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Long-Acting Reversible Contraception (LARC) is a group of highly effective, well tolerated prescription contraceptives. There are 3 distinct groups of LARC. There is an injectable, a subdermal implant, and intrauterine devices. With the exception of the Paragard IUD, which is a copper containing IUD without any hormone, all other LARCs are progesterone only forms of contraception (meaning they do not contain the hormone estrogen).

Depo Provera (150mg medroxyprogesterone acetate) is an IM injection given in the deltoid or gluteal muscle every 3 months (4 times per year). It is the option with the highest dose of progestin and is the most likely to lead to amenorrhea (no menstrual bleeding). There can be a delay in the return of fertility after stopping Depo Provera. It is associated with a possible decrease in bone density especially in the first 2 years of use, although this is typically temporary and reversible. I recommend daily calcium and vitamin D supplements as well as regular weight bearing exercise in women using this LARC as their contraceptive choice.

The Nexplanon (68 mg etonogestrel) is an implant that is a 4 cm rod, about the size of a matchstick that is placed under the skin in the upper arm. It is designed to be easier to place and remove then an IUD and does not have the associated cramping and pain of IUD placement or removal. The Nexplanon can cause an irregular bleeding pattern. Amenorrhea is possible but about 15% of users will experience prolonged bleeding or more frequent bleeding. Nexplanon is to be removed in 3 years.

Intrauterine devices or IUDs makes up the largest category of LARC. The Paragard IUD is the only copper containing IUD. Because of this and its lack of any progesterone (hormone), it is associated with menses that may be longer and heavier. It is to be removed in 10 years. The Skyla IUD (13.5 mg levonorgestrel) has the lowest dose of hormone of any LARC and is a smaller size to better accommodate (be more comfortable) a uterus that has not experienced a full term pregnancy. It is to be removed within 3 years. The Kyleena IUD (19.5mg levonorgestrel) is also a smaller size IUD but is a contraceptive for up to 5 years. Both a Mirena IUD and a Liletta IUD contain 52 mg of levonorgestrel and are full size IUDs. The Mirena IUD has the approval to treat heavy menstrual bleeding for up to 5 years and both of these IUDs are contraceptives for up to 6 years. All IUDs are associated with cramping, bleeding, and discomfort with their placement and removal. All of the progestin IUDs can cause irregular bleeding patterns especially during the first 6 months of use.

LARC contraceptives offer the advantage of protection against pregnancy for a longer period of time without having to remember to take something that is daily, weekly, or monthly. Additional pros and cons of each LARC should be discussed prior to making a decision as to whether any LARC is the right choice for you.

Type:

Name and Link to Website:         

FDA Approved for:

Copper IUD

Paragard

10 years

Progestin IUD

Liletta

6 years

Kyleena

5 years

Skyla

3 years

Mirena

6 years (5 years for bleeding)

Arm Implant

Nexplanon

3 years



We’d like to support our patients in making telehealth visits as easy and as valuable as possible. Please review the tips below in order to best prepare for your visit. 

  1. Choose your tech.

It is helpful to decide ahead of time what device you may use for your telemedicine visit. The easiest method that we suggest is using the texted link that you will receive 30 minutes before your scheduled appointment time. The link will open the appointment directly in the browser of your smartphone without requiring you to download any additional apps or login to any accounts. If this method does not work for you, then you can use a computer, laptop, or tablet to sign into your patient portal either through our website, www.rwwc.com, or the app ‘healow’ to attend your appointment. Having a reliable internet connection is also important.

  1. Set-up prior to your appointment.

Make sure you ask your provider’s office about any technology set up that may need to occur ahead of your telemedicine visit. This may include downloading an app or creating a new account. Neither of these are required for Rittenhouse Women’s Wellness Center, however if you are referred to a specialist, their setup may differ from ours. You should ask for a contact number in case there is a problem during your telemedicine visit. Doing this will reduce the stress of managing new technology during the actual telemedicine visit.

  1. Choose a quiet, private place.

Find a place for your appointment that is quiet so you can hear your provider, and they in turn can hear you. This will reduce distractions and interruptions, making your appointment more productive.

