What app should I use to track my period?
Author: Dr. Sonia Rebeles
Date: August 29, 2016

“What app should I use to track my period?”

I’ve been asked many times by my patients to recommend a period tracking app. I usually recommend the most popular ones I’ve heard other women mention. The truth is, most menstrual cycle tracking apps are inaccurate, with little or no health professional involvement or citation of the medical literature.

A recent scientific article out of Columbia University (citation below) evaluated these apps, and out of 108 free menstrual tracking apps, only 20 were deemed accurate and are listed by rank as shown below.


I found it interesting that the researchers’ initial search for apps that tracked women’s cycles yielded over 1100 apps, most of which were inaccurate.  Apps were considered accurate based on their ability to predict cycle length and ovulation and whether the app contained misinformation.  Nineteen percent of apps evaluated contained misinformation.  Only one app reported professional involvement and cited the medical literature.

As a health care provider, I believe these researchers gave us very valuable insight into the reliability of phone applications used to track menstrual cycles, fertility, and ovulation.  With the ongoing advancement of technology and its expansion into so many realms of our lives, including keeping track of our health, we should expect accurate, quality products only.  Whether you are a patient or a healthcare provider, I hope you find this information as useful as I did.

From: Moglia ML, et al.  Evaluation of Smartphone Menstrual Cycle Tracking Applications Using an Adapted APPLICATIONS System. Obstet Gynecol 2016(Jun);127(6):1153-60 [PMID: 27159760]

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Dr. Sonia Rebeles Expert Seminar
Author: Dr. Sonia Rebeles
Date: February 15, 2016

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My Medical Mission Trip to Chiapas, Mexico
Author: Dr. Sonia Rebeles
Date: October 18, 2015

It was the day after the Labor Day weekend 2014 when I awoke at 3 AM, bags packed and ready for pickup in an hour by a private chauffeur to el Aeropuerto de Ciudad Juarez, located across the border from my hometown of El Paso, Texas.   It was not longer than four years prior when Ciudad Juarez was once known as the murder capital of the world, averaging 8.5 killings per day.  For some reason, I was undaunted. I knew I had a job to do.

Dr. German Hernandez, a nephrologist in El Paso, had approached me a month prior, soliciting my surgical expertise.  He had been attending medical mission trips in Chiapas, Mexico for the past few years, serving the poor people of the region pro bono at Hospital San Carlos.  This nonprofit hospital primarily serves the low-income indigenous population in the region, at a cost affordable to patients, and often accepts barter as a form of payment.

For several months, the nuns who run Hospital San Carlos in the town of Altamirano were seeking a gynecologist to perform much needed surgeries on women such as hysterectomy, ovarian cyst removal, and repair of pelvic prolapse.  Pelvic prolapse occurs when defects in the support of the pelvic floor manifest due to childbirth or heavy lifting.  Any of a number of different organs prolapse or “fall out” through the vagina, such as the bladder, rectum, small intestine or uterus.

Oftentimes the women of Chiapas were seen traveling long distances carrying heavy loads of leña (firewood) or sacks full of vegetables atop their heads, all whilst also cradling a small infant in their arms.   They succumbed to childbirth without obstetric services and delivered their children out in the jungle without assistance, oftentimes in filthy, muddy conditions.  Large families with many children were common, often all found living in poverty in one-room shacks.

I never imagined the severity of gynecologic pathology, including pelvic prolapse, that I would see.   Despite my training, which included experience serving an indigent population on the U.S.-Mexico border, I was unprepared, to say the least, to operate on these women.  For one, I was the only surgeon in the entire hospital.  These thoughts entered my head numerous times: “Who can I call on if I need help during surgery?”  “What if there is a complication?” “What if she bleeds too much?”  There was no availability of O-negative, disease-free blood products.  Family members, hospital staff, or the doctors themselves would have to donate blood at a moment’s notice.

The second aspect of my feeling of being unprepared was that I had grown accustomed to using the seemingly limitless expanse of technology in the United States:  laparoscopy, lasers, robots, hemostatic agents, fancy electrocautery, to name a few.   I had to fall back on the old school way of doing things: my two hands, a scalpel, meticulous millimeter-by-millimeter dissection, and sound knowledge of the female anatomy.

IMG_5553Thankfully, the women I operated on all had successful outcomes.  When we rounded on these women at the hospital the days following their surgery, they looked at me with their deep, penetrating eyes and wrinkled faces and reached out with their worn, leathered hands in gratitude.  They spoke to me in their indigenous Tzeltal languages, which had to be translated into Spanish for me.  “Thank you.”  “I will pray for you.” “God bless you,”  they said.

I was blessed, multiple times, throughout that trip to Chiapas, and the blessings have been ongoing.  I came back to the U.S. recharged and with a renewed sense of purpose not just in my career, but also in my life.  “You see the face of God in these patients,” German had told me before my trip.  He was absolutely right.

