Sunday, August 31, 2014

Bike Happily and Safely

Exercise programs should include activities for aerobic conditioning, activities for strengthening, and activities for stretching. Each sport/workout will use it's own set of muscles and ligaments and the most fittest among us participate in various sports, not just one type of exercise.As for curing gyno conditions, it is possible to have lighter periods and fewer cramps with exercise. On the other hand, if your menstrual periods are changing or you have bleeding during any workout, that is a reason to be evaluated for any underlying problems. Biking can be done happily and safely, but reading this list that another blogger directed me two made me want to pass this link on, and remind women that is a bit old, but it does cover the danger issues fairly comprehensibly.

Thursday, August 28, 2014

Menopausal Atrophic Vaginitis Gets A New Name!

Besides sounding a bit horrendous, and also being an extraordinarily confusing term, gynecologists have finally proposed a term that can replace atrophic vaginitis.  The International Society for the Study of Women's Sexual Health and the North American Menopause Society have rolled out a new term for genital symptoms associated with menopause: genitourinary syndrome of menopause (GSM). The term has been or will be introduced by David J. Portman, MD, from the Columbus Center for Women's Health Research in Ohio, and colleagues in Climacteric, the Journal of Sexual Medicine, Maturitas , and Menopause. Terminology is everything, and getting the word out will maybe be easier as the groups point out that men don't use the word 'penis' to talk about errectile dysfunction, and thus we shouldn't 'have to use the word vagina' when talking about sex for women. It is still a condition that is untreated in many women although simple treatments like coconut oil helps in the early stages, as women progress they may want to try vaginal lubricants like Replens, as it progresses estrogen creams like Estrace, Premarin and vaginal treatments like Estring or the newest medication Osphema. Other simple therapies may work as well, just treating the surface layer of the vaginal walls is often not as important as addressing the tightness and narrowing of the vaginal which can be treated in a variety of ways, some even say with sex toys!

Are Your Birth Control Pills Making You Fat?


Women are always questioning whether a recommended treatment will cause them to get fat, and the question comes up with contraceptive use daily in the life of a gyno. The causes weight gain, and the causes obesity are both similar and many, but it's not likely that you got fat from your oral contraceptive pills (OCP). Many women do believe that OCPs cause weight gain, but well controlled studies just do not back this up. Generally studies of healthy women over a period of time find that about a third of them will gain weight. The good news is that also during those studies about 1/5th of the participants actually lose weight. Birth control pills could cause weight gain due to water retention, accumulation of fat, or due to increased hunger drive followed by increased caloric intake. But these factors do not affect all women and it has mostly been found that pill users were no more or less likely to gain weight than non OCP users. However, a few studies found that OCP users did gain a small amount of weight, on the order of a couple of pounds.But that is also postulated to be water weight that resolves within the first three months of use. Calorie consumption and exercise is still the major contributor to weight gain in women on the birth control pills, so work on your energy balance, on the pills or off.

Wednesday, August 27, 2014

Who Should You Ask About When To Get Your Next Pap Smear?

