surgery done originally in an inpatient setting, where the patient would stay in the hospital for several days, to an outpatient surgery setting.  We have essentially accomplished this with procedures up to the hysterectomy, which once was a 4-day hospital stay and included 8 weeks of recovery. Oftentimes, it can now be a same-day surgery, going home the same day. That, of course, is for the big surgeries.  Twenty years ago we were doing operating room procedures for urinary incontinence and bleeding and it again started off as inpatient surgery, migrated to outpatient surgery and recently has become essentially an office procedure. 

Many advantages of in-office procedures have become apparent, and this drive will continue in the future as it offers many excellent outcomes, opportunities and advantages for the patient as well as for the health care system from a delivery standpoint.   First, this transition is based upon the idea that these procedures are becoming less invasive.  When these procedures are done here in the office setting, as opposed to the hospital setting, they also offer more of a personal savings while delivering an equal or better outcome.  These issues in combination with an office setting save the health care system, insurance companies and oftentimes the patient a very significant amount of money. This is because the procedures become less intricate with fewer people involved, faster stays, fewer drugs and less equipment is required.

Here at Women’s Care of Wisconsin we have transformed many surgeries over the past years.  Traditionally, these procedures were urinary incontinence and LEEP procedure of the cervix, which have been done in the office setting successfully for more than twenty years.  We have now added several other office procedures that nationally and state-wide continue to be done in hospital settings. Women’s Care does office Botox for incontinence of the bladder and frequency and urgency symptoms.  This procedure is very effective when other medication has not been successful.  There’s no incision, it typically takes about 20 minutes, it’s often covered by insurance, very durable and we have again had very excellent outcomes with this in the office-based setting.

Likewise, hysteroscopy and ablation, which is the destroying of the lining of the uterus, has also migrated to the office setting and is often covered by insurance. This procedure is done to effectively eliminate or at least successfully diminish the amount of pain and bleeding encountered by a woman during her cycle. With this procedure, there are no incisions, it only takes a few minutes of time and offers the ability for the patient to return to work typically the next day.  This procedure is particularly helpful in an office setting as we are able to perform this procedure at a much lower cost to the insurance company and that is often reflected in what the patient has to pay. We are effectively delivering this procedure in a fashion that is if anything better, more pleasing to the patient, a fraction of the cost, and has an identical outcome.

While all of these office procedures have offered significant cost savings to patients and their insurance companies, the goal has been to offer better service with the same outcomes in a more personal setting.  I think we have achieved this and we have been able to bring the cost down while delivering this perfect triad of advanced care.  By creating an environment where we can have less paperwork, fewer handoffs between strangers and essentially taking this into an office setting where the patient can oftentimes be functioning the next day. At Women’s Care we are continuously improving ourselves as we drive towards a better delivery system in general. In particular, Women’s Care strives to deliver to our patients and our communities excellent care of which we can all be proud.

If you have any questions, feel free to contact us and see what services we can provide for you. I’m sure that you will be most pleased with the outcomes that we can deliver.

Dr. Eric Eberts is an Obstetrician/Gynecologist at the Appleton and Neenah locations of Women's Care of Wisconsin. Contact Dr. Eberts at 920-729-7105.

Providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at www.womenscareofwi.com.

 

 

The Importance of Full Term Pregnancies

Pregnancy is one of the most exciting and vulnerable times of a woman's life. Most of us have thought about pregnancy and how our pregnancy would go long before we were actually pregnant. Most of the time, everything goes just right. However, almost one in eight women deliver preterm (defined as less than 37 weeks).                                                      

If a woman believes she is in preterm labor, she should call her doctor immediately and be evaluated. 

Why do women give birth early?

Half of preterm deliveries are because of preterm labor, while the other half has a medical indication for early delivery such as preeclampsia or their bag of water may have broken early.

Who is at increased risk?

There are some risk factors for preterm delivery. They include women with a history of preterm delivery, short cervical length noted on ultrasound, a history of cervical surgeries such as a D&C, and smoking (another reason to quit, ladies). If a woman is found to have a short cervical length, there are medical management options. Women with a history of preterm delivery are treated with medications in later pregnancies. 

The providers of Women’s Care believe having a healthy pregnancy starts before a woman is pregnant. Healthy babies begin with healthy mothers. We promote a well-balanced lifestyle to our patients, which means preconception care, proper nutrition, routine exercise, a healthy, safe environment, as well as a daily prenatal vitamin with folic acid. With good guidance, avoidable conditions that may have everlasting consequences may be prevented. We would love the privilege to take care of you and answer any questions you might have about pregnancy care or preterm deliveries.

The physicians at Women's Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care.

Meet our providers and learn more about infertility, gynecology, pregnancy care, midwifery services, procedures and surgery, incontinence, osteoporosis, menopause management and more at www.womenscareofwi.com. Or call or text us at 920.729.7105.

Endometrial Ablation in the Office Setting

Abnormal uterine bleeding, in the form of heavy menstrual flow or irregular cycles, is one of the most common complaints that bring women in to see a gynecologist. A procedure called an endometrial ablation is a minimally invasive treatment option that uses technology to destroy the lining of the uterus to reduce menstrual flow. It can be performed right in your doctor’s office without the use of general anesthesia and with minimal down time.

Endometrial ablation in general refers to any procedure that destroys (i.e., ablates) the endometrium (uterine lining). When this technique was initially introduced, laser was used as the energy source. This limited the performance of endometrial ablation to operating rooms that were equipped with expensive and oftentimes cumbersome laser equipment.

