Sergio Vignali, MD FACOG Obstetrics & Gynecology

04/12/2026

https://www.doximity.com/newsfeed/2d27bca1-ebf2-4951-baf1-95d443a1dcbe/public

The third trimester is often portrayed as the final stretch—a countdown to the birth of a baby and a joyful finish line.

03/13/2026

The danger of unregulated pellets
Ordway presented a case study of a postmenopausal woman who sought care at an anti-aging clinic for 4 years, receiving 16 testosterone pellets. Upon presentation to a traditional clinical setting, the patient exhibited severe bloating, weight gain, and mood instability. Laboratory analysis revealed serum testosterone levels exceeding 200 times the upper limit of the normal female physiologic range.

“These compounded hormones are often marketed as safer, but they don't have to go through the same regulatory process,” Ordway explained. She noted that while FDA-approved products must include safety labels, compounded alternatives do not, which creates a false sense of security.

“The pellets are also tricky because once [they’re] in, you can't exactly take [them] out,” she added.

Navigating withdrawal and recovery
The patient’s recovery underscored the severity of hormonal mismanagement. After discontinuing the pellets to restore physiologic levels, the woman experienced profound withdrawal symptoms, including heightened mood instability and loss of libido. Because the patient originally sought treatment for genuine menopausal distress, HRT had to be slowly reintroduced. The abstract noted that the patient did not return to a "sense of normalcy" regarding her physical and mental health for 2 years.

“You really shouldn't be going through testosterone withdrawal if you're staying within this normal level,” Ordway said, emphasizing that the goal of HRT is to return hormones to pre-menopausal physiologic ranges rather than supraphysiologic levels.

Contemporary OB/Gyn articles

01/26/2026

Sergio Vignali, MD, is a board-certified obstetrician-gynecologist. He earned his medical degree from the Universidad Central de Venezuela, Luis Razetti School of Medicine in Caracas, Venezuela, and completed a general surgery residency at Hospital Miguel Pérez Carreño. After moving to the United States, he completed his OB/GYN residency at Bethesda North Hospital in Cincinnati, Ohio.

Dr. Vignali has practiced in Florida and Ohio, most recently in Daytona Beach, Florida, and previously at Premier Women’s Center in Troy, Ohio, and the Family Health Center of South Florida in Fort Myers, Florida, where he also owned a private practice. He has served as adjunct clinical faculty and preceptor at multiple institutions, including Bethesda North Hospital, Kettering College, Wright State University, Nova Southeastern University, and Florida State University College of Medicine.

01/26/2026

https://www.facebook.com/share/r/17zejUxdKi/?mibextid=wwXIfr

12/10/2025

Happy holidays!!

11/15/2024

If you get prescribed doxycycline in your first trimester it can be ok!

This cohort study examines the association between first trimester exposure to tetracyclines and the risk of major congenital malformations among infants in Sweden.

01/02/2023

Happy new year!! From Florida

12/16/2022

DECREASE LIBIDO IN FEMALE?
Bupropion — If a patient with a distressing sexual problem greatly desires a pharmacologic intervention, after nonpharmacologic treatments have been tried, bupropion is often the first choice. Bupropion is FDA approved to treat depression and assist with smoking cessation; use for SSRI-induced sexual dysfunction is an off-label indication. As a centrally acting agent, the mechanism of action is likely similar to that of flibanserin. Long-term safety data are available, and risks and side effects are well characterized. Generic formulations are available, so cost is low. Bupropion should be dosed in the morning, and patients should be observed for increased anxiety, insomnia, and hypertension.

07/25/2022

06/08/2022

Contraception allows an individual to prevent pregnancy and control when and if they become pregnant. As such, contraception can offer people support in achieving their reproductive, educational, economic, social, health, and personal goals. Many contraceptive methods also have additional noncontraceptive benefits, including but not limited to menstrual regulation and treatment for certain conditions such as endometriosis, polycystic ovarian syndrome, and heavy menstrual bleeding, among others.

Call Dr Vignali to discuss your options