Cervical cancer detection is more than just a pap smear, it's getting regular pelvic examinations, following up episodes of bleeding or pain, and having a personal gyno to consult regarding how to lower your cancer risks. But, ultimately, most do rely on regular pap smear testing to determine their risk for cervical cancer. Pap smears are a sampling of the cervical cells to determine whether the cells are normal. As such pap tests don't treat cancer, they seek it, as in a simple screening test. Pap smear testing cannot detect all cancer, just most of it, yet who to test, and exactly how to test has been under debate as we try to further eliminate cervical cancer, but focus on safety and cost for American women. Many organizations have produced pap smear guidelines. American Cancer Society recommendations can be found at this link  .The American Society for Colposcopy and Cervical Pathology can be found at this link, where they discuss the guidelines that were put in place in 2012. The NIH expresses their views on cervical cancer screening at the Gynecologic Cancer Foundation.  Under age 21: You probably don't yet need a pap. Under age 30: Get a regular pap ever 3 years, keep getting pelvic exams, and some physicians believe in beginning HPV testing over the age of 25. Over age thirty? Add a HPV test to your pap, or alternatively begin with an HPV test. Previous abnormal pap smears will change what your gyno recommends for pap test screening? You may have recurrence risk for over 20 years. We have told women that they need yearly pap smears for so many years that even though it's been a recommendation since 2003 to do fewer pap smears gynos often sticking to the every year pap. And you and your gyno know more about your risks, and the absolute costs and potential for harm the test would have in your case. Drs. Chelmow, Waxman, Cain and Lawrence writing a commentary on this topic in Obstetrics and Gynecology in April of 2012 have said that the 'yearly' plan was 'chosen arbitrarily.' It's hard for gynos to switch gears, and we didn't embrace the every other or every third year smears as a group. Now again we have  extended the overall interval that pap smears are necessary, and it's all based on your age, and the next factor is your history of cervical disease and HPV disease. We know that Gardasil vaccination will affect this as well, but currently whether you have been vaccinated against HPV disease doesn't change when we recommend pap smear testing. Very specific factors in your case have to be discussed with your individual gyno. She may not have even had time to digest all the technical information in these guidelines. They are published on line for those who are interested in the details.
New Pap Testing Recommendations March 2012 And the newest information, now that the health care law has gone into effect: Plans must cover HPV testing! So for women over the age of 30, even with a normal pap test, if you haven't had HPV testing, it is now covered by most plans, and will be covered by all plans with in the year. For more specific information regarding what the Affordable Health Care Act covers for women check their website.

Friday, August 22, 2014

Overall Cancer Risk Lower, But Don't Skip Mammograms if You Have A Progesterone IUD

Determining one's cancer risk from hormone exposure is difficult as hormones both protect against and cause cancer. A levonorgestrel-releasing intrauterine device (IUD) like Mirena or Skyla may protect users against cancers of the endometrium, ovary, pancreas, and lung, but increase their risk for breast cancer, according to a new study by Tuuli Soini, MD, from the Department of Obstetrics and Gynecology, Hyvinkää Hospital, Finland, and colleagues write in an article published in the August issue of Obstetrics & Gynecology.
Among women in Finland, Dr. Soini and coauthors analyzed data on all Finnish women between 30 and 49 years of age who were reimbursed for the levonorgestrel-releasing IUD between 1994 and 2007 for the treatment of  heavy menstrual bleeding or menorrhagia.  The breast cancer incidence among users of the hormone-releasing IUD was 7% higher than expected compared with women who did not use the IUD, with an excess of 188 cases. Among women who had  at least 2 IUDs, there was an excess of 76 cases, for an increase of 20%.
However the levonorgesterel IUDs can protect against cancer also. Compared with the general population, the standardized incidence ratio for endometrial adenocarcinoma after at least 1 levonorgestrel-releasing IUD  the risk is half as great, and the risk of ovarian cancer was also reduced by almost half.Even lung and pancreatic cancers were reduced in the IUD users.
The risk of breast cancer after at least 1 purchase was almost 20% greater, and even lightly higher if the IUD had been used for at least 5 years. 

This research was supported by research grants from Helsinki University Hospital and Hyvinkää Hospital. The authors have disclosed no relevant financial relationships.
Obstet Gynecol. 2014;124:292-299.

Wednesday, August 20, 2014

HPV Shots Protection Holds For Many Years in Young Women and In Young Men

The CDC is trying for figure out why more women are not taking advantage of the HPV Vaccine. Rebecca B. Perkins, MD, from the School of Medicine, Boston University, Massachusetts, and colleagues sent a 15-item questionnaire to 1000 ACOG members. Of the 366 obstetrician/gynecologists who completed and returned the questionnaires, 92% reported offering vaccination to patients, but only 27% of their eligible patients were vaccinated. The most highly cited barrier to vaccination was refusal by parent or patient.

