Casper Women's Care Blog


What is it?  Perimenopause is the years prior to menopause beginning in your 30’s or 40’s. The estrogen produced by the ovaries start to fluctuate.

Symptoms: Changes in menstrual cycle. Some women may experience longer or shorter cycles, menstrual bleeding could be heavier or lighter, may skip cycles.

Changes in menstrual bleeding should be discussed with your health care provider because abnormal menstrual bleeding could be sign of a problem. Some women may also experience hot flashes, night sweats, sleeping problems, vaginal dryness, and urinary symptoms.

Some women do not experience any perimenopausal symptoms, or very mild symptoms, a few women will have some severe symptoms.

Catherine Monhollen APRN

Contraceptive (Birth Control) Options


Barrier Options: Condoms, Spermicides, Diaphragm, Sponge, Cervical cap

How they work: Barrier contraception works by blocking  sperm from reaching the women’s egg. Also offer protection from sexually transmitted infections. Barrier contraception does not affect female hormones, or breast milk production.

Most can be purchased at drug stores, Diaphragm and cervical caps must be fitted and prescribed by your health care provider. Diaphragms and cervical caps are rarely used.

Effectiveness: Not as effective as other forms of contraception. Approximately 18 to 28 women out of 100 will become pregnant using barrier contraception.

Use: Must be used correctly and with every act of sex. If not use correctly, or forgotten, may require use of emergency contraception (Plan B). A single act of unprotected sex can result in a pregnancy.

Spermicides require a 10-15 min waiting time before having intercourse. Can cause vaginal burning or irritation. The sponge can be inserted up to 24 hours prior to sex, must be left in for 6 hours after sex. Do not leave the sponge for longer than 30hours.


Progesterone Only Forms: Pills, Injection

How they work: Thicken cervical mucus, thin the lining of the uterus, prevent ovulation.

Can be used in women with certain health concerns such as hypertension, migraine headaches, endometriosis, seizure disorders

Effectiveness of Pill form: Must be taken at the same time every day, if late taking by 3hrs or more must use back up contraception such as condoms for 2-3 days. About 40% of women on progesterone only pills will continue to ovulate.

Injection form: Given every 13 weeks in your health care providers office. You have a 2-week window to receive injection.

Effectiveness: With perfect use 1 out of 100 women will become pregnant, otherwise about 6 out of 100 women will become pregnant due to being late receiving next injection.

Benefits: Better at thinning lining of uterus, possibility of no menstrual cycles, can improve menstrual bleeding due to fibroids, can help with the pain associated with endometriosis.

Possible side effects: Irregular menstrual cycles, headache, nausea, breast tenderness, bone loss (injection)

Combination Forms (estrogen/progesterone): Pills, Patch and Vaginal Ring

How they work:  Stop ovulation, thicken cervical mucus, thin lining of uterus. Very effective if use correctly.

Effectiveness: With typical use 9 out of 100 women will become pregnant. With consistent correct use 1 out of 100 women will become pregnant.

Benefits: Can regulate, shorten, lighten menstrual periods, reduce menstrual cramps, may improve acne, may help reduce unwanted hair growth, decreases risk of breast, ovarian, colon cancer, may help menstrual migraines.

Not recommended in women who have migraines with aura, women age 35 and smoking.

Possible side effects: Breast tenderness, nausea, headache, vaginal irritation (ring), skin irritation (patch), breakthrough bleeding.

Long Term Reversible Contraception: Nexplanon subdermal implant, Skyla IUD, Mirena IUD, Paragard IUD.

How they work: The Nexplanon, Skyla and Mirena IUD have progestin hormone. A Progestin thins the lining of the uterus which helps prevent a fertilized egg from implanting, thickens cervical mucus making it harder for sperm to reach the egg, stops ovulation.

Nexplanon, and Skyla last 3 years, Mirena last for 5 years.

The Paragard IUD is non-hormonal it has a thin copper wire wrapped around the T shape. Copper acts as a spermicide, the Paragard also thickens the cervical mucus, making it harder for sperm to fertilize an egg, it also irritates the lining of the uterus helping prevent a fertilized egg from implanting.

Paragard last for 10 years.

Effectiveness:  Most effective forms of contraception with less than 1 in 100 women becoming pregnant. Twenty times more effective than the pill, patch, ring forms of contraception.