  1. Prepare your medical history. 

Just as in an in-person visit, having accurate medical history available is helpful. If you have seen other providers, been to the ER or had a hospitalization- make sure to share the details with your providers. 

  1. Obtain vital signs.

If you are able to, it is helpful to obtain vital signs prior to your appointment. If you have an electronic blood pressure cuff, you can obtain blood pressure and heart rate. You can take your weight and temperature as well at home and report during your telemedicine visit. You can also take pictures of any rashes or skin lesions you have questions about. 

  1. Write down questions ahead of time.

The stress of a new type of visit can be a distraction when trying to remember all the things you may want to ask your physician. Writing down important questions you have for your physician ahead of time will help you remember them during your visit.

  1. At the end of your telemedicine visit, set up a follow-up visit as necessary.


Understanding the basics of hygiene is crucial to maintaining health and preventing disease. Hygiene has been THE hot topic since the Coronavirus pandemic began. While our top hygiene exercise is currently social distancing, the Center for Disease Control(CDC) has put emphasis on practices such as washing your hands often and for 20 seconds at a time, coughing and sneezing into your elbow, and staying home if you are sick.

While these are some of the most important tips, there are countless hygiene rules that we should be following throughout our everyday lives. There are two categories to describe these types of hygiene: Personal and Domestic.

Personal Hygiene

Personal Hygiene is how you take care of your body. These basic habits minimize the risk of infection and also enhance overall health.

  • Bathe regularly: Wash your body and hair often. Your body is constantly shedding skin, and that skin needs to come off.
  • Trim your nails: Keeping your finger and toenails trimmed and in good shape will prevent problems such as hang nails and infected nail beds. Keep your feet clean and dry.
  • Brush and floss your teeth: At the very least, brush your teeth twice a day and floss daily. Brushing minimizes the accumulation of bacteria in your mouth, which can cause tooth decay and gum disease.
  • Wash your hands: We all know this one… Washing your hands before preparing or eating food, after going to the bathroom, after coughing or sneezing, and after handling garbage, goes a long way toward preventing the spread of bacteria and viruses. Keep a hygiene product, like an alcohol-based sanitizing gel, handy for when soap and water isn’t available.
  • Sleep: Get plenty of rest. At least 8 hours. Lack of sleep can leave you feeling run down and can compromise your body’s natural defenses, your immune system.

Domestic Hygiene

It is also important that everything in your living space is kept clean. Rubbish and dirt build up quicker than most people realize, allowing germs and parasites to multiply and grow. This will lead to people living in the space getting sick.

Domestic hygiene activities include all the jobs which are done to keep the household and people’s clothes and bedding clean.

  • Sweeping and washing floors
  • Dusting all surfaces
  • Cleaning toilets, showers and sinks
  • Washing clothes and bedding
  • Washing dishes and cooking utensils after meals
  • Washing your pets and cleaning up after them

Additional steps that you can take to keep your household clean include:

  • Taking off shoes before entering your home: This helps lessen the chances of bringing outside bacteria into the home (ie. Animal droppings, dust, dirt, mud etc.) At the very least, keep your shoes off furniture.
  • Donating or throwing away things you don’t need: A cluttered home provides more space for bacteria to hide and grow.
  • Keeping a schedule: If you have a busy calendar, schedule time to clean so that it does not get overlooked or pushed off.

References:



Remember, your pharmacist is a part of your healthcare provider team. It is important that you take the opportunity to ask your pharmacist key questions that will help you understand your prescribed therapy. How much you know about your prescribed medication will help empower you to optimize the way you comply with your therapy and potentially enhance the intended therapeutic benefit. Here are a few questions to ask your pharmacist regarding your prescribed medications:

  • Will this prescription interact with my current medications?
  • When should I ideally take this medication?
  • How should I take this medication; ie. With or without food, avoiding certain foods…
  • What are some side effects (adverse events) that I should be aware of?
  • Is the dose for this medication fixed? Or may I adjust based on my symptoms?
  • Are there generic forms for this medication with identical therapeutic benefit?
  • I take …(mention any over the counter supplements you may be taking)…, will any of these over the counter supplements potentially interact with this prescription medication?
  • If I miss a dose, should I attempt to make up for it by taking it once I remember, or should I stick with the prescription schedule allowing for a missed dose?
  • Is there anything specific to this medication that I haven’t considered that I should know about? Please assume that even the most elementary points are of interest to me.