More recently, newer ways of achieving quick, effective destruction of the uterine lining using other energy sources, such as heated fluid and radiofrequency electricity, have allowed physicians to offer endometrial ablation safely in an office setting.

Endometrial ablation is not appropriate for every woman suffering from abnormal uterine bleeding. Premenopausal patients with a normal uterus, without evidence of cancer or pre-cancer and who have completed childbearing, are considered candidates for this procedure. Your physician will run tests, such as a pelvic ultrasound and a biopsy of the lining of the uterus, to determine the advisability of ablation in your particular case.

Endometrial ablation itself does not provide effective contraception and any pregnancy that occurs after a woman has had an ablation is extremely dangerous. Therefore, your doctor will often recommend permanent sterilization as well if you have not already undergone tubal ligation, or your partner has not had a vasectomy.

For more information or to schedule an appointment, call or text 920.729.7105.

All About 3D Ultrasound

Whether you’re expecting your first child, adding a little brother or sister to the family, or just curious about advancements in medical technology, a lot of people have questions about 3D ultrasounds.  

With the help of Jackie Saunders, ultrasound supervisor at Women’s Care of Wisconsin, we’re here to answer some of the most common questions patients have surrounding 3D ultrasounds and learn a little bit more about why this technology is so beneficial for patients and doctors alike. 

With the help of Jackie Saunders, ultrasound supervisor at Women’s Care of Wisconsin, we’re here to answer some of the most common questions patients have surrounding 3D ultrasounds and learn a little bit more about why this technology is so beneficial for patients and doctors alike. 

With the help of Jackie Saunders, ultrasound supervisor at Women’s Care of Wisconsin, we’re here to answer some of the most common questions patients have surrounding 3D ultrasounds and learn a little bit more about why this technology is so beneficial for patients and doctors alike.

One common misconception you may have heard is that 3D ultrasounds are replacing 2D ultrasounds. This simply isn’t the case. Jackie explains that instead of replacing 2D technology, 3D technology works in adjunct with it.

“3D just gives us even more information than 2D,” Jackie says. “We build off of the 2D image, so it doesn’t go away, but 3D gives us more information for a better prenatal diagnosis.”

In order to better understand how this technology builds off of each other, we asked Jackie what the biggest difference is between 2D and 3D.

“The biggest difference, really, is how the image is acquired and displayed,” she explains.

While 2D uses just a single image or a single plane of information taken from various angles, 3D is multiplanar and rapidly acquired. This means 3D technology gives obstetricians a volume of information to work with, which makes it easier for them to identify potential health concerns.

And 4D ultrasound takes that 3D volume of information and puts it in continual motion, like a movie.

One of the most common questions we get from patients about about ultrasounds is whether or not they are safe for the mother and the baby.

Jackie reassures patients that “ultrasound is very, very safe in the hands of skilled sonographers and skilled physicians,” and that medical professionals have “very specific guidelines to follow ensuring patient safety.”

While a lot of soon-to-be mothers are excited to see their baby in 3D for the beautiful pictures, this technology does more than just produce realistic images.

“On our end, 3D technology has been so beneficial in allowing us to have  improved visualization of the developing fetus,” Jackie explains.

For example, in the case of a baby that might have a cleft lip or palate, 3D enhances the prenatal diagnosis. This information is beneficial for the surgeon who can now see the anomaly in-depth and in greater detail, for the pediatrician who is planning how best to care for the baby, and for the parents who now have extra time to prepare.

“The number one thing parents want to know is, ‘Is my baby okay?’” Jackie says. “3D ultrasound has revolutionized things for the obstetrician, so we can help answer that question.”

The uses for 3D ultrasound technology expand beyond pregnancy as well.

“3D in gynecology allows us to see uterine malformations, help specify ovarian masses and tumors, identify intrauterine devices (IUD’s) and their location and just provide us with more information for better diagnosis all around,” Jackie explains.

3D ultrasound technology also provides a unique and unforgettable bonding tool for soon-to-be mothers, fathers and even siblings.

“The 3D is just so clear!” Jackie tells us.

While the excitement of a mother and father seeing their baby for the first time is hard to beat, 3D ultrasounds are also emotionally beneficial for mothers who have previously miscarried or had pregnancy loss as well as for couples dealing with infertility.

“It’s just such a clear visual of the developing fetus that gives such relief to the family!” Jackie shares. “The clarity of 3D ultrasounds allows them to see exactly what is going on with their baby, offering an extra level of comfort and security.”

Jackie adds that the fetus does need to cooperate in positioning for a good 3D or 4D image.

“I just love to see moms and dads, especially first time parents, get so excited to see their baby,” Jackie tells us. “It’s so exciting and it never gets old for me.”

If you’re expecting and looking to schedule an appointment with one of our providers, please call or text us at 920.729.7105 or click here.

What You Need to Know About Subfertility

Deciding you are ready to add to your family—whether it is your first baby or maybe baby number two—is a big step for any couple. Then, your well-meaning friends and family tell you to “just relax and it will happen.” Unfortunately, now it has been a year of trying and it still hasn’t happened. It may feel like everyone else around you is getting their positive pregnancy tests, which can be a very devastating and isolating time for any couple.

