“Travel in Pregnancy” – with Dr. Caroline Friedman

On this episode of Healthful Woman, Dr. Fox and Dr. Friedman discuss the nuanced advice they give patients regarding travel during pregnancy. They cover topics like timing travel during pregnancy, advice for different types or stages of pregnancy, and considerations for flying, destinations, and more.

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Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics and women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB/GYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. All right, welcome back to the podcast. Caroline Friedman, how you doing? 

Dr. Friedman: I’m great. How are you? 

Dr. Fox: Very good. So I mean, travel and pregnancy is something we used to talk about with our patients all the time, not so much in the past year. 

Dr. Friedman: No. In a different perspective, I guess. 

Dr. Fox: In a different way. But I thought that, you know, we’re recording in May, and this is probably gonna drop sometime in June. And obviously, with more vaccinations and the infection rates going down, restrictions will be lifted, at some point, people are gonna start traveling again, people already have started to travel again, but more and more we’ll. And we thought it’d be a good time, just first of all, just to cheer us up to talk about travel, like, “Hey, we’re gonna go away again.” But also it is an important topic because pregnant women ask us about this all the time. 

Dr. Friedman: Totally. 

Dr. Fox: And I find that it’s fun to not only talk about what they can and can’t do, but just I mean, they get to talk about places they’re going, and where have we been, and where should we stay? And this used to be a lot about Zika, but now not as much. 

Dr. Friedman: No. 

Dr. Fox: Excellent. So why do people ask this question all the time? What is the concern in general? 

Dr. Fox: Well, I think in general, in pregnancy, people wanna make sure that anything they’re doing is okay because it’s a little bit different. And travel requires, you know, depending on where you’re going and how you’re getting there, some advanced planning, some financial deposit, or a commitment. And people wanna make sure that what they’re doing is gonna be okay and are gonna be safe for them in their pregnancy. 

Dr. Fox: So if someone asked you a question, “I wanna go here,” during pregnancy. What are the, sort of, factors or variables that go into how you talk to her about that? 

Dr. Friedman: Yeah, I mean, first of all, I think it depends on where they’re planning to go, at what point in the pregnancy they’re planning to go, how complicated or uncomplicated the pregnancy or the patient’s own medical history may be, and like, the reason for going. Because I think that people either in the old days had to go places for work and we’re gonna get fired if they didn’t, or didn’t wanna tell their job, or whatever it may be. Or they’re going away for their best friend or their sibling’s wedding, or they’re just going with because they wanna go away and really have a little bit more flexibility about it. So I think that’s important to consider as well. 

Dr. Fox: Yeah, I find the same way, it’s real easy to just tell somebody no, right? “Can I go away?” “No, you can’t go away.” Like, it’s very, very easy to say that. But I don’t think it’d be fair because it’s clearly much more nuanced as you said, you know, there’s a big difference between driving 3 hours to go to your sister’s wedding than it is flying 12 hours to spend 2 days on a beach as you want to. And, again, not a value issue, it’s just a matter of people’s, I don’t know, their tolerance to take on a slight amount of risk with change based on their circumstances. So in terms of the point in gestation, why does that matter so much, where they are in pregnancy? 

Dr. Friedman: Well, certainly different things can happen at different points in the pregnancy. So in the first trimester, women may not be feeling great, or there’s a potential risk for a miscarriage. And so whether that’s gonna happen somewhere far away, or during a long flight, those are kind of the things you were gonna worry about. In the third trimester close to your due date, you’re thinking about, could you go into labor? Could your water break? Could you have a concern that you would wanna go see your doctor the same day or the next day for? And if you’re far away, how are you gonna do that and where are you gonna get your care and things like that? 

Dr. Fox: Right. And what about in terms of, you said, what their own history is, like what their own…how the pregnancy has been going. 

Dr. Friedman: Right. So for patients, let’s say, who’ve had a history of a preterm delivery at 30 or 32 weeks, we may feel more strongly about them not traveling at that point in their current pregnancy, as opposed to someone who has never had that history, and therefore the risk of a complication or going into labor at that point is a little bit lower. Or let’s say they have a medical condition that may be exacerbated by traveling or just could happen and if they’re not near their doctor, what are we gonna do to help them? 