Your healthcare provider team works hard to collaborate, optimize and calculate your therapy. You should know that you are also an integral factor in your therapeutic outcomes. Join the team by ensuring you ask the questions above and become an engaged team member for your greater health outcomes.



As winter sets in and we enter the coldest months of the season, we often start to feel and see the effects on our health. Winter poses unique health problems that we do not generally see throughout the year due to colder temperatures, less hours of daylight and less access to fresh and healthy foods. If we are aware of what may be coming our way over the next few months implementing a few easy things into your life can prevent winter from getting the best of you.

  • Common cold/flu/sore throat/cough

It is no surprise to anyone that you are more likely to get sick during the winter and this year has been especially bad for many of our patients. While the cold weather does not cause the viruses, we are spending more time indoors and in close proximity of each other, which allows viruses to spread easily. The cardinal rule to avoiding viruses and bacteria is hand washing. Whether you work in an open plan office, ride SEPTA to work or stay at home with your children, washing hands often and thoroughly with warm soapy water can help keep many of the viruses and bacteria at bay. As with any illness, when you start to feel that tickle in your throat or increase in fatigue, listen to your body. It is best not to try to push through. Start to increase hydration, rest and limit exposure to the cold air. If you are feeling sick, we always recommend avoiding public spaces to protect others around you. If you have been feeling unwell for a few days or weeks and feel you need to be evaluated in our office, we try to keep appointment slots open daily for you to be seen.

  • Dry skin

With increase in hand washing and a decrease in moisture in the air our skin starts to dry and can sometimes even crack. Using an unscented cream or Vaseline on the dry areas between hand washing or bathing can help replenish the skins hydration. Another simple solution for dry skin is increasing water intake, this will rehydrate your skin from inside out. Avoid harsh soaps, and use warm water rather than hot water when bathing to prevent stripping your skin of its natural moisture. It is also recommended to use a humidifier in your bedroom while you sleep to counter the dry air coming from heaters.

  • Poor indoor air quality

We tend to spend more time indoors with windows shut and heaters going during the winter. To ensure that the air you are breathing is clean make sure to change your air filters, vacuum and dust surfaces more often than normal and wash your bed linens regularly. If you are using heaters or have a fireplace, make sure you have working smoke and carbon monoxide detectors installed in your home.

  • Seasonal depression or winter blues

Even if you do not have seasonal depression or seasonal affective disorder it is not uncommon to feel more lethargic and less happy during the winter months. Days are shorter and nights are longer and getting into sunlight and outside regularly can be a challenge. Do you best to stick to your normal routine throughout the year, plan activities to get you out of the house and keep up with exercise and activity. It can feel hard to get up and go in the winter, but finding a friend or partner to do this with you can help you get there and keep your mood lifted.

  • Weight gain

As winter sets in we start to lean into comfort foods and foods that are convenient. There is also a lack of fresh vegetables in the winter that make our meals less bright and healthy. Make sure to make your meals as colorful as possible with a variety of vegetables and lean proteins. Canned and frozen vegetables can make that easier during winter months or try a new winter vegetable or recipe you have never tried before! And as always, get out and get moving for at least 30 minutes per day.

Be proactive about your health this season. We are still offering flu vaccines at the office and it is not too late to get yours. Wash your hands regularly, cover your mouth when you cough or sneeze. Stay active and engaged with friends and family. And as always, stay hydrated and listen to your body when it needs a bit more rest than normal.



