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[phone call] minutes I would be
and then I can meet you! Does that sound good? Alright, okay
and they're knocking I gotta go! Okay bye. Come in!
Good morning! I'm Marilyn, I'm the public health nurse that's going to see you today.
So, what brings you in today? Well I just need a routine pelvic exam.
I like to get this done right around my birthday
every year and it's time. That way I don't forget.
Oh, good for you! So your tying it to some other important event in your life
Good for you.
So, tell me how old you are? I'm 43
Almost! My birthday is in like in a week
Ok you're one of those people that changes to the next age - you turn one age and you're already the next in your mind
yeah you turn on a junior do next in your mind
one of the things I ask women when they come in for these kinds of visits
is what are your periods like? When was your last period?
Um, they are a little irregular, but um...
you know I'm kinda getting to that age where ...
I have the most months but every once in a while you know it'll be like
3 three weeks longer than normal.
They always start again.
Yeah, actually I just finished my period last week.
Okay and that's how you remembered to come for your appointment. Okay what day was it?
The day of the month? It was last
Tuesday is when I finished.
Okay, and do you have any kinds of issues with your periods? Are you having cramps,
are you having like heavier bleeding or changes in bleeding patterns?
It seems to be a little bit less than it had been during my younger years but
nothing really radically different. Okay and and do you have
anything that you use for birth control?
No. I don't, well I don't need it! I have one of those tipped uterous,
and I mean I'm 43 and I've been active for
you know over 20 years and I've never been pregnant and
I don't think I can get pregnant, basically. And ... which is okay!
Okay so wait, back up a second - so you're telling me you've had
sex regularly for 20 years and never had a pregnancy
and never use birth control in like 20 years? Well, I mean a ***. Like I haven't had an IUD
or you one of those shots, I mean I definitely use condoms.
Okay. But you know if you try not to get pregnant that may not be the best way to
keep a pregnancy from happening.
are one of the methods that maybe don't have as high a rate of effectiveness as some of the other things!
But you know, with that tipped uterus,
I mean I've been told that the chances of me getting pregnant are so slim anyway,
it's really not a concern.
Okay alright. And tell me about partners? What's your partner situation right now?
Well, I'm not in a committed, like romantic relationship, necessarily.
I like live with my best friend, and we've lived together for
a while now, like eight years. And we're...
And is this a male partner? It is a male partner, yes. And I mean
we're definitely involved sexually, but it's kind of like a friend, like a best friend thing.
it's not really ...
so you know occasionally he'll have dates with other people. Occasionally I will.
But, it's just kind of a steady friendship type of thing.
Okay. So it sounds like maybe you're having sex with more
than one partner.
It's rare, but yes it does happen occasionally.
And then are you also using condoms when you're with
all these partners as well?
Well with new person for sure. I don't wear them usually with my friend.
And so as I
go through several questions related to this visit
one of the things I check with women about is just how they're using alcohol.
And so I wanna go through some tough questions with you today. Yeah, absolutely.
In a typical week, how many drinks do you have that might contain alcohol?
In a week ... Well,
you know probably 3 three times a week maybe?
Okay, and how much
alcohol do you drink at that one time that you're drinking? Oh, just a glass of wine
it's usually a glass of wine in the evening with dinner
Or maybe before bed occasionally? But you know
So I've got those big wine glasses, but I never
fill them, you know, just maybe half-way up or so?
Okay, alright. So
a half of a large glass of wine, maybe three nights a week. Does that sound right?
Yeah and three nights would be tops, two would probably be
a little bit more normal. Okay, alright. In the past 90 days how many times have you
had more than three drinks on one occasion?
Oh, ninety days? Maybe once.
Maybe once, twice at most.
Okay. How many drinks does it take to make you feel
At least two, again it depends on what I'm drinking but
I'm not too adventurous with my drinking. Okay.
Have people annoyed you by criticizing your drinking? No.
Okay. And have you felt you ought to cut down on your drinking?
No I haven't really. Okay. Have you ever had a drink first thing in the morning to
steady your nerves or get rid of a hangover?
Oh no, no. Sounds like that has not been as issue for you at all. No!
Okay. Are you familiar with what
the recommendations are for women and their drinking and what
would be defined as lower risk drinking and
what a binge level of drinking would be for a woman?
Well I know I have friends who are definitely out of range.
Okay. But I don't know that what's considered too much.
Well the level of drinking you're doing is definitely in the lower
risk range. So what we tell women is that
one or less alcoholic drink per day,
so about seven or less per week is considered low-risk.
So one of the things that I tell women is that
binge level drinking for women is less than it would be for men.
So if we drink three or more drinks on one occasion, which is
defined as maybe over about two hours time, that's that's defined as a
binge for us.
Oh, just three? Three,
exactly. So depending on what the what the
unit or the glasses you're using, you may have - if you have a giant wine glass
you may be drinking three glasses in that one glass.
Oh okay. Because the volume is five ounces of wine
per serving. Okay. You said you had some friends that
am are using alcohol in a way that's of concern? I do.
So one of the things you might think about as a friend,
is to just give them a little bit of information about what
healthier drinking might look like. You know they're so defensive! Anytime
I've tried to,
you know, even just suggest
that they stop, they just get really irritated
with me. I don't want to lose a friendship. You want to be a friend.
Yeah. Have you ever thought about a way
to, have you ever considered if you have
a friend thats drinking a significant amount, have you ever done
something like being a designated driver?
Oh yeah, I'm driven quite a few times. Okay, good.
And then the other thing I want to give you is information about
what we know is
one dose of alcohol. For example,
if you are a wine drinker, unfortunately the amount of
wine that we're talking about is five ounces, and when you pour five ounces of
wine into one of those big glasses! It's like half a measuring cup! Exactly.
It doesn't look like much.
So on of the strategies that work for some of us is to use a smaller glass.
[laughter] If the psychology of
making it look like it's a little bit more volume sometimes that helps.
But in terms of your alcohol use, I think that
you're doing a really responsible thing.
So, back to your periods! One of the things that you're also experiencing
is what I would call peri-menopause.
We're all different terms of how our biological clock is ticking and what's
gonna happen in terms of when we're gonna stop having cycles.
But the fact that you're having some periods that are getting longer between
when they're happening tells me that probably you're getting some
some cycles where you don't release an egg necessarily.
Okay. But I can't tell you that you wouldn't necessarily have the option
becoming pregnant. So I would like you to just pay attention to making sure you're
with all your partners or something to protect yourself.
And, try to time the alcohol use to times of your monthly cycle
that are maybe the front end of the cycle... Why is that?
... before you would have ovulated, for example.
Oh but really it's been this long, I can't see it happening now!
It may not, but I've had women in your age range who have,
finally something works, or they have a different partner,
or something and they have a little surprise. You're kidding! No.
Even after forty? Yeah. Yeah I
have had that happen. I've seen that happen.
So, anyway, just to be aware of that. Okay.
Okay, so it's move on and get you checked ...