Dr. Fox: Right, I think what’s interesting is, you know, what we’re discussing just in these first few minutes, so much of it is logistics, which I think surprises people because a lot of people are concerned that maybe travel itself is dangerous, like getting on a plane somehow is a danger to the pregnancy. And they learn really quickly that it’s basically not, like it’s safe, I mean, the cabins are pressurized, so it’s not an issue of like altitude. And the scans that people go through, they’re worried about the radiation, there’s like no radiation in those scans. There’s actually more radiation from the flight, just on being like on a plane than there is from the actual scanner. 

Dr. Friedman: Right. Which is obviously also very, very, very low. It’s not a problem. 

Dr. Fox: Yeah. And so there’s really no concern and people who are flight attendants work when they’re pregnant until a certain point, but that’s just because again, they don’t want them going into labor. And so it’s not that the travel itself is unsafe. I tell people if they went up in a plane and flew around for three hours and landed at the same spot, that’s okay. The one exception is for very, very long flights, we get concerned maybe of the development of a blood clot. 

Dr. Friedman: Right. Exactly. 

Dr. Fox: So explain that. Why is that the case of long flights? 

Dr. Friedman: Well, when you’re sitting still, whether it’s in a long car ride or a long flight, sometimes the blood that’s going through your veins and circulating through your body can kind of pool down in your legs and your lower extremities. And if it’s not circulating, kind of can clot there. And so stretching your legs, doing some exercise in the seat, getting up and walking around every few hours. Or if you’re in a car stopping, pulling over and just stretching your legs can help to prevent that. 

Dr. Fox: Right, right. Ironically, it seems to me that people who get blood clots after long flights tend not to be pregnant because they’re the only ones who can actually like sit still for eight hours, you know, and read and watch movies. 

Dr. Friedman: Exactly, fall asleep. 

Dr. Fox: Right. Whereas if you’re pregnant, almost always, you got to get up to go to the bathroom anyways every couple hours. 

Dr. Friedman: Exactly. 

Dr. Fox: Or if you’re traveling, you already have kids, you’re running after somebody. And so it’s very unusual for a pregnant woman to just sit still on a flight for eight hours. It just doesn’t happen that much. But that would in theory be a concern. But that’s basically it in terms of the travel itself. We really don’t have concerns. It ends up being logistics. 

Dr. Friedman: Exactly. 

Dr. Fox: Okay. So we spoke about the timing of travel. How do you determine…like people say, “What’s your cutoff for travel? When can I travel until?” Do you have a hard stop for women? 

Dr. Friedman: I personally don’t. I mean, I guess I would say, you know, no later than 36, 37 weeks, just because we know a lot of people go into labor then. Some airlines have cut-offs, but it, sort of, varies and is fairly arbitrary. And again, it’s like they don’t know what’s going on in the pregnancy or your history. So I wouldn’t really pay attention to that. I wouldn’t go beyond that. Or I’d have a letter or a reason, just in case. But I think it’s more about, again, how the pregnancy is going, the reason for going. And it’s just a conversation that we have. 

Dr. Fox: Yeah, I mean, the airlines, you can go online and find their policies. And it’s the funniest thing. Well, it’s like, “How did they verify this? Like, what are they doing? Like, did they ask for medical records?” And people are like, “Can you give me a letter?” I was like, “What would you like the letter to say?” I mean, like they don’t…First of all, they can’t even ask if you’re pregnant. Like, it’s illegal. 

Dr. Friedman: Not allowed. Yeah. 

Dr. Fox: You know, so that’s number one. Number two, they can’t ask how far pregnant you are, they can just put a policy up there. And I think it’s obviously meant that if you were flying on your due date, and when it’s a labor, they could say, “Well, you didn’t follow our policy.” But it’s not saying that it’s really enforceable. Cruise lines have a very early gestational age, they’re actually a little bit more complicated. And they sometimes do require letters from doctors because for them, like, the whole cruise is done. 

Dr. Friedman: Derailed. Exactly. 

Dr. Fox: If something happens whereas a flight, you know, usually they can just land where they’re supposed to. Worst case they land early and then take off again, a cruise, it’s a little bit harder to do that. 

Dr. Friedman: Sure. 

Dr. Fox: But yeah, I have the same thing. So let’s let’s talk about first trimester. Let’s just start in beginning. So if someone’s in the first trimester. Is there any situation where you would tell someone they couldn’t or shouldn’t travel? 

