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Sunday, September 25, 2016

PMDD Still A Perplexing Condition That Has Significant Mental Effects

PMDD is a very perplexing condition as the more we study we find out a lot about the condition, but still lack a treatment or a cure. Most women think that the ultimate cause of these symptoms are due to hormones are in disarray if they have Premenstrual Syndrome (PMS) or the severe kind called PMDD. It has long been argued whether these conditions are fundamentally physical, or mental, or even real as The American Psychological Association even relatively recently brings up the question of whether it is a real disorder. One of the biggest debates in the gyno world in the past few years is whether PMS/PMDD would benefit by being labeled psychological, as there are a variety of brain responses the condition causes.Hormones and the menstrual cycle control both PMS and PMDD.  It's not necessarily that a PMS/PMDD patients' levels are different than others…but they have much the same hormonal swings normal women have but as far as physical and emotional symptoms are these hormones can trigger a very different response. Estrogen peaks during ovulation, and a lesser peak during the third week. Progesterone peaks in that 3rd week and then the levels plummet to very low during the period itself. The worse symptoms of PMS are are 5 days before and 5 days after menses, so these symptoms do not even correlate with hormonal swings most people have.

The psychological /mental symptoms of PMS and PMDD are thought to be primarily due to changes these hormones induce in three main brain transmitter systems: these brain chemicals include opioid, GABA (gama-aminobutyric acid), and the serotonin systems. Think of transmitters as keys that when inserted into their proper locks will turn on certain brain functions. If there are not enough "keys" these functions cannot be turned on very promptly, if there are jammed locks, then the function won't ever occur. It's very complex as sometimes it's not the hormone that triggers the action, but one of its metabolites (as they get metabolized they get into other hormones). So the actual outcome of what the brain effect has to do with your hormone level, how much it's been metabolized, and your natural levels of the brain transmitters.

Fatigue is often an important component of the PMS and PMDD complex and Some menstrual fatigue is due to a mild degree of anemia or deficiency of other vitamins do to the blood loss of menstruation. Some menstrual fatigue and the disordered thinking women get with their cycles (and fog) is due to the disruption that is produced by headaches and poor sleep.In addition some of these side effects can be worsened by those treatments that make other aspects of PMS better. Often gyno docs will treat PMS with progesterone. Progesterone in high doses makes one sleepy, so this might contribute in the second half of the cycle.

Sugar metabolism disorder can also make one think and function poorly. The hormones of the menstrual cycle affect the effectiveness of insulin's ability to direct the processing of sugar, so the highs are higher and lows are lower, we think this may also be related to cortisol, but cortisol has more of a daily variation rather than closely linked with our cycles. This is the main reason to avoid sugar. But too much sugar intake can cause gas, diarrhea, and water retention so to a large extent the effects of sugar on our mental functions is not severe, but the effects of sugar on the physical part of PMS can be important. Gynos think that the mental symptoms that are mood or anxiety related may be related to changes in serotonin, and the thinking may be more related to the GABA system or the opioid system.

Cortisol peaks in awakening and not changed based on menstrual cycles. We first began to realize how cycles and lack of cycles can alter cortisol peaks when we began studying the cortisol light response in women with PMDD. It turns out there is a blunted phase shift response to bright light in women with PMDD. Women with shifted biological clocks have more hormone related problems such as moodiness, PMDD and menopausal mood changes.
Simple therapies for fatigue and foggy thinking are useful no matter what the cause: better rest, iron, good nutrition, exercise. Ultimately changing the neurotransmitters may be the best way to fight brain fog. You can preload opiods earlier in the cycle by being a high exerciser in that 2nd and third week before PMS/PMDD hits in the third week..  Long term and the more fit exercisers also have steadier and overall lower estrogen levels so they won't quite have the peaks and valleys of hormones, so that may be why this works. Cardio and strength building both help release endorphins as does yoga. The breathing exercises of yoga also help pace our physiologic rhythms and improve thought processing.

 Treating migraines or headaches very promptly will help the disordered thinking around PMS time. Migraines should be treated promptly as if you let them get out of control they are more disabling and jumbling to your thinking. Eventually we also learn that behavioral strategies will help clear brain fog. Note taking to focus on what someone is telling you. No one sounds smart if you have to "hum and haw" to think, but literally repeating the question back helps you sort as you respond. Extra sleep. Caffeine, it can be a mental boost when used judiciously, it's something that you have to weigh against other side effects. Alcohol is to be avoided if possible. Again, not well worked out exactly why, but every study says it makes symptoms worse. Chasteberry tree extracts have been shown to help irritability and anxiety of PMS time of the month, but I haven't exactly seen studies of "thinking or processing" better. Calcium and Vitamin D also shown to reduce symptoms over time. Just like exercise and yoga can increase the release of substances that help us be calm and elevate the mood, so can massage. Massage would be good as well as healing touch, probably due to endorphin release and stabilizing release of adrenaline and cortisol.but if you still have brain fog, it's time to see your gyno.