Friday, August 15, 2014

How Physicians Define 'Normal' For the Thyroid Gland

Thyroid disease is on the rise, not due to increased numbers of patients with any different thyroid levels than they ever had, but due to physicians treating more of the mildly elevated TSH patients.
And the mild elevation is determined by a mere formula stating that normal means everyone except the top 2.5% or the bottom 2.5%, this is what a statistician would term the "95% confidence level" . For patients and their physicians the trouble with numbers, when it comes to the thyroid, is that it is not linked to symptoms such as depression or fatigue.Nor is treatment of mild elevation linked to weight changes. It has been shown that treating patients with mildly elevated thyroid can prevent that patient from ever having overt hypothyroidism. In her editorial in JAMA, Dr. Ann Cappola, one of the associate editors, points out that too many patients are being prescribed thyroid when their numbers are only slightly off, and that there is no clear benefit for this type of treatment. Over treatment with too much thyroid medication, however, is not safe. Women have special considerations with thyroid management, especially if they are pregnant. And women who have been treated with too much thyroid replacement have been reported to have abnormal heart rhythms and bone fractures. The point is ultimately to work with your physician to achieve levels that correlate with optimal health. You want medicine, not math, to determine your personal thyroid management.

Thursday, August 14, 2014

For Cases of Prepremature Menoapsue Women Need To Check Their Chromosomes, Their Thyroid, and Their Adrenal Glands, Not Just Their Estrogen Levels

The condition of premature menopause is a potentially serious disorder with consequences on more than just the ovaries, but can affect the thyroid gland as well as the adrenal gland. A working group from European Society of Human Reproduction and Embryology drafted the first international guidelines for managing premature ovarian insufficiency trying to address this issue. They have pointed out that some individuals who have POI  actually have chromosome disorders such as Turner's syndrome (X0) that should be identified prior to undergoing IVF or other fertility procedures like donor eggs. A young woman having irregular periods or occasionally hot flashes, in her 30s, may be given a diagnosis of menopause, but it's not always true that she's actually transitioned permanently though menopause. The normal age of menopause is menopause occurring the age of 40. Menopause before 40 has been called premature, or premature ovarian failure (POF), or Premature ovarian insufficiency (POI). The understanding physicians have had previously was that the ovaries have a set number of eggs, and when a woman’s eggs are all used up then we go into menopause. We have a preset number of eggs (genetically), we can lose eggs when we have disease of the ovaries or surgery of the ovary, and those things can cause individual cases of premature menopause. But something was discovered to be off in the thinking of most cases of POF. As far back as 1996 we discovered that even if the whole picture appears to be premature menopause, in research settings when the patients underwent ovarian biopsies they were actually found to still have eggs and follicles left, thus some hope for pregnancy (or some risk for pregnancy if you are trying to not get pregnant). It is not just running out of eggs, something else must be occurring to put a woman into early menopause. The newest thought is that some  with POI, do not have the full blown syndrome, but just go into a phase where their eggs won’t respond well, but they actually do exist. In some women it’s that their pituitary FSH no longer works to wake up any eggs, in others it apparently was a type of self induced (auto-immune) inflammation. Networks of white cells called lymphocytes would invade the ovary and this is perhaps why the eggs wouldn’t respond.So this is the reason some women can transiently go into menopause, but actually recover and begin to have normal cycles again.The women who have POI may or may not be able to have donor eggs to be able to have children, and the current guidelines for this condition are undergoing extensive review.

Tuesday, August 12, 2014

New Colon Cancer Test Approved

The US Food and Drug Administration (FDA) today approved Cologuard (Exact Sciences Corporation), a stool-based colorectal cancer (CRC). Finding colon cancer in the early stages is so important because it is very preventable in the precancer stage, and very treatable in the early stage. Colonoscopy is still going to be the best way to determine if cancer is or is not present and this new test won't replace colonoscopy.
Cologuard analyzes stool specimens for evidence of blood or evidence of DNA pieces that are shed by precancerous polyps or actual colon cancer.Like colonoscopy the test is designed as a screening test for individuals over the age of 50. Risk factors for colon and rectal cancer include those with inflammatory bowel conditions, those with prior colon or rectal cancers, and those with family history of cancer cases that include bowel cancers. You can also protect yourself against colon cancer by eating fruit and vegetables, increasing fiber and increasing your physical activity. World Health Organization study showed that for ever 10 grams of fiber you increase per day you lower your colon cancer risk by 10%.In this WHO study only whole grain fiber was protective. For diet and nutritional advice, and how to balance competing nutritional needs, see your women's health primary care provider to discuss.