Dr. Friedman: You know, if we’re following someone who’s been having maybe some bleeding complications in the first trimester and we’re concerned that there’s a high chance that they might miscarry, we would probably, or I would probably recommend delaying the travel a little bit just to see what happens just because heavy bleeding on an airplane can be traumatic for somebody. But again, not because a flight or a car trip is going to make a pregnancy miscarry or not. Or if you’re far away and the miscarriage does happen, are you gonna be upset that you’re not with your own doctor and maybe you have to go to emergency room or something like that? But otherwise, not really. 

Dr. Fox: Yeah, I mean, if someone has a healthy first trimester, I pretty much…they can go wherever they want essentially. And I tell them the same thing that all early pregnancies, there’s a chance of miscarriage. It’s not gonna be caused by you traveling and, you know, I say, “Well, if you’re going to L.A., well, are you okay, if something happened there? Would you be okay going in an emergency room there and finding a doctor?” And if the answer is like, “That’s like the most horrifying thing that could possibly happen to me,” then maybe you don’t wanna do it. 

And then you start getting into the where are you going question, right? So someone says, “I’m going to Pittsburgh for a meeting.” All right, like, they have good medical care, they have doctors. It may be really sucky to, like, be in an emergency room or a doctor you don’t know, but you’ll be okay, like, physically. “I’m going to Pittsburg, I’m going to Canada. I’m going to Florida. I’m going to L.A. Whatever it is. I’m going to Germany. I’m going to Italy.” But then people start saying, “Well, I’m going on this safari,” or, “I’m going on this remote island where you have to take a plane, then a boat, then a Jeep, then someone has to carry you 12 blocks. And then you have to climb up a tree.” And it’s sort of like, “Well, listen, if you’re like six hours from the nearest medical provider, probably you’ll get away with it. But you may wanna reconsider ever going somewhere like that in pregnancy unless you’re okay being in that situation.” When my wife was pregnant with our twins…I mean, we were dumber than doorknobs. I mean, we knew nothing, literally nothing about anything related to pregnancy. And we were camping in Alaska, in Denali. 

Dr. Friedman: Oh, my God. 

Dr. Fox: And like, we were six hours from a phone. I mean, forget about from a doctor. And like, when we got back, the doctor calls, like, “You went where? Like, what?” And we were like, “Yeah, that was pretty dumb. She was pregnant with twins.” But, all right, listen, we survived, everything went okay. But if someone asked me I would say, “Bad idea.” 

Dr. Friedman: Yeah, I would do that. 

Dr. Fox: Yeah. That’s a bad idea. But that’s something to consider, right, in terms of where are we going? What are my options? You also have to think of like, what’s my disaster plan in case all hell breaks loose? 

Dr. Friedman: Right. Exactly. 

Dr. Fox: And you know, occasionally in early pregnancy, miscarriage can be dangerous. It almost never is dangerous, but it could be. Or sometimes people if we’re concerned that they might have an ectopic pregnancy, that’s when we usually ground them. Because then really, it could be bad. And so we’ll say, “All right you may have an ectopic just do not travel. Just stay put until we sort this out.” 

Dr. Friedman: Exactly. 

Dr. Fox: But fortunately, that the exception. 

Dr. Friedman: Yep. 

Dr. Fox: Okay, so that’s the first trimester. How do you feel about the second trimester? 

Dr. Friedman: Personally, I think the second trimester is really the best time to travel. Most women are feeling better if they have been having some nausea or vomiting or something like that. You know, it’s still before a baby is viable up until 24 weeks. And so if, God forbid, something really horrendous did happen and you were not able to access us, your doctors, or any medical care quickly, it wouldn’t be necessarily a life or death situation. And those things are all really, really rare at that point in the pregnancy. And so most people don’t really have complications between, let’s say, 13 and 24 weeks. 

Dr. Fox: Yeah. Yeah. And I agree, your risk of miscarriage is, sort of, bottomed out at about 1% or whatever it is, it’s really, really low by the time you get to the second trimester and the risk of preterm birth is also really, really low. And like you said, for all the symptoms that women have in pregnancy, they’re usually better…not always, but they’re usually better in the second trimester. And they don’t feel as big as they will in the third trimester. 