First, let’s define subfertility: in a woman less than 35 years old, it is defined as failure to conceive after 12 months of regular intercourse. In a woman over 35, it is defined as failure to conceive after 6 months of regular intercourse. 15-20% of couples find out they are pregnant each month after regularly trying to conceive, and 80-85% of couples become pregnant after a year of trying. That leaves about one in five couples headed to their doctor for an evaluation of subfertility.

About 20% of subfertility is due to a problem with ovulation. A woman is likely ovulating if she gets regular periods. Other signs of ovulation are breast tenderness prior to a period, +LH surge, and a temperature spike on basal body temperature charting. If ovulation issues arise, medications can be given to help women ovulate. As we get older, our egg quality and quantity decline—there are blood tests that can determine egg quality and quantity.

Fallopian tubal damage accounts for about 15% of subfertility. Tubal damage can be caused by endometriosis, prior sexually transmitted infections, or pelvic adhesions. The fallopian tubes can be evaluated via different procedures. Male factor accounts for another 25% of subfertility. A semen analysis should be performed early in the evaluation of a subfertile couple.

Next, endometriosis and cervical factor each account for 6 % of subfertility. Some clues that a woman could have endometriosis are painful periods, pain days prior to a period, and pain with intercourse.

Finally, about 28% of couples are given the diagnosis of unexplained subfertility. This diagnosis is given after a thorough evaluation has been performed, but no cause has been found.

No matter the cause of a couple’s subfertility, there are treatment options that the fertility specialists at Women’s Care of Wisconsin can help with. Sometimes, a couple will get a positive pregnancy test with some education about timing of conception, medications to help a woman ovulate, or intrauterine insemination. Sometimes a couple needs a more specialized treatment plan with a fertility specialist (Reproductive Endocrinologist). No matter what your journey is to conceive a baby, Women’s Care of Wisconsin will be there every step of the way.

The physicians at Women's Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care.

Meet our providers and learn more about infertility, gynecology, pregnancy care, midwifery services, procedures and surgery, incontinence, osteoporosis, menopause management and more at www.womenscareofwi.com. Or call or text us at 920.729.7105.

November is Prematurity Awareness Month

Pregnancy is one of the most exciting and vulnerable times of a woman's life. Most of us have thought about pregnancy and how our pregnancy would go long before we were actually pregnant. Most of the time, everything goes just right. However, almost one in ten women deliver preterm (defined as less than 37 weeks). These babies miss out on the important growth and development that happens in the final weeks. Preterm birth is a leading cause of infant mortality. Babies who survive can have health problems, both short- and long-term.

Some of the signs and symptoms of a preterm labor are:

• Contractions (the abdomen tightens like a fist) every 10 minutes or more often
• Pelvic pressure – the feeling that the baby is pushing down
• Low, dull backache
• Cramps that feel like a menstrual period
• Abdominal cramps with or without diarrhea

It is important to notify your doctor if you think you are experiencing preterm labor.

While we don’t understand all the reasons some babies are born too soon, we do know that some factors increase the risk of preterm birth: young or advanced age of the mother, cigarette or substance abuse, stress, depression, and carrying more than one baby. Socioeconomic factors also play a role, many of which are more common in African- American communities and threaten the health of pregnant women and their families.

The Centers for Disease Control (CDC) has identified five proven strategies to reduce preterm births:

• Prevent unintended pregnancies and achieve an ideal length of time between pregnancies
• Provide women ages 18–44 years access to health care before and between pregnancies to help manage chronic conditions and modify other risk behaviors
• Identify women at risk for giving birth too early and offer effective treatments to prevent preterm birth
• Discourage deliveries before 39 weeks without a medical need
• When in vitro fertilization is used, elect to transfer just one embryo, as appropriate, to reduce multiple births.

As November is Prematurity Awareness Month, we invite everyone – future parents, pregnant women and everyone supporting them through their pregnancy, healthcare providers, public health professionals, and others – to learn about preterm birth and take action to prevent it.

The providers of Women’s Care of Wisconsin believe having a healthy pregnancy starts before a woman is pregnant. Healthy babies begin with healthy mothers. We promote a well-balanced lifestyle to our patients, which means preconception care, proper nutrition, routine exercise, a healthy, safe environment, as well as a daily prenatal vitamin with folic acid. With good guidance, avoidable conditions that may have everlasting consequences may be prevented. We would love the privilege to take care of you and answer any questions you might have about pregnancy care or preterm deliveries. Call or text us at 920.729.7105 if you have any questions or concerns.

A Visionary Program 100 Years in the Making

 

On October 18, 2022, ThedaCare announced the creation of an Obstetrical Emergency Department (OB-ED) and Hospitalist Program. Through the program, set to begin in 2023, women who are more than 16 weeks pregnant would bypass the emergency department and go directly to an obstetrical triage area located in the Family Birth Center at ThedaCare Regional Medical Center-Neenah. This program will supplement the care of a woman’s OB provider; her doctor will continue to provide care in the facility. The program ensures a highly specialized doctor to be available to evaluate a woman immediately, without waiting for the patient’s doctor to arrive on site, or providing a consultation over-the-phone.  

“The OB-ED and Hospitalist Program can redefine the standard of women’s care in the hospital setting to help continue safe patient care,” said Dr. Eric Eberts, Department Chair of Obstetrics at ThedaCare. “Because a trained physician evaluates every patient, our goal is that expectant mothers can leave the hospital with peace of mind, focusing on the health and well-being of their family.” 