Video of Dr Rebeles Mission Trip to Chiapas Mexico

For more information: http://www.hospitalsancarlos.org/

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Virtually Scarless Hysterectomy with the da Vinci® System
Author: Dr. Sonia Rebeles
Date: August 29, 2015

Great news for patients facing benign hysterectomy: I am excited to offer da Vinci® Single-Site® Hysterectomy for qualified patients – it’s another minimally invasive option that may provide patients with virtually scarless results.

Minimally invasive Single-Site hysterectomy offers patients the potential benefits of a short hospital stay and minimal scarring. At K&B Surgical Center we put our patients first and strive to provide you with the most minimally invasive surgical options. We are truly thrilled to be a leader in this field in Southern California.  As one of a limited number of hospitals offering this option for patients who need a hysterectomy for benign conditions, we are demonstrating our ongoing commitment to providing patients with up-to-date minimally invasive surgical options.  I am extensively trained and experienced in robotic-assisted surgery since completion of my fellowship in Minimally Invasive Gynecologic Surgery in 2009.  I have performed hundreds of robotic-assisted gynecologic surgeries over the past seven years since the inception of my advanced gynecologic training.

da Vinci Single-Site Hysterectomy offers the following potential patient benefits:

  • Low rate of complications
  • Low blood loss
  • Low conversion rate to traditional  laparoscopy and open surgery
  • Short hospital stay
  • Virtually scarless

During a da Vinci procedure, the surgeon is 100% in control of a robotic-assisted system, which translates the surgeon’s hand movements into smaller, more precise movements of tiny instruments inside your body. The da Vinci System features a magnified 3D high-definition vision system. As a result, da Vinci enables the surgeon to operate with enhanced vision and precision.  The specially designed Single-Site instruments allow the surgeon to perform hysterectomy through a single incision in the belly button, leaving the scar almost unnoticeable.

Here’s what the future of single site surgery has in store for my patients.  For the latest on these innovative technologies, follow me on:

See The Minimally Invasive Robotic System Video

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The Angelina Jolie Effect
Author: Dr. Sonia Rebeles
Date: March 25, 2015

There’s a well known public health phenomenon whereby a celebrity’s very personal journey through a health scare or cancer diagnosis becomes publicized, which subsequently raises awareness of that particular condition.

Katie Couric raised awareness about colon cancer. At least acutely, everyone started getting their screening colonoscopies. Farah Fawcett’s battle with anal cancer got people talking about one of those cancers nobody likes to talk about. Patients suddenly started asking questions about whether or not to get anal Pap smears.

We associate Angelina Jolie with the diagnosis of breast cancer and the question of double mastectomy, and now, prophylactic salpingooophorectomy (a fancy word for removing the Fallopian tubes and ovaries).

So…do you need to get all of these, sometimes invasive, tests for cancer done? It’s like I tell my patients, it all depends on risk factors and family history. Not all cancers behave in the same way. When patients say, they want XYZ test done because “cancer runs in my family,” I have to clarify and ask which kind? In other words, which organ or part of the body was primarily affected? And more specifically, which relative(s) were affected?

The lifetime risk of developing ovarian cancer is 1.4% or 1 in 70 women. For breast cancer, it’s about 12%, or 1 in 8 women. Angelina Jolie tested positive for the BRCA gene, a test which she opted for based on her family history. Her risk of developing breast cancer was over 80%, and her risk of ovarian cancer as a carrier of this gene was also increased.

The bottom line is talk to your doctor, and be upfront (with your gynecologist especially) about things like smoking and your sexual history. Get informed about your family history…and be specific. Then you can mutually decide which tests you need, and when.

P.S. I don’t look forward to getting my Pap smear done either, if it makes any of you feel better about going. I’m only human.

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Treatment Options for Heavy Periods
Author: Dr. Sonia Rebeles
Date: February 25, 2015

“I really, really love having a period,” said NO woman…EVER. I’m being facetious, of course, but, as a woman, I know that I have never (and will never) utter those words.

There are numerous options for control of our monthly cycles, from oral contraceptive pills (OCPs), to more permanent methods such as endometrial ablation (destruction of the the lining of the uterus), or hysterectomy (removal of the uterus).

Reversible methods of cycle control such as OCPs are the gynecologist’s most basic tool. Yes, they are used traditionally and primarily to prevent pregnancy. When I prescribe these medications for heavy/irregular/annoying periods, I prefer to refer to them as a medication that hormonally manipulates the menstrual cycle.

OCPs aren’t for everyone, but there are many misconceptions about their risks and benefits. For example, did you know that OCPs decrease your risk of ovarian and endometrial (uterine) cancer? Did you know they can help with acne? Did you know you can safely have just 3-4 periods a year while on hormonal cycle control? Did you know they won’t cause weight gain (provided you don’t eat more or exercise less)?

I’ve only grazed the surface in this post. Major surgery isn’t for everyone. Come talk with me to find out what your best non-surgical options are, especially if you really, really DON’T love having a period, and aren’t quite ready to part with your uterus yet.

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