Dr. Friedman: Exactly. 

Dr. Fox: And so like people are still, like, okay going away. They’re okay putting on a swimsuit. They’re okay going to the beach. I mean, like, it’s, sort of, like… 

Dr. Friedman: They’re just feeling better, more energy, and they kind of enjoy the trip more if that’s the purpose of the trip. 

Dr. Fox: Yeah. So a lot of people, if they schedule those babymoons, they’ll do it sometime in the 20-week range plus-minus for that reason. But yeah, and all the other things still apply, but you will be potentially far away, and are you going somewhere with medical care? The third trimester is when it starts to get real interesting in terms of talking about statistics. And that’s what people really try to pin me down. You know, “Can I travel up to 28 weeks, up to 32 weeks, up to 34 weeks?” And I just, sort of, say, “Well, listen, you go anytime you want, but ultimately, your odds of something happening just start going up, right. Even if it’s, you know, are you comfortable with a 5% chance of going into labor where you’re going?” If the answer’s yes, fine, go. Like, if you don’t mind going into labor in Miami, go, like nothing’s gonna happen to you. You’ll just go into labor in Miami if that happens. And people have to make that decision for themselves, what level of…I don’t wanna call it a risk because it sounds, like, negative, but what chance are they comfortable with that they may end up delivering in that city that they’re going to, or that country? 

Dr. Friedman: Well, and then the follow-up to that is not only delivering but if we’re talking 20, 30, 32, 34 weeks, if you do deliver, your baby will be at the NICU for a period of time. And so then, you know, not necessarily coming back after your weekend to Miami or maybe a week, it could be a few weeks to a few months, depending on what we’re talking about. 

Dr. Fox: Yeah, the earlier you are, if something happens, the longer you’re gonna stay. Because either you’re gonna be parked in a hospital hoping not to deliver or you will have delivered and the baby’s parked in the NICU. And that has logistical concerns. 

Dr. Friedman: Totally. 

Dr. Fox: Or if someone’s going overseas, now you have to start dealing with, “I gotta get a passport for this baby to come back into the country.” And again, it’s not meant to scare people because again, the likelihood of any of these things happening is really low. 

Dr. Friedman: Very low. 

Dr. Fox: But for some people will be like, “Oh, no, I don’t wanna be part of that.” And they, sort of, put the line earlier, or they’ll say, “I’m not gonna travel for leisure up until, you know, past a certain point. But if there’s a meeting I have to go to, or a wedding I have to go to, or a funeral, God forbid, something, all right, I’ll take my chances because I need to do it.” And that’s where it’s, sort of, that calculation comes back to… 

Dr. Friedman: Exactly. 

Dr. Fox: In terms of this counseling, and we just give them the best information we can. Sometimes where people are higher risk for let’s say preterm birth, like twins or prior preterm, we’ll do some sort of assessment like, “All right, come in the week before we’ll check your cervix. We’ll see what’s going on just so we can give you a sense of are your odds higher or lower, but all bets are off.” 

Dr. Friedman: Right. We can’t say for certain. 

Dr. Fox: Yeah, someone’s like, “Can you guarantee I won’t deliver in the next week?” “Nope.” 

Dr. Friedman: Nope. 

Dr. Fox: No, I can’t. I wish I could. 

Dr. Friedman: Exactly. 

Dr. Fox: That would just be wonderful. For people who are going away, is there something they need to, sort of, know about or bring with them if they’re traveling that you recommend, anything in particular? 

Dr. Friedman: It’s never a bad idea to have, sort of, a copy of your records, or maybe just a summary with, like, your prenatal labs and your due date and any other information. If you’ve had complications, your history, things like that, just so if something does happen, you can give that to whoever is assessing you in the emergency room or the hospital or wherever you end up going. 

Dr. Fox: Right, especially if you’re going for a long time. Someone’s like, “I’m going somewhere for a month,” or something like that, that’s pretty important. It also depends on what the pregnant woman needs, where she’s in pregnancy, and in terms of sometimes make sure you have the medications you need based on where you’re going, or things you take for symptoms, or different clothing. I mean, there’s a lot of variables that come about in pregnancy that aren’t often there when you travel in general. And in terms of the airplane, you know, again, there is no concern going through the airport metal detectors or the one where you stand with your hands up like you’re getting arrested and they scan you. It’s totally safe. That’s not an issue. The plane itself is fine as long as, again, you can move around and do all these things on yourself. What about infections in terms of like travel and endemic infections? What do people need to know about that? 