The creation of an OB-ED and Hospitalist Program is an important milestone in ThedaCare’s history. For 113 years, ThedaCare has proudly provided care for the people in Northeast and Central Wisconsin, and that opportunity was made possible more than a century ago when Theda Clark Peters directed a significant portion of her estate to be used to build a hospital in Neenah so that people in the community would have local access to medical care.

Before her sudden passing at age 32 in 1903, just three days after giving birth to her only child, Theda Clark Peters directed a significant portion of her estate to be used to build a hospital in Neenah so that people in the community would have local access to medical care. On October 18, 1909, the sixth birthday for Theda’s daughter, ThedaCare opened its first doors.

“ThedaCare is honored to continue the vision of the Theda Clark Peters and her family by providing care to patients and families, and empowering each person to live their unique, best life,” said Lynn Detterman, Senior Vice President of the ThedaCare South Region. “The creation of the OB-ED and Hospitalist Program can help ensure mothers and babies have the most up-to-date technology, and facilities designed with patients in mind to allow care teams to continue to offer the right care, in the right place.”

Dr. Eberts noted that the program aims to provide support for ThedaCare’s other hospitals, including those in rural communities.

“The OB-ED and hospitalist program can help ensure that expectant mothers continue to receive timely, specialized care for themselves and their babies,” said Dr. Eberts. “We will have providers with the patient, ready to step in to provide care and help improve outcomes and peace of mind.”

Learn more via NBC 26’s exclusive report, which includes Dr. Eberts’ special connection to Theda Clark Peters.

Midwives: A Special Kind of Care

Midwives are best known for their care of women during pregnancy and childbirth, to make that journey as pure and natural as possible. Midwifery care is often described as having a “high touch, low tech” approach to medical care. Midwives are experts in supporting women in normal, healthy childbirth and focus heavily on building relationships with women and their families by listening and providing information, guidance, and counseling in a shared decision-making process.

Midwives are experts in pregnancy and health education, a combination that perfectly matches the needs of most women. They maintain and monitor the health of the woman and baby before, during and beyond pregnancy.

Words from patients can give a sense of perspective to those considering the services of a midwife:

• A midwife was with me for all of my pregnancies. I could call for literally anything and I was never afraid to ask questions, and I had plenty. It was the same feeling that you have with a good friend, where you’re always comfortable.
• My midwife was so knowledgeable and advocated for me in every way possible. She listened to every concern of mine, never interrupted, never took anything for granted.
• I talked to the midwife about my husband a lot, and she got to know him and made the same connection with him as she did me. That was amazing and awesome.

For many women, having the same care provider that they saw during their entire pregnancy with them throughout their labor and delivery is very comforting.

“One of the reasons I became a midwife was because I really enjoyed the relationships and bonds I was able to form with my patients,” said Kay Weina, Certified Nurse Midwife at Women’s Care of Wisconsin. “To care for them throughout their pregnancy, to be there for the delivery, and then to see them for years to come and grow with them, it’s really special.”

What many women do not know is that midwives specialize in the health needs of women throughout life. Midwives listen to your concerns about health and sexuality, perform pap tests and breast exams, provide birth control methods and family planning, as well as a host of other services.

"As midwives, we can essentially provide for women's health across their lifespans,” said Elise Gessler, Certified Nurse Midwife at Women’s Care of Wisconsin. “We don't just do labor and birth. We take care of teenagers with contraception, we do STI testing, we do wellness exams, and we treat menopause."

If you’re interested in seeing Kay (Neenah, Oshkosh) or Elise (Appleton), you can schedule your first appointment by calling or texting 920.729.7105. Learn more about them by clicking here.

The Path to Pregnancy is Not Always Easy

Dealing with fertility problems is hard. About one in six couples are troubled with fertility issues, and it affects both men and women equally.

Simply put, a lot goes into the conception process. There’s the egg, sperm, fallopian tubes, fertilization, the women’s embryo, hormones, and not to mention each of those pieces needing to be in a healthy state. All but one of those parts could function properly and infertility could still be the result. We at Women’s Care of Wisconsin are here for those times. We specialize in the diagnosis and treatment of infertility and will help you navigate this journey to make your dreams come true.

In having a conversation about fertility, here are some common questions regarding the process, treatments, and how we’re here to help.

How long do you wait before speaking with a doctor about possible fertility issues?

Fertility can happen at many points within a lifetime, and infertility issues differ at each of those points as well. A general rule of thumb is if you are over or under the age of 35. Couples under the age of 35 statistically have better chances of conceiving, yet should look into additional options after a year of actively trying (actively trying means you are having intercourse around ovulatory times month by month). Patients over the age of 35 should intervene just after six months.

Can you explain the difference between IUI and IFV?

The big technical difference is where the fertilization of the egg and sperm takes place. During IUI, the doctor inserts the sperm directly into the uterus to fertilize. With IVF, the egg and sperm are manually combined in a laboratory dish and then transferred to the uterus. We can facilitate any IUI treatments by providing medication, tracking cycles, and stimulating the ovulation cycle while collecting and processing the sperm to be placed in the uterus in our own office. If you were to choose the IVF route, we would be the helping hand in that process of referring our best local clinics in the area to take care of you, then assisting once you choose your preferred facility.

When would you recommend IVF to a patient?

We recommend each individual go through the initial testing and treatment options, then work in a conversation about additional options following those. Usually, we would like to start an IVF discussion with a patient after 3-4 rounds of insemination. However, time frames will be individualized to each couple depending on a multitude of personal factors.

