After learning their goals, this doctor helps women plan
Your contraceptive choice depends on your family plans, your symptoms and your lifestyle
When Dr. Madolyn H. Krengel talks to a new patient about contraception, her first question is always, What’s your goal?
“Contraception is effective in preventing a pregnancy, but that’s not always a patient’s first priority. It can also be used for controlling acne, cramps, heavy flow, PMS symptoms and other conditions,” she says. “I can walk through options that fit best with their lifestyle.”
As a primary care physician at Pacific Medical Centers (PacMed) Northgate, Dr. Krengel’s patients come to her for a wide range of preventive care and treatment. When appropriate, she tries to add contraception to the conversation, to better understand her patient’s perspective.
“If they’re hesitant, I start by asking, ‘How would you feel if you were to become pregnant in the next year?’ That helps me understand their needs. We don’t need to make a decision right away either — I’m happy to explore options,” she says.
The power to choose
“Contraception has been available long enough that we can take it for granted. But I think it’s a really powerful thing to be able to choose when you get pregnant,” Dr. Krengel says.
Every contraception has a different level of effectiveness. Dr. Krengel can explain the benefits and risks, and help you find the method that’s right for you. Would you prefer to “set it and forget it,” or do you like having daily control?
“Young women are more likely to be focused on preventing a pregnancy,” adds Dr. Krengel. “Women in their 30s may be ‘between children’ and thinking about timing their next pregnancy. I also remind patients: as long as you’re having a period you can get pregnant, regardless of your age.”
Non-hormonal options:
- Copper IUD: Inserted by a healthcare professional into the uterus, it should be removed after 10-12 years. “It’s just as effective as getting your tubes tied, though it can cause heavy or more painful periods.”
- Condoms: Less effective as a contraceptive, but the only form of birth control that lowers your risk of contracting sexually transmitted diseases.
Hormonal options:
- Pill: “There are dozens of birth control pills available with varying levels of hormones, so if you tried one and had a bad experience, it doesn’t mean that all pills are off the table,” Dr. Krengel says.
- Patch: Sticks to the skin; replaced once a week.
- Ring: A flexible circular device you insert in your vagina; replaced once each cycle.
- IUD: Inserted in the uterus by a healthcare professional; effective for about five years.
- Nexplanon: A small, flexible strip implanted in the arm by a physician; removed after three years.
- Injection (the Depo shot): Injected by a doctor every 90 days. “It’s a great method for women who want to keep their contraception use private from a partner or anyone else living at home,” Dr. Krengel says.
Pediatrician says, Wellness starts in infancy!
Developmental, behavioral and mental health advice for infants, children, teens and young adults
2 to 3 years. That’s about how long the current waitlist can be for an appointment at Seattle-area autism clinics. If, at that appointment, your child receives an autism spectrum disorder diagnosis, it can be another 18 months before your child starts receiving Applied Behavior Analysis therapy.
“One of my interests is helping children with developmental concerns get the services they need, as early as possible. Early diagnosis and treatment leads to better outcomes,” says Dr. Nawal Alkharouf, a Pediatric Specialist at Pacific Medical Centers (PacMed) Canyon Park, who recently certified as a Center of Excellence provider for autism. “I strongly believe we primary care providers should do more to help children and families with developmental, behavioral and mental health concerns, given the scarcity and high demand for specialists.”
If you suspect your child may have autism spectrum disorder, Dr. Alkharouf is now certified to give you a diagnosis — and you won’t have to wait two years for an appointment.
The importance of regular well child visits
Regular doctor’s visits in an infant’s first two years of life aren’t just for immunizations — they’re essential for tracking growth and development of things like speech and motor skills. With the pandemic, many parents have cancelled or postponed well child visits. Children also interacted less with teachers, daycare workers and their peers, which has also lead to delayed diagnosis and treatment.
“Studies show better outcomes when intervention services like speech, occupational or physical therapy are initiated early. That’s why well child visits are so important,” Dr. Alkharouf says.
Mental health in infants, teens and young adults
“Suicide is now the second-most common cause of death in young people between ages 10 and 24, and stress can affect young children and infants too. I strive to do more continuing medical education to get better at recognizing, diagnosing, and managing common mental health conditions like depression, anxiety, and behavior problems in children,” Dr. Alkharouf says.
Mental health challenges are not the same for every child or teen, but Dr. Alkharouf lists some possible signs of stress:
- Infants may be fussier, be more difficult to console, or have sleep or feeding issues.
- Toddlers and young children may have more tantrums, be hesitant to explore, or regress to bedwetting after potty training.
- Older children and adolescents may show sudden changes in behavior (an outgoing teen showing little interest in friends, for example); changes in sleep or appetite; problems with concentration at school and changes in appearance.
“One of the best ways you can help your children is to pay attention to your own mental health — our stress trickles down to our kids. I’m someone who loves to meditate and hike, and I really believe nature is the best healer. Include your family with things you enjoy, like hiking or yoga, so they see you demonstrating positive habits of mindfulness and exercise,” Dr. Alkharouf says.
7 things parents can do to prevent suicide
- Don’t let your teen’s depression or anxiety snowball. We all have bad days, but if a “bad day” lasts a week or more, seek professional help.
- Knock on the door and start a conversation. Listen without judgement, and pay attention to body language. “Poor communication between parent and child is a common trait in families who’ve been affected by suicide.”
- Share your feelings. Tell your teen that you experience these feelings too, emphasize that your child is not alone and that stressful times will pass and things will get better.
- Encourage your teen not to isolate from family and friends, but don’t push if they’re not ready.
- “Countless scientific studies show that exercise can put the brakes on mild to moderate depression — even going for a walk can release positive endorphins,” Dr. Alkharouf says.
- If you own guns, keep them locked or temporarily remove them from the house. “Guns are much more fatal than other forms of self-harm.”
- The goal is to rebuild confidence and self-esteem, so stay positive and don’t expect too much too soon.
For immediate help, call the National Suicide Prevention Lifeline at 1-800-273-8255.