Celebrating American Heart Month every February provides an annual opportunity to reflect on our lifestyle choices, and how these impact our cardiovascular health. Cardiovascular Disease (CVD) is the leading killer of both men and women in the U.S. (and increasingly, worldwide).  CVD includes Coronary Artery Disease, Stroke, and Peripheral Artery Disease (PAD).  Many of the biggest risk factors for CVD-related morbidity and mortality are preventable and modifiable.  Smoking, overweight/obesity, poor diet, and inactivity all contribute to increased CVD risk.  Modifying these risk factors, in turn, can prevent/improve other well-known risks, including Hypertension, Diabetes, and High cholesterol.

Smoking is perhaps the biggest modifiable risk factor for CVD—don’t start!  Stopping smoking will start lowering one’s cardiovascular risk within months, and within years, a former smoker’s risk is equivalent to that of a nonsmoker.  It really is never too late to quit, from a cardiovascular perspective.

Improving one’s diet improves heart heath independently, but also by reducing other CVD risk factors such as obesity, high blood pressure, diabetes, and high cholesterol. Following a diet which includes plenty of fruits and vegetables, fiber, monounsaturated fats, and foods with a low glycemic index, as well as 2-3 servings of seafood weekly (a great source of omega-3 fatty acids), is advised.  The Mediterranean Diet is a great example of a heart-healthy diet strategy.

Physical activity is one of the most critical tools for reducing one’s CVD risk and for weight loss.  Most experts recommend 150 minutes of moderate-intensity aerobic activity a week for heart health (less if you are exercising more vigorously).  Conversely, studies have also shown that prolonged periods of inactivity, such as sitting at work or watching TV, can increase your cardiovascular risk significantly.  The answer—get up and get moving!   Even lower-intensity exercise such as brisk walking makes a difference.

Making therapeutic lifestyle changes can have a tremendous impact on your cardiovascular health.  It can be daunting to alter longstanding habits, but the benefits are immeasurable.  Enlist help if you need it—see a nutritionist, get a trainer, set up a lunchtime walking date with a coworker or an office appointment to discuss medication for smoking cessation—whatever it takes!   Your heart is worth it!



It is after hours and you are experiencing health-related concerns. Your PCP is not available; you have two options: urgent care or emergency room.  What is the difference and which one should you choose?

Simply put, the difference is the severity of the health problem. If the condition is life-threatening and your care may require rapid or advanced treatments, go to an emergency room. If you have a minor illness or injury that needs to be treated right away, but is not a true emergency, go to an urgent care.

At Rittenhouse Women’s Wellness Center, we encourage all of our patients to contact us if you are experiencing any type of health related issue. While in most cases we will recommend you come into our office to be evaluated, sometimes we will not be able to see you as quickly as an urgent care or an emergency room would. Even if we cannot be the ones to see you, we want to help you make a decision on what to do next.

As a guide…

Here are symptoms that are best evaluated in an urgent care:

  • Fever without a rash
  • Vomiting or persistent diarrhea
  • Abdominal pain
  • Wheezing or shortness of breath
  • Dehydration
  • Moderate flu-like symptoms
  • Sprains and strains
  • Small cuts that may require stitches

Here are symptoms that are best evaluated in an emergency room:

  • Chest pain or difficulty breathing
  • Weakness/numbness on one side
  • Slurred speech
  • Fainting/change in mental state
  • Serious burns
  • Head or eye injury
  • Concussion/confusion
  • Broken bones and dislocated joints
  • Fever with a rash
  • Seizures
  • Severe cuts that may require stitches
  • Facial lacerations
  • Severe cold or flu symptoms
  • Vaginal bleeding with pregnancy


Winter is just around the corner—the days are getting shorter and the holidays are upon us. Winter can be a depressing time of year for many as the holidays wrap up, the hours of darkness increase, and the temps continue to drop. However, cooler temps have a number of health benefits including: the ability to burn more calories, fight infections, and clear up skin—all of which can make the holiday season and winter months a little brighter.

When exposed to the cold our bodies are constantly working to keep us warm and regulate our core body temps. This process uses a significant amount of energy and burns calories in the process. Exposing your body to cooler temps also helps to increase your amount of brown fat. Brown fat is mitochondria rich fat which helps to boost your metabolism making it easier to burn more calories and indulge in a few extra holiday treats.