So, no matter if you’re just starting to think of the conception process or you are months or years in, Women’s Care of Wisconsin is here to provide education, diagnosis, and treatments, and be with you every step of the way. It’s our goal to make your dreams of having a baby a reality.

To schedule your own personal consultation, call or text 920.729.7105 to set up an appointment with one of our three fertility specialists. Click on their names to learn more about each.

Dr. Allison Brubaker 

Dr. Amanda Reed 

Dr. Sara Swift

Therese Yarroch MD on Endometriosis

Are you doubling over in pain during your period? Do you have cramps you just can’t seem to shake throughout the month? For 1 in 10 women, these killer cramps are a symptom of endometriosis. Although endometriosis affects 190 million women worldwide, many go undiagnosed. Here’s what you need to know about this painful disease and how to find out if endometriosis could be affecting you.

What is Endometriosis?

"Endometrial cells are what make up the lining of the uterine cavity," Dr. Yarroch explains. "In women with endometriosis, these cells are found outside of the uterus where they cause inflammation."

Sometimes referred to as “endometrial implants,” they can be found on the ovaries, fallopian tubes, bladder, bowels and anywhere else in the pelvic region. This inflammation can result in pain and significant scarring to the surrounding tissue.

What Causes Endometriosis?

"We do have evidence that there is an increased risk of endometriosis in women with heavy menstrual bleeding and longer or more frequent menstrual cycles," Dr. Yarroch says.

Doctors also know that estrogen plays a role and women who have a close female relative with endometriosis are 5-7 times more likely to have it themselves.

Spotting the Symptoms

Although it’s a common misconception that endometriosis only occurs in women over the age of 20, the truth is that the disease can develop as soon as a girl gets her first period and can span the rest of a woman’s reproductive years.

"The most common symptom of endometriosis is pelvic pain," Dr. Yarroch says. “While this pain usually coincides with menstruation, some women can experience this symptom throughout their entire cycle.”

Other symptoms to look out for include:

• Pain during or after sex
• Severe cramps that do not go away with NSAIDs or that impede the activities of your everyday life
• A heavy menstrual flow
• Periods that last longer than 7 days
• Nausea or vomiting
• Urinary and bowel disorders
• Difficulty getting pregnant

Not every woman will experience all of these symptoms, but approximately 30%-40% of women who have endometriosis will experience issues with fertility.

Getting a Diagnosis

If you suspect that you may have endometriosis, we encourage you to speak with your doctor or make an appointment with one of the providers at Women’s Care. The only way to know for sure if you have endometriosis is through a surgical procedure called laparoscopy.

Treating the Symptoms

There are a wide range of treatment options for endometriosis and your doctor may suggest a few less invasive methods before ordering a biopsy. At Women’s Care, we work with you to choose a plan that fits your needs and your lifestyle. Some of the most common treatments include:

The use of NSAIDs, such as ibuprofen (advil, motrin) and naproxen sodium (aleve). NSAIDs can help relieve or lessen the pain caused by endometriosis by stopping the release of prostaglandins, one of the main chemicals responsible for painful periods. While NSAIDs can help manage the pain-related symptoms of endometriosis for some women, it’s not effective in every case.

Birth control methods such as the pill, the patch and the ring are often helpful to treat the pain associated with endometriosis because they reduce heavy bleeding. This method works best for women who only have severe pain during their period and not during the rest of their cycle.

Progestins are recommended for women who do not get pain relief from or who cannot take hormonal birth control that contains estrogen (such as smokers). This synthetic form of the natural hormone progesterone is available by prescription as a pill or an injection.

GnRH therapy uses medicines that work by causing temporary menopause. The treatment actually causes the ovaries to stop producing estrogen, which causes the endometriosis implants to shrink.

For some women, surgery may be the best treatment method. While there isn’t a cure for endometriosis yet, it is possible to remove some of the scar tissue and lesions with surgery.

If you have endometriosis, surgery could be an option if you:

• Have severe pain
• Have tried medications, but still have pain
• Have a growth or mass in the pelvic area that needs to be examined
• Are having trouble getting pregnant and endometriosis might be the cause

"It is important to note that there are other conditions that can cause many of the same symptoms as endometriosis," Dr. Yarroch explains. "An OB/GYN can help determine if endometriosis is the appropriate diagnosis."

So What Now?

"Endometriosis can have a significant impact on a woman's life. Fortunately, there are treatment options available to manage pain and minimize recurrence," Dr. Yarroch says.

If you have endometriosis or believe you could have endometriosis, we strongly encourage you to speak with your doctor or one of our highly trained providers. We want you to know that at Women’s Care, we’re devoted to you and your health. We’re here to meet both your physical and your emotional needs each step of the way, from diagnosis to treatment and recovery.

Dr. Therese Yarroch sees patients in Appleton and Shawano. To schedule an appointment with her, please call or text 920.729.7105. Learn more about Dr. Yarroch here.

Meet Effie Siomos MD, Women’s Care of WI

Effie Siomos is a strong advocate for women taking steps to care for themselves.

“We need to do nice things for ourselves once in a while,” Siomos said. “Make time to meet a friend for lunch. Take a walk, ride a bike, sign up for a mud run. See your doctor.”

Wait, what?