Friday, September 23, 2016

Fitness Friday: A Message About Iron Stores and Your Health

New information shows that ferritin, a marker of our iron stores, is a very important component of our health. Ferritin has been linked to insulin resistance, atherosclerosis, and bone metabolism. Too much iron is not healthy for our bones, our sexual health, and or livers. So balance is the key, and it is healthy to lower those ferritin levels. Higher ferritin levels accelerate bone loss, leads to osteoporosis and osteoprotic fractures. Feritin is actually a protein that is produced in situations like infection, immune dysfunction, and overall body inflammation. It plays an important role in osteoporosis though the mechanism of inflammation. Ferritin has also been associated with fatty liver disease It's often true that a particular medication is studied in what I would call 'blinders fashion medicine', meaning the medication is studied in a group of women with the condition, and only with that condition. Often medications that might interact are exclusions from the studies, and data bout overall health over time with medication use is not collected either. Sometimes this reveals untoward effects. All is not bleak, lots of excellent studies are done over time. and in the newest study looking at the role of the osteoporosis medicine risedronate we find that it causes ferritin to be lowered, and in fact this may explain why we see improved bone health, and improved overall health and lower cardiovascular disease in women taking the medication. In fact osteoporosis medicines lower all cause mortality for women. Iron, as healthy as it is, may in some cases be toxic as well. So it's important for your bone health to know what your ferritin level is. Check with your gyno to see if you need a test of your ferritin. 

Wednesday, September 21, 2016

Wellness Wednesdays: First 5 Tests You Should Have if You Have Low Libido

You need good physical, vaginal and emotional health if you are going to have good sex. In 5 simple steps you can be evaluated to see if you are physiologically and emotionally ready for good sex. At Women's Health Practice we suggest the following quick work up. All of these tests are covered by basic insurance plans and all have treatable solutions that will make you healthier as well as your sex healthier
1. Basic vital signs: especially blood pressure check
2. Basic nutritional status evaluation: are you anemic, have B vitamin or D vitamin deficiencies
3. Basic vaginal health exam: the number one cause of poor sex is poor vaginal tissue health
4. Basic emotional health screening
5. Physical exam looking for neurologic, muscular, or fitness reasons of poor health

Once you have had these tests, consider your options. There is a medication called Addyi which is approved for premenopausal women with low libido. And there are treatments to improve vaginal health, arousal with sex, and orgasms with MonaLisa Touch or the O shot. www.womenshealthpractice.com

Monday, September 19, 2016

Flying Advice: Don't Just Take Your Favorite Leggings

What do you reach for when flying out of bed to workout? Favorite shirt? Leggings? Health strategies to improve your health when flying,.

1. Hydration. When you fly you will likely dehydrate. If you want to just purchase bottled water you are less likely to be in contact with local bacteria that may upset your stomach.
2. Aspirin  Low dose aspirin is a good way to prevent blood clots, but this is medication and you need to discuss your medication in context with whatever else you take when you see your health care provider. 
3. Support stockings. It's especially smart to wear support stockings during long plane rides, long immobile days at work, and if you have to stand hours on hard concrete, but you can also wear them during work outs as and extra measure to prevent blood clots. Women flying always should wear some compression stockings, especially the compression on the ankles from these stockings helps not only reduce risk of blood clots, but it reduces the risk of ankle swelling. Wearing support hose is one strategy with virtually no side effects!
4.Adjust your thinking on oral contraceptives. For those who travel all the time, think about what your personal blood clot risk is and The risk of developing a blood clot that is serious is about 1-5 per 10,000 women; it rises to 3-12/10,000 if you are on a combination hormonal contraceptive, and the risk is between 5-20/10,000 women during pregnancy and that risk remains higher than normal in the post partum period of time. The vaginal ring as a contraceptive would approximately double the risk of a blood clot verses women on the lowest dosage of oral contraception. In that case we say that the vaginal ring approximately could cause one extra case in 10,000 per year. The biggest differences between oral contraceptive pills is in the type of progesterone. The studies on which progesterone pill type is safest haven't always been conclusive, but the pills with the levonorgestrel seem to be the safest with respect to blood clots. If a woman has trauma or surgery this many increase her risk, whether or not she is on hormonal contraception, and it's also important for health care providers to be able to separate out the impact of all your personal risk factors so we can understand how to best help you as an individual minimize their risks of blood clots, and the condition thromboembolism (a blood clot that travels to the lungs or elsewhere).
5. Exercise. Exercise is a great mental way to stay sharp, it fights jet lag, and helps prevent blood clots when you are traveling. Trouble is how to fit it in. You have to plan. Will there be a pool, will there be a gym, can you squish in a quick run before catching your plane? How about having your trainer design a 10 minute no equipment workout for you to do where ever you are staying. In the long run normalizing weight, having a proper amount of exercise, not being a smoker, in addition to wearing support stockings all reduce your risk of having a blood clot. So to the extent that you have gained weight, you have elevated your personal risk of blood clots. Taking a low dose aspirin is also a strategy that is important for some women, but consult your gyno or primary care provider first, some women are put at risk.

Sunday, September 18, 2016

Research priorities For Contraception That Were published By NICHD

The NICHD priorities for studying contraception,
Selected research topics include (but are not limited to):
  • Studies of the ability of progestin- and testosterone-based topical gels to reduce gonadotropin levels and reversibly inhibit sperm production (spermatogenesis)
  • Studies of a progesterone receptor modulator, CDB-2914, as an emergency oral contraceptive when taken within 72 hours of unprotected intercourse
  • Studies of the efficacy of a novel female condom for preventing both pregnancy and sexually transmitted infections
  • Studies of progestin-based compounds that can prevent pregnancy without increasing the risk of blood clots and other venous thromboembolism-type conditions, especially in obese women
  • Studies of the use of a novel progestin- and estradiol-releasing vaginal ring for effective contraception without increasing the risk of blood clots and other venous thromboembolism-type conditions, especially in obese women

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Vaginal Contraceptive Ring

If you are a female between the ages of 18 and 35 you may be eligible for a contraceptive ring investigational contraceptive medication study. Qualified participants will receive study-related medical evaluations and care at no cost. If interested, please call 217-356-3736.

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