Throughout the winter we are exposed to more viruses, such as the common cold and the flu. However, cold winter weather enhances our immune system. Studies have shown that stress-inducing conditions, such as exposing yourself to cold temperatures, activates the immune system. Additionally, during the winter months allergies are low and sleep is enhanced further increasing the body’s ability to fight infections. While we may be more at risk, we are better able to fight off infections in the winter months.

Lastly, cooler temps make for clearer skin. When skin is exposed to moderately cool temps the blood vessels constrict, meaning there is a decrease in blood flow to the vessels closest to the skin. This constriction leads to less redness and inflammation. Plus, during colder months your skin naturally produces less oil and sebum the culprit of acne breakouts. Despite these benefits winter can also be very drying to the skin so it is extremely important to continue to moisturize throughout the winter as much as possible to give your skin that nice flawless winter glow.

To read more about the health benefits of clearer skin you can follow this link.

https://www.netdoctor.co.uk/beauty/a27237/reasons-why-the-cold-weather-is-actually-good-for-your-skin



One of the top reasons patients come in to see their primary care provider is because they are having musculoskeletal pain or chronic pain. It is common for patients to want a “quick fix” or something that will take away their pain immediately, but non-pharmacologic pain management often has better outcomes and better long-term pain control. Additionally, it has been shown that the long-term use of pain medications have diminishing effects over time and can cause other chronic health problems.

Pain, especially chronic pain, does not always correlate to the physical state of the body but there are many contributing factors including sleep, nutrition, stress, and emotions. A non-pharmacologic approach to pain management includes, but is not limited to, physical therapy, exercise, acupuncture, and psychotherapy.

  • Physical therapy: Physical therapists are highly trained and skilled in assessment and diagnosis of causes of pain. They can prescribe exercises targeting your specific impairments and help you with lifestyle modifications and pain management strategies that can safely decrease pain symptoms. The results from physical therapy often have long-term benefits
  • Exercise: It is often thought that when in pain resting is the best method to ease discomfort, but it is actually shown to increase pain and cause weakness in the area. Gentle movements and walking can successfully decrease pain and prevent the area that is causing discomfort to become stiff or weak.
  • Acupuncture: Alternative modalities and holistic approaches to pain management have varying degrees of efficacy but many studies show that acupuncture is clinically proven to reduce pain with long-term benefits. Many insurance companies are now covering acupuncture services as pain management therapy.
  • Psychotherapy: Pain is often rooted in depression, anxiety or mental stress. Seeking care from a mental health professional or engaging in cognitive behavioral therapy can greatly reduce pain symptoms.


Getting an appropriate amount of restful sleep is important for a variety of reasons. Sleep effects our mental and cognitive function, our immune systems, and our general overall health. If we are not getting enough sleep, we may experience poor health outcomes including new or worsening anxiety and depression, obesity, and cardiovascular disease. Adults should get 7-9 hours of sleep each night. Unfortunately, about 1/3 of adults in the United States are not getting enough sleep.

There are many things that we can do to help improve our quality and duration of sleep. If you are struggling to get adequate sleep, try to incorporate at least a few of the following recommendations into your daily bedtime routine:

– Have a sleep schedule: Try to go to sleep and wake up at the same times each day.
– Avoid naps, especially later in the day.
– Limit caffeine during the day, especially within 4 to 6 hours of bedtime.
– Exercise daily: The current recommendations are to get 150 minutes per week of moderate-intensity exercise.
– Avoid using electronics at least 30 minutes before bed.
– Create a relaxing sleep environment: this may include a cool bedroom, blackout curtains or an eye mask, and a sound machine or ear plugs.
– If you wake up in the middle of the night and have trouble falling back asleep, go into a different room and participate in a relaxing activity until you feel drowsy enough to fall asleep again.


rittenhouse-logo-white

1632 Pine Street
Philadelphia, PA 19103
Phone: 215-735-7992
Fax: 215-735-7991
Email: info@rwwc.com

Hours

Monday – Friday:  8am – 8pm

Saturday: 9am – 2pm

Sunday: Closed

Copyright by Rittenhouse Women's Wellness Center. All rights reserved.