Monday, August 11, 2014

Stop Forgetfulness By Positive Thinking

You were relating a story about one of your favorite books, and sure enough, you cannot remember the author, or the title, or the main character, or all three! Frustrating, but so common. The end of a long day, preoccupation with other things, or even plane old not putting enough effort into those word, time or place associations that help our memory was probably at fault. For some menopausal women, however, there are other medical issues.
It turns out that if you think you are on your game, then you are. The research from the Seattle Midlife Women’s Health Study showed that 60% of women in the menopausal transition report decreased memory function over the past few years, including forgetfulness. The Decision at Menopause study was also relied upon for some of their findings.  Yet their studies also revealed an effect on perception of your function as it actually correlates to your memory function. Positive attitude again comes through as an important indicator of success.Of course it's easier to have a positive attitude if your gyno confirms that is warranted, so don't skip the yearly visits, she has things to say to your about how to keep sharp and keeping positive!

No Hormones, No Hot Flashes

For women with hot flashes they are treatable. Severe symptoms will require medication, for those with mild symptoms they should try life style and simple modifications like your diet, your activity, your clothing, and your weight. Paced breathing is one of the best strategies to try, but you need to do it twice a day, and it's best if also combined with muscle relaxation techniques. As part of dietary modification look at your caffeine intake which definitely can worsen symptoms. When a bit of extra exercise and a bit of weight management doesn't work, look to medications. Hormones are a good alternative for many women and they likely will work the best for large populations of women. However we know that not everyone is a candidate for hormone solutions to hot flashes and we have other therapies that are used both on and off label. Brisdelle, which is 7.5 mg of paroxetine has become the first prescription, non-hormonal therapy for moderate to severe hot flashes associated with menopause. Not all women are suitable for this therapy, some medications such as SSRIs for depression can serve a dual purpose of treatment of hot flashes. The newest hormonal therapy, actually is a very unique combination of new medications, called Duavee. Untreated hot flashes have significant effects on moods and memory and weight as well as other health consequences and it's time your gabbed with your gyno to decide what to do.

Next Breast Cancer Genes Identified and Coded

Working off the hypothesis that almost all cancer is ultimately mediated through changes in our genes, researchers have decided to classify genetic changes as Categories I, II, and III. Category I genes are the most strongly associated with the diseases they have been linked to and Category III genes associated with either the disease only slightly, or perhaps we just don't understand them well enough to be categorized as more significant. This is different from the typical categories we talk about which are based on cell types and cell behavior. Dutch reasearchers found another gene that is rare, but can also lead to increased cancer incidence as does the BRCA1 and BRCA2 genes. In a recent report the new gene was revealed. This gene is the genetic defect that leads to many cancers and cancers at a young age, so in the carriers of this gene earlier mammograms are going to be recommended. The gene is called multiple endocrine neoplasia type 1 (MEN1) is caused by gene defects MEN1 tumor-suppressor gene and has previously been identified as the cause of various GI and endocrine tumors. Another genetic defect has been reported to be associated and that is called PALB2 gene. The top researcher in onclogy have begun to talk about Next Generation Sequencing (NGS) is a method of genomic analysis that can be used to detect mutations in select genes that predispose women to hereditary breast and/or ovarian cancer, and this panel is much more extensive than the panels used in the past looking primarily at BRCA1/2 testing. NGS panel testing may be an answer for the over 80 percent of those who undergo testing for mutations in the major breast cancer susceptibility genes  receive a negative, or uninformative result to their tests. The NGS tests used are expanding all the time, from the original 21 tests that were offered when this technology was invented. Cancer prevention involves more than just living well, eating well, and exercising well, it means working closely with your primary care physician to understands your personal risks and how to lower them. Genetic testing may in fact be right for you.