“I know people don’t think of going to the doctor as something nice you can do for yourself, but just do it,” said the OB/GYN from Women’s Care of Wisconsin. “It will make your day-to-day life better.”

With special interests that include pregnancy care, performing in-office procedures and minimally invasive surgeries, and consults with moms and daughters to manage heavy periods or discuss birth control, Siomos has seen—countless times—women who have been dealing with issues for three, five seven years until they finally come in to see her.

In one classic exchange, a patient said she had been dealing with a problem in silence ever since the birth of her baby. Siomos asked how old her baby was.

“He’s going into high school,” was the reply.

“It’s easier to take care of our kids or our parents than it is to take care of ourselves,” said Siomos. “Just because your friend doesn’t have the issue doesn’t mean this is your lot in life. There are so many options to get you back to where you should be.”

Siomos loves good conversations with patients and feels that by paying close attention, she can make sure people are getting what they need at her office.

“Whatever the issue, there are physical symptoms that come with it, but there’s an emotional component as well, and paying attention to that really helps guide the treatment for what the patient wants or needs and what solution is best for them,” Siomos said.

Though a Chicagoland native, Siomos has spent her entire career practicing in rural communities, first in Beaver Dam following her residency, and now in Berlin.

“It’s a nice way to practice medicine,” said Siomos. “It just feels a little more personal. People look after each other.”

Such a perspective, said Siomos, dovetails perfectly with the culture at Women’s Care of Wisconsin, the organization she joined in 2019.

“A lot of times when you go to a doctor's office you're not just getting the doctor. You're getting the person at the front desk, you're getting the person who takes your blood pressure and puts you in a room, you’re talking to the nurse if you're calling with a question afterwards. There are all these layers to what makes a great experience, and that’s where Women’s Care of Wisconsin really stands out,” said Siomos. “It’s our people.”

With a family background in healthcare, it wasn’t surprising to see Siomos follow the path, as she weighed a university job against a more hands on career in the field. The latter solidified itself upon her first delivery, an experience she described as different from anything else she had experienced in med school.

“It was an amazing chance to be part of someone’s life at such a moment,” Siomos said. “It’s also an extraordinary opportunity to make an impact in ways that might not be typical for healthcare.”

Many days find Siomos in her Berlin clinic, spending time with patients discussing their concerns and healthcare goals and learning what’s important to them, while other days she’s in surgery for planned procedures such as a hysterectomy or the removal of cysts.

It’s a job with plenty of variety, which Siomos embraces.

“It’s a great way to get to know people, when you can sit down and talk to them about what decisions would be best in their life,” she said. “I get to teach and present what treatments are available and provide my patients with a clear understanding of their options,” said Siomos.

Gone are the days, she said, of patting someone on the knee and sending them on their way, often with the cursory (and demeaning) advice to just tough it out.

“There are so many different ways women want to interact with their health care,” said Siomos. “And we have so many ways to help.”

Dr. Effie Siomos sees patients at Women's Care of Wisconsin in Berlin, located at 225 Memorial Drive, Suite 2030. To schedule an appointment with Dr. Siomos, please call or text 920.729.7105.

The Circle of Care: In Their Own Words

At Women's Care of Wisconsin, we empower women by involving them in all of their health care decisions. We strive to know our patients well, helping them achieve their personal goals and live their best lives. The doctors and midwives of Women's Care offer a well-rounded approach to OB/GYN care, one that meets both the physical and emotional needs of patients throughout every phase of life.

We call it our Circle of Care. It's not a slogan or catchphrase. For us, it's the foundation of the practice, delivering a premium experience that is completely built around you.

A good way to understand the significance of the Circle of Care and your part in it is to hear from the providers at Women's Care, in their own words.

David Austin Anderson MD, OB/GYN
“The Circle of Care is best represented by the ability to follow your patients through their journey and get to know them and their family. I love being a part of some of the greatest moments in my patients’ lives.”

Gretchen Augustine DO, OB/GYN
“The Circle of Care is our vision to take care of the whole patient on the whole journey, instead of just a piece of it.”

Allison Brubaker MD, OB/GYN
“The Circle of Care means developing a rapport with patients. They keep coming back to you—for their pregnancy, afterwards for postpartum, later on for their GYN care, you see them when they’re going through menopause, and then you start seeing their daughters and their granddaughters.”

Eric Eberts MD, OB/GYN
“I care about how the teamwork happens. We’re all partners here; we support one another. We have strengths, specialties, and the trust in each other to do the best for every patient that walks through our door, no matter the issue. Your patient, my patient. That’s completing the Circle.”

Valary Gass MD, OB/GYN
“I want my patients to feel that they were heard. There’s no one single fit for everyone, so I educate them on treatment options so they can choose what’s going to meet their goals and fit their lifestyles.”

Elise Gessler CNM
“I want to learn more about my patients and spend more time with them, and being a midwife I can really get to know them and care for them through all aspects of their life. To me, that represents what the Circle of Care is all about.”

Amanda Reed MD, OB/GYN
"At Women’s Care of Wisconsin, I have support all around me, and that also supports our patients, who are taken care of every step of the way. We really have it together here, and I hear that from patients all the time."

Adriana Schaufelberger MD, OB/GYN
“I love being there for the patient. I get to see them through their life span, so many important moments. It’s critical to have that connection.”