Dr. Friedman: Well, I think just keep in mind that COVID is still a thing, even if you’re vaccinated, so follow the rules, wear your mask. Understand that, you know, anytime you’re traveling or being around more people, you are increasing your risk for exposure. So it’s certainly better now than it was a year ago when we were saying absolutely don’t travel. But if you’re vaccinated and you’re following those rules, you’re doing a good job at reducing your risk. And then the whole Zika thing, which is, we think, probably less of a big deal than we thought it was in 2016 or so. And CDC is not really updating or reporting active cases, I think it’s more dependent on the countries which have probably stopped doing that, but it doesn’t mean that the virus is completely gone. So in theory, it could still be something you’re putting yourself at risk for, and there’s no treatment for it. So the best thing, if you’re going to a country that has had Zika in the past to just wear your bug spray, wear long pants, long clothes, and try to prevent getting any mosquito bites. 

Dr. Fox: Right. I think CDC has shut down the Zika department temporarily. 

Dr. Friedman: Yeah, they’ve been busy. 

Dr. Fox: They’re like, “Everybody, go to the COVID center.” 

Dr. Friedman: Exactly. 

Dr. Fox: “Zika, you’re gonna wait.” 

Dr. Friedman: Exactly. 

Dr. Fox: No, but you know, Zika existed before that outbreak… 

Dr. Friedman: Sure. 

Dr. Fox: There was just such a big outbreak and they were seeing birth defects that became so relevant for pregnant women who were traveling. Now that Zika is, sort of, spread globally and it’s potentially anywhere, but fortunately, very, very rare. It’s, sort of, at that level of other viruses that people could always catch could be problematic. It’s just one of the risks we take when we’re pregnant in general. Fortunately, it’s very low. Getting bug bites is best to be avoided if possible, there’s other things you can catch from mosquitoes. And also, sort of, know where you’re going. There’s some places that have more endemic infections than others and whether that’s an issue and whether it’s a place that you need to be vaccinated to go to. Again, this is a little more exotic travel than, you know, go to Pittsburgh. Or maybe there is a vaccine if you need to go to Pittsburgh, I’m not sure. All of our Pittsburgh listeners, please email in if there’s anything endemic there that we need to know about. 

But that’s something to keep in mind. And in terms of it may be a place you want to avoid if it has infections for what you can’t be vaccinated when you’re pregnant or can’t take the prophylactic medication, for example. Again, but these are pretty uncommon, particularly when going to most of the travel destinations that we’re going to. There are other issues in terms of travel, and this is whether you’re even going in a car or on an airplane, you know, basic safety like seatbelts. 

Dr. Friedman: That’s always a good idea. 

Dr. Fox: Yeah. I mean, just basics. It’s important to remember that these things are important in life for everybody. But obviously, when you’re pregnant, it’s a very big deal to have, God forbid, accidents and you’re not buckled appropriately. There is some concern that people had that maybe seatbelts would like hurt the pregnancy. And there’s a way you’re supposed to wear your seatbelt and, sort of, low. But ultimately, if you’re in a car crash, you’re better off with the seatbelt than without… 

Dr. Friedman: Hundred percent. 

Dr. Fox: …whether you’re pregnant or not. And that’s important. And also, I think, women who are on certain medications, it’s important, like for example, if a woman’s on a blood thinner, why might that be relevant when she’s traveling? 

Dr. Friedman: If there is an issue and she does get hurt and has increased bleeding or a concern about something like a placental abruption or something like that, she should be extra cautious. 

Dr. Fox: Yeah, it’s important for that, also sometimes people when they’re traveling need to make sure with their medications, taking them through security. Some of these pregnant women, whether doing fertility treatments or if they’re not pregnant yet or they are pregnant, still doing progesterone shots, or they’re doing whether it’s insulin for diabetics, or they’re on blood thinners, and for many women’s the first time they’ve ever done this, I mean, they don’t take these medications otherwise, and now they’re going through security with a bunch of needles. And they have to, sort of, sort that out, you know, “How do I make sure to do this that’s appropriate,” and you’re not arrested because you shouldn’t be, it’s legal. But just to be on top of that, and also one of the nice things about it if you happen to be on a blood thinner, it’s much less likely to get a blood clot when you’re pregnant and traveling. 