Benefits: Hormonal IUD’s help reduce menstrual cramps and heavy menstrual bleeding. Can be used after a childbirth, abortion, miscarriage. Does not interfere with breastfeeding, physical activity or intercourse.

Paragard is the most effective form of emergency contraception. Possible side effects: With Paragard IUD, menstrual pain and bleeding may increase. Bleeding between periods may occur. These can be common in the first few months of use. Pain and heavy bleeding usually decrease within 1 year of use. Ectopic pregnancy is another possible side effect.

The Hormonal IUDs may cause spotting and irregular bleeding in the first 3 to 6 months of use. The amount of menstrual bleeding and the length of the menstrual period usually decrease over time. Menstrual pain also usually decreases. Some women may experience an absence of menstrual bleeding with hormonal IUDs.

If you are interested in any contraception, or have more questions, please schedule an appointment to discuss further.

Catherine Monhollen FNP-BC

Interstitial Cystitis: The Mysterious Pelvic Pain You’ve Never Heard Of

Interstitial Cystitis (IC for short) has gone by many names, and most commonly known as Painful Bladder Syndrome. Unfortunately, it has been a poorly understood condition and can take years to be diagnosed properly.

If you have a chronic pelvic pain that doesn’t seem to be getting better despite treatments and evaluations, consider these symptoms:

  1. Pelvic pain that can be dull or sharp, mild or moderate or severe, and can be intermittent or constant.
  2. A personal history of frequent urinary tract infections and/or vaginal infections that have been treated with minimal or no improvement in symptoms
  3. A personal history of being told you had urinary tract infections and/or vaginal infections in childhood
  4. All other testing to evaluate pelvic pain has been negative.

IC is a condition that can be associated with chronic bladder inflammation, and this can be so chronic that it may be present as early as childhood. It is often mistaken as a urinary tract infection (UTI), vaginal yeast infection, endometriosis, or irritable bowel syndrome. In fact, the average time for diagnosis is 8 years. It is more common in women than men and most often diagnosed in patients most often in their 40’s or later. The cause of it is unknown, however it behaves similar to an allergy, where the release of histamines from the bloodstream can result in inflammation of the inner bladder mucosa. The bladder has many nerves and when it is inflamed it can result in a crampy pelvic pain, burning with urination, and sometimes a discolored urine. Due to its proximity to the vaginal cavity, it may also cause the sensation of vulvar pain and vaginal irritation.

Pain is most commonly triggered due to problematic foods and beverages. The kidneys filter the blood and all that excess waste is collected in the bladder. Foods or drinks that are high in acid or potassium tend to cause an inflamed bladder to become more painful, and thus trigger a cascade of nerve stimulation that can cause the bladder to spasm. This will result in urinary frequency, painful urination, lower pelvic pain, vulvar pain or vaginal irritation. I compare this to pouring lemon juice on a paper cut: when the bladder is inflamed, adding irritating foods is like “pouring the lemon juice”.

The condition is one that does not have a specific test to identify and diagnose it as such. When a patient presents with the above symptoms, a series of testing and exams must be done to rule out other causes of the pain. Primarily, urinary testing must be done to eliminate an infection as the cause. Vaginal exams will be performed to diagnose any possible vaginal infection as the cause. This will also help your provider to evaluate the uterus and ovaries as well as examine the bladder for any other abnormalities such as masses or lesions.

The primary treatment for IC is dietary modification. A diet low in acid and potassium will aid in eliminating the symptoms. As this is a chronic condition, symptoms may flare periodically over a lifetime, but being aware of what foods or beverages may trigger the condition is the most important thing in controlling the symptoms. The most common foods that can trigger bladder pain are: citrus foods (oranges, lemons, etc.) and their juices, tomatoes (or any tomato-based product), carbonated beverages, artificial sweeteners, and vinegar. This is by no means an exhaustive list of foods to eliminate, and you can find a more complete diet at In addition, I will also recommend use of certain essential oils to aid in pain modulation. Lavender essential oil helps reduce inflammation and pain. Adding this to a warm bath of epsom salts can often help to reduce pain during times of IC flares. Simple dietary modification and use of occasional oils is often enough to treat the condition. Medication therapy is not often recommended but can be in more severe cases. The use of narcotic pain medication is not recommended and can often make the pain worse.

If you have experienced these symptoms and have not been able to find the relief you need, please call for an evaluation for this condition.

Carrie L. Merrill D.O.