Marissa Schloesser MD, OB/GYN
"We’re following women through their life, through various journeys, from teenage years to reproductive years through menopause. There’s so much joy in each of those journeys, but the transitions can be difficult or stressful for patients, who look to us to help guide them through these challenging moments. We may not always have the answer for them, but we can always help them through it and help them get to a place that they need to be.”

Effie Siomos MD, OB/GYN
“Something that doesn’t get emphasized enough in health care is teamwork. All of us at Women’s Care understand the importance of each moment in the patient journey and use those as opportunities to elevate the experience.”

Sara Swift MD, OB/GYN
“It’s not just caring for women from their teenage years to their menopausal years, but it’s also caring for a woman as a whole, not just physically but mentally and emotionally as well.”

Maria Vandenberg MD, OB/GYN
“There is no greater privilege than standing next to a woman as she transitions to adulthood, becomes a mom, and lives a healthy life. Building life-long relationships with my patients is an important part of my practice. I strive to help women make health care decisions that are the best options for them."

Kay Weina CNM
“It's your body and it's your baby, and it's your choice. These decisions are up to you and I'm just there to help you figure that out and to answer the questions that you might have.”

Briana Williams DO, OB/GYN
“Developing relationships with patients and seeing them transition through multiple years of their life is the best part of my career.”

Therese Yarroch MD, OB/GYN
“We go through some critical times with our patients, and we are there to make a difference.”

Meet David Anderson MD, Women’s Care of WI

“I just love obstetrics, and not only for delivering babies,” said Dr. David Anderson. “I love that you can follow your patients through their journey and get to know them and their families.”

 
Joining Women’s Care of Wisconsin in 2021, Anderson brings his considerable skills and congenial personality to the renowned team of board-certified gynecologists, obstetricians, midwives, and nurse practitioners.

With a patient-centered approach to care, Anderson provides OB/GYN services to women of all ages and stages of life. His specializations range from birth control guidance, family planning, and obstetrical care, as well as treating incontinence issues and managing menopausal symptoms.  

His enthusiasm for obstetrics is apparent when describing the birth of his own daughters.

“The first was magical, special as any first birth any father has ever witnessed,” Anderson said. “Although watching the birth via Skype was not the plan.” 

Out of the country pursuing his medical degree at the time of his daughter’s arrival in the world, Anderson committed himself to a different experience for the birth of their second child.

He achieved that, delivering his own daughter.

“I so appreciated being there and being the first to hold her,” said Anderson.

While the OB/GYN realm would become his calling, it took Anderson a while to discover it. His brother and brother-in-law, both physicians, were the catalysts for his desire to pursue a medical career.

“I appreciated their love for their craft. They are both very good at what they do. Just as important, they are also very happy with what they do. That influenced me greatly,” said Anderson.

In addition to providing obstetric care, Anderson sees many patients in the GYN space, women with abnormal bleeding, often post-menopausal, which can lead to Anderson performing a hysterectomy, as well as pain issues (endometriosis, for example) in women of reproductive age, often treated with minimally invasive laparoscopic surgery. Both procedures are specialties for Anderson.

Asked to describe his philosophy of care, Anderson puts himself in the shoes of his patients.

“If this was me, I’d be looking for the provider to give me all the knowledge and advice I’m looking for so I can make the best decision for myself,” said Anderson. “And to be very kind.”

Key to Anderson’s approach is listening to his patients and asking questions to get an idea of what they are looking for, as well as discovering where they are at in their journey.

Anderson noted the impact of the experience he and his wife had with their OB/GYN specialist prior to starting their family.

“He sat down with us, really listened and took the time to understand where we were and what we had done up to that point,” said Anderson. “Just so thankful to look back on that time and be able to say we were being heard. And that’s how I start with my patients.”

While obstetrics and minimally invasive gynecology surgery are mainstays of his practice, Anderson also has a special interest in urogynecology, the diagnosis and treatment of pelvic floor and bladder conditions.

He credits a dynamic obstetric and gynecological residency program for providing the breadth of experience that would lay the foundation for his practice. It was busy too—over 6,000 babies were delivered per year.

Anderson, who grew up in Arizona and completed his undergraduate degree at Arizona State University, earned his medical degree at St. George’s School of Medicine, a private medical school and international university in Grenada, West Indies. Despite those more desert-like and tropical climates, Anderson embraces Wisconsin temperatures and weather variety.

“I absolutely love this weather,” he said. “This is where I want to be.”

His patients will tell you he’s a positive, caring person who is there for them, helping in any way he can, a good listener who brings his extraordinary skill set and teaching ability to every encounter.

“I have to admit, I love being a part of some of the greatest moments in my patients’ lives. My happiness and satisfaction come from seeing those I help.”

Dr. David Anderson sees patients at Women's Care of Wisconsin locations in Appleton and Shawano. To schedule an appointment with Dr. Anderson, please call or text 920.729.7105.

When Should My Daughter Have Her First Gynecologist Visit?

For many young women, the thought of seeing a gynecologist for the first time can feel scary or even embarrassing, but this should be a time when your daughter feels comfortable and is able to ask questions about her developing body. We talked with Dr. Valary Gass of Women’s Care of Wisconsin to provide you with the information you need to help your daughter feel more positive and less stressed out about her first gynecologist visit.

What Age Should I Schedule My Daughter’s First Gynecologist Visit? “The American College of Obstetrics and Gynecology recommends that girls between the ages of 13-15 visit with a gynecologist,” Dr. Gass explains.
For many parents, a reasonable time to talk with your daughter about scheduling her first appointment is after her first menstrual period. The real purpose of this appointment is to establish a relationship between your daughter and her gynecologist so she can feel comfortable asking questions and learn about what changes she can expect as she develops.