Dr. Friedman: Exactly. 

Dr. Fox: So just to summarize, when someone comes to you and says, “Hey, I’m thinking of going to Florida for vacation for a week.” Ultimately, take me through that conversation. 

Dr. Friedman: So we start by reviewing the chart, and then having the conversation of, “Okay, Florida. Great. When are you going? Why are you going? And what are, sort of, your thoughts about it and contingency plans in case something does happen?” And then they say, “Well, what do you mean if something could happen?” And then I talk through the potential complications or risks and reassure them that it’s very unlikely that something will happen, but we’ve seen it all. So we’ve seen things happen. You know, I’m just making sure they’re prepared and they fully understand what they’re taking on. And then they can determine whether or not it’s worth it for them. 

Dr. Fox: Yeah, I find that most of the time, the conversation does not end up changing their travel plans. Usually, they’re just asking for reassurance like, “Hey, is this okay?” And usually you have to say something like, “Yeah, it’s okay.” We go through, you know, “This could happen, this could happen.” I mean, listen, things could happen when we go to the supermarket, anything can happen at any point. But as long as they, sort of, get it, what we’re thinking about, and they may say, “Oh, maybe I won’t go 36 weeks for a week because I really don’t wanna deliver in Florida.” And someone else would be like, “You know what? My sister lives in Florida, my mother lives in Florida. If I went into labor that week… 

Dr. Friedman: It’d be fine. 

Dr. Fox: …whatever, not the end of the world.” Okay, fine, and then go. And so we don’t…it’s one of the reasons we don’t put a hard line or a hard stop on this because it’s not valuable. People like, they ask me what’s our policy on it? And I’m like, “We don’t have a policy.” But we talk to people and we’ll figure it out. And I think that is important if someone’s giving you like a hardline policy, that’s just because it’s easier. It’s easier to say, “You can travel up into this point, and not after this point.” But it’s not like it’s guaranteed to be safe before and guaranteed to be dangerous afterwards. 

Dr. Friedman: Exactly. 

Dr. Fox: They’re both probably safe, it’s just a matter of degree. 

Dr. Friedman: Exactly. 

Dr. Fox: And there is some nuance to it. So where are you gonna go next? What’s your big travel plan when the world opens up? 

Dr. Friedman: When the world opens up, I think I’m gonna go try to see my own family out west. 

Dr. Fox: My folks are trying to get to Israel, which right now is, like, crazy, you have to like prove all the documentation and this. And told them the second they get they’re probably gonna lift all those restrictions. But it’s still very challenging, particularly international travel. Domestic right now is doable, but weird, right? Because you got the masks and the this. And it’s, sort of, like very a little creepy. But it’s actually been shown to be pretty safe, which is nice. And I think hopefully with time, this will just get a little more normal and people can enjoy and we can get back to answering all these questions about travel. It’ll be nice. 

Dr. Friedman: Yes, And we can re-record this without any mention, hopefully, of COVID. 

Dr. Fox: Yeah, we’ll scrub out all the COVID, it’ll just be a bleep. 

Dr. Friedman: It will be like the Zika talk. 

Dr. Fox: We’ll bleep it out. We’ll bleep out all the COVID. 

Dr. Friedman: Exactly. 

Dr. Fox: Well, Caroline, thank you so much for coming on. 

Dr. Friedman: My pleasure. Thanks for having me. 

Dr. Fox: It seems like a straightforward topic, but it comes up so often. And I think this will be really helpful for people to listen to before they make their plans. And obviously, we’re available to talk about this or just travel advice. I love to talk about where to go, and what to do, and where to stay. 

Dr. Friedman: A hundred percent. 

Dr. Fox: And it’s a lot of fun. And if you happen to get in a room with Bender about travel, plan an hour. 

Dr. Friedman: Exactly. 

Dr. Fox: All right, have a good one. Thanks a lot. 

Dr. Friedman: Thanks, you too. 

Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. if you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day. The information discussed in “Healthful Woman” is intended for educational uses only, it does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.