Sunday, August 10, 2014

Faint Positive Pregnancy Tests

Pregnancy testing has come a long way in the past 100 years! But still women have questions about their home pregnancy test. Often it is confusing if that home pregnancy test just shows a very faint line. In fact that faint line is probably accurate, but perhaps you tried to test too soon. We all are a bit impatient, but remember that fertilized egg won't implant for a few days after conception Nopregnancy test, no matter how accurate will  prove yet you have a healthy on going pregnancy. This is why repeat testing over several days has become popular. One hundred years ago, it really took 2-3 months to determine if you were pregnant. In Marianna Wheel's popular Harpers book of 1914 called Before the Baby Comes she cautioned that "cold and change of climate (among other things) can cause you to skip your period, but if not that, and you skip two successive menstrual periods [you] may be fairly positive of your condition [pregnant]!" But skip ahead a century, and now we have a plethora of medical grade tests available directly to consumers, but there are still questions as to which test! Women will tell you they've often taken that pee test to see if they are pregnant! And though women want to rely on the information they get from their home tests, what they ask is it more accurate to actually take a blood test at the gyno office to see if they really are pregnant. I get a lot of questions: like 'I looked later and saw a faint second line' and that is not according to your package instructions on the urine pregnancy tests. So the question patients ask is which test to get and for the most part the gynos just say, be sure to get any pregnancy test if you suspect you are pregnant. As the sooneryou know you are pregnant the sooner you can make those health choices that will come up daily! But what most patients and physicians mean is getting a test for those substances that we can test for in the urine or in the blood. Probably it would be more rhetorically (grammatically?) accurate to say that a real pregnancy test is one where you can truly verify the pregnancy itself…like a transvaginal ultrasound...because that is the baby, not just a substance made by the placenta, which is what we are testing in the pee or the blood. But that requires a bit more patience as it takes awhile, at least a month or more into the pregnancy, for those ultrasound tests to be positive. Mostly though, the first test of pregnancy in your pee or your blood is a test for HCG or human chorionic gonadotropin. This is a substance made by placentas. HCG is secreted into the blood stream and then excreted out into the urine. And companies have developed extraordinarily accurate tests to determine the presence of HCG as early as possible in a pregnancy. And typically blood testing can pick up very minute levels and is very accurate. But now and then individuals (yes, rarely men too) can have circulating substance that shows a positive HCG test that is not HCG at all. It has been nick named “phantom” HCG. It is another antibody that is similar enough to the HCG molecule that it binds to the test agents and reads positive. Usually it only reads falsely positive in blood. These molecules tend to be large, and may not actually be spilled intact into the urine. So oddly, the negative urine test is more accurate in this case, and can reveal the true nature of the so called “phantom” HCG, or positive ‘pregnancy’ test when in fact there is no pregnancy. How common is this? I used to say rare, but some studies quote rates of 1-2% of the population may have these antibodies that may read this way on a test. So don’t just assume that blood tests are “better,” some interpretation is important for every test you ever take! And as we say to all the gals, gabbing with your gyno is the best way to solve these dilemmas!

Saturday, August 9, 2014

Pregnancy After Uterine Ablation

Endometrial ablation treatments to control heavy menstrual bleeding render the uterus infertile, or we should say they typically render the uterus inhospitable for pregnancy. Women who have an endometrial ablation should not try to get pregnant and should be using effective contraception. The endometrial ablation technique often fails to render the uterus infertile, gynos always insist on having their patients use contraception after the procedure.The  endometrial ablation techniques are designed to eliminate the endometrial tissue (the lining tissue) of the uterus, either residual tissue or regeneration of the tissue is relatively common. The use of hormones can make this regneration of tissue more likely. When endometrial lining regeneration occurs women have been both at risk and voluntarily undergoing pregnancy after endometrial ablation in greater and greater numbers. In a recent Clinical Opinion by the Society of Maternal-Fetal Medicine they point out that one of the risk factors for having serious bleeding from the placenta in pregnancy. This bleeding after ablation in pregnancy due to a rare placental abnormality acreta (the placenta growing abnormally deep or through the wall of the uterus is pregnancy after an endometrial ablation. The actual statistical risk of this occurring is not known. It is more likely if other factors have occurred: prior C-sections prior uterine surgeries including curettage or uterine fibroids. There are known ultrasound appearances that can be a partial tip off, but the signs can be hard to see. The condition usually is not a problem until the pregnancy is being ended: such as during the delivery. Personal consultation with your gyno before a pregnancy is always best.

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Uterine Fibroid Study

If you are a female between the ages of 18 and 50 years old and are experiencing abnormal bleeding due to uterine fibroids, you may be able to take part in the VENUS research study, testing an investigational medicine. Qualified participants will receive study-related medical evaluations and care at no cost. If interested, please call 217-356-3736.

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