Preparing For Your Daughter’s First Gynecologist Visit
The most important thing you can do to help ease your daughter’s nerves is talk to her. Explain to her why this visit is important and help her understand what she can expect. Having an open dialogue with your daughter will encourage her to ask questions and feel more comfortable about the experience.
It is also a good idea to have your daughter create a list of questions she may have for her gynecologist before the visit. Sometimes being nervous can cause us to be forgetful, so writing these questions down on a piece of paper will help her make sure she doesn’t leave anything out.
Common topics for questions include periods, hormones, birth control, sex, and sexually transmitted infections. These are all normal topics for your daughter to have questions about. Remind her that anything discussed with her gynecologist is protected by privacy laws, so she shouldn’t feel embarrassed about asking these questions.

What Your Daughter Can Expect During Her Visit “Most of the time, a girl’s first gynecologist appointment does not involve a pelvic exam,” Dr. Gass says, “but it should include taking a careful medical history, addressing any concerns like bad periods, and considering things like HPV vaccinations." During your daughter’s first gynecologist visit, she can expect to have a general physical exam where the nurse will record her height, weight, and blood pressure. Her gynecologist may then check for common health problems and talk with her about her medical history. While her gynecologist will probably not conduct a pelvic exam during her first visit, it is likely that your daughter will have an external genital exam. During the external genital exam, your daughter’s gynecologist will exam her vulva and may use a mirror to help her identify parts of her own body that she has yet to discover. The most important thing to keep in mind is that this visit is an opportunity for your daughter to speak openly with her gynecologist and ask questions.

When Is a Pelvic Exam Necessary? “The American College of Obstetrics and Gynecology suggests that most women begin regular Pap smear screening at age 21,” Dr. Gass says. At that point, women should continue regular screening every three years until age 30 when they can switch to having a Pap smear with HPV co-testing every five years. Your daughter most likely will not need a pelvic exam during her first gynecologist visit, unless she has expressed complaints of lumps, bumps, pelvic pain, or abnormal discharge. In these instances, her gynecologist may decide a pelvic exam is necessary.

When Should My Daughter Stop Seeing Her Pediatrician? Once your daughter is seeing a gynecologist regularly, you may wonder if she needs to continue seeing her pediatrician. This is largely up to you and depends on the specific needs your daughter has as well as her gynecologist’s preference for their practice. It is perfectly normal for your daughter to continue seeing her pediatrician well into college and it can be helpful if she has a complicated medical history. Just make sure your daughter continues her annual gynecologist visit as well.

Schedule An Appointment If you would like to schedule an appointment with one of our providers at Women’s Care of Wisconsin, please call or text us at 920.729.7105

Protecting Yourself from STIs

With the spread of STIs on the rise, we want to make sure every woman in our Circle of Care has the information she needs to live a safe and healthy life. That's why we're breaking down the most effective ways to prevent contracting an STI and what symptoms require a prompt visit to your OB/GYN.

What are STIs?
Sexually transmitted infections (STIs) are infections or viruses spread from person to person by intimate physical contact or through sexual intercourse. Common STIs include chlamydia, gonorrhea, HPV, genital herpes, and syphilis.

Aside from colds and the flu, STIs are the most common contagious (easily spread) infections in the United States. The American College of Obstetricians and Gynecologists reports that there are millions of new cases each year, so it's important to know the facts when it comes to protecting your body.

How Can I Protect Myself?
The good news is, that there are a lot of different ways you can protect yourself. You can reduce your risk of contracting an STI by:

• Limiting your number of sexual partners. 
• Using protection (such as condoms) every time you have vaginal, oral, or anal sex. 
• Making sure you are up to date on all of your immunizations. Vaccinations are available for hepatitis B as well as some forms of HPV.

 Regular screening is also key to catching an STI early if you do contract an infection.

 "It's recommended that sexually active women between the ages of 15 and 25 have at least annual gonorrhea and chlamydia screening," Dr. Gass says.

There are some STIs that can be cured, but early detection is important.

"Additional screening can be offered for HIV, syphilis, hepatitis C, and other STIs," Dr. Gass says.

What are the Most Common Symptoms of an STI?
Some of the most common STI symptoms to look out for include:

• A burning sensation when urinating
• Sores, bumps, rashes, or blisters in the genital or anal area
• Abnormal discharge 
• Redness or swelling in the genital area
• Pain in the pelvic or abdominal area
• Pain, soreness, irritation, or other discomforts during intercourse
• Bleeding after intercourse
• Recurring yeast infections 

 If you believe you are at risk for contracting an STI, it is very important to schedule an appointment with your healthcare provider.

    "Sexually transmitted infections can have an impact on future fertility," Dr. Gass says.

    During pregnancy, STI's can also cause harm to the fetus. If you are pregnant and you or your partner have had -- or may have -- an STI, be sure to inform your doctor so you can work out a treatment plan that will decrease the chances of your child getting the infection.

Schedule An Appointment

"If you have concerns about STIs or believe you could need screening, please talk to your healthcare provider," Dr. Gass says. 

At Women's Care, our providers are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information, and compassionate, caring staff.

To schedule an appointment with one of our providers to discuss STI screening or any other health related topic, please call us at 920-